SOAP Note Format

Patient Information:

Tina Jones is an obese 28-year-old African American female, who comes in today for evaluation and treatment of asthma exacerbation.

S.

CC (chief complaint)

“I came in because I’ve been having breathing problems, and my inhaler just isn’t working the way it normally does.”

HPI: include all the information regarding the CC using the OLDCART format.

Onset: 2 days ago

Location: Nose and lungs

Duration: 2 days

Characteristics: Chest feels tight and she has noticed some wheezing, with non-productive, dry cough

Aggravating Factors: Worse at night when she is lying down on her back.

Relieving Factors: Albuterol inhaler 3 puffs every four hours (however, does not feel like it is completely under control). Drinking water helps with the cough.

Treatment: Albuterol inhaler 3 puffs every four hours

Current Medications:

Albuterol 90 mcg/spray 3 puffs every four hours as needed for wheezing when around cats

Allergies:

Penicillin= rash

Cats and dust= runny nose, itchy and swollen eyes and increased asthma symptoms

Ms. Jones denies any food or latex allergies

PMHx:

Asthma diagnosed at age 2 ½

Last time hospitalized for asthma was when she was a little girl, has never been intubated

Type 2 Diabetes Mellitus diagnosed at age 24

Menarche at age 11

Sexually active with men only, last tested for STIs four years ago, never tested for HIV

Soc Hx:

Tine is a supervisor at Mid American Copy and Ship she has been working there since she was in high school. She is single and never been pregnant. Tine is a non-smoker and reports drinking alcohol socially with friends once a month. Reports the use of Marijuana from age 18 to 20. Tina is part of a book club and enjoys going to church talks. She currently lives with her mother and sister.

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Fam Hx:

Tina reports her sister also has asthma. Denies any family history of COPD, or any throat or neck surgeries. Her mother is living and has high cholesterol and hypertension. Her father passed away in a car accident a year ago. Father had high cholesterol, hypertension and type 2 diabetes. Her bother is obese and her sister has asthma. Tina denies any family history of eczema or COPD.

ROS: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: Constitutional: Head: EENT: etc. You may list these in paragraph format or bullet format. Always document the systems in order from head to toe. You may focus the ROS to match the chief complaint unless you are doing a complete health history.

CONSTITUTIONAL:  No weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclera. Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat.

SKIN:  No rash or itching.

CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY:  Reports shortness of breath, chest tightening, wheezing and non-productive dry cough

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain.

GENITOURINARY:  No burning on urination, never been pregnant. Last menstrual period started yesterday.

NEUROLOGICAL:  No headache, No change in bowel or bladder control.

MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No enlarged nodes.

PSYCHIATRIC:  No history of depression or anxiety.

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES: History of asthma, with allergy to cats, dust and penicillin.

O.

Physical exam: See above ROS.

Diagnostic results: None

A.

Differential Diagnoses

Asthma exacerbation

1. No intervention is self-evident. Provide a rationale and evidence based in-text citation for each intervention

Diagnostics:  

Order PFTs to be completed after exacerbation to have a baseline

Obtain oxygen saturation

 

 

Rx: list treatments and medications you will order and “continue previous meds” if pertinent. State dosages, length of treatment and reason for choosing a specific treatment or drug.

Tina would be started on corticosteroids such as Flovent (44mcg per actuation) 2-4 puffs inhaled bid

Continue with Albuterol inhaler as well.

Education: think about covering yourself legally; also indicate when written instructions are given.

 

Tine would be educated on the importance of seeing her asthma doctor regularly to manage and treat asthma symptoms.

 

Encourage her to keep a log of her asthma symptoms and triggers, and bring to her next visit for review.

Referral/Consults:

 

Ms. Jones would be referred to an Allergist for evaluation and treatment.

 

Follow up: indicate when patient should return to clinic and provide detailed instructions indicating if the patient should return sooner than scheduled or seek attention elsewhere.

 

Follow up appointment would be in 2-4 weeks to review asthma log and make sure medications are helping.

 

Reference

Prieto Centurion, V., Huang, F., Naureckas, E. T., Camargo, C. J., Charbeneau, J., Joo, M. J., & … Krishnan, J. A. (2012). Confirmatory spirometry for adults hospitalized with a diagnosis of asthma or chronic obstructive pulmonary disease exacerbation. BMC Pulmonary Medicine, 1273. doi:10.1186/1471-2466-12-73. Retrieved from: http://web.a.ebscohost.com.chamberlainuniversity.idm.oclc.org/ehost/pdfviewer/pdfviewer?vid=4&sid=285efade-b569-4623-8faf-d8f0d3ad546f%40sessionmgr4007

 

APN Capstone Portfolio Part 2

 

Table of Contents

APN Capstone Portfolio Part 2. 1

Background. 4

Exemplar #1: NR503 Population Health, Epidemiology & Statistical Principles. 5

Chamberlain Program Outcomes. 7

AACN MSN Essentials. 7

NONPF Core Competencies. 7

Connect. 8

Reflection. 8

References. 8

Exemplar #2: NR505 Advance Research Methods: Evidence-Based Practice). 9

(Week 4; Research Literature, Design Approach and Sampling Guidelines). 9

Chamberlain Program Outcomes. 10

MSN Essentials. 10

NONPF Competencies. 11

Connection. 11

Reflection. 11

References. 12

Exemplar #3: NR507 Advanced Pathophysiology. 12

Chamberlain Program Outcomes. 14

AACN MSN Essentials. 14

NONPF Core Competencies. 14

Connect. 15

Reflection. 15

References. 16

Exemplar #4: NR508 Advanced Pharmacology. 16

Chamberlain Program Outcomes. 17

AACN MSN Essentials. 18

NONPF Core Competencies. 18

Connect. 18

Reflection. 18

References. 19

Exemplar #5: NR509 Advanced Physical Assessments. 20

Chamberlain Program Outcomes. 21

AACN MSN Essentials. 21

NONPF Core Competencies. 21

Connect. 22

Reflection. 22

References. 22

Exemplar #6: NR510: Leadership and Role of the Advanced Practice Nurse. 23

Chamberlain Program Outcomes. 24

AACN MSN Essentials. 24

NONPF Core Competencies. 25

Connect. 25

Reflection. 25

Reference. 26

Exemplar #7: NR 511 Differential Diagnoses and Primary Care. 27

Chamberlain Program Outcomes. 28

AACN MSN Essentials. 28

NONPF Core Competencies. 28

Connect. 29

Reflection. 29

References. 30

Exemplar #8: NR601 Primary Care of the Maturing and Ageing Family. 30

Chamberlain Program Outcomes. 31

AACN MSN Essentials. 32

NONPF Core Competencies. 32

Connect. 32

Reflection. 33

References. 33

Exemplar #9: NR 602 Primary Care of the Childbearing and Childbearing Family. 34

Chamberlain Program Outcomes. 35

AACN MSN Essentials. 35

NONPF Core Competencies. 35

Connect. 36

Reflection. 36

References. 37

Exemplar #10: NR 602 Advanced Clinical Care and Practice Across the Lifespan Practinum.. 37

Chamberlain Program Outcomes. 38

AACN MSN Essentials. 39

NONPF Core Competencies. 39

Connect. 40

Reflection. 40

References. 41

References. 42

Appendix 1: Tabulation of achieved program 0utcome, MSN Essentials and NONPF Competencies. 45

Background

On account of the intense and comprehensive nursing education program that I have undergone at Chamberlain College of Nursing, resulting into an award of Masters of Science in Nursing, here is a compilation of a reflection through the journey. The reflection entails the Program Outcomes, Master’s Education Essentials and the Core Competencies of the National Organization of Nurse Practitioners Faculties with the abbreviations as PO, MSN Essentials, and NONPF. Further, this documentation also covers ten exemplars with an assessment on views of the right argument that all of the above requirements have been covered.

Exemplar #1: NR503 Population Health, Epidemiology & Statistical Principles

In #Week 6 of this course we conducted an Evaluation of Epidemiological Problem. This assignment enabled the students to meet different course outcomes. The assignment required defining key terms in community health, epidemiology, and population-based research. We also gained the knowledge and skills to compare study designs used for obtaining population health information from observation, surveillance, community, and control trial-based research. The assignment also enabled us to commonly used measures of health risk and identify appropriate outcome measures and study designs applicable to epidemiological subfields, for instance chronic disease, infectious disease, reproductive health, environmental exposures, and genetics. We were able to identify important sources of epidemiological data and evaluate a public health problem as regards to place, person, magnitude, and person.

The task was to discuss HIV/AIDS and give its background information. The assignment was able to realize that HIV/AIDS is both an infectious disease and an epidemic disease. Learning that, since its onset, HIV/AIDS has claimed over 35 million lives was very scaring. HIV is considered infectious because it causes a severe impairment of the immune system, which then leads to AIDS (Moyer, 2015). With a weak immune system, AIDS patients become susceptible to other cancers, diseases and infections – often called opportunistic infections since their causal organisms only take advantage of the weakened immune system (Maartens, Celum & Lewin, 2014).

I was able to learn about the worrying prevalence statistics of AIDS with 23,304 people estimated to be living with HIV in Houston Texas (Maartens, et al., 2014). I also established the current surveillance techniques and strategies of HIV in the US and a clear descriptive epidemiological analysis. Finally, I was able to understand the screening and diagnosis methods of HIV. I was then able to develop and action plan for dealing with the disease or infection when I finished my MSN.

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Chamberlain Program Outcomes

This assignment enabled me to meet course outcome PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care). The course was able to realize Program Outcome #1 by calculating HIV prevalence in Houston Texas and breaking it down to address particular interests of the populations. The assignment discussed the surveillance methods for HIV, which is one of the techniques that support community intervention plan. I was able to successfully suggest an intervention plan of increasing health awareness on HIV to help in its prevention.

AACN MSN Essentials

This assignment met the AACN MSN Essential I: Background for Practice from Sciences and Humanities. This MSN Essential captures the importance of obtaining an understanding of a disease and using an informed background for practice to manage its prevalence. As demonstrated in the assignment, in identifying HIV’s prevalence and designing an intervention for Houston Texas, I relied on nursing scientific findings to advocate for quality and improved health outcomes.

NONPF Core Competencies

The NONPF that I was able to demonstrate with this assignment were Practice Inquiry, Scientific Foundation and Technology and Information Literacy Competencies. I was able to think critically while compiling data on HIV and being able to apply evidence-based practice to design the intervention plan. I also included research outcomes for practice improvement and improving patient outcomes. I also had to include knowledge from other disciplines as a way of practice inquiry. Using spreadsheet application demonstrated technology and information competency.

Connect

The concepts that I can connect with from the exemplar are screening and surveillance. In nursing context, screening is used to refer to a test conducted to determine a health condition prior to manifestation of symptoms. Screening helps to detect diseases and conditions in their early periods to improve treatment outcomes. This makes screening an essential part of preventive care (Moyer, 2015).

On the other hand, disease surveillance refers to information-oriented activity encompassing gathering, analyzing and interpreting relevant health data from varied and different sources (Houston Health Department. 2015). This requires the use of informatics and technology to enhance surveillance and enable real time analysis. Surveillance leads to effective disease management and enhances preventive measures (Moyer, 2015).

Reflection

This course was very insightful. It enables accomplishments of Program Outcome #, which is to promote safe and high-quality patient-driven care anchored in holistic health tenets. To produce the document of HIV program, I had gone through several scientific studies on HIV prevalence in Houston to understand the disease’s status in the target population. I also had to compare different studies to conclude on the prevalence and determine the incident rate. Understanding the epidemiological perspective of the disease enabled proper identification of the intervention plan. I was also able to apply evidence-based practice in the work.

References

Houston Health Department. (2015). HIV Surveillance Program. HIV Infection in Houston: An Epidemiologic Profile 2010-2014. Houston, Texas; 2015.

Maartens, G., Celum, C., & Lewin, S. R. (2014). HIV infection: epidemiology, pathogenesis, treatment, and prevention. The Lancet, 384(9939), 258-271.

Moyer, V. A. (2015). Screening for HIV: US preventive services task force recommendation statement. Annals of internal medicine, 159(1), 51-60.

Exemplar #2: NR505 Advance Research Methods: Evidence-Based Practice)

(Week 4; Research Literature, Design Approach and Sampling Guidelines)

In NR505 the assignment was Research methods and evidence-based practice. In week #4 of about Research Literature, Design Approach and Sampling Guidelines. I chose obesity in children and adolescents as the phenomenon of interest in the evidence-based practice project. The selected nursing issue for the project was prevention of adolescent and childhood obesity, with the overall aim being to prevent obesity’s co-morbidities. Child and teenage obesity has become a key problem in our society today. I was able to discuss the literature support research of the research, as well as identify the appropriate theoretical framework, research design and methodology including sampling method procedure.

Literature support generated three key pieces of information. The reviewed CDC (2017) document recommended the need for multi-disciplinary research to help develop proper behavioral interventions to prevent childhood obesity. The CDC document also gave a conclusive perspective of diet and exercise as the proper initiatives for obesity control. In a longitudinal study, Cunningham, Kramer & Narayan (2014) agreed with the CDC recommendation and suggestions. Kliegman, et al (2016) suggested the Nelson Textbook of Pediatrics as the key resource for approaches that can help pediatric care including obesity. Lobstein, et al (2015) study concluded an improved governance of food markets and food supply can help address the challenge of obesity. However, it would be impractical to govern food markets and supply, thus instead education should be improved.

The theoretical framework suggested for the study was Henderson’s Needs Theory. The argument was that although the theory works well with inpatients, it can support the problem of helping obesity patients (Ahtisham & Jacoline, 2015). The suggested research approach and design of the study would be qualitative study with a non-experimental (descriptive) inquiry-based design based on the Grounded Theory (GT). The research, as suggested, use interviews and existing documents as its primary data collection tools.

Chamberlain Program Outcomes

The assignment enabled realization of program outcome (PO) #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing). This is because, evidence-based practice is one of the ways through which nurses can advocate for desirable health outcomes. The assignment enabled the application of the ability to design an evidence-based research. The process involves selecting an appropriate research article, summarizing and reviewing its relevance and information, research design, methodology, sampling and presentation of research findings.

MSN Essentials

This assignment met MSN Essential VI: Health Policy and Advocacy. I was able to engage in advanced research method, and research critique, to inform health advocacy and policy as to attain MSN Essential VI. It is evident that an MSN prepared nurse can apply research outcomes, become a change agent, resolve a nursing practice issues, and help disseminate research findings. I concluded that being able to translate findings of a nursing research is an important.

NONPF Competencies

To achieve the assignment outcome, I needed such NONPF Competencies as policy, scientific foundation and health delivery systems. Policy and health delivery systems competencies enabled me to use health informatics for determining the best guidelines for managing critical health issues. Through scientific foundation I was able to critique different study findings to generate appropriate information for the research. Through health delivery systems competency I was able to synthesize nursing practice methods that would improve patient outcomes.

Connection

I was able to connect with two concepts from this exemplar – research gap and research limitations. Research gaps are the areas with inadequate information, which constraints the research’s effective conclusion. A research gap often leads to recommendation of a new research to further the information. One can conclude there’s a research gap only after a comprehensive literature review.

Research Limitation are the research aspects that inhibit a researcher from attaining the full potential of the research outcomes. It is assumed that every research has a given limitation level such as resources, scope or knowledge. Limitations are the conditions, which an investigator cannot fully manage and will constraint the research’s conclusions and methodology.

Reflection

I thank this course for giving me insight on conducting scientific research and critique. Through program Outcome #5 I am now able for advocating for the realization of a positive health outcome through engaging evidence-based compassionate and collaborative advanced nursing practices that are evidence-based. Having gone through this course, it is evident that nurses could experience challenges in research critiques and general research conduct. Nurses should therefore exhibit NONPF Core Competencies particularly the scientific foundation competencies.

References

Centers for Disease Control and Prevention. (2017). Childhood Obesity Facts. Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion.

Kliegman, R. M., Schor, N. F., St Geme III, J. M., & Behrman, R. E. (2016). Nelson Textbook of Pediatrics. Philadelphia: Elsevier.

Lobstein, T., Jackson-Leach, R., Moodie, M. L., Hall, K. D., Gortmaker, S. L., Swinburn, B. A., . . . Mc Pherson, K. (2015). Childhood and adolescent obesity: Part of a bigger picture. The Lancet, 2510-2520.

National Collaborative on Childhood Obesity Research. (2012). Childhood Obesity in the United States. NCCOR.

 

 

Exemplar #3: NR507 Advanced Pathophysiology

The NR507 Course of Advance Pathophysiology was key in realizing the Chamberlin trained nurse practitioner’s program outcomes, master’s essentials, and core competencies. Pathophysiology focuses on the symptoms and function of diseased organs, to enable diagnosis and effective patient care. The different between pathophysiology and pathology, is that pathology studies all aspects of a disease, and not just the organic function. The question that NR507 sought to answer is how the study of pathophysiology help nurses in their practice. Nurse practitioners must have the right information coupled with practice knowledge and skills to be able to achieve the best evidence-based, comprehensive quality patient outcomes.

Pathophysiology entails Disease and etiology, signs and symptoms, investigation and diagnosis, treatment and prognosis. Pathophysiology puts together all of these steps. Nurse practitioners are expected to have a clear understanding of the process from the etiology and symptoms, through to medical testing, investigation, diagnosis and finally prognosis. It is clear that pathophysiology works closely with evidence-based practice. Thus, nurse can conduct more effective treatments through pathophysiology especially in such situations where anxious, scared patients don’t really understand their conditions. Nurses can educate the patients and calm them down.

There are cases where, through pathophysiology, nurses can help generate a valuable discovery for a patient’s healthcare team. Acting – in their usual crucial role – as their patients’ advocates, it is possible that nurses could catch some overlooked signs or and make them know to the doctor. The course sheds the light of pathophysiology as a way of facilitating the nurses’ knowledge to enable them to comfortably walk their patients through the process of disease etiology, testing, diagnosing, treating and prognosis. Nurses become effective in their work when they clearly understand the different ways biological processes and human organs behave in the presence of a disease. This experience and practice skills is gained through. effective research.

Chamberlain Program Outcomes

I found this course highly critical since it concerns understanding a disease, correct diagnosis, treatment and its prognosis for effective and quality patient care through proper professional identity. Thus, this course met two program outcomes. It met PO #2: Create a caring environment for achieving quality health outcomes (Care-Focused) and PO #4: Integrate professional values through scholarship and service in health care (Professional identity). Pathophysiology ensures that the patient’s care environment is perfect for achieving quality treatment outcomes.

AACN MSN Essentials

The course managed to achieve MSN Essential IV: Translating and Integrating Scholarship into Practice and MSN Essential VIII: Clinical Prevention and Population Health for Improving Health. These two essentials are connected to PO #4, which this course was also able to meet. An MSN prepared nurse must be able to integrate broad, effective patient-centered, culturally competent and organizational concepts to assess, manage and deliver proper clinical care to the patient. As an MSN prepared nurse, I can use pathophysiology to manage a patient and the disease following through all the necessary steps learned throughout the nursing course with appropriate understanding to achieve quality health outcome for the patient.

NONPF Core Competencies

To effectively achieve this course, it was imperative to have such NONPF competencies as quality, independent practice and health delivery systems Competencies. To be able to apply pathophysiology, an MSN trained nurse must exhibit independent practice competencies. It is only through independent practice that the nurse can bring to the doctor’s attention certain aspects of the disease that were overlooked. This competency is supported by quality-oriented practice and having a clear knowledge of the health delivery systems.

Connect

The Autonomic Nervous System, controls the body’s internal organs functions. It controls body muscles and is also an integral part of the peripheral nervous system (Tappen, 2016). The renal system is comprised of body organs, which filter out excess fluid and other substances from the bloodstream. It is responsible for the production, storage and elimination of urine is done. The kidneys, being key part of the renal system, help to excrete excess fluid waste. Further, the kidney filters waste and extra blood from the blood system (Tappen, 2016).

Reflection

One among the many useful and important courses in MSN, this this NR507 Advanced Pathophysiology course sought to answer the question of how the study of pathophysiology help nurses in their practice. It is now clear to me that through this course the nurse can conduct more effective treatments especially in such situations where anxious, scared patients don’t really understand their conditions. I even learned that there are cases where, through pathophysiology, nurses can help generate a valuable discovery for a patient’s healthcare team. This course was important in realizing two program outcomes: PO #2: Create a caring environment for achieving quality health outcomes (Care-Focused) and PO #4: Integrate professional values through scholarship and service in health care (Professional identity). Understanding pathophysiology is an important aspect of nurse evidence-based treatment.

 

References

American Association of Colleges of Nursing.  The Essentials of Masters Education for Nursing (2011). Retrieved from http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf

Robinson, B. K., & Dearmon, V. (2013). Evidence-based nursing education: Effective use of instructional design and simulated learning environments to enhance knowledge transfer in undergraduate nursing students. Journal of Professional Nursing, 29(4), 203-209.  doi: 10.1016/j.profnurs.2012.04.022

Tappen, R. M. (2016). Advanced nursing research: From theory to practice. Jones & Bartlett Publishers.

Exemplar #4: NR508 Advanced Pharmacology

The focus of this course is on advanced knowledge base and practice skills of pharmacology across in different clinical settings. It discusses the principles of clinical pharmacology, pharmacokinetics, therapeutics, and drug metabolism. Being a dynamic science, advanced Pharmacology as explained in NR508, built upon the previous knowledge to augment our understanding of treatment complexities with pharmacological interventions. The whole of this course expands knowledge of the principles of pharmacology specific to the APN’s role. As a student I was able to explore, analyze, evaluate, and apply common drugs used for treatment of chronic diseases and some self-limiting acute conditions and apply evidence-based practice for prescriptive intervention.

In reflection, through this course, and as an MSN trained nurse, I can now compile patients’ information to provide appropriate evidence-based diagnosis and treatment. I can boast of better understanding of the integration and application of appropriate and quality care to patients while also focusing on organizational standards, and considering distinct and dynamic individual and family populations. I have learned this important aspect of treatment through pharmacokinetics and giving patients appropriate drug choices it is possible to achieve quality treatment.

Through completion of NR 508, I can discuss the principles and concepts of pharmacokinetics, pharmacotherapeutics and pharmacodynamics. I can also now demonstrate an understanding of the key drug classifications with regards to rationale, risks, indications, and efficacy for the pharmacotherapeutic agents regularly prescribed in acute and primary care settings. I also gained the knowledge to evaluate relevant and current research findings to come up with prudent and quality pharmacological interventions. This course has also enabled me to be able to design suitable pharmacologic interventions. This class was one of those that are both enlightening and challenging. I gained the knowledge necessary to arrive at definitive patient diagnosis and establish an apt a treatment plan.

Chamberlain Program Outcomes

I believe this course me program outcome (PO) #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing). It is important that nurses communicate effectively to patients on the drugs given and treatment plan offered. It is possible that NR508 MET PO #5 because it is the only outcome that champions for desirable health outcomes through compassionate and evidence-based encompassed with collaboration

AACN MSN Essentials

The course attained AACN MSN Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes. MSN Essential VII addresses interprofessional collaboration that enhances patient outcomes and quality of population health. As an MSN prepared nurse, I now understand that to attain quality care, it is important to collaborate with other healthcare professionals so as manage and coordinate the care.

NONPF Core Competencies

Through this course (NR508) it is evident that one needs to show Health Delivery Systems Competencies and practice competencies. These two competencies impact the operationalization of public health and community programs. Using these competencies, a nurse can engage inquiry to come up with appropriate diagnosis, treatment plan and drug prescription. You also need to eb culturally competent to deliver appropriate healthcare and work with others in the healthcare field for effective patient outcomes.

Connect

Through this course, can connect with two terms – allergy and NSAIDs. In the context of pharmacology an allergy is used to refer to the immune system’s response – unnecessary – to a harmless foreign substance (Lilley, Shelly & Snyder, 2019). NSAIDs, on the other hand are non-steroidal anti-inflammatory drugs, which work by obstructing prostaglandins. prostaglandins are the chemicals that trigger the inflammation and pain signal. NSAIDs then help to relieve the inflammation from pain (Lilley, Shelly & Snyder, 2019).

Reflection

This course has benefitted me a lot. Other than knowing the essentials and specific applications of advanced pharmacology, I managed to attain PO #5, which advocates for desirable health outcomes through compassionate and evidence-based approach to nursing practice while elevating collaboration. It is understandable that you cannot work alone when you are a nurse practitioner and that you have to engage other practitioners in the healthcare field to attain quality healthcare outcomes. The course is also aligned to MSN Essential VII, which addresses interprofessional collaboration for enhanced patient outcomes. Thus, while conducting evidence-based and compassionate care, elevating interprofessional collaboration also leads to enhanced patient outcomes.

References

Chamberlain College of Nursing. (2016). Graduate Program Outcomes. Retrieved from http://www.chamberlain.edu

Chamberlain College of Nursing. (2017). Pharmacokinetics, Pharmacodynamics, Art of Pharmacotherapeutics, Reproductive System Medications and Drug-OTC-Herbal Interactions. Week 1 lesson. Retrieved from http://www.chamberlain.edu

Lilley, L. L., Shelly Rainforth Collins, P., & Snyder, J. S. (2019). Pharmacology and the nursing process. Mosby.

 

 

 

 

 

 

Exemplar #5: NR509 Advanced Physical Assessments

The name and expectation of the NR509 course is far much different from time one needs to successfully complete the course. I never expected that this course would involve that much activity and time. There is much study and practical application in this course than any other MSN course. I was even overwhelmed with the amount of documentation and information involved with the patients.

This course is best for those planning to undertaking autonomous practice. An FNP is an example of an autonomous practicing nurse. They have the knowledge for emergency nursing, primary care, night-nurse practitioners, community matrons, critical care, occupational therapists, physiotherapists, and working in different pre-surgical clinics, and day surgery, among other places. The course aims to enable one, as a practitioner, to develop advanced physical assessment skills and apply them in a clinical context, including when working as an autonomous practitioner.

Immersion weekend – the lab component of NR-509: Advanced Physical Assessment – gave me a great experience while also being nerve wracking. Occurring in week 7 of NR-509, the Immersion Weekend offered me an opportunity to demonstrate competence and engage critical thinking in my health assessment skills. The course has designed the Immersion Weekend to teach us appropriate assessment techniques on various general medical complaints, which help prepare us for practicum experiences in NR-511. This means, one has to do well in NR509 so as to understand NR511.

Even after all the preparations, study and documentations, NR509 was still difficult to pass. I still had low scores in the NR509 APEA exams in three areas – Neurology, Gastroenterology, and Respiratory. I had to put a lot of work to ensure that I performed well in these three areas so that I would succeed in NR511. Also, to succeed in NR509, one has to be well versed with the previous MSN courses that come before 509, and take keen consideration of pharmacology and pathophysiology.

Chamberlain Program Outcomes

The content and information of this course meets those of Chamberlain MSN PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care). Through this course I have become keener on screening and diagnostics both of which exemplify Program Outcome #1 for provision of safe, patient-centered and high-quality care. Conducting advanced physical assessments require not only clear and informed background in nursing, but critical thinking and evidence-based practice.

AACN MSN Essentials

The course met the conditions for arriving at Essential IX: Master’s-Level Nursing Practice. Clearly, advanced physical assessments highly impact individuals’ healthcare outcomes. Its achievement requires clear and well-defined background in nursing which provokes the essentials of master’s level nursing practice. It is a clear demonstration of advanced level of understanding and comprehension of advanced nursing and its relevant fields.

NONPF Core Competencies

The course also needs a demonstration of NONPF Independent Practice Core competencies. It gives an opportunity to work autonomously exhibiting independent practice as a competency. It also involved independently analyzing the given case studies with stellar profession and distinguished care to provide accurate diagnosis and establish quality outcome. A competent MSN prepared nurse should distinguish between normal and abnormal health results, which is supported by this course.

Connect

I can connect with two terms in this course – shadow-health and gastroenterology. Gastroenterology, as a field of medicine, is involved with interrogating, diagnosing, and suggesting treatment that also encompasses listing preventive care for gastrointestinal and hepatological tissues and organs (Tappen, 2016). Shadow health, on the other hand, is a software that gives healthcare students a virtual learning opportunity through simulations (Foronda et al., 2019). Thus, it enables students to test their nursing knowledge and skills and hence build their confidence.

Reflection

The name and expectation of the NR509 course is far much different from time one needs to successfully complete the course. I never expected that this course would involve that much activity and time. There is much study and practical application in this course than any other MSN course. I was even overwhelmed with the amount of documentation and information involved with the patients. The sensitivity is on its screening and diagnostic processes, which both inform the treatment plan making any mistake – if any – at this stage costly and fatal and costly. I discovered that conducting advanced physical assessments needs stellar background in nursing information and proper develop critical thinking. Students can use Shadow Health and case studies to test their physical assessment’s skills and knowledge.

References

Codina, L. M. T. (2007). Adult nurse practitioner intensive review: Fast facts & practice questions. New York: Springer Pub. Co.

Foronda, C. L., Alfes, C. M., Dev, P., Kleinheksel, A. J., Nelson Jr, D. A., O’donnell, J. M., & Samosky, J. T. (2017). Virtually nursing: Emerging technologies in nursing education. Nurse educator, 42(1), 14-17.

Tappen, R. M. (2016). Advanced nursing research: From theory to practice. Jones & Bartlett Publishers.

Exemplar #6: NR510: Leadership and Role of the Advanced Practice Nurse

This course was not only important but also practice assuring. Id defined the leadership and role of an APNs practitioners in a wide range of possible careers and employment opportunities. Holding either MSN or a doctorate in nursing, APNs are considered to be the most highly trained category of all registered nurses. They conduct certain functions previously reserved for medical doctors such as diagnosing condition, requesting and/or interpreting laboratory tests, and prescribing medications among others. They have a wide scope of practice and lots of duties to perform either as practitioners or leaders.

APNs apply technical, cognitive and integrative abilities to carry out their practice in ethical and safe approaches for quality outcome of patients. APN must also have the capability of peer and patient education, research and inquiry, mentorship and accountability in interpreting and utilizing research to advance and improve nursing practice. There are two main themes identified in the role of an ANP – organization and system‐focused leadership and Patient‐focused leadership. These are the main leadership orientations of APNs as they seek to contribute to and improve the clinical care environment for patients and their families, other nurses including other healthcare providers, and the entire healthcare system.

Being an APN requires a one to have an MSN. Other MSN’s proceed to earn a doctoral degree to become Clinical Nurse Specialists. With an MSN one also has to obtain a certification after sitting an exam to become an APN. (“Advanced Practice Nursing Fact Sheet”, 2017). It is also important to consider the federal and state Licensure and Regulatory Requirements to practice as an MSN trained APN. With an additional certification, degree and license, being an MSN prepared APN means having a higher responsibility. Further, a complex job title, higher knowledge, more skills and authority give APN new challenges and equal opportunities. Nevertheless, regardless of having higher roles or authority, an APN must always keep in mind that providing quality and safe healthcare is paramount.

Chamberlain Program Outcomes

This course meets the needs of program outcome (PO) #3: Engage in lifelong personal and professional growth through reflective practice and appreciation of cultural diversity (Cultural Humility). Nurses are generally leaders both to patients and to their lower ranking colleagues. By pursuing an APN level nursing career, one is aligning with Program Outcome #3 that urges continuous personal and professional growth through reflective practice and appreciation of cultural diversity.

AACN MSN Essentials

This course realizes AACN MSN Essential II: Organizational and Systems Leadership. APN’s are naturally leaders because of their skill levels and associated responsibility, roles and authority. Thus, they must demonstrate both organizational and systems leadership to promote safe and quality care. They must also engage critical thinking in their decision making and engage systems-wide view.

 

NONPF Core Competencies

The accurate and obvious competency that this course instill is the Leadership Competency. As an MSN APN I have to build on leadership competencies (Hickey & Brosnan, 2012). This is because you will have more responsibilities, key roles and authority, which put you in a leadership position. As a leader you have to act on the best interest of all the stakeholders involved in the care process including patients, junior colleagues and other health sector practitioners. You must also exercise effective communication skills and participate in professional organizations to enhance your leadership competences.

Connect

Systems-wide view: seeks consider the organization’s entire units or departments in a bid to accomplish a practical approach to leadership. The systems-wide concept views an organization from a cause-effect view which supports implementation of corrective measures (Cherry & Jacob, 2016).

Nursing leadership is a dynamic concept of nursing that, simply stated involves mentoring (or coaching) and building of supportive relationships to maximize individual potential and enhance professional growth. Mentorship involves a nurse leader sharing their knowledge, behaviors, skills, and attitudes with other nurses (Cherry & Jacob, 2016).

Reflection

APNs are trained to be leaders and demonstrate leadership competencies. This course not only teaches leadership but also gives leadership opportunities for APNs in care environment. While nursing leaders provide higher level leadership, individual nurses are always engaged in leadership, for instance when assigned students or nursing interns. This course is aligned with Program Outcome #3, which urges nurses and APNs to indulge in continuous personal and professional growth while considering cultural diversity

Reference

Advanced Practice Nursing Fact Sheet | 2017 NurseJournal.org. (2017). Retrieved from http://nursejournal.org/advanced-practice/advanced-practice-nursing-fact-sheet/

About Boards of Nursing | NCSBN. (2017). Retrieved from https://www.ncsbn.org/about-boards-of-nursing.htm

Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.

Hickey, J. V., & Brosnan, C. A. (2012). Evaluation of health care quality in advanced practice nursing. New York: Springer Pub. Co.

 

 

 

 

 

 

 

 

 

Exemplar #7: NR 511 Differential Diagnoses and Primary Care

Through Differential Diagnosis and Primary Care nurse practitioners systematically approach treatment symptoms and signs with careful approach as they see them practice. NR 511 was the key test of my education and learning as an MSN prepared nurse. Organized into categories different categories such as mass, pain, bloody and non-bloody discharge, abnormal laboratory results, and functional changes, this course offers a clinical reference for diagnosis and taking appropriate steps in ensuring that the patient gets appropriate diagnosis. I had the opportunity to conduct my first FNP program clinical rotation. As an MSN, you are prepared to handle different aspect of care and diagnosis. In rotation, I realized that there is more that I need to learn as far as diagnosis and primary care is concerned. Primary care is intensive unlike ER, with the need for more follow up and abroad treatment for quality outcome. There is even more time needed to obtain lab results, hence diagnosis and treatment plan must be based on advanced physical test and the patient’s history.

There is also a key difference between primary care and ER when it comes to medication and treatments. In primary care, there are many protocols and many treatment options and sometimes patients have numerous comorbidities that that must be considered while choosing a plan of care. This often calls for differential diagnosis to ensure that the treatment plan addresses specific diseases and not comorbidities.

Primary care indulge different areas of clinical health and rotation exposes you to different patients in terms of age, gender, and disease infections. You have to be updated in treatment methods and ensure that you have the correct information going into treatment. As an MSN trained APN, you are a leader and perceived to be more knowledgeable and with more skills. Thus, it is only prudent to ensure that you follow the right procedures and ensure quality outcome.

Chamberlain Program Outcomes

NR 511 met PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care). The differential diagnosis and primary course as it helps the MSN APN nurse determine the final diagnosis of the patient and subsequent treatment plan. Thus, it enables the realization of Program Outcome #1, which advocates for safe, high-quality, patient centered healthcare that is premised on holistic health principles. A critical element of the patient’s safety is ensuring that the patient is given correct of a medical condition or illness is a critical element of patient safety and quality attributes of a healthcare system. The treatment plan should be supported with an evidence-based information.

AACN MSN Essentials

The course helped in the realization of two AACN MSN Essentials – Essential V: Informatics and Healthcare Technologies and Essential IX: Master’s-Level Nursing Practice. The realization of these essentials is demonstrated through the achievement of PO #1. Differential diagnosis and Primary care have a direct impact on patient’s healthcare outcomes as addressed by Essential IX addresses. This is because any nursing aspect that directly impacts healthcare outcomes encompass MSN practice due to their requirement of detailed, keener and more informed with high accountability demands.

NONPF Core Competencies

This course managed to demonstrate the need for Quality CompetenciesThrough this course, MSN-APN trained nurses develop NONPF’s quality competencies to enable them operationalize all the other important competencies. One can achieve this trough applying the current and best research study findings and results to clinical practice. Nurse practitioners should also consider the complex relationships between quality, safety, and cost in healthcare delivery. This competency has many other aspects that an MSN-APN nurse must demonstrate.

Connect

Differential Diagnoses – when a patient has a condition that is difficult to understand, clinicians and nurse practitioners use differential diagnosis to distinguish one condition, disorder or disease from others, especially when these conditions present close or similar clinical features (Gorenstein & Comer, 2015). This makes differential diagnosis a systematic diagnostic method that can identify a particular disease where there is a possibility of multiple alternatives.

Test sensitivity – In medical diagnosis, clinicians use test sensitivity to describe a test’s ability “to correctly identify those with the disease (true positive rate)” (Cummings et al., 2015). This is the exact opposite of test specificity which describe the test’s ability to correctly identify those without the disease (true negative rate) (Cummings et al., 2015).

Reflection

I can categorically say that this course was very critical in MSN because it directly addresses the healthcare’s sensitive stages. It informs the patient’s final diagnosis and all the subsequent treatment plan that the nurse will give. By meeting the requirements of PO #1 this course also directly advocates for f safe, high-quality and patient-centered healthcare that is premised on key holistic health principles. It emphasizes quality outcome and patient safety, which are salient element of healthcare provision. It also encourages evidence-based practice for better outcome.

 

References

Cummings, J., Soomans, D., O’laughlin, J., Snapp, V., Jodoin, A., Proco, H., … & Rood, D. (2015). Sensitivity and specificity of a nurse dysphagia screen in stroke patients. MedSurg Nursing, 24(4), 219-224.

Gorenstein, E. & Comer, R. (2015). Case studies in abnormal psychology. New York, NY: Worth Publishers, a Macmillan Higher Education Company.

National Organization of Nurse Practitioner Facilities. (2013). Nurse practitioner population focused competencies. http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/Competencies/CompilationPopFocusComps2013.pdf

Exemplar #8: NR601 Primary Care of the Maturing and Ageing Family

Part of nursing is being able to provide primary care from pediatrics to the aged population. This course was an opportunity to learn and practice about providing primary care for the maturing and ageing population. This is a very delicate population and one that needs intensive care. Primary care for this category of this population is more intense during prognosis and managing them after treatment (Boeckxstaens & De Graaf, 2011). As an MSN trained APN practitioner, it is important to not only demonstrate leadership but also advocate for the well-being of the patients after treatment.

During this course, I was able to learn that primary care doesn’t mean a fixed organizational structure or style but a blend of functional and variable characteristics to the needs – present and emerging – of the older persons (Boeckxstaens & De Graaf, 2011). Clearly, multimorbidity, disability, dependence and frailty play out often and differently in the aging persons; making a key challenge for primary care to be able to provide an adaptable response to these individuals’ needs. Indeed, caring for the elderly needs involving them in the care decisions since, contrary to what’s believed, the elderly consider their life quality as high (Boeckxstaens & De Graaf, 2011). Furthermore, providing care for the elderly requires coordination and continuity with other specialist care programs.

The central theme of primary care for the old and ageing is delivering seamless integrated care. I learned that instead of disease management, primary care prefers case management approach. This involves proactive geriatric assessment to know the individual’s functional, medical, and social needs, including isolation, and loneliness. We also need clinical or MSN practice guidelines for multimorbidity to avoid costly uncoordinated and multiple prescriptions. Importantly, primary care is a teamwork, and coordinated healthcare provision, and nurses have a significant role in ensuring quality care and alignment with home (family) care and social services

Chamberlain Program Outcomes

This provisions and lessons in this course meet Chamberlain’s PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing). For example, when I helped an elderly patient get a referral by coordination and liaising her service with the relevant office, I operationalized PO #5, which advocates for positive outcomes through collaborative, evidence-based and compassionate practice. The mere fact that coordination and delivering of seamless integrated care in primary care for the ageing is a fulfilment of the PO #5.

AACN MSN Essentials

This course realized the fulfillment of MSN Essential VII, which advocates for Interprofessional Collaboration for Improving Patient and Population Health Outcomes. This essential is in line with PO #5 on the issue of coordinated and integrated care delivery. As an MSN NP you need to be working with different hospital/care departments to support the patient’s and a referral quality result. It is important that a NP consult and coordinate care with other health professionals as provided in essential VII.

NONPF Core Competencies

This course and the achievement of the practical outcomes that I managed to achieve shoed the need for Ethics Competencies as the NONPF core competencies. Dealing with elderly patients needs not only need compassion but also ethics both in their diagnosis and prognosis. I discovered that the elderly person’s families need to be helped to understand the situation including the patient’s prognosis. This is only possible when you infuse ethical principles in decision making.

Connect         

Geriatrics: refers to the branch of social science or medicine that deals with the health and care of old people (Zaccagnini & White, 2015). This is basically what this course entailed.

Orthopaedic: is a special branch of medicine that deals with the correction of the body’s deformities of bones and muscles. It addresses the diagnosis, corrections, preventing, and treatment of individuals with their skeletal deformities (Zaccagnini & White, 2015). Most old people need to undergo orthopaedic treatment.

Reflection

In summary, I learned that the central theme of primary care for the old and ageing is delivering seamless integrated care. I learned that instead of disease management, primary care prefers case management approach. This involves proactive geriatric assessment to know the individual’s functional, medical, and social needs, including isolation, and loneliness. Nurses also need clinical or MSN practice guidelines for multimorbidity to avoid costly uncoordinated and multiple prescriptions. Importantly, primary care is a teamwork, and coordinated healthcare provision, and nurses have a significant role in ensuring quality care and alignment with home (family) care and social services

Primary care for the old have complex demands. Fortunately, nurses have adequate training to navigate through these complex demands for positive and quality patient outcome. It also needs ethics as a competency to be able to deal with the old and aging population. Further, dealing with this population needs interprofessional collaboration to enhance population and patient health outcomes.

References

Berry, S., Kiel, D. P., Schmader, K. E., & Sullivan, D. J. (2017). Falls: Prevention in nursing care facilities and the hospital setting. Uptodate. com.

Boeckxstaens, P., & De Graaf, P. (2011). Primary care and care for older persons: position paper of the European Forum for Primary Care. Quality in primary care, 19(6), 369.

Zaccagnini, M., & White, K. (2015). The doctor of nursing practice essentials. Jones & Bartlett Learning

 

Exemplar #9: NR 602 Primary Care of the Childbearing and Childbearing Family

This course course provides an NP student with the essential knowledge, information and experience to be able to diagnose and manage a childbearing/childrearing family and provide them with primary care as well as manage their common health problems. The course placed emphasis on assisting childrearing families to maintain or reach the highest level of functioning and health, focusing on health maintenance, health promotion. I am glad that this course prepared me to meet the MSN PO #1, MSN Essential VII, and the NP Core Competencies #8.

This course is focused on the primary care for low risk of a childbearing woman and her newborn. It is important for an FNP because it applies developmental theoretical perspective, for achieving primary care for during childbearing in a family practice setting. Also, the given clinical component gives the opportunity fo the MSN-FNP’s to integrate the learned theoretical content from their prior courses and use them in clinical gynecologic and obstetrical family practice. It gives the FNP-student nurse practitioner (SNP) skills needed for a quality holistic, primary care of the woman obstetrical client in ambulatory and family practice care.

This course also offers the practice and principles of care for the childbearing woman and family throughout the ante- and post-partum stages. The course explains this process through different ethnicities, ages, and social circumstances and also involves advanced physical assessment (NR509) and management of both normal pregnancy and different pregnancy complications. On top of the different pregnancy’s physiological changes, the course also helps to examine the psychological issues that are commonly encountered during the pregnancy’s prenatal and post-partum care provision.

Furthermore, the builds on human development and growth to focus on support knowledge of assessment and management of chronic and acute health care problems that practitioners encounter in primary care of family, and sometimes pediatric, settings. It analyzes the medical problems and conditions of expectant women, unborn and born infants, as well as children and adolescents within the context of a FNP framework.

Chamberlain Program Outcomes

Program outcome #1 advocates for providing high quality, safe, patient-centered care grounded in holistic health principles (summarized as holistic health & patient-centered care). The significance of holistic care was first emphasized by Florence Nightingale. Holistic care gives a patient satisfaction in the provided healthcare, which is also their right (Andrus, 2014). Through this course, and by meeting MSN PO #1 I am able to address childbearing patients and families’ social, physical, emotional, and spiritual needs, and support them in dealing with their illnesses, to improve their lives.

AACN MSN Essentials

The course achieved MSN Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes. Achievement of this essential recognizes that an APN MSN-prepared nurse, being a leader and member of interprofessional teams, collaborates, consults, and communicates with other professionals in the healthcare field to coordinate and manage care (Andrus, 2014). As an MSN, you coordinate and lead interdisciplinary care teams across different care environment to improve health outcomes. This professional identity is achieved through MSN Essential VII.

NONPF Core Competencies

This course demonstrates the Nurse Practitioner Core Competency # 8: Ethics Competencies. This is because it ensures integration of ethical principles in care decision making, ensures evaluation of the ethical consequences of care decisions. It also applies ethically sound solutions to complex issues related to individuals, populations and systems of care. As an FNP this course has prepared me to promote patient-centered, comprehensive holistic care (Sohi, Champagne & Shidler, 2015). Thus, I know that, ethically it is the patients’ right to choose the type of care they feel comfortable with and can refuse care when they are not comfortable with a given care. This means that the nurse – an MSN-APN prepared FNP – has a responsibility to provide patients with enough information about the treatment and care so that they can make informed decision.

Connect

Postnatal depression: is the form of depression, which a parent can undergo after childbirth. The major victims are mothers but it can also affect fathers. The signs of postnatal depression include difficulty bonding with the new baby, insomnia or intense irritability. If untreated it can go for a long time and can lead to a major depression (Agrawal, 2015).

Postpartum hemorrhage entails excessive bleeding after childbirth. The hemorrhage often takes place after the delivery of the placenta. Its causes include uterine muscles’ loss of tone, or a bleeding disorder or sometimes when the placenta fails to be delivered completely or when it’s tone (Agrawal, 2015).

Reflection

This is one of the courses that is suitable for an FNP because it offers a lot of ways that help the FNP on addressing the social, emotional, spiritual, and physiological needs of parents after childbirth. In essence it helps to the student to operationalize Program Outcome # 1, which urges nurses and care givers to offer safe, high quality and patient-oriented care while considering holistic healthcare tenets. Also, it provides for collaboration and coordination while handling patients enhance desired quality health outcomes. For example, through Essential VII, this course helps you to learn to appreciate other professionals in your team and appreciate the significance of collaboration.

References

Agrawal, P. (2015). Maternal mortality and morbidity in the United States of America.

Andrus, V. L. (2014). Person-Centered Care: Enhancing Patient (Person) Engagement. Beginnings, 34(1), 18-21.

Sohi, J., Champagne, M., & Shidler, S. (2015). Improving health care professionals’ collaboration to facilitate patient participation in decisions regarding life-prolonging care: An action research project. Journal of Interprofessional Care, 29(5), 409-414.

Exemplar #10: NR 602 Advanced Clinical Care and Practice Across the Lifespan Practinum

As an MSN-FNP this course is very essential for my practice. This course has helped me achieve MSN-FNP Program Outcome #4: professional identity (Integrate professional values through scholarship and service in health care). This course offered an opportunity for practical experience in nursing scholarship. As described by the American Association of Colleges of Nursing (2011), scholarship includes the activities, which systematically advance the practice, research and teaching of nursing through a rigorous inquiry. The course also supports other MSN qualities such as leadership, advanced practice, coordination, collaboration and authority in advocating and providing quality care.

This enabled attainment of course MSN Essential IV: Translating and Integrating Scholarship into Practice. This essential recognizes that the MSN-prepared nurse must apply research outcomes in the practice to make informed decisions and solve practice problems through evidence-based practice. The MSN-prepared nurse also works as a leader and change agent in healthcare setting. Utilizing the guidelines of clinical practice to recognize, plan, manage and treat diseases satisfies this essential.

This course – being an important APN course – continues to provide expanded the practical and theoretical knowledge of diagnostic and disease management principles specific to the MSN-FNP’s, for healthcare needs of all individuals across all ages. It enables students to further their skills in diagnosis, health promotion, prevention of illness, and general care management of complex chronic and acute conditions, as well as behavioral health. This course leads the student to develop and maintain such care strategies as patient education, follow-up, referral, and protocol development through an experience in clinical practicum in an advanced practice setting.

This course solidifies the FNP’s clinical experience, which involves developing knowledge and skills that supports provision of quality healthcare outcome through best research and evidence-based care. Achievement of the course leads to attainment of numerous Nurse Practitioner Core Competencies, key among them being competency # 7: Health Delivery System Competencies. This cluster of competencies (#7) refer to the design, planning, and implementation of community and public health programs for quality healthcare outcome and encompass such skills as effective communication, leadership, compassion, coordination, research and evidence-based practice in care provision (AACN, 2011).

Chamberlain Program Outcomes

This course has helped me achieve MSN-FNP Program Outcome #4: professional identity (Integrate professional values through scholarship and service in health care). This program outcome is especially important for aspiring FNPs in the clinical practice. For example, I have learned to provide primary care to patients of different ages, class and identities, which is important in FNP practice. As an MSN-FNP prepared nurse you’re expected to become a leader and have more skills in different care settings that will make you stand out among other practitioners. Thus, this course has offered important insights on not only MSN requirements but also cultural diversity and behavioral health concerns.

 AACN MSN Essentials

The meeting of PO #4 enabled attainment of MSN Essential IV: Translating and Integrating Scholarship into Practice. Also, MSN essential III: quality improvement and safety comes close to this course. Expectedly, conducting advanced primary care to different age groups of patients and conduction differential diagnosis requires reliance on both Essential III and IV. As an FNP, attaining MSN level of practice required covering numerous theories, practical, simulations, laboratory sessions and case studies and being able to apply them in real-world.

 NONPF Core Competencies

This course solidifies the FNP’s clinical experience, which involves developing knowledge and skills that supports provision of quality healthcare outcome through best research and evidence-based care. Achievement of the course leads to attainment of numerous Nurse Practitioner Core Competencies, key among them being competency # 7: Health Delivery System Competencies. This cluster of competencies (#7) refer to the design, planning, and implementation of community and public health programs for quality healthcare outcome and encompass such skills as effective communication, leadership, compassion, coordination, research and evidence-based practice in care provision (AACN, 2011).

 

Connect

Cryotherapy: is a form of therapy treatment that involves using freezing temperatures. It is also known as cold therapy, and used to cool body temperature and bring it down at the cellular and tissue level for therapeutic benefits (Song et al., 2016). It is a relatively new concept.

Immunization: often confused vaccination, and sometimes referred to as inoculation. Vaccination involves administering a vaccine (a mild form an infectious agent) in to your body (usually by injection). Immunization is the result of vaccination. The vaccine helps to stimulate the body’s immune system so that the body can recognize the disease and gradually build defenses against the pathogen to protect the body from future infection (Wilder-Smith et al., 2017).

Reflection

This course is an essential course for every MSN-FNP nurse because it forms the core of nursing care. Through this course one gets the opportunity to identify with all MSN Program Outcomes especially PO #4, which requires a nurse practitioner to incorporate scholarship and professional values in healthcare service. This course solidifies the FNP’s clinical experience, which involves developing knowledge and skills that supports provision of quality healthcare outcome through best research and evidence-based care. Achievement of the course leads to attainment of numerous Nurse Practitioner Core Competencies, key among them being competency # 7: Health Delivery System Competencies. This cluster of competencies (#7) refer to the design, planning, and implementation of community and public health programs for quality healthcare outcome and encompass such skills as effective communication, leadership, compassion, coordination, research and evidence-based practice in care provision (AACN, 2011).

 

References

American Association of Colleges of Nursing (AACN). (2011). Defining Scholarship for the Discipline of Nursing. Retrieved from http://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/Defining-Scholarship.

Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. (2016). Translating research findings to clinical nursing practice. Journal of Clinical Nursing, 26(5-6), 862-872.

Goroll, A., & Mulley, A. (2014). Primary care medicine: Office evaluation and management of the adult patient (7th ed.). China: Wolters Kluwer Health.

Wilder-Smith, A., Longini, I., Zuber, P. L., Bärnighausen, T., Edmunds, W. J., Dean, N., … & Gessner, B. D. (2017). The public health value of vaccines beyond efficacy: methods, measures and outcomes. BMC medicine, 15(1), 138.

 

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References

American Association of Colleges of Nursing (AACN). (2011). Defining Scholarship for the Discipline of Nursing. Retrieved from http://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/Defining-Scholarship.

Advanced Practice Nursing Fact Sheet | 2017 NurseJournal.org. (2017). Retrieved from http://nursejournal.org/advanced-practice/advanced-practice-nursing-fact-sheet/

About Boards of Nursing | NCSBN. (2017). Retrieved from https://www.ncsbn.org/about-boards-of-nursing.htm

Agrawal, P. (2015). Maternal mortality and morbidity in the United States of America.

Andrus, V. L. (2014). Person-Centered Care: Enhancing Patient (Person) Engagement. Beginnings, 34(1), 18-21.

Berry, S., Kiel, D. P., Schmader, K. E., & Sullivan, D. J. (2017). Falls: Prevention in nursing care facilities and the hospital setting. Uptodate. com.

Boeckxstaens, P., & De Graaf, P. (2011). Primary care and care for older persons: position paper of the European Forum for Primary Care. Quality in primary care, 19(6), 369.

Centers for Disease Control and Prevention. (2017). Childhood Obesity Facts. Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion.

Chamberlain College of Nursing. (2016). Graduate Program Outcomes. Retrieved from http://www.chamberlain.edu

Chamberlain College of Nursing. (2017). Pharmacokinetics, Pharmacodynamics, Art of Pharmacotherapeutics, Reproductive System Medications and Drug-OTC-Herbal Interactions. Week 1 lesson. Retrieved from http://www.chamberlain.edu

Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management. Elsevier Health Sciences.

Codina, L. M. T. (2007). Adult nurse practitioner intensive review: Fast facts & practice questions. New York: Springer Pub. Co.

Cummings, J., Soomans, D., O’laughlin, J., Snapp, V., Jodoin, A., Proco, H., … & Rood, D. (2015). Sensitivity and specificity of a nurse dysphagia screen in stroke patients. MedSurg Nursing, 24(4), 219-224.

Curtis, K., Fry, M., Shaban, R. Z., & Considine, J. (2016). Translating research findings to clinical nursing practice. Journal of Clinical Nursing, 26(5-6), 862-872.

Gorenstein, E. & Comer, R. (2015). Case studies in abnormal psychology. New York, NY: Worth Publishers, a Macmillan Higher Education Company.

Goroll, A., & Mulley, A. (2014). Primary care medicine: Office evaluation and management of the adult patient (7th ed.). China: Wolters Kluwer Health.

Foronda, C. L., Alfes, C. M., Dev, P., Kleinheksel, A. J., Nelson Jr, D. A., O’donnell, J. M., & Samosky, J. T. (2017). Virtually nursing: Emerging technologies in nursing education. Nurse educator, 42(1), 14-17.

Hickey, J. V., & Brosnan, C. A. (2012). Evaluation of health care quality in advanced practice nursing. New York: Springer Pub. Co.American Association of Colleges of Nursing.  The Essentials of Masters Education for Nursing (2011). Retrieved from http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf

Houston Health Department. (2015). HIV Surveillance Program. HIV Infection in Houston: An Epidemiologic Profile 2010-2014. Houston, Texas; 2015.

Kliegman, R. M., Schor, N. F., St Geme III, J. M., & Behrman, R. E. (2016). Nelson Textbook of Pediatrics. Philadelphia: Elsevier.

Lilley, L. L., Shelly Rainforth Collins, P., & Snyder, J. S. (2019). Pharmacology and the nursing process. Mosby.

Lobstein, T., Jackson-Leach, R., Moodie, M. L., Hall, K. D., Gortmaker, S. L., Swinburn, B. A., . . . Mc Pherson, K. (2015). Childhood and adolescent obesity: Part of a bigger picture. The Lancet, 2510-2520.

Maartens, G., Celum, C., & Lewin, S. R. (2014). HIV infection: epidemiology, pathogenesis, treatment, and prevention. The Lancet, 384(9939), 258-271.

Moyer, V. A. (2015). Screening for HIV: US preventive services task force recommendation statement. Annals of internal medicine, 159(1), 51-60.

National Collaborative on Childhood Obesity Research. (2012). Childhood Obesity in the United States. NCCOR.

National Organization of Nurse Practitioner Facilities. (2013). Nurse practitioner population focused competencies. http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/Competencies/CompilationPopFocusComps2013.pdf

Robinson, B. K., & Dearmon, V. (2013). Evidence-based nursing education: Effective use of instructional design and simulated learning environments to enhance knowledge transfer in undergraduate nursing students. Journal of Professional Nursing, 29(4), 203-209.  doi: 10.1016/j.profnurs.2012.04.022

Sohi, J., Champagne, M., & Shidler, S. (2015). Improving health care professionals’ collaboration to facilitate patient participation in decisions regarding life-prolonging care: An action research project. Journal of Interprofessional Care, 29(5), 409-414.

Tappen, R. M. (2016). Advanced nursing research: From theory to practice. Jones & Bartlett Publishers.

Wilder-Smith, A., Longini, I., Zuber, P. L., Bärnighausen, T., Edmunds, W. J., Dean, N., … & Gessner, B. D. (2017). The public health value of vaccines beyond efficacy: methods, measures and outcomes. BMC medicine, 15(1), 138.

Zaccagnini, M., & White, K. (2015). The doctor of nursing practice essentials. Jones & Bartlett Learning

 

 

 

Appendix 1: Tabulation of achieved program 0utcome, MSN Essentials and NONPF Competencies

Exemplar# Title	Program outcome	MSN Essentials Met	NONPF Core Competencies Met
Exemplar I: NR503 Population Health, Epidemiology & Statistical Principles	PO #1: Provide high quality, safe, patient-centred care grounded in holistic health principles (Holistic Health & Patient-Cantered Care)	Essential I: Background for Practice from Sciences and Humanities	Scientific Foundation Competencies. Technology and Information Literacy Competencies
Exemplar II: NR 505 Advance Research Methods Week 3	PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing)	Essential VI: Health Policy and Advocacy	Scientific Foundation Competencies Policy Competencies
Exemplar III: NR 507 Advanced Pathophysiology	PO #2: Create a caring environment for achieving quality health outcomes (Care-Focused) PO #4: Integrate professional values through scholarship and service in health care (Professional identity)	Essential VIII: Clinical Prevention and Population Health for Improving Health	Independent Practice Competencies. Policy Competencies.
Exemplar IV: NR 508 Advanced Pharmacology	PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing)	Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes.	Health Delivery Systems Competencies
Exemplar V: NR 509 Advanced Physical Assessments	PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care).	Essential IX: Master’s-Level Nursing Practice	Independent Practice Competencies
Exemplar VI: NR510: Leadership and Role of the Advanced Practice Nurse	PO #3: Engage in lifelong personal and professional growth through reflective practice and appreciation of cultural diversity (Cultural Humility))	Essential IX: Master’s-Level Nursing Practice	Leadership Competencies
Exemplar VII NR 511 Differential Diagnoses and Primary Care	PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care)	Essential V: Informatics and Healthcare Technologies Essential IX: Master’s-Level Nursing Practice	Quality Competencies
Exemplar VIII: NR 601 Primary Care of the Maturing and Ageing Family	PO #5: Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice (Extraordinary nursing))	Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes	Ethics Competencies
Exemplar IX: NR 602 Primary Care of the Childbearing and Childbearing Family	PO #1: Provide high quality, safe, patient-centered care grounded in holistic health principles (Holistic Health & Patient-Centered Care)	Essential VII: Interprofessional Collaboration for Improving Patient and Population Health Outcomes.	Ethics Competencies
Exemplar X: NR 602 Advanced Clinical Care and Practice Across the Lifespan of Practinum	PO #4: Integrate professional values through scholarship and service in health care (Professional identity)	Essential III: Quality Improvement and Safety Essential IV: Translating and Integrating Scholarship into Practice	Health Delivery Systems Competencies

NR 661 Alternative Assignment

Table of Contents

• Introduction
• Disease Presentations
  • HEENT ( Mastoiditis, Corneal Abrasion)
  • Pulmonary (Pertussis, Cystic Fibrosis)
  • Hematology (Lead Toxicity, RH Incomparability)
  • Neurology (Carpal Tunnel Syndrome, Meningitis)
  • Gastrointestinal (Hirschsprung’s Disease, Appendicitis)
  • Cardiovascular (Heart Murmurs, Kawasaki Syndrome)
  • Orthopedic (Rotator Cuff Syndrome, Gout)
  • Endocrinology (Addison’s Disease, Precocious Puberty)
  • Dermatology (Fifth Disease, Herpangina)
  • Urology and STD (Trichomoniasis, Urinary Incontinence)
  • Pregnancy (Incompetent Cervix, Acute Cystitis)
  • NR 661 Alternative Assignment
  • Men’s Health ( Testicular Cancer, Erectile Dysfunction)
  • Psychiatry ( Bulimia Nervosa, Anorexia Nervosa)
  • Growth and Development ( Down Syndrome, Failure to Thrive)
• Health promotion
  • Depression Screening in Adolescents
  • Prostate Cancer Screening
• Conclusion

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Introduction:

As a future Nurse Practitioner, I know I will encounter countless patients whom will present an array of disease signs and symptoms. While I understand that I cannot be fully and completely prepared for what I will encounter, I do understand that I must prepare myself as much as I can. Based on the results from my predictor exam and recounting the information I have reviewed, I know there are several diseases that need I need to understand better. Therefore, I will base this paper on those diseases. Furthermore, I will discuss health promotion in areas  that I am less familiar, and I will justify why health promotion is needed in such areas.  The last portion of this paper will consist of  presenting  the common signs and symptoms patients exhibit that make it appropriate for screening to be done. NR 661 Alternative Assignment.

Disease Presentations

HEENT (Mastoiditis, Corneal Abrasion)

Mastoiditis is a bacterial infection affecting the Mastoid Process-more specifically, the mastoid cells and the mastoid antrum. This infection usually results from an untreated or inadequate treated  Acute Otitis Media. The common organisms causing this infection are: Haemophilus Influenzae, Streptococcus Pneumoniae, Moraxella Catarrhalis, Staphylococcus Aureus, Pseudomonas Aeruginosa, some Mycobacterium species and some fungi as well. The course of this infection begins when the bacteria causing the Acute Otitis Media (AOM) invades this region causing the air cells to become filled with blood and pus. NR 661 Alternative Assignment. The increased blood and pus causes cell to  coalesce (fused together) forming abscesses and decreasing circulation. The fusing together of cells contributes to decreased blood supply to the bone cells leading to cell death (bone death).

The common signs and symptoms for this infection include a spiking fever, postauricular pain, erythema, tenderness; a bulging tympanic membrane, profuse otorrhea,  possible hearing loss, possible evidence of a protruding or displace pinna, and headache. A small percentage of patients may be asymptomatic. To make the definite diagnosis Otoscopic examination is a must. In addition, labs (CBC, ESR, fluid aspiration and culture) are necessary; plus, a CT of the temporal bone may be obtained, and patient may also have Audiometry. NR 661 Alternative Assignment.

Preventing this condition by ensuring that it does not develop should be the first goal and this may be achieved by providing the appropriate interventions when treating AOM.  However, once the condition has developed-treatment option depend on the length of the infection, severity, and the insulting pathogen. The University of San Francisco provides treatment guidelines for head and neck infections. The guideline states that for an acute infection (< 1 month), the best antibiotic would be Ampicillin to treat against Step Pneumo and to treat against Staph Aureus the antibiotic choice is Vancomycin. Now, in a chronic infection (> 1 month), to treat against Pseudomonas Aeruginosa and Staphylococcus Aureus Piperacillin-tazobactam (Zosyn) should be administered. In addition, when severe infection is present Vancomycin may be added, and to treat against Anaerobes Ofloxacin Otic Solution should be prescribed. For those patients who do not respond to antibiotic treatment, surgery might have to be considered. Patients should also be assessed for the need to receive topical steroids, analgesics, and antipyretic. One last important point to mentioned is that treatment should not be delayed; in the event the infective pathogen is unknown the patient should receive a broad-spectrum antibiotic. Once the culture results are available if the antibiotic selected is not appropriate; this should be replaced with the indicated antibiotic.

According to Hollier (2016), 8 to 13% of patients presenting with eye/vision complaints have suffered sustained a corneal abrasion. This can occur do to trauma to the eye or a foreign body such as contact lenses. The patient will usually present with complaints of feeling something in the eye which may be causing significant pain, increased lacrimation, photophobia, redness, and a constricted pupil NR 661 Alternative Assignment. To make the proper diagnosis vision test should be done; the fundus should be carefully examined. If the patient’s history and examination are indicative that this is the problem; fluorescein staining should be done to confirm the diagnosis. This procedure will allow for tissue damage to be visualized when exposed to a Wood’s lamp.

Treatment plan should include irrigation with normal saline to try to flush out the material and a topical anesthetic to allow for examination.  Next the patient should receive Antibiotics-(Erythromycin ophthalmic, Sulfacetamine Ophthalmic, and Neomycin or Bacitracin Ophthalmic)-may be prescribed to prevent infection. Additionally, the patient should receive medication for pain such as an NSAID. Moreover, referral to an Ophthalmologist should be consider when the injury is the result of chemical or thermal exposure and when the injury has caused significant damage or when vision has been impaired. It is important to notify the patient that these injuries usually resolved within 3 to 5 days; once the cells have regenerated. NR 661 Alternative Assignment. The patient should wear a patch or protective dressing if there is a possibility that the patient will be touching the eye; for example, young children or confused patients. Education should also include preventing future injuries (American Association for Pediatric Ophthalmology and Strabismus, 2017).

Pulmonary (Pertussis, Cystic Fibrosis)

The incidents of Pertussis (Whooping Cough) increased steadily between the year 2000 to 20015; this according to data collected by the United States National Library of Medicine National Institute of Health (Bozio, Skoff, Pondo & Liang (2017) NR 661 Alternative Assignment. This disease is caused by the gram-negative bacteria Bordetella Pertussis. Incidents of this infection are higher in children younger than 18 years old and those who are not immunized or are only partially immunized. However, incidents have also increased in older adults and this is believed to be the result of decreased immunity. The infection is characterized by three stages: Catarrhal stage; for approximately 1to 2 weeks the patient will experience fever, rhinorrhea, nasal congestion, conjunctival irritation and redness, and cough. The second stage-paroxysmal stage is characterized by intensive cough on inspiration which can last for several minutes. This last for 2 to 4 weeks and the third stage is known as the convalescent stage- the patient has persistent cough that last for 1 to 2 weeks. In total the symptom last about 6 weeks. The CDC recommends a nasopharyngeal culture to be obtained along with a PCR; this should be done during the 0 to 3 weeks of the infection. In addition, a CBC should be done which should demonstrate a WBC of >20,000. A chest x-ray may be done; if that is the case, it will demonstrate atelectasis. Treatment plan will include antibiotics such as Azithromycin or Clarithromycin (Macrolide). In addition, patient should be place in airborne isolated for 5 days after antibiotics were initiated. Close contacts should receive antibiotics prophylactically NR 661 Alternative Assignment.

Immunization is the first prevention for this disease. The CDC recommends that children should receive 4 doses of the DTaP vaccine starting with the first dose at 2 to 4 months and receiving the last does by age 6. Children 7 years of age or older, preteens, pregnant women and any adult who has not received the vaccine at all should receive the Tdap vaccine (Centers for Disease Control and Prevention, 2018).

Cystic Fibrosis is a very difficult condition to manage. This is an autosomal recessive disorder that causes impair in what is known as the Cystic Fibrosis Transmembrane  Regulator (CFTR) enzyme. This enzyme abnormal function is responsible for altering the chloride and water transport across epithelial cells resulting in cell dehydration. In exocrine glands this leads to thick secretions which lead to the formation of plugs. The most affected organs are the lungs, pancreas, Gastrointestinal and urogenital organs ( Hollier, 2016).

The most common test administered to make a diagnosis is what is known as the sweat test. Genetic testing can also be done but to make a definite diagnosis in addition to a positive sweat test or a positive genetic test one other conditions must be present. These include: COPD, pancreatic insufficiency, or a sibling also affected with the condition. An array of symptoms take place in this condition. The patient usually has re-current respiratory infections with mucopurulent sputum production, GI symptoms such as failure to thrive,  hepatosplenomegaly, and fatty liver. As the condition progresses the patient will exhibit barrel chest, hypoxemia, delayed growth, and electrolyte imbalances. There is no cure for the condition; the goal is to decrease the symptoms and to prevent infections. Because the main issue with this condition is recurrent respiratory infections and impair nutrition treatment plan should focus on addressing these issues. Patients should be prescribed breathing treatment via which hypertonic solution mucolytics, antibiotics, and bronchodilators can be given. The patient also needs to have a diet high in fat and protein, pancreatic enzyme to break down fats; this will help in nutrition. Moreover, several conditions can arise from this disorder and each should be treated in accordance with approved guidelines. In addition, extensive education needs to be provided to the patient-if possible-and to the caregiver. The patient should receive all scheduled vaccines. And parents should receive genetic counseling (American Academy of Pediatrics, 2018).

Hematology (Lead Toxicity, RH Incompatibility)

Lead toxicity results from exposure to items that contain lead or form working in occupation where lead exposure is a risk. Commonly children under 5 years of age are affected; however, it can affect anyone at any stage in life. Lead attaches to red blood cell causing hypochromic microcytic anemia. Increased levels of lead leads to irreversible damage to several organs; especially the brain. Blood is usually obtained to check for lead levels; a level of > 10 mg/dl is abnormal. Depending on the level of toxicity symptoms may range from abdominal pain, headaches, tremors, nausea, to lethargy, seizures, and encephalopathy-just to mentioned some (Knollmann-Ritschel, & Markowitz, 2017).

Per CDD guidelines no safe level of lead has been determine but treatment should be initiated when level is 10mg/dl or more. Treatment consist of administering a chelating agent. Penicillamine and Dimercaptosuccinic Acid (Succiner) are two of those agents. Lead will bind to these agents and then it will be removed through the renal system. It is important to know that this procedure requires referral to a specialist trained in caring for this condition such as a Hematologist. In addition, it is imperative that the patient is removed from the source of exposure. Lastly, extensive education on possible signs and symptoms of permanent damage should be discussed with the patient and caregivers.

Rh Incompatibility results when an RH negative mother is carrying an RH positive fetus. It usually does not take place during the first pregnancy unless the mother has been previously exposed.  In this case the mother’s IgG antibodies will attack the fetus or newborn. The infant will usually develop Jaundice, congenital anemia, of fetal hydrops. To make the diagnosis the mother will have prenatal antibodies identification then the mother and the infant-once born-should have Coombs’ test. Other diagnostic tests include: CBC with differential. Prevention is the initial treatment. Mothers who have this condition must receive RhoGAM at 28 weeks of gestation and within 72 hours post-delivery. The infant has to be watched carefully for symptoms. In the event the child develops symptoms-blood transfusion and hydration are the first steps to take. In addition, the mother should be monitor throughout the pregnancy. It is important that the mother understand what this condition is and why it can possibly be very dangerous to the baby (CDC, 2018).

Neurology (Carpal Tunnel Syndrome, Meningitis)

Carpal Tunnel Syndrome a condition that develops as a result of inflammation of the synovium that surrounds ligaments and tendon in the carpal tunnel. This inflammation causes narrowing and compression of the median nerve. As the median nerve becomes compressed the person will experience numbness, tingling, pain, and weakness in the wrist, hand, at times in the entire arm. It is believed that is caused by repetitive motion such as typing but it also can be cause by other conditions that cause inflammation. Diagnosis will be based on patient’s history and it can also be supported by performing a Phalen’s test and/or a Tinel’s test. Diagnostic studies such as Electromyogram and nerve conduction studies are recommended. To treat the condition a splint can be apply to the affected wrist, NSAIDs to treat pain; pain and inflammation can also be treated by corticosteroids injections to the affected  the wrist. Also, the patient should limit activities that contribute to the condition. Referral to neurology and/or surgery should be done if patient does not experience significant relief with the mentioned interventions (American Academy of Orthopaedic Surgeons, 2018).

Meningitis is an inflammation of the meninges in brain and the spinal cord. The infection may be cause by bacteria, viruses, Fungi, parasites, and from brain injuries or diseases such as cancer. The condition may be highly contagious such as in the case of Meningococcal meningitis. The very young, very old, and immunocompromised are at highest risk for becoming infected. Sings and symptom include: headache, nausea and vomiting, nuchal rigidity, irritability, and there may be recent history of URI. Severe symptoms include: seizures, decrease level of consciousness, and respiratory symptoms. A kernig and Brudzinski sign may be done as part of the assessment. To make a definite diagnosis the patient needs to CSF aspiration through via lumbar puncture. CFS is analyzed for presence of infection. Treatment will depend on the type of infection present and the type of symptoms that need to be managed. A primary care provider who encounter a patient who demonstrates signs and symptoms of meningitis must send the patient to the hospital immediately (Hollier, 2016).

Gastroenterology (Hirschsprung’s Disease, Appendicitis)

            Hirschsprung’s Disease is a congenital disorder associated with trisomy 21. Experts argue that it results when nerve cells stop reproducing in a region or regions in the colon. The absence of these cells causes the movement of stool to stop becoming leading to the affected are to become distention and enlarged. The symptoms developed a short time after birth. The infant may present delay meconium passing, vomiting, distended abdomen, and poor feeding. If the condition is undetected early; it leads to malnutrition, delayed growth, chronic constipation, and anemia. To diagnose the condition the provider may do a rectal which if positive may produce the release of stool and/or gas from the rectum. An abdominal x-ray should be done to assess for obstruction and a biopsy should be done to analyze if nerve cells are absent from the region. Another very important and positive sign is that the patient’s symptoms of obstruction will not resolve by providing stool softeners or laxatives. The condition will require surgery. Surgery will consist of removing the affected area and reconnecting non-affected tissue to each other  (pull-through procedure. In the event the area affected is significantly large, an ostomy can be done. Ostomies are usually reverse once the colon has healed but, in some cases,  these will be permanent. Patient should be monitor for signs of infection and obstructions. It is important to educate the patient about diet. Once part of the colon has been removed the child may need to increased fluid intake to compensate for fluid loss and the patient may need to have sodium levels checked to ensure this stay within normal limits (The National Institute of Diabetes and Digestive and Kidney Diseases, 2018).

Appendix is pouch that extends from the large intestine on the right side of the abdomen. It may become infected by bacteria, or it may become obstructed by fecal material-both conditions lead to inflammation causing an array of symptoms. Symptoms include severe abdominal pain that start around the umbilicus and moves to the right lower quadrant of the abdomen. Other symptoms include: nausea, vomiting, anorexia, fever, and diarrhea. It is clear what causes this condition to develop or what is the exact purpose of this sack; what is clear is that once it becomes inflamed and infected it may rupture producing a sever infection (Mayo Clinic, 2018). To diagnose the condition careful physical assessment should be done. Labs to evaluate for infection and a CT or KUB  should be done for visual inspection of the appendix. Once the diagnosis is made-patient should be referred immediately for surgery. Also, the patient needs avoid food and water in preparation for surgery (Hollier, 2016).

Cardiovascular (Heart Murmurs, Kawasaki Syndrome)

            Heart murmurs are common in infants and young children. But, these also are common in the elderly and may develop during pregnancy. In young children most of these murmurs present no threat to normal heart function. However, in the elderly almost always indicate disease valves. A murmur is a sound that occurs do to disturb blood flow through a stenotic or disease valve or it may be the result of increased flow as a response to disease such as anemia. A diastolic murmur is always considered abnormal and treatment is needed (Hollier, 2016).

A murmur is usually detected during physical exam; it can also be detected by doing an echocardiogram. Other test to make the diagnosis may include EKG, CT, and chest x-rays. The patient may present several symptoms depending on the what valve is affected and how severe is the impairment. Conditions such as Heart Failure, arrhythmias, or pulmonary symptoms may develop. Primary care should refer patient to cardiology when symptoms are present or when diastolic murmurs are present (Yurek, Jakub & Menacho, 2015).

Kawasaki Syndrome is a condition cause by an immune response; the exact cause is unknown. In this condition inflammation of the medium size vessel occurs affecting virtually any organ in the body. Children from Asian descent are at highest risk. Symptoms include: High fever, non-tender adenopathy, non-vesicular and polymorphous rash, diffused oral erythema-strawberry tongue, pharyngeal exudate, edema and erythema of the hands and feet with evidence of skin peeling and crusting of the lips. It can cause myocardial infarction and other organ disease and if untreated it can lead to death. Laboratory tests such as CBC, ESR, and C-reactive protein are done. In addition, the patient may have an EKG and chest x-ray to evaluate for cardiac complications. Treatment include bedrest, intravenous immunoglobulin which may shorten the condition and aspirin in titrated doses for 6 to 8 weeks (Hollier, 29016).

Orthopedics (Rotator Cuff Syndrome, Gout)

Rotator Cuff Syndrome is considered when injuries have occurred to in any of the rotator cuff muscles. Injuries may occur do to trauma, degenerative changes, muscle strain/impingement or decreased blood supply to the site. It can affect anyone at any stage of life, but males are often more affected. Symptoms include: pain and tenderness which may be localized or travel to adjoint muscles and may travel down to the arm, limited range of motion, weakness, and a grating sensation. A positive Hawkins, Neer, Empty can and lift off test indicates muscle impingement; a positive drop arm test indicates full thickness cuff tear, and a positive cross arm test indicates disease in the acromioclavicular joint. X-rays are usually done to make the diagnosis; Ultrasound and MRI may be done to evaluate severity. Initial treatment is rest, strengthening and stretching exercises. Medications to treat pain and inflammation include NSAIDs and steroid injections. For patient who present with a full thickness tear surgery should be done within 1 to 2 weeks and for those patients who show no improvement within 3 to 6 months of therapy, referral to Orthopedics should be done for surgical evaluation (Hollier, 2016).

Gout may have several etiologies. Essentially what takes place is that there is an excess of uric acid in the blood. Uric acid is a compound form by carbon, nitrogen, oxygen, and hydrogen. It is  the product of purine breakdown; organ meats, fish, and certain vegetables contain high amount of purines. Usually uric acid is excreted by the kidney-any impairment in renal function may lead to uric acid buildup. Also, other conditions such as alcoholism, hepatic dysfunction, and enzyme deficiency can cause the buildup. The increased amount leads to crystal deposits in the joint (usually the one of the toes) causing pain and inflammation. Other signs will include swelling, erythema, and skin desquamation. In advanced Gout crystals may deposit in the subcutaneous tissue- these are known as Tophi.  Lab tests such as CBC, ESR, serum uric acid level and an x-ray is done. The condition is treated by avoiding foods high in purines,  rest, and increased fluid intake (3 or more liters per day). Pharmacological interventions include high dose NSAIDs or corticosteroids, local steroid injections, and Colchicine during an  acute attack. In addition, an evaluation of possible underline disease should be done (Singh & Edwards, 2018).

Endocrinology (Addison’s Disease, Precocious Puberty)

            Decrease function of the Adrenal glands is known as Addison’s Disease. The impairment causes decreased release of glucocorticoids and mineralocorticoids. The majority of cases result from autoimmune response and in some instances,  it results from long term corticoid steroid use. Also, some medications can potentiate the condition. People between the ages of 30 to 50 years old and women more than men are usually affected. Symptoms develop slowly. The patient will complain of increased fatigue, amenorrhea, depressive symptoms, skin color changes, weight loss, cold intolerance, salt craving, gastrointestinal symptoms, and hair loss. Diagnosis is made after careful assessment of symptoms and by administering Adrenocorticotropic hormone which if the adrenals are not functioning normally; cortisol levels in the blood  will rise. Also, because this condition will affect electrolyte; all electrolytes should be evaluated NR 661 Alternative Assignment. An EKG may depict ST segment changes and an EEG will demonstrate slow activity. In addition, a CBC should be done to assess for anemia and an abdominal CT will allow for assessment of the glands. Treatment should include diet modification, replacement of electrolytes as necessary, glucocorticoids and mineralocorticoids; calcium and vitamin D. The patient will need to maintain this regiment for life and understand that he/she will need close monitoring of hormonal level and for any worsening of symptoms. Primary care provider should refer the patient to an Endocrinologist. It is imperative that the patient understands that without treatment death will occur (Hollier, 2016) NR 661 Alternative Assignment.

Precocious Puberty refers to the onset of puberty before the expected age. Causes may have an underline disease or may occur without know cause. Those who are at highest risks for developing this condition include those with positive family history of the disorder, exposure to radiation, congenital defects, those who suffer from hypothyroidism, and any insult to the central nervous system. NR 661 Alternative Assignment. To diagnosed care assessment of Tanner staging should be done. Blood tests will depict LH and FSH I females, and testosterone in males. In addition, TSH should be evaluated, an x-ray of the wrist and hand should be done to evaluate bone age. MRI, CT, and US may be needed to evaluate for neoplasms. Treatment will include hormone therapy (Leuprolide and Naferelin). A Histrelin implant may be implanted. Endocrinology referral is necessary-patient should be evaluated every 3 to 6 months (Hollier, 2016) NR 661 Alternative Assignment.

Dermatology (Fifth Disease, Herpangina)

            Fifth Disease is also known as Erythema Infectoosum or Slapped-Cheek Disease. This is cause by the Parvovirus B19 and the most cases present in those between the ages of 5 to 18 years. It is uncommon to take place in infants or the elderly; none the less, it can happen in these groups. Symptoms will develop over several days (4 to 14 days). Low grade fever, flu-like symptoms, a bright rash will develop over the cheeks; rash will continue to develop on the torso and limbs. The patient will also demonstrate swelling in the knees and wrists; symptoms are symmetrical. Diagnosis is done by patient’s history and may be confirm by doing a Parvovirus viral DNA and PCR. Because this is a viral infection no medication is effective or available and the patient should receive supportive care and education. NSAIDs may be given to treat fever and pain. Pregnant women should avoid contact with anyone infected with this virus. Exposure may lead to fetal death.  In eh event a fetus has been exposed-blood transfusion and IVIG may be given. The good news is the condition will resolve. Usually no follow up is necessary but education about hygiene and avoiding crowed places (Arthritis Foundation, 2018). NR 661 Alternative Assignment.

The Coxsackie A and B viruses are  the most common cause of Herpangina. However, other viruses such as the   B virus, Enterovirus 71 and sometimes Echovirus and Adenovirus may also cause the infection. The infection mostly occurs during the summer months; mostly children are affected. The patient will present an array of symptoms. The hallmark signs would be painful blisters in the oral mucosa and high fever-fever may be as high as 106 degrees; other symptoms will include malaise, drooling, decreased appetite and diarrhea. Diagnosis is based on physical findings-blisters are usually very distinctive in this infection. However, there is doubt the patient may a CBC with differential and lesion cultured may be done NR 661 Alternative Assignment. Treatment is directing to infection prevention. This infection is transmitted through feces, saliva and sometimes through respiratory droplets. The child and care giver need to have education on proper hygiene especially when going to the bathroom and the child should stay home from school or daycare until fever has been absent for at least 24 hours. The patient should be instructed to drink plenty of fluids and get enough rest; foods that may irritate the mucosa should be avoided. To minimize the pain the patient may receive oral solutions to dumb the tissue and/or solutions that can coat the area (Stanford Children’s Health, 2018). NR 661 Alternative Assignment.

Urology and Sexually Transmitted Diseases (Trichomoniasis, Urinary Incontinence)

            Trichomoniasis is one of the most common sexually transmitted diseases. It is caused by Trichomonas vaginalis (protozoan); both women and men may become infected. Non-Hispanic black women have the highest infection rate. Once the parasite has been transmitted it has an incubation period of 4 to 28 days. Symptoms presented include: vaginal itching, significant amount of frothy discharge that may appear yellowish, grayish-green. The patient may complaint of dysuria, fishy odor, and on examination the vagina and cervix appear erythematous. However, some patients may be asymptomatic and only experience postcoital bleeding. To treat this condition antibiotics are necessary. The common antibiotic prescribed is Metronidazole (Flagyl); it may be given in a single dose (2 gm) or it can be given in 5oomg doses twice a day for 7 days. A second antibiotic that can be used is Tinidazole 2gms orally time one-time dose. The patient should be educated about STDs and the dangerous risks associated with these diseases NR 661 Alternative Assignment. Also, the partner or partners needs to receive antibiotics as well (Hollier, 2016).

Caucasian women and the elderly are at highest risk for suffering urinary incontinence, but it can happen to virtually any person; this is the case because this condition can have many underline causes. It can result from increased stress apply to the detrusor muscle such as in pregnancy or it can be the results of this muscle weakness. It is also related to advance  aging, psychiatric and neurological diseases, and/or infections. Diagnosis is made by gathering patient’s history, doing a physical exam, and  focusing on underline conditions. In addition, a urinalysis and a PSA should be done to ruled out infection and Prostate conditions; post void measurements may help to determine the presences of obstruction (neoplasms), and a cough stress test will help to determine that weakness in the cause for the condition. Treatment starts by focusing on the underline cause and it will include: Kegel exercises to strengthen the detrusor muscle, periodically sit to void even when there is no urge to void, practice good hygiene to protect the skin, eat a healthy diet and avoid alcohol. Some patients will need to be evaluated by a Urologist if surgery (TURP) is a possibility (Urology Health, 2018). NR 661 Alternative Assignment.

Pregnancy (Incompetent Cervix, Acute Cystitis in Pregnancy)

Pregnancy may be a time of joy for many women, but it can also potentiate several conditions. An incompetent cervix refers to the dilation of the cervix that usually takes place during the second trimester of pregnancy. This may result from underline genetic cervical anomalies or it can be related to prior cervical accidental traumas or surgical procedures. Women who have this condition often experience spontaneous abortions and may have had several spontaneous abortions in the past. The patient usually will experience uterine contractions and bulging of the cervix membranes is observed. Ultrasound to assess for the condition should be done and blood tests to rule out infections should be done as well.  Treatment will consist of bedrest and cervical cerclage (stitching of the cervix) to prevent fetal loss. The procedure carries risks-it may not stop fetal loss or premature rupture of membranes can occurs. Most women will carry the pregnancy to term but other will  deliver prematurely (Hollier, 2016) NR 661 Alternative Assignment.

A second condition that can develop during pregnancy is acute cystitis. Do to anatomical, physiological, and hormonal changes during pregnancy the risks for developing cystitis is high. The common pathogen causing the infection is E-coli. The patient complaints of suprapubic pain, urgency and/or frequency, dysuria; but, in some women may be asymptomatic. To make a diagnosis a urine dip stick test should demonstrate nitrates and leukocytes; a urine culture should demonstrate 25,000  to 100,00 colonies-in this case even if no symptoms are present the patient needs antibiotics. Antibiotics may include a Cephalosporin (Keflex) 500mg  twice a day for 3 to 7days. Other antibiotics that also work to resolve the infection are Macrobid, Augmentin, and Amoxicillin. In the event this is not treated it can progress to Pyelonephritis and premature labor. The patient should receive education on how to avoid possible exposures, eating a healthy diet, and report any worsening of symptoms or recurrent symptoms (Hollier, 2016) NR 661 Alternative Assignment.

Men’s Health (Testicular Cancer, Erectile Disfunction)

            Testicular cancer is the most common type of cancer in men between the ages of 20 to 35. Causes are unknown but it some conditions may precipitate the development. For example, those who had undecadent testicle, and family history of the disease have been found to be a greatest risk. This cancer may originate in the seminomas and no seminomas cells. Understanding which cells are involve is important because it will also dictate the treatment plan.  The patient will usually report feeling a lump on the testicle, discomfort and/or fluid buildup in the scrotum, pain the in lower abdomen and/or groin, and an overall change on how the testicle feels. To make a diagnosis several test/procedures should be done. Tumor markers (Alpha-fetoprotein and Beta-human chorionic gonadotropin) should be obtained. An ultrasound of the testicles should be done, and a biopsy will need to be done as well. Treatment depends on the type of cells involved and the stage of the disease. The patient may be treated with chemotherapy drugs, radiation or surgical removal of the tumor. NR 661 Alternative Assignment. The patient should be taught how to do testicular self-exam. Teaching about avoiding exposure to substances that can increase risks (smoking and drinking alcohol) should be done. It is important to mentioned to the patient that there is always a risk of cancer returning-therefore, regular screening and tumor markers should be check at least annually (National Cancer Institute, 2017).

Many conditions (Cardiovascular, Neurologic, Hormonal, Psychogenic) can cause Erectile Dysfunction (ED). Also, medication side effects and recreational/illegal drugs can potentiate the condition. Although the incidences are significant, and it can impact the patient’s greatly, many men find it extremely difficult to discuss the condition with their doctor. However, once it is reported the common complaint is inability to maintain an erection and/or inability to ejaculate. To make a diagnosis screening questionnaires-the International Index of Erectile Dysfunction and the Sexual Health Inventory for Men-should be done. A CBC, TSH, A1C, Lipid profile, and a complete metabolic panel should be done. In addition, hormones-FSH, LH, Prolactin, testosterone- should be measured. Last, a PSA and DRE should be done to evaluate for prostate pathologies. A procedure known as Rigi scan is used to check tumescence and a doppler estimator can be done to assess for blood flow to the penis. Treatment is directed to the underline cause. However, in some cases penile implant may be an option and patient may wish to take a PDE5 inhibitor; the biggest concern with thus drug would be the development of priapism (Hollier, 2016) NR 661 Alternative Assignment.

Psychiatric (Bulimia Nervosa, Anorexia Nervosa)

            Bulimia and Anorexia share similar features. Both disease affect females more than males; both  occurs in teen and young adult years, and both have no specific cause. However, those who suffer either disease may suffer from low self-esteem, may have underline mental disorders or have family history of mental disorder. In anorexia the patient present symptoms of malnutrition, and metabolic disfunction. The person has a disturbed body image and is exceedingly concern with weigh gain which leads to limiting food intake. On the other hand, in Bulimia, the person engages in episodes of  eating compulsively which brings feeling of loss of control and tends to regain the feeling of control by self-inducing vomiting, using laxatives, or engaging in rigorous exercises.  Diagnosis is based on history. Lab (CBC, CMP, TSH, glucose level, lipid panel, drug screening and the PROMIS screening should be done. Treatment consist of psychiatric/psychology interventions. SSRI can be used if the patient is believed to be depress-this is common-nutrition education should be arranged and patient should be closely monitored to ensure treatment plan is being follow (Hollier, 2016).

Growth and Development (Down Syndrome, Failure to Thrive)

Down Syndrome is a genetic disorder associated with an extra chromosome 21(trisomy 21). The physical features are first signs to observed. A flat nasal bridge, protruding tongue, small head, low set ears, skin folds at the back of the neck and delayed development are common findings. The child will usually have other conditions such heart anomalies and gastrointestinal atresia. Diagnosis can be made in utero by doing amniocentesis evaluating or  a chromosomal study can be ordered. Management for this patient will be complex. Underline conditions need to be address. The child will need to have immunizations according to schedule; nutrition should be closely monitored. Parents should receive thorough education on the condition and should be referred to genetic consoling. Information on support groups and special programs for the child should be provided (Hollier, 2016) NR 661 Alternative Assignment.

Failure to Thrive is diagnosed when the child does not grow or gain weight as expected for age and gender. The exact cause is unknown, but experts believe that it may have a genetic component. Also, studies have showed that poor family dynamics, inadequate parent baby bounding, and an array of  diseases may be the cause. Careful history, and physical assessment must be done. For children whose are severely malnourished or are presenting symptoms of metabolic disfunction and dehydration,  immediate admission to a hospital for intervention is a must.  Underline cause assessment should include examining family dynamics and educating/supporting caregivers. The goal is to improve nutrition; thus,  referrals to a nutritionist may be helpful. In addition, if family issues are present a referral for counseling should be done and family therapy should be considered (Johns Hopkins Medicine, 2018) NR 661 Alternative Assignment.

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Health Promotion Topics (Depression in Adolescents, Prostate Cancer Screening)

            The latest data obtained from the American Foundation for Suicide Prevention showed that suicide continues to crease in all age groups but in it is increasing more rapidly in those  between the ages of 15 to 24. Moreover, a risk behavior survey done in 2015 demonstrated that children as young as 7 years old reported feelings depicting depression symptoms and  Hispanic girls were found to be the highest group reporting suicide attempts and receiving medical intervention for depression.   Both, U.S. National Library of Medicine (USNLM) and the United States Preventive Task Force (USPTF) have published guidelines to screen for depression. While both are similar in recommendation; age for initiating screening differs-no consensus as to at what age screening should begin. This is obviously a problem. While data clearly demonstrates that children as young as 8 years are having depression symptoms, a clearer and concusses approach should be taken. Often these younger children behavior may be mistaken as being shy when in reality the child may be experiencing depression. Depression may have many different underline causes. Often children will appear to be quiet and do not make eye contact when the provider asks questions. Subjective data will include reports of decrease appetite, fatigue, insomnia, difficulty completing school work, behavior problems and lack of interest in social activities. Physical assessment may reveal hypotension, bradycardia, signs of malnutrition if the patient is not eating well. All these findings support the need for depression screening regardless of age. If the child does not feel that someone cares about their feelings and symptoms; the condition will worsen, and suicide attempts become a reality.

The American Cancer Society repots that in 2018 about 164,000 new cases of Prostate cancers were reported and 29,430 men died from this disease. The disease is most commonly diagnosed in African American men 65 year of age or older. This is the second leading cause of death in men in the united states behind lung cancer. The typical subjective symptom will include difficulty voiding, a weak urine stream, blood in the urine or in the semen, erectile dysfunction, and/or pelvic pain. In a scenario like this, screening should be done regardless of age or race. Assessment should include prostate examination by doing a digital rectal exam, a PSA level should be done-a high value will indicate prostate disease. Anytime a patient reports symptom that may indicate prostate involvement; screening should be done regardless of age and race. As mentioned, this disease is the 2^nd leading cause of death in men over the age of 65 in this country. This indicates that a more proactive approach should be taken. NR 661 Alternative Assignment.

Conclusion:

Completing this assignment has provided significant insight that will be invaluable as I prepare myself to become a Nurse Practitioner.

Reference:

Bozio, C., Skoff, T., Pondo, T., & Liang, J. (2017). Epidemiology and Trends of Pertussis among Infants:

 

United States, 2000–2015. In Open forum infectious diseases (Vol. 4, No. Suppl 1, p. S5). Oxford

 

University Press.

 

Hollier, A. (2016). Clinical Guidelines in Primary Care. Advanced Practice Education Associates.

 

Knollmann-Ritschel, B. E., & Markowitz, M. (2017). Educational case: Lead poisoning. Academic

 

pathology, 4, 2374289517700160.

 

Singh, J. A., & Edwards, N. L. (2018). EULAR gout treatment guidelines by Richette et al.: uric acid and

 

neurocognition. Annals of the rheumatic diseases, 77(4), e20-e20. NR 661 Alternative Assignment

 

Yurek, L. A., Jakub, K. E., & Menacho, M. M. (2015). Severe symptomatic aortic stenosis in older adults:

 

Pathophysiology, clinical manifestations, treatment guidelines, and transcatheter aortic valve

 

replacement (TAVR). Journal of gerontological nursing, 41(6), 8-13.

 

https://idmp.ucsf.edu/pediatric-guidelines-head-and-neck-infections-mastoiditis

 

https://aapos.org/terms/conditions/39

 

http://pediatrics.aappublications.org/content/early/2016/03/22/peds.2015-1784

 

https://cdc.gov

 

https://orthoinfo.aaos.org/en/diseases–conditions/carpal-tunnel-syndrome/

 

https://www.niddk.nih.gov/health-information/digestive-diseases/hirschsprung-disease

 

https://www.arthritis.org/about-arthritis/types/fifth-disease/

 

https://www.stanfordchildrens.org/en/topic/default?id=herpangina-90-P01855

 

https://www.urologyhealth.org/urologic-conditions/urinary-incontinence

 

https://www.cancer.gov/types/testicular/patient/testicular-treatment-pdq#section/_1

 

https://afsp.org/about-suicide/suicide-statistics/

 

https://www.ncbi.nlm.nih.gov/

NR 661 Alternative Assignment

 

Research Critiques and PICOT Statement Final Draft Essay Sample

Prepare this Research Critiques and PICOT Statement Final Draft Sample assignment as a 1,500-1,750 word paper using the instructor feedback from the previous course assignments and the guidelines below.

PICOT Question

Revise the PICOT question you wrote in the Topic 1 assignment using the feedback you received from your instructor.

The final PICOT question will provide a framework for your capstone project (the project students must complete during their final course in the RN-BSN program of study). Research Critiques and PICOT Statement Final Draft Sample Research Critiques and PICOT Statement Final Draft Essay Sample.

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Research Critiques

In the Topic 2 and Topic 3 assignments, you completed a qualitative and quantitative research critique on two articles for each type of study (4 articles total). Use the feedback you received from your instructor on these assignments to finalize the critical analysis of each study by making appropriate revisions.

The completed analysis should connect to your identified practice problem of interest that is the basis for your PICOT question.

Refer to \”Research Critiques and PICOT Guidelines – Final Draft.\” Questions under each heading should be addressed as a narrative in the structure of a formal paper.

Proposed Evidence-Based Practice Change

Discuss the link between the PICOT question, the research articles, and the nursing practice problem you identified. Include relevant details and supporting explanation and use that information to propose evidence-based practice changes.

 

Research Critique Guidelines

Qualitative Study

Background of Study:

• Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.
• How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. Research Critiques and PICOT Statement Final Draft Sample.
• Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.
• List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.
• Were the purpose and research questions related to the problem? Research Critiques and PICOT Statement Final Draft Essay Sample

Method of Study:

• Were qualitative methods appropriate to answer the research questions?
• Did the author identify a specific perspective from which the study was developed? If so, what was it?
• Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include?
• Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study.
• Did the author evaluate or indicate the weaknesses of the available studies?
• Did the literature review include adequate information to build a logical argument?
• When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings? Research Critiques and PICOT Statement Final Draft Sample 

Results of Study

• What were the study findings?
• What are the implications to nursing?
• Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing?

Ethical Considerations

• Was the study approved by an Institutional Review Board?
• Was patient privacy protected?
• Were there ethical considerations regarding the treatment or lack of?

Conclusion

• Emphasize the importance and congruity of the thesis statement.
• Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.
• Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.
• Integrate a summary of the knowledge learned. Research Critiques and PICOT Statement Final Draft Sample. 

 

Quantitative Study

Background of Study:

• Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.
• How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem. Research Critiques and PICOT Statement Final Draft Sample.
• Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.
• List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.
• Were the purpose and research questions related to the problem? Research Critiques and PICOT Statement Final Draft Sample Research Critiques and PICOT Statement Final Draft Essay Sample.

 Methods of Study

• Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify?
• Was informed consent obtained from the subjects or participants?
• Did it seem that the subjects participated voluntarily in the study?
• Was institutional review board approval obtained from the agency in which the study was conducted?
• Are the major variables (independent and dependent variables) identified and defined? What were these variables? Research Critiques and PICOT Statement Final Draft Sample.
• How were data collected in this study?
• What rationale did the author provide for using this data collection method?
• Identify the time period for data collection of the study.
• Describe the sequence of data collection events for a participant.
• Describe the data management and analysis methods used in the study.
• Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis? Research Critiques and PICOT Statement Final Draft Sample.
• What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses?
  

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Results of Study

• What is the researcher’s interpretation of findings?
• Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings?
• What limitations of the study were identified by researchers?
• Was there a coherent logic to the presentation of findings?
• What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing?
• What suggestions are made for further studies? Research Critiques and PICOT Statement Final Draft Sample.

Ethical Considerations

• Was the study approved by an Institutional Review Board?
• Was patient privacy protected?
• Were there ethical considerations regarding the treatment or lack of?

Conclusion

• Emphasize the importance and congruity of the thesis statement.
• Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.
• Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.
• Integrate a summary of the knowledge learned. Research Critiques and PICOT Statement Final Draft Sample.

Reference

Burns, N., & Grove, S. (2011). Understanding nursing research (5th ed.). St. Louis, MO: Elsevier. Research Critiques and PICOT Statement Final Draft Essay Sample