Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study- Part One

You are a family nurse practitioner (FNP) employed as a contract (1099 independent contractor) in a busy primary care practice for 2 years. The providers in the group include one physician, who is also the owner of the practice, and two other nurse practitioners, who are staff employees (W2 employees). The owner of the practice recently made comments about the need to produce more revenue. You relate with his concerns and feel that you have several strategies that could be helpful. Your contract is up for renewal in 3 months. You are highly satisfied with your job and want to stay with the group. You see 20 patients per day on average and take call every third weekend. Organizational Behavior and Business Influence

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Discussion Question:

What negotiation strategies should you use to propose a contract renewal? How does your role as a 1099 contractor benefit the practice over the W2 employees? What evidence will you present to the practice to reinforce your value in the practice both in terms of revenue and patient satisfaction? Consider any additional services you may be willing to provide under your contract. Use logical reasoning, and provide evidence based rationales for your decisions.Keep in mind that your negotiation terms and conditions must be within the legal scope of practice for an ANP.

Assignment 1: Assessing the Genitalia and Rectum

Patients are frequently uncomfortable discussing with health care professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

In this assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

GENITALIA ASSESSMENT

Subjective:

• CC: “I have bumps on my bottom that I want to have checked out.”
• HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.
• PMH: Asthma
• Medications: Symbicort 160/4.5mcg
• Allergies: NKDA
• FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD
• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

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Objective:

• VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
• Heart: RRR, no murmurs
• Lungs: CTA, chest wall symmetrical
• Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia
• Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney
• Diagnostics: HSV specimen obtained

Assessment:

• Chancre
• PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

To prepare:

With regard to the SOAP note case study provided:

• Review this week’s Learning Resources, and consider the insights they provide about the case study.
• Consider what history would be necessary to collect from the patient in the case study.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
• Identify at least five possible conditions that may be considered in a differential diagnosis for the patient. GENITALIA ASSESSMENT

To complete:

Refer to Chapter 5 of the Sullivan text. Analyze the SOAP note case study.  Using evidence based resources, answer the following questions and support your answers using current evidence from the literature.

• Analyze the subjective portion of the note. List additional information that should be included in the documentation.
• Analyze the objective portion of the note. List additional information that should be included in the documentation.
• Is the assessment supported by the subjective and objective information? Why or Why not?
• Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis?
• Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from current evidence based literature.

The field of nursing has changed over time. In a 750-1,000 word paper, discuss nursing practice today by addressing the following:

1. Explain      how nursing practice has changed over time and how this evolution has      changed the scope of practice and the approach to treating the individual.
2. Compare      and contrast the differentiated practice competencies between an associate      and baccalaureate education in nursing. Explain how scope of practice      changes between an associate and baccalaureate nurse.
3. Identify      a patient care situation and describe how nursing care, or approaches to      decision-making, differ between the BSN-prepared nurse and the ADN nurse.
4. Discuss      the significance of applying evidence-based practice to nursing care and      explain how the academic preparation of the RN-BSN nurse supports its      application.
5. Discuss      how nurses today communicate and collaborate with interdisciplinary teams      and how this supports safer and more effective patient outcomes Nursing Practice Today.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

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

Nursing Standardized Simulation

SCENARIO OVERVIEW

David Montanari is a 19-year-old male who suffered a T4-T5 burst fracture and a right scapula fracture as a result of a motorcycle accident on Sunday. He underwent spinal fusion on Sunday evening and has had an uneventful recovery period. David has no sensation or movement below the nipple line and is bedbound. He is frustrated and anxious about his condition and is refusing postoperative interventions, including pain medication and use of the incentive spirometer. 

REVIEW AND COMPLETE PRIOR TO THE START OF PRE-BRIEFING: 

In order to prepare for the simulation, you are required to complete the pre-briefing questions below and submit to the faculty facilitating the simulation prior to the start of pre-briefing. If you do not complete the pre-briefing questions below and submit to faculty facilitating the simulation prior to the start of pre-briefing, you will not be permitted to participate in the simulation. 

Please keep in mind you will also be required to recognize a variety of signs and symptoms linked to abnormalities in these skills Nursing Standardized Simulation. 

                                           Questions

1. What are three nursing interventions for a post-operative patient? 

2. What patient findings might you notice for a patient with immobility issues? 

3. Describe complications that can occur as a result of immobility for all body systems.

PLEASE USE APA FORMAT AND INCLUDE REFERENCES LESS THAN 5 YEARS OLD Nursing Standardized Simulation

subacute care and postacute care

QUESTION 1

1. What government program was designed to cover medical expenses for the indigent who cannot afford to pay for health services?

5 points   

QUESTION 2

1. Consumer demand was the catalyst for the creation of community based programs

 True

 False

5 points   

QUESTION 3

1. Who owns and operates the overwhelming majority of assisted living facilities?

5 points   

QUESTION 4

1. The long-term care system works best when it maintains its focus on medical treatment, rather than being distracted by quality of life and other non-medical or non-clinical services.

 True

 False

5 points   

QUESTION 5

1. Why does subacute care appeal to reimbursers such as Medicare, MCOs, and private insurance companies, as an option to hospitalization?

5 points   

QUESTION 6

1. One difference between subacute care and postacute care is that subacute care provides outpatient services, while postacute care provides inpatient services.

 True

 False

5 points   

QUESTION 7

1. An admission to a nursing facility for a consumer who cannot remain at home because of disabilities or care needs would best be categorized as a:

5 points   

QUESTION 8

1. Whether a subacute care unit is freestanding or physically housed within a larger facility, it will most likely be affiliated with, or even owned and operated by, a hospital or nursing facility.

 True

 False

5 points   

QUESTION 9

1. A residential setting for seniors that might provide supportive services is called

5 points   

QUESTION 10

1. Rather than simply maintain their current quality of life, most seniors moving into senior housing want their quality of life to improve.

 True

 False

5 points   

QUESTION 11

1. A senior housing complex that is built by a municipality to serve the needs of its citizens is an example of a facility that is:

5 points   

QUESTION 12

1. Medicare reimbursement is available for certified home health and hospice care providers, but not for adult day care.

 True

 False

5 points   

QUESTION 13

1. The basic philosophy of home health care is to:

5 points subacute care and postacute care 

QUESTION 14

1. Since assisted living facilities focus primarily on quality of life and autonomy for consumers, they must contract with outside agencies in order to provide healthcare services for their residents.

 True

 False

5 points   

QUESTION 15

1. Residents who move from an independent living community to an assisted living facility most often do so because of:

5 points   

QUESTION 16

1. A hospital that purchases a nursing home and a home care agency is creating a horizontally integrated system

 True

 False

5 points   

QUESTION 17

1. One weakness of the current long-term care system is that it focuses on payment availability.  The reason it has this focus is that:

5 points   

QUESTION 18

1. Given the philosophy of hospice, palliative care is more important that curative care

 True

 False

5 points   

QUESTION 19

1. What is true about accreditation?

5 points   

QUESTION 20

1. The vast majority of all long term care facilities are owned by for-profit organizations.

 True

 False

5 points   subacute care and postacute care