18 Oct What changes in prescriptive authority have taken place in the United States in the past ten years?

What changes in prescriptive authority have taken place in the United States in the past ten years? What are the implications of limited prescriptive authority for the advanced practice registered nurse (APRN)?

 

The advanced practice registered nurse role requires an intensive set of clinical skills, knowledge, and integrative abilities that synthesizes nursing knowledge. What does interprofessional collaboration mean to you? Provide examples with your rationale.

 

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

 

 

 

NURS663A Primary Care Adult and Geriatric Patient Theory

 

Week 2 Discussion

 

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example,  #2 Carl, type 2 diabetes.

 

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.

 

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

 

In your peer replies, please reply to at least one peer who chose a different case study.

 

Case Studies

 

1. Marissa is a 29-year-old transgender female (male to female) who works as produce manager at Whole Foods. She is not currently in a monogamous relationship. Marissa smokes a pack of cigarettes a day, smokes marijuana occasionally, and drinks 10 to 12 beers every weekend. Marissa is 5’9, 162 lbs. She presents to the clinic for a physical exam and preventative care. This is the brief information that you have obtained from her intake sheet. Discuss your strategy and plan of care.

 

2. Carl is a 67-year-old Hispanic male with type 2 diabetes who takes metformin 1000mg twice daily. He stopped smoking more than 20 years ago and does not drink. He is 5’8’ and weighs 188 lbs. His last cholesterol level reading last month was 188 triglycerides 108, A1C 6.9. His blood pressure has been maintained at a normal range. What health promotion priorities do you have for Carl on this visit?

 

3. Mary is a 72-year-old grandmother of six, who recently moved to your area to be closer to her older son who recently lost his wife. She lives with her son and two teenage grandsons. Mary has not had a physical exam in about 5 years, but she does not report any significant health issues. She has a history of hypertension that has been controlled with Lisinopril for the past five years. Discuss your health promotion priorities for Mary.

 

 

 

 

 

 

 

NURS663A Primary Care Adult and Geriatric Patient Theory

 

Week 3 Discussion

 

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example,  #2 Carl, type 2 diabetes.

 

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.

 

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

 

In your peer replies, please reply to at least one peer who chose a different case study.

 

Case Studies

 

1. Jenny, a 66-year-old retired cook, presents with a vesicular rash on the right side of her face. She experienced pain on that side 2 days ago, but thought it was just a headache. She has been under a lot of stress lately because she is caring for her husband who has Alzheimer’s disease. What is your initial diagnosis?

 

2. A 48-year-old male presents with a two-month history of nighttime headaches that are becoming more frequent. The pain awakens him at night. He has no other somatic complaints and no other significant medical history. What are your initial diagnosis, differential diagnosis, and treatment plan?

 

3. Sally is a 22-year-old female who  recently became bothered by a rash that is itchy, red, inflamed, and dry. She also has scaly areas that she says are getting worse. The rash is only around her umbilicus and on her elbows. Both of her parents have psoriasis, but she doesn’t believe this is the problem, because it appears to be different from her parents’ lesions. She is living in Florida, is under a lot of stress in high school, and just recovered from a lingering upper respiratory infection (URI).

 

 

 

NURS663A Primary Care Adult and Geriatric Patient Theory

 

Week 4 Discussion

 

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example,  #2 Carl, type 2 diabetes.

 

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.

 

In your peer replies, please reply to at least one peer who chose a different case study.

 

Case Studies

 

1. Sandy is a 64-year-old patient with a 10-year history of recurrent sinusitis. She presents to your primary care clinic today complaining of “head congestion.” She also reports that she had a “cold” last week with symptoms of cough and “runny nose.” Two days ago, she developed a headache that was “worse” when bending over but improved with Tylenol. She describes the headache as a “3 out of 10” and says it is primarily a “frontal headache.” She also reports that her nasal congestion has become worse. She has been blowing her nose even more, and the discharge from her nose has become thicker, with a yellow-green color. She has been taking pseudoephedrine for the past 48 hours with little relief of her nasal congestion. She denies tooth pain or pain on chewing. She has no past history of seasonal allergies, although she was treated for sinusitis 6 months ago in your clinic as well as approximately one year ago.

 

The remainder of her medical history is essentially negative. Her temperature taken at the clinic is 99.6°F.  On physical examination, she has tenderness to palpation in the frontal area and no maxillary tenderness, and nasal mucosa is erythematous as is her pharynx. Her submaxillary nodes are enlarged bilaterally, but there is no cervical lymphadenopathy. Her lungs are clear to auscultation. Her heart has a regular rate and rhythm and is negative for murmurs, gallops, and rubs. Her vital signs are:

 

Blood pressure:128/88; Pulse: 78 and regular; Respiratory rate: 20 p/min, non-labored.

 

2. Maeve, a 62-year-old widow, presents with an elevated papule that has a pearly appearance with a little crusting on her back above her bra strap. It’s about 8 mm and brown. She states that she didn’t even know it was there until she was wearing a bathing suit recently, and someone at the pool suggested that she have it checked out by a doctor. Since she’s now aware of it, she states that it itches.

 

3. Callie is a 32-year-old female with complaints of a hoarse voice for the past three days, painful swallowing without drooling, fever with a Tmax of a 103 yesterday with chills, and occasional body aches. She presents to the clinic with a temperature of 99, while other vital signs are within normal limits. Cervical lymph nodes are mildly enlarged and tender. Both tympanic membranes (TM) are full and erythematous without bulging or drainage and no facial pain. Pharynx is erythematous and swollen without exudate. She has no other complaints and no significant past history; she has no sick contacts.

 

 

 

NURS663A Primary Care Adult and Geriatric Patient Theory

 

Week 5 Discussion

 

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example,  #2 Carl, type 2 diabetes.

 

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.

 

In your peer replies, please reply to at least one peer who chose a different case study.

 

Case Studies

 

1. Mason is a 55-year-old homeless man, who you are seeing today for the first time. He is a smoker and states that he has frequent colds and a routine morning cough. He used to be short of breath just walking up hills, but states that he now has difficulty breathing with everyday activities and is having trouble trying to find food because he cannot walk very far. He just wants medicine to help him survive on the streets. On examination, you find him using his accessory muscles to breath. His vital signs are 99°, 100 beats per minute, 28 respirations/min., blood pressure 140/90. Breath sounds are distant with end expiratory wheezes. He has a slight barrel chest and neck vein distention.

 

2. Debra, a 56-year-old female, comes to the clinic complaining of a cold she has had for several weeks that just will not go away. She states she has a dry hacking cough, muscle aches, and a headache. While it is very hot outside, she is shivering with a sweater on. She has tried many over-the-counter medications with no effect. She looks ill and is very fatigued. On chest auscultation, she has some inspiratory crackles and diminished breath sounds. You note some dullness on percussion over her left lower lobe. Her temperature is 100.5°.

 

3. Calvin is a 36-year-old lawyer who is coming in today for worsening cough over the past four days. He has had some yellow sputum sporadically throughout the day; he says he has felt hot but has not taken his temperature. He has a history of asthma and has been using his Proventil inhaler every 2 to 3 hours for the past 3 to 4 days. He has no other medication. He says that other than the cough, he feels a little fatigued, and he notices that his energy level is less when he plays hockey with his men’s league twice a week.  His SaO2 is 96% HR 102, BP 144/82. He has bilateral wheezes posteriorly on inspiration, worse at the base.

 

 

 

NURS663A Primary Care Adult and Geriatric Patient Theory

 

Week 6 Discussion

 

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example,  #2 Carl, type 2 diabetes.

 

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.

 

In your peer replies, please reply to at least one peer who chose a different case study.

 

Case Studies

 

1. Jim is a 69-year-old male who comes in today complaining of dyspnea on exertion, and you have noted that he has gained about 25 pounds since his last visit 7 months ago. He tells you that he is not sleeping at night because of a constant cough, and he thinks he has a cold because he is coughing up pink frothy “spit”. He is extremely fatigued because of his lack of sleep.  Your examination reveals bilateral 3+ pitting edema with his lower extremities being cool to the touch, distended abdomen, hepatomegaly, hacking cough, and S3 with a gallop. Jim had a myocardial infarction (MI) 15 years ago, and his currently on medication for hypertension.

 

 2. Matthew is a 52-year-old truck driver who is seeing you today for his physical. He states that he has been in his usual state of health, but missed his physical for the past few years.  His BP is 165/90, HR 90, Height 6’2, Weight 204. Total Cholesterol 244, HDL 32 LDL 166 Triglycerides 344 A1C 6.8.

 

 3. Jennifer is an 84-year-old who recently returned from London with her husband. She comes to your clinic as a walk-in from the airport because she does not feel well. She has felt shaky, a little short of breath, and slightly light-headed for the past 2 to 3 hours. She did not take her Norvasc or Lisinopril this morning because she didn’t feel well. She presents to you slightly diaphoretic. Her BP is 90/50, HR is 155, RR 20. She is alert and oriented.

 

 

 

NURS663A Primary Care Adult and Geriatric Patient Theory

 

Week 7 Discussion

 

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example,  #2 Carl, type 2 diabetes.

 

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.

 

In your peer replies, please reply to at least one peer who chose a different case study.

 

Case Studies

 

1. A 25-year-old male graduate student is seen in the office with the chief complaint of upper abdominal pain. He states that he noticed the pain intermittently over the past several weeks. He notices that he gets a gnawing pain about 2 hours after he eats. He also notes that he has some bloating and occasional nausea with the pain. He states that the pain is relieved by antacids most of the time.

 

2. A 34-year-old female presents with the complaint of a sudden excruciating pain in her back and points to her flank area on the right side. She rates the pain as 10 on a scale of 1 to 10, with 10 being the worst. She also complains of nausea with the pain. She states that she has never had anything like this before, and the pain is subsiding a little now.

 

3. A 30-year-old male comes in complaining of 2 days of loose to watery diarrhea, 4 to 5 times a day with significant nausea and one episode of vomiting today. He has a temperature of 100.5 on presentation and HR of 102. His skin is slightly pale, and he is complaining of abdominal cramping. He states that he was in his usual state of health prior to the diarrhea and denies any unusual travel or food. His abdomen is generally tender with no rebound or guarding.

 

 

 

NURS663A Primary Care Adult and Geriatric Patient Theory

 

Week 8 Discussion

 

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example,  #2 Carl, type 2 diabetes.

 

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.

 

In your peer replies, please reply to at least one peer who chose a different case study.

 

Case Studies

 

1. A 72-year-old male is seen in the office with a complaint of difficulty urinating and starting urinary stream. The patient states he has had problems starting urinary stream for about 10 years, but over the past 2 months, he has noticed that not only is this difficult, but at times, it is very difficult to empty his bladder. He reluctantly states that he has had a few episodes of incontinence.

 

2. A 67-year-old man is seen in the office with complaints of erectile dysfunction (ED). He says he has not had any desire for sex, and he has difficulty maintaining an erection.

 

3. Harold is a 66-year-old male who presents with chills, a 101° fever, and low back pain.  His wife tells you that he has been having leaking of his urine for the past 2 to 3 days, a loss of appetite, and that Tylenol is not helping his back pain. Harold tells you that he feels like he constantly has to have a bowel movement, but he has not had any diarrhea, and does not feel constipated.

 

 

 

 

 

 

 

 

 

 

 

NURS663A Primary Care Adult and Geriatric Patient Theory

 

Week 7 Assignment  

 

Analyze and describe the pathophysiology of the disease process and discuss the evidence-based pharmacological treatments in your state and how they affect management of the disease in your community. (3/4 – 1 page)

 

Discuss the clinical guidelines for assessment, diagnosis, and patient education for the disease process. (3/4 – 1 page)

 

Analyze how the disease process affects patients, families, and populations in communities. (3/4 – 1 page)

 

Discuss briefly three strategies you could use to implement best practices for managing the disease in your current healthcare organization. (3/4 – 1 page)

 

The body of your paper needs to be 3-4 pages long. This does NOT include the title page and reference page. Papers that are more than 4 pages long will not be accepted. You must reference a minimum of two (2) scholarly sources on your paper and reference national guidelines.

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