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NURS6521 Advanced Pharmacology
Week 2 Assignment
Pharmacotherapy for Cardiovascular Disorders
..heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke—some of the leading risk factors for heart disease…
—Murphy et al., 2018
Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.
Photo Credit: Getty Images/Science Photo Library RF
As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.
Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from /orders/www.cdc.gov/nchs/products/databriefs/db328.htm
To Prepare
Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
Review the case study assigned by your Instructor for this Assignment.
Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.
By Day 7 of Week 2
Write a 2- to 3-page paper that addresses the following:
Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

NURS6521 Advanced Pharmacology
Week 3 Assignment
Asthma and Stepwise Management
Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors.
Photo Credit: Getty Images
One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment.
To Prepare
Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.
Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.
Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.
By Day 7 of Week 3
Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:
Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.
Explain the stepwise approach to asthma treatment and management for your patient.
Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.

NURS6521 Advanced Pharmacology
Week 4 Assignment
Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom.
Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.
To Prepare
Review the case study assigned by your Instructor for this Assignment
Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.
Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder.
Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
By Day 7 of Week 4
Write a 1-page paper that addresses the following:
Explain your diagnosis for the patient, including your rationale for the diagnosis.
Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

NURS6521 Advanced Pharmacology
Week 8 Assignment
Decision Tree for Neurological and Musculoskeletal
For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.
Photo Credit: Getty Images/Science Photo Library RF
To Prepare
Review the interactive media piece assigned by your Instructor.
Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.
By Day 7 of Week 8
Write a 1- to 2-page summary paper that addresses the following:
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

NURS6521 Advanced Pharmacology
Week 11 Assignment
Off-Label Drug Use in Pediatrics
The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.
When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.
Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.
To Prepare
Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.
Reflect on situations in which children should be prescribed drugs for off-label use.
Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.
By Day 5 of Week 11
Write a 1-page narrative in APA format that addresses the following:
Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.
Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

NURS6521 Advanced Pharmacology
Week 5 Forum                            
Diabetes and Drug Treatments
Each year, 1.5 million Americans are diagnosed with diabetes (American Diabetes Association, 2019). If left untreated, diabetic patients are at risk for several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations.
For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes.
Reference: American Diabetes Association. (2019). Statistics about diabetes. Retrieved from http://diabetes.org/diabetes-basics/statistics/
To Prepare
Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes.
Select one type of diabetes to focus on for this Discussion.
Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment.
Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments.
By Day 3 of Week 5
Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples.
By Day 6 of Week 5
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management.

NURS6521 Advanced Pharmacology
Week 8 Forum
Decision Making When Treating Psychological Disorders
Psychological disorders, such as depression, bipolar, and anxiety disorders can present several complications for patients of all ages. These disorders affect patients physically and emotionally, potentially impacting judgment, school and/or job performance, and relationships with family and friends. Since these disorders have many drastic effects on patients’ lives, it is important for advanced practice nurses to effectively manage patient care. With patient factors and medical history in mind, it is the advanced practice nurse’s responsibility to ensure the safe and effective diagnosis, treatment, and education of patients with psychological disorders.
Photo Credit: Getty Images/iStockphoto
For this Discussion, you will select an interactive media piece to practice decision making when treating patients with psychological disorders. You will recommend the most effective pharmacotherapeutic to treat the psychological disorder presented and examine potential impacts of pharmacotherapeuticson a patient’s pathophysiology.
To Prepare
Review this week’s interactive media pieces and select one to focus on for this Discussion.
Reflect on the decision steps in the interactive media pieces, and consider the potential impacts from the administration of the associated pharmacotherapeutics on the patient’s pathophysiology.
By Day 3 of Week 8
Post a brief explanation of the psychological disorder presented and the decision steps you applied in completing the interactive media piece for the psychological disorder you selected. Then, explain how the administration of the associated pharmacotherapeutics you recommended may impact the patient’s pathophysiology. How might these potential impacts inform how you would suggest treatment plans for this patient? Be specific and provide examples.
By Day 6 of Week 8
Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different interactive media piece on a psychological disorder, and provide recommendations for alternative drug treatments to address the patient’s pathophysiology.

NURS6521 Advanced Pharmacology
Week 9 Forum
Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders
As an advanced practice nurse, you will likely experience patient encounters with complex comorbidities. For example, consider a female patient who is pregnant who also presents with hypertension, diabetes, and has a recent tuberculosis infection. How might the underlying pathophysiology of these conditions affect the pharmacotherapeutics you might recommend to help address your patient’s health needs? What education strategies might you recommend for ensuring positive patient health outcomes?
For this Discussion, you will be assigned a patient case study and will consider how to address the patient’s current drug therapy plans. You will then suggest recommendations on how to revise these drug therapy plans to ensure effective, safe, and quality patient care for positive patient health outcomes
Photo Credit: Getty Images
To Prepare
Review the Resources for this module and reflect on the different health needs and body systems presented.
Your Instructor will assign you a complex case study to focus on for this Discussion.
Consider how you will practice critical decision making for prescribing appropriate drugs and treatment to address the complex patient health needs in the patient case study you selected.
By Day 3 of Week 9
Post a brief description of your patient’s health needs from the patient case study you assigned. Be specific. Then, explain the type of treatment regimen you would recommend for treating your patient, including the choice or pharmacotherapeutics you would recommend and explain why. Be sure to justify your response. Explain a patient education strategy you might recommend for assisting your patient with the management of their health needs. Be specific and provide examples.

NURS6521 Advanced Pharmacology
Week 1 Assignment
Ethical and Legal Implications of Prescribing Drugs
What type of drug should you prescribe based on your patient’s diagnosis? How much of the drug should the patient receive? How often should the drug be administered? When should the drug not be prescribed? Are there individual patient factors that could create complications when taking the drug? Should you be prescribing drugs to this patient? How might different state regulations affect the prescribing of this drug to this patient?
These are some of the questions you might consider when selecting a treatment plan for a patient.
Photo Credit: Getty Images/Caiaimage
As an advanced practice nurse prescribing drugs, you are held accountable for people’s lives every day. Patients and their families will often place trust in you because of your position. With this trust comes power and responsibility, as well as an ethical and legal obligation to “do no harm.” It is important that you are aware of current professional, legal, and ethical standards for advanced practice nurses with prescriptive authority. Additionally, it is important to ensure that the treatment plans and administration/prescribing of drugs is in accordance with the regulations of the state in which you practice. Understanding how these regulations may affect the prescribing of certain drugs in different states may have a significant impact on your patient’s treatment plan. In this Assignment, you explore ethical and legal implications of scenarios and consider how to appropriately respond.
To Prepare
Review the Resources for this module and consider the legal and ethical implications of prescribing prescription drugs, disclosure, and nondisclosure.
Review the scenario assigned by your Instructor for this Assignment.
Search specific laws and standards for prescribing prescription drugs and for addressing medication errors for your state or region, and reflect on these as you review the scenario assigned by your Instructor.
Consider the ethical and legal implications of the scenario for all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
Think about two strategies that you, as an advanced practice nurse, would use to guide your ethically and legally responsible decision-making in this scenario, including whether you would disclose any medication errors.
By Day 7 of Week 1
Write a 2- to 3-page paper that addresses the following:
Explain the ethical and legal implications of the scenario you selected on all stakeholders involved, such as the prescriber, pharmacist, patient, and patient’s family.
Describe strategies to address disclosure and nondisclosure as identified in the scenario you selected. Be sure to reference laws specific to your state.
Explain two strategies that you, as an advanced practice nurse, would use to guide your decision making in this scenario, including whether you would disclose your error. Be sure to justify your explanation.
Explain the process of writing prescriptions, including strategies to minimize medication errors.

NURS6521 Advanced Pharmacology
Week 2 Assignment
Pharmacotherapy for Cardiovascular Disorders
..heart disease remains the No. 1 killer in America; nearly half of all Americans have high blood pressure, high cholesterol, or smoke—some of the leading risk factors for heart disease…
—Murphy et al., 2018
Despite the high mortality rates associated with cardiovascular disorders, improved treatment options do exist that can help address those risk factors that afflict the majority of the population today.
Photo Credit: Getty Images/Science Photo Library RF
As an advanced practice nurse, it is your responsibility to recommend appropriate treatment options for patients with cardiovascular disorders. To ensure the safety and effectiveness of drug therapy, advanced practice nurses must consider aspects that might influence pharmacokinetic and pharmacodynamic processes such as medical history, other drugs currently prescribed, and individual patient factors.
Reference: Murphy, S. L., Xu, J., Kochanek, K. D., & Arias, E. (2018). Mortality in the United States, 2017. Retrieved from /orders/www.cdc.gov/nchs/products/databriefs/db328.htm
To Prepare
Review the Resources for this module and consider the impact of potential pharmacotherapeutics for cardiovascular disorders introduced in the media piece.
Review the case study assigned by your Instructor for this Assignment.
Select one the following factors: genetics, gender, ethnicity, age, or behavior factors.
Reflect on how the factor you selected might influence the patient’s pharmacokinetic and pharmacodynamic processes.
Consider how changes in the pharmacokinetic and pharmacodynamic processes might impact the patient’s recommended drug therapy.
Think about how you might improve the patient’s drug therapy plan based on the pharmacokinetic and pharmacodynamic changes. Reflect on whether you would modify the current drug treatment or provide an alternative treatment option for the patient.
By Day 7 of Week 2
Write a 2- to 3-page paper that addresses the following:
Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.
Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.
Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements.

NURS6521 Advanced Pharmacology
Week 3 Assignment
Asthma and Stepwise Management
Asthma is a respiratory disorder that affects children and adults. Advanced practice nurses often provide treatment to patients with these disorders. Sometimes patients require immediate treatment, making it essential that you recognize and distinguish minor asthma symptoms from serious, life-threatening ones. Since symptoms and attacks are often induced by a trigger, advanced practice nurses must also help patients identify their triggers and recommend appropriate management options. Like many other disorders, there are various approaches to treating and managing care for asthmatic patients depending on individual patient factors.
Photo Credit: Getty Images
One method that supports the clinical decision making of drug therapy plans for asthmatic patients is the stepwise approach, which you explore in this Assignment.
To Prepare
Reflect on drugs used to treat asthmatic patients, including long-term control and quick relief treatment options for patients. Think about the impact these drugs might have on patients, including adults and children.
Consider how you might apply the stepwise approach to address the health needs of a patient in your practice.
Reflect on how stepwise management assists health care providers and patients in gaining and maintaining control of the disease.
By Day 7 of Week 3
Create a 5- to 6-slide PowerPoint presentation that can be used in a staff development meeting on presenting different approaches for implementing the stepwise approach for asthma treatment. Be sure to address the following:
Describe long-term control and quick relief treatment options for the asthma patient from your practice as well as the impact these drugs might have on your patient.
Explain the stepwise approach to asthma treatment and management for your patient.
Explain how stepwise management assists health care providers and patients in gaining and maintaining control of the disease. Be specific.

NURS6521 Advanced Pharmacology
Week 4 Assignment
Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders
Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms, such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe a treatment that targets the cause rather than the symptom.
Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Assignment, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.
To Prepare
Review the case study assigned by your Instructor for this Assignment
Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.
Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors, such as pregnancy, drugs, or a psychological disorder.
Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
By Day 7 of Week 4
Write a 1-page paper that addresses the following:
Explain your diagnosis for the patient, including your rationale for the diagnosis.
Describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
Justify why you would recommend this drug therapy plan for this patient. Be specific and provide examples.

NURS6521 Advanced Pharmacology
Week 8 Assignment
Decision Tree for Neurological and Musculoskeletal
For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.
Photo Credit: Getty Images/Science Photo Library RF
To Prepare
Review the interactive media piece assigned by your Instructor.
Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.
By Day 7 of Week 8
Write a 1- to 2-page summary paper that addresses the following:
Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

NURS6521 Advanced Pharmacology
Week 11 Assignment
Off-Label Drug Use in Pediatrics
The unapproved use of approved drugs, also called off-label use, with children is quite common. This is because pediatric dosage guidelines are typically unavailable, since very few drugs have been specifically researched and tested with children.
When treating children, prescribers often adjust dosages approved for adults to accommodate a child’s weight. However, children are not just “smaller” adults. Adults and children process and respond to drugs differently in their absorption, distribution, metabolism, and excretion.
Children even respond differently during stages from infancy to adolescence. This poses potential safety concerns when prescribing drugs to pediatric patients. As an advanced practice nurse, you have to be aware of safety implications of the off-label use of drugs with this patient group.
To Prepare
Review the interactive media piece in this week’s Resources and reflect on the types of drugs used to treat pediatric patients with mood disorders.
Reflect on situations in which children should be prescribed drugs for off-label use.
Think about strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Consider specific off-label drugs that you think require extra care and attention when used in pediatrics.
By Day 5 of Week 11
Write a 1-page narrative in APA format that addresses the following:
Explain the circumstances under which children should be prescribed drugs for off-label use. Be specific and provide examples.
Describe strategies to make the off-label use and dosage of drugs safer for children from infancy to adolescence. Include descriptions and names of off-label drugs that require extra care and attention when used in pediatrics.

NURS6521 Advanced Pharmacology
Week 7 Exam
Question 1A patient taking Metformin (Glucophage) is scheduled for a cardiac cath. The patient asks why he can’t take his metformin the day of the test. What is the most appropriate reply?
Answers:
Metformin interacts with the dye used in the test.  You can take the Metformin starting the day after the test.
You can develop lactic acidosis if you take metformin and are given dye.  You should have a serum creatinine drawn before restarting the medication.
The combination of metformin and the dye stimulates the liver to release insulin causing hypoglycemia.  You can restart the metformin 48 hours after the test.
Dye is a cytochrome system inducer that affects metformin.   You should wait 3 days before restarting the metform so you don’t develop a toxic level of the drug.
Question 2
A child is prescribed an inhaled corticosteroid agent to decrease respiratory inflammation related to exposure to an animal. The patient’s parent administers a higher than prescribe dose of the medication for 5 days. What should the APRN monitor the child for?
Answers:
tachycardia
adrenal insufficiency
hypokalemia
hypoglycemia
Question 3
Mr. Lacuna is an 83-year-old resident of a long-term care facility who has a diagnosis of moderate Alzheimer disease. Mr. Lacuna’s physician recently prescribed oral rivastigmine, but he was unable to tolerate the drug due to its gastrointestinal effects. As a result, he has been ordered the transdermal patch form of the medication. When administering this form of rivastigmine, the nurse should
Answers:
teach Mr. Lacuna about the importance of rotating sites when he applies the patch.
teach Mr. Lacuna’s family to apply a second patch if they notice an acute exacerbation of his confusion.
apply the patch to Mr. Lacuna’s back to reduce the chance that he will remove it.
apply the patch to a mucous membrane to facilitate complete absorption.
Question 4
A 53-year-old man has been treated for severe asthma for several years with prednisone. Recently, his physician initiated alternate-day therapy for him. The patient tells the nurse that he would rather take the medication every day to prevent confusion. Which of the following would be the best response by the nurse?
Answers:
“This schedule will be more convenient for you.”
“This schedule will enable you to lose weight.”
“This schedule will decrease the cost of your medication.”
“This schedule allows rest periods so that adverse effects are decreased but the anti-inflammatory effects continue.”
Question 5
John is a newly diagnosed diabetic that contacts the office  with complaints of severe nausea and vomiting.  What instructions should the APRN provide related to his insulin doses?
Answers:
I will call in a prescription for metformin for you to take in place of your insulin.
Monitor your blood sugar every 4  hours and take regular insulin based on the blood sugar reading.
Stop your insulin while you are not eating and restart it at half strength when you can keep liquids down.
There is no need to change your insulin dosage while sick.  Continue your regular doses
Question 6During a clinic visit, a patient complains of having frequent muscle cramps in her legs. The nurse’s assessment reveals that the patient has been taking over-the-counter laxatives for the past 7 years. The nurse informed the patient that prolonged use of laxatives
Answers:
may cause nutrient deficiencies.
may counter the therapeutic effect of other drugs.
causes acidic urine and urinary tract infections.
inhibits biotransformation of drugs.
Question 7
Which of the following statements best defines how a chemical becomes termed a drug?
Answers:
A chemical must have a proven therapeutic value or efficacy without severe toxicity or damaging properties to become a drug.
A chemical becomes a drug when it is introduced into the body to cause a change.
A chemical is considered a drug when the Food and Drug Administration (FDA) approves its release to be marketed.
A chemical must have demonstrated therapeutic value to become a drug.
Question 8 The Nurse Practitioner’s assessment of a community-dwelling adult suggests that the client may have drug allergies that have not been previously documented. What statement by the client would confirm this?
Answers:
“I tend to get sick in the stomach when I take antibiotics.”
“I’ve been told that aspirin might have caused my stomach bleed a few years back.”
“I broke out in hives and got terribly itchy when I started a new prescription last year.”
“When I fell last year, the doctor said that it might have been because of my blood pressure pills.”
Question 9
A Nurse Practitioner is teaching an older adult patient about polypharmacy. Which of the following statements best describe this term?
Answers:
Taking more than one drug when the patient deems it necessary
Taking several drugs simultaneously
Increasing the dosage of a drug by the patient
Taking one drug one day and another drug the next day
Question 10
A 33-year-old woman has irritable bowel syndrome (IBS). The physician has prescribed simethicone (Mylicon) for her discomfort. Which of the following will the nurse monitor most closely during the patient’s drug therapy?
Answers:
Drug toxicity
Anorexia
Increased abdominal pain and vomiting
Increased urine output
Question 11
Decongestants are recommended to use in which of the following patients?
Answers:
patients with otitis media
patients with coronary artery disease
patients taking monoamine oxidase inhibitors
patients with hypertension
Question 12
A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by
Answers:
blocking adrenergic receptors and producing antisympathetic effects.
inhibiting the movement of calcium ions across the cardiac muscle cell membrane.
decreasing sodium and potassium conduction.
weakening diastolic depolarization and the action potential duration.
Question 13
Mrs. Houston is a 78-year-old woman who resides in an assisted living facility. Her doctor prescribed digoxin at her last visit to the clinic and she has approached the nurse who makes regular visits to the assisted-living facility about this new drug. What teaching point should the nurse emphasize to Mrs. Houston?
Answers:
The importance of having required laboratory work performed on time
The need to take the medication at the same time each day regardless of her heart rate
The  technique for using a home blood pressure cuff
Timing household activities to coincide with the administration times of her digoxin
Question 14
The Nurse Practitioner is treating a patient that takes frequent doses of antacids for his heartburn and is also taking an enteric coded aspirin.  What instructions should be provided to the patient?
Answers:
The aspirin is less effective when taken with an antacid so you need to increase the dose.
There is no effect of the antacid on the aspirin so they can be taken when it is convenient for you
The antacid destroys the aspirin so you should stop taking any antacids
The medications should be taken at least 2 hours apart.
Question 15
A patient has recently been prescribed a drug that treats his hypertension by blocking the sympathetic receptors in his sympathetic nervous system. This action is characteristic of
Answers:
an adrenergic antagonist.
an adrenergic agonist.
acardiotonic.
a neurotransmitter.
Question 16
In light of her recent high blood pressure readings, a patient has been started on a thiazide diuretic and metoprolol (Lopressor), which is a beta-adrenergic blocker. What is the most likely rationale for using two medications to address the patient’s hypertension?
Answers:
The adverse effects of each drug may cancel each other out.
Using two drugs for a health problem tends to increase patient compliance with the drug regimen.
Using lower doses of two separate drugs may lessen the risk of adverse reactions.
Using the two drugs to treat a health problem may create a synergistic effect.
Question 17
An elderly postsurgical patient has developed postoperative pneumonia in the days following abdominal surgery and is being treated with a number of medications. Which of the following medications that the nurse will administer has the slowest absorption?
Answers:
A sublingual benzodiazepine that has been prescribed to help the patient sleep
An intravenous (IV) antibiotic that is being administered by IV piggyback at 150 mL/hour
An oral antidepressant that the patient has been taking daily for several years
An intramuscular (IM) injection of an opioid analgesic
Question 18
A 79-year-old patient in a long-term care facility is to receive an intravenous fat emulsion. Which of the following lab values would be a priority for the nurse to assess before administration?
Answers:
Blood glucose levels
Serum potassium levels
Serum sodium levels
Triglyceride levels
Question 19
A woman has a long history of seasonal allergies that are typically accompanied by rhinorrhea, red eyes, and frequent sneezing. Sneezes are a result of
Answers:
a CNS reflex that is initiated by receptors in the nasal cavities.
a reflex that is caused when irritants come into contact with cilia.
elevated CO2 levels that are detected by chemoreceptors in the large vessels.
stimulation of goblet cells and mast cells by the presence of microorganisms.
Question 20
A Nurse Practitioner is providing discharge planning for a 45-year-old woman who has a prescription for oral albuterol. The Nurse Practitioner will question the patient about her intake of which of the following?
Alcohol
Answers:
Coffee
Alcohol
Salt
Vitamin C

NURS6521 Advanced Pharmacology
Week 11 Exam
Question 1
A male patient has been brought to the emergency department during an episode of status epilepticus. Diazepam is to be administered intravenously. The APRN will be sure to
Question 2
Which of the following would the nurse include in a teaching plan about the signs and symptoms of thrombophlebitis and thromboembolism that should be reported by a patient taking estrogen?
Question 3
A patient is being seen in the emergency department for a sprained ankle and is given a drug to relieve pain. When a second dose of the pain medication is given, the patient develops redness of the skin, itching, and swelling at the site of injection of the drug. The most likely cause of this response is
Question 4
A 7-year-old child has tonsillitis and is prescribed penicillin V, which is to be administered at home. The nurse will instruct the parents to administer the drug
Question 5
A 66-year-old woman has experienced a significant decline in her quality of life as a result of worsening rheumatoid arthritis. Her physician has prescribed etanercept and the APRN is responsible for facilitating this new aspect of the patient’s drug regimen. This will involve the administration of
Question 6
A postmenopausal patient is prescribed bisphosphonates to treat osteoporosis. The nurse will instruct the patient to take the drug
Question 7
When planning care for a patient who is receiving filgrastim (Neupogen) for a nonmyeloid malignancy, the nurse should formulate which of the following patient outcomes? (Select all that apply.)
Question 8
A 15-year-old boy who has been taking dextroamphetamine for the treatment of ADHD has been experiencing a depressed mood and a sense of hopelessness. He confides in the school nurse that he has begun taking his stepfather’s antidepressant to improve his mood. After immediately phoning the boy’s stepfather, the nurse learns that the drug in question is phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI). The nurse should recognize that this combination of drugs creates a serious risk of what health problem?
Question 9
An elderly woman is slated for a hemiarthroplasty (hip replacement surgery) after falling and breaking her hip on the stairs outside her home. The woman’s pain in the time since her injury has been severe, and her care team has been treating it with morphine. Which of the following administration schedules is most likely to control the patient’s pain?
Question 10
A patient is taking flavoxate hydrochloride (Urispas) to help control an overactive bladder. On a follow-up visit to the clinic, the nurse will question the patient about which of the following?
Question 11
Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to
Question 12
A Nurse Practitioner is caring for a 10-year-old boy who complains of chronic headaches. His mother reports that she gives him Tylenol at least three times a day. Which of the following will the nurse work with the physician to evaluate?
Question 13
A 45-year-old woman with acute leukemia is going to begin chemotherapy with vincristine. The nurse is aware that vincristine must always be administered
Question 14
A 68-year-old man is being treated for benign prostatic hypertrophy (BPH) and began treatment with finasteride (Proscar) 3 months ago. When planning the care of this patient, what desired outcome should the nurse prioritize?
Question 15
A 45-year-old female patient is prescribed ciprofloxacin to treat a bronchial infection. A nursing assessment revealed that she started taking daily vitamin supplements about 2 years ago. To maximize the therapeutic effects of the ciprofloxacin therapy, the nurse should advise the patient to
Question 16
A Nurse Practitioner is obtaining baseline physical data from a 7-year-old patient who is to be started on dextroamphetamine for ADHD. After obtaining vital signs, height, and weight, the nurse will prepare the patient for an
Question 17
The nurse recognizes that the potential for teratogenic drug effects is not static throughout the prenatal and postnatal periods. The potential for teratogenic effects is highest during
Question 18
A patient has been admitted to the critical care unit of the hospital with bacterial septicemia that has failed to respond to initial antibiotic treatment. The patient’s most recent blood cultures reveal the presence of methicillin-resistant Staphylococcus aureus (MRSA) in the patient’s blood. The nurse will anticipate that this patient will likely require intravenous administration of what antibiotic?
Question 19
A nurse practitioner has administered filgrastim to a diverse group of patients in recent months. Which of the following patients should the nurse observe for extremely elevated white blood cell counts following administration of the drug?
Question 20
A patient is taking etoposide for a testicular tumor refractory to treatment. The nursing assessment reveals that he is also taking warfarin. The nurse must carefully monitor for which of the following?

Week 1 discussion Effective communication is vital to constructing an accurate
and detailed patient history. A patient’s health or illness is influenced by
many factors, including age, gender, ethnicity, and environmental setting. As
an advanced practice nurse, you must be aware of these factors and tailor your
communication techniques accordingly. Doing so will not only help you establish
rapport with your patients, but it will also enable you to more effectively
gather the information needed to assess your patients’ health risks.For this Discussion, you will take on the role of a
clinician who is building a health history for one of the following new
patients:
76-year-old Black/African-American male with disabilities
living in an urban setting
Adolescent Hispanic/Latino boy living in a middle-class
suburb
55-year-old Asian female living in a high-density poverty
housing complex
Pre-school aged white female living in a rural community
16-year-old white pregnant teenager living in an inner-city
neighborhood
To prepare:
With the information presented in Chapter 1 in mind,
consider the following:
How would your communication and interview techniques for
building a health history differ with each patient?
How might you target your questions for building a health
history based on the patient’s age, gender, ethnicity, or environment?
What risk assessment instruments would be appropriate to use
with each patient?
What questions would you ask each patient to assess his or
her health risks?
Select one patient from the list above on which to focus for
this Discussion.
Identify any potential health-related risks based upon the
patient’s age, gender, ethnicity, or environmental setting that should be taken
into consideration.
Select one of the risk assessment instruments presented in
Chapter 1 or Chapter 26 of the course text, or another tool with which you are
familiar, related to your selected patient.
Develop at least five targeted questions you would ask your
selected patient to assess his or her health risks and begin building a health
history.
By Day 3
Post a description of the interview and communication
techniques you would use with your selected patient. Explain why you would use
these techniques. Identify the risk assessment instrument you selected, and
justify why it would be applicable to the selected patient. Provide at least
five targeted questions you would ask the patient.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the “Post to Discussion Question” link
and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different
days who selected a different patient than you, using one or more of the
following approaches:
Share additional interview and communication techniques that
could be effective with your colleague’s selected patient.
Suggest additional health-related risks that might be
considered.
Validate an idea with your own experience and additional
research.
Week 2
discussion
Discussion: Diversity and Health Assessments
In May 2012, Alice Randall wrote an article for The New York
Times on the cultural factors that encouraged black women to maintain a weight
above what is considered healthy. Randall explained—from her observations and
her personal experience as a black woman—that many African-American communities
and cultures consider women who are overweight to be more beautiful and
desirable than women at a healthier weight. As she put it, “Many black women
are fat because we want to be” (Randall, 2012).
Randall’s statements sparked a great deal of controversy and
debate; however, they emphasize an underlying reality in the health care field:
different populations, cultures, and groups have diverse beliefs and practices
that impact their health. Nurses and health care professionals should be aware
of this reality and adapt their health assessment techniques and
recommendations to accommodate diversity.
In this Discussion, you will consider different socioeconomic,
spiritual, lifestyle, and other cultural factors that should be taken into
considerations when building a health history for patients with diverse
backgrounds.
Case 1
JC, an at-risk 86-year-old Asian male is physically and
financially dependent on his daughter, a single mother who has little time or
money for her father’s health needs. He has a hx of hypertension (HTN),
gastroesophageal reflux disease (GERD), b12 deficiency, and chronic
prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12
injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and
states “I came for my annual physical exam, but do not want to be a burden to
my daughter.”
Case 2
TJ, a 32-year-old pregnant lesbian, is being seen for an
annual physical exam and has been having vaginal discharge. Her pregnancy has
been without complication thus far. She has been receiving prenatal care from
an obstetrician. She received sperm from a local sperm bank. She is currently
taking prenatal vitamins and takes Tylenol over the counter for aches and pains
on occasion. She a strong family history of diabetes. Gravida 1; Para 0;
Abortions 0.
Case 3
MR, a 23-year-old Native American male comes in to see you
because he has been having anxiety and wants something to help him. He has been
smoking “pot” and says he drinks to help him too. He tells you he is
afraid that he will not get into Heaven if he continues in this lifestyle. He
is not taking any prescriptions medications and denies drug use. He has a positive
family history of diabetes, hypertension, and alcoholism.
To prepare:
Reflect on your experiences as a nurse and on the
information provided in this week’s Learning Resources on diversity issues in
health assessments.
Select one of the three case studies. Reflect on the
provided patient information.
Reflect on the specific socioeconomic, spiritual, lifestyle,
and other cultural factors related to the health of the patient you selected.
Consider how you would build a health history for the
patient. What questions would you ask, and how would you frame them to be
sensitive to the patient’s background, lifestyle, and culture? Develop five
targeted questions you would ask the patient to build his or her health history
and to assess his or her health risks.
Think about the challenges associated with communicating
with patients from a variety of specific populations. What strategies can you
as a nurse employ to be sensitive to different cultural factors while gathering
the pertinent information?
By Day 3
Post an explanation of the specific socioeconomic,
spiritual, lifestyle, and other cultural factors associated with the patient
you selected. Explain the issues that you would need to be sensitive to when
interacting with the patient, and why. Provide at least five targeted questions
you would ask the patient to build his or her health history and to assess his
or her health risks.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the “Post to Discussion Question” link
and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses
By Day 6
Respond on or before Day 6 to at least two of your
colleagues who selected a different patient than you, using one or more of the
following approaches:
Suggest additional socioeconomic, spiritual, lifestyle, and
other cultural factors related to the patient.
Critique your colleague’s targeted questions, and explain
how the patient might interpret these questions. Explain whether any of the
questions would apply to your patient, and why.
Week 3
discussion
Discussion: Assessment Tools and Diagnostic Tests in Adults
and Children
When seeking to identify a patient’s health condition,
advanced practice nurses can use a diverse selection of diagnostic tests and
assessment tools; however, different factors affect the validity and
reliability of the results produced by these tests or tools. Nurses must be
aware of these factors in order to select the most appropriate test or tool and
to accurately interpret the results.
Not only do these diagnostic tests affect adults, body
measurements can provide a general picture of whether a child is receiving
adequate nutrition or is at risk for health issues. These data, however, are
just one aspect to be considered. Lifestyle, family history, and culture-among
other factors-are also relevant. That said, gathering and communicating this
information can be a delicate process.
In this Discussion, you will consider the validity and
reliability of different assessment tools and diagnostic tests. You will
explore issues such as sensitivity, specificity, and positive and negative
predictive values. You will also consider examples of children with various
weight issues. You will explore how you could effectively gather information
and encourage parents and caregivers to be proactive about their children’s
health and weight.
To prepare:
Review this week’s learning resources and consider factors
that impact the validity and reliability of various assessment tools and
diagnostic tests. We will also review examples of pediatric patients and their
families as it relates to BMI.
This week you will be assigned one of the following DB by
your instructor.
Select one of the following assessment tools or diagnostic
tests to explore for the purposes of this Discussion:
Mammogram
Prostate-specific antigen (PSA) test
Body-mass index (BMI) using waist circumference for adults
Select one of the examples on which to focus for this
Discussion. What health issues and risks may be relevant to the child you
selected?
Overweight 5-year-old boy with overweight parents
5-year-old girl of normal weight with obese parents
Severely underweight 12-year-old girl with underweight
parents
Search the Walden Library and credible sources for resources
explaining the tool or test you selected. What is its purpose, how is it
conducted, and what information does it gather?
What does the literature discuss regarding the validity,
reliability, and are there any issues with sensitivity, specificity, predictive
values, ethical dilemmas, and controversies related to the test or tool?
Based on the risks you identified, consider what further
information you would need to gain a full understanding of the child’s health.
Think about how you could gather this information in a sensitive fashion.
Consider how you could encourage parents or caregivers to be
proactive toward the child’s health.
By Day 3
Post a description of how the assessment tool or diagnostic
test you selected is used in health care. Based on your research, evaluate the
test or the tool’s validity and reliability, and explain any issues with
sensitivity, reliability, and predictive values. Include references in
appropriate APA formatting.
OR
Post an explanation of the health issues and risks that are
relevant to the child you selected. Describe additional information you would
need in order to further assess his or her weight-related health. Taking into
account the parents’ and caregivers’ potential sensitivities, list at least
three specific questions you would ask about the child to gather more
information. Provide at least two strategies you could employ to encourage the
parents or caregivers to be proactive about their child’s health and weight.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the “Post to Discussion Question” link
and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues who selected a
different tool test, or child health example than you, using one or more of the
following approaches:
Critique your colleague’s evaluation of the validity and
reliability of the tool or test selected.
Suggest alternative or additional tools or tests that should
be considered when gathering information about specific conditions or symptoms.
Based on the risks you identified, consider what further
information you would need to gain a full understanding of the child’s health.
Think about how you could gather this information in a sensitive fashion.
Consider how you could encourage parents or caregivers to be
proactive toward the child’s health.
Suggest additional health risks or issues that could be
relevant to the child.
Critique your colleagues’ questions, and suggest how the parents
or caregivers might interpret these questions. Provide alternate or additional
questions.
Suggest an additional strategy for gathering patient
information or promoting proactivity
Week 5
discussion
Discussion: Assessing the Ears, Nose, and Throat
Most ear, nose, and throat conditions that arise in
non-critical care settings are minor in nature. However, subtle symptoms can
sometimes escalate into life-threatening conditions that require prompt
assessment and treatment. Nurses conducting assessments of the ears, nose, and
throat must be able to identify the small differences between life-threatening
conditions and benign ones. For instance, if a patient with a sore throat and a
runny nose also has inflamed lymph nodes, the inflammation is probably due to
the pathogen causing the sore throat rather than a case of throat cancer. With
this knowledge and a sufficient patient health history, a nurse would not need
to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would
probably perform a simple strep test.
In this Discussion, you consider case studies of abnormal
findings from patients in a clinical setting. You determine what history should
be collected from the patients, what physical exams and diagnostic tests should
be conducted, and formulate a differential diagnosis with several possible
conditions.
Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following specific case studies for this Discussion.
Also, your Discussion post should be in the Episodic/Focused SOAP Note format,
rather than the traditional narrative style Discussion posting format. Refer to
Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the
Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP
notes have specific data included in every patient case.
Case 1: Nose Focused Exam
Richard is a 50-year-old male with nasal congestion,
sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an
itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat
for redness and inflammation, you notice him touch his fingers to the bridge of
his nose to press and rub there. He says he’s taken Mucinex OTC the past two
nights to help him breathe while he sleeps. When you ask if the Mucinex has
helped at all, he sneers slightly and gestures that the improvement is only
minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with
clear thin secretions and enlarged nasal turbinates, which obstruct airway flow
but his lungs are clear. His tonsils are not enlarged but his throat is mildly
erythematous.
Case 2: Focused Throat Exam
Lily is a 20-year-old student at the local community
college. When some of her friends and classmates told her about an outbreak of flu-like
symptoms sweeping her campus over the past two weeks, Lily figured she
shouldn’t take her three-day sore throat lightly. Your clinic has treated a few
cases similar to Lily’s. All the patients reported decreased appetite,
headaches, and pain with swallowing. As Lily recounts these symptoms to you,
you notice that she has a runny nose and a slight hoarseness in her voice but
doesn’t sound congested.
Case 3: Focused Ear Exam
Martha brings her 11-year old grandson, James, to your
clinic to have his right ear checked. He has complained to her about a mild
earache for the past two days. His grandmother believes that he feels warm but
did not verify this with a thermometer. James states that the pain was worse
while he was falling asleep and that it was harder for him to hear. When you
begin basic assessments, you notice that James has a prominent tan. When you
ask him how he’s been spending his summer, James responds that he’s been
spending a lot of time in the pool.
To prepare:
With regard to the case study you were assigned:
Review this week’s Learning Resources and consider the
insights they provide.
Consider what history would be necessary to collect from the
patient.
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 10 possible conditions that may be
considered in a differential diagnosis for the patient.
Note: Before you submit your initial post, replace the
subject line (“Week 5 Discussion”) with “Review of Case Study ___,” identifying
the number of the case study you were assigned.
By Day 3
Post an episodic/focused note about the patient in the case
study to which you were assigned using the episodic/focused note template
provided in week 5 resources. Provide evidence from the literature to support
diagnostic tests that would be appropriate for each case. List five different
possible conditions for the patient’s differential diagnosis and justify why you
selected each.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the “Post to Discussion Question” link
and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different
days who were assigned different case studies than you. Analyze the possible
conditions from your colleagues’ differential diagnoses. Determine which of the
conditions you would reject and why. Identify the most likely condition and
justify your reasoning.
Week 7
discussion
Discussion: Assessing the Heart, Lungs, and Peripheral
Vascular System
Take a moment to observe your breathing. Notice the
sensation of your chest expanding as air flows into your lungs. Feel your chest
contract as you exhale. How might this experience be different for someone with
chronic lung disease or someone experiencing an asthma attack?
In order to adequately assess the chest region of a patient,
nurses need to be aware of a patient’s history, potential abnormal findings,
and what physical exams and diagnostic tests should be conducted to determine
the causes and severity of abnormalities.
In this Discussion, you will consider how a patient’s
initial symptoms can result in very different diagnoses when further assessment
is conducted.
Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following specific case studies for this Discussion.
Also, your Discussion post should be in the Episodic/Focused SOAP Note format,
rather than the traditional narrative style Discussion posting format. Refer to
Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the
Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP
notes have specific data included in every patient case.
To prepare:
With regard to the case study you were assigned:
Review this week’s Learning Resources and consider the
insights they provide.
Consider what history would be necessary to collect from the
patient.
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.
Note: Before you submit your initial post, replace the
subject line (“Discussion – Week 6”) with “Review of Case
Study” identifying the number of the case study you were assigned.
By Day 3
Post an episodic/focused note about the patient in the case
study to which you were assigned using the episodic/focused note template
provided in week 5 resources. Provide evidence from the literature to support
diagnostic tests that would be appropriate for each case. List five different
possible conditions for the patient’s differential diagnosis and justify why
you selected each.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the “Post to Discussion Question” link
and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different
days who were assigned different case studies than you. Analyze the possible
conditions from your colleagues’ differential diagnoses. Determine which of the
conditions you would reject and why. Identify the most likely condition, and
justify your reasoning.
Week 8
discussion
Discussion: Assessing Muscoskeletal Pain
The body is constantly sending signals about its health. One
of the most easily recognized signals is pain. Musculoskeletal conditions
comprise one of the leading causes of severe long-term pain in patients. The
musculoskeletal system is an elaborate system of interconnected levers that
provide the body with support and mobility. Because of the interconnectedness
of the musculoskeletal system, identifying the causes of pain can be
challenging. Accurately interpreting the cause of musculoskeletal pain requires
an assessment process informed by patient history and physical exams.
In this Discussion, you will consider case studies that
describe abnormal findings in patients seen in a clinical setting.
Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following specific case studies for this Discussion.
Also, your Discussion post should be in the Episodic/Focused SOAP Note format,
rather than the traditional narrative style Discussion posting format. Refer to
Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the
Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP
notes have specific data included in every patient case.
Case 1: Back Pain
A 42-year-old male reports pain in his lower back for the
past month. The pain sometimes radiates to his left leg. In determining the
cause of the back pain, based on your knowledge of anatomy, what nerve roots
might be involved? How would you test for each of them? What other symptoms
need to be explored? What are your differential diagnoses for acute low back
pain? Consider the possible origins using the Agency for Healthcare Research
and Quality (AHRQ) guidelines as a framework. What physical examination will
you perform? What special maneuvers will you perform?
spine
Case 2: Ankle Pain
A 46-year-old female reports pain in both of her ankles, but
she is more concerned about her right ankle. She was playing soccer over the
weekend and heard a “pop.” She is able to bear weight, but it is
uncomfortable. In determining the cause of the ankle pain, based on your
knowledge of anatomy, what foot structures are likely involved? What other
symptoms need to be explored? What are your differential diagnoses for ankle
pain? What physical examination will you perform? What special maneuvers will
you perform? Should you apply the Ottowa ankle rules to determine if you need
additional testing?
ankle
Case 3: Knee Pain
A 15-year-old male reports dull pain in both knees.
Sometimes one or both knees click, and the patient describes a catching
sensation under the patella. In determining the causes of the knee pain, what
additional history do you need? What categories can you use to differentiate
knee pain? What are your specific differential diagnoses for knee pain? What
physical examination will you perform? What anatomic structures are you
assessing as part of the physical examination? What special maneuvers will you
perform?
knee
To prepare:
With regard to the case study you were assigned:
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 you were assigned.
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.
Note: Before you submit your initial post, replace the
subject line (“Discussion – Week 8”) with “Review of Case Study
___.” Fill in the blank with the number of the case study you were
assigned.
By Day 3
Post an episodic/focused note about the patient in the case
study to which you were assigned using the episodic/focused note template
provided in week 5 resources. Provide evidence from the literature to support
diagnostic tests that would be appropriate for each case. List five different
possible conditions for the patient’s differential diagnosis and justify why
you selected each.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the “Post to Discussion Question” link
and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on 2 different
days who were assigned different case studies than you. Analyze the possible
conditions from your colleagues’ differential diagnoses. Determine which of the
conditions you would reject and why. Identify the most likely condition, and
justify your reasoning.
Week 9
discussion
Discussion: Assessing Neurological Symptoms
Imagine not being able to form new memories. This is the
reality patients with anterograde amnesia face. Although this form of amnesia
is rare, it can result from severe brain trauma. Anterograde amnesia
demonstrates just how impactful brain disorders can be to a patient’s quality
of living. Accurately assessing neurological symptoms is a complex process that
involves the analysis of many factors.
In this Discussion, you will consider case studies that
describe abnormal findings in patients seen in a clinical setting.
Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following specific case studies for this Discussion.
Also, your Discussion post should be in the Episodic/Focused SOAP Note format,
rather than the traditional narrative style Discussion posting format. Refer to
Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the
Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP
notes have specific data included in every patient case.
Case 1: Headaches
A 20-year-old male complains of experiencing intermittent
headaches. The headaches diffuse all over the head, but the greatest intensity
and pressure occurs above the eyes and spreads through the nose, cheekbones,
and jaw.
Case 2: Numbness and Pain
A 47-year-old obese female complains of pain in her right
wrist, with tingling and numbness in the thumb and index and middle fingers for
the past 2 weeks. She has been frustrated because the pain causes her to drop
her hair-styling tools.
Case 3: Drooping of Face
A 33-year-old female comes to your clinic alarmed about
sudden “drooping” on the right side of the face that began this
morning. She complains of excessive tearing and drooling on her right side as
well.
To prepare:
With regard to the case study you were assigned:
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 you were assigned.
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.
Note: Before you submit your initial post, replace the
subject line (“Discussion – Week 9”) with “Review of Case Study
___.” Fill in the blank with the number of the case study you were
assigned.
By Day 3
Post an episodic/focused note about the patient in the case
study to which you were assigned using the episodic/focused note template
provided in week 5 resources. Provide evidence from the literature to support
diagnostic tests that would be appropriate for each case. List five different
possible conditions for the patient’s differential diagnosis and justify why
you selected each.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the “Post to Discussion Question” link
and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different
days who were assigned different case studies than you. Analyze the possible
conditions from your colleagues’ differential diagnoses. Determine which of the
conditions you would reject and why. Identify the most likely condition, and
justify your reasoning.
</pclass=”msonormal”>

<pclass=”msonormal”>Week 1
discussion
Effective communication is vital to constructing an accurate
and detailed patient history. A patient’s health or illness is influenced by
many factors, including age, gender, ethnicity, and environmental setting. As
an advanced practice nurse, you must be aware of these factors and tailor your
communication techniques accordingly. Doing so will not only help you establish
rapport with your patients, but it will also enable you to more effectively
gather the information needed to assess your patients’ health risks.
For this Discussion, you will take on the role of a
clinician who is building a health history for one of the following new
patients:
76-year-old Black/African-American male with disabilities
living in an urban setting
Adolescent Hispanic/Latino boy living in a middle-class
suburb
55-year-old Asian female living in a high-density poverty
housing complex
Pre-school aged white female living in a rural community
16-year-old white pregnant teenager living in an inner-city
neighborhood
To prepare:
With the information presented in Chapter 1 in mind,
consider the following:
How would your communication and interview techniques for
building a health history differ with each patient?
How might you target your questions for building a health
history based on the patient’s age, gender, ethnicity, or environment?
What risk assessment instruments would be appropriate to use
with each patient?
What questions would you ask each patient to assess his or
her health risks?
Select one patient from the list above on which to focus for
this Discussion.
Identify any potential health-related risks based upon the
patient’s age, gender, ethnicity, or environmental setting that should be taken
into consideration.
Select one of the risk assessment instruments presented in
Chapter 1 or Chapter 26 of the course text, or another tool with which you are
familiar, related to your selected patient.
Develop at least five targeted questions you would ask your
selected patient to assess his or her health risks and begin building a health
history.
By Day 3
Post a description of the interview and communication
techniques you would use with your selected patient. Explain why you would use
these techniques. Identify the risk assessment instrument you selected, and
justify why it would be applicable to the selected patient. Provide at least
five targeted questions you would ask the patient.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the “Post to Discussion Question” link
and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different
days who selected a different patient than you, using one or more of the
following approaches:
Share additional interview and communication techniques that
could be effective with your colleague’s selected patient.
Suggest additional health-related risks that might be
considered.
Validate an idea with your own experience and additional
research.
Week 2
discussion
Discussion: Diversity and Health Assessments
In May 2012, Alice Randall wrote an article for The New York
Times on the cultural factors that encouraged black women to maintain a weight
above what is considered healthy. Randall explained—from her observations and
her personal experience as a black woman—that many African-American communities
and cultures consider women who are overweight to be more beautiful and
desirable than women at a healthier weight. As she put it, “Many black women
are fat because we want to be” (Randall, 2012).
Randall’s statements sparked a great deal of controversy and
debate; however, they emphasize an underlying reality in the health care field:
different populations, cultures, and groups have diverse beliefs and practices
that impact their health. Nurses and health care professionals should be aware
of this reality and adapt their health assessment techniques and
recommendations to accommodate diversity.
In this Discussion, you will consider different socioeconomic,
spiritual, lifestyle, and other cultural factors that should be taken into
considerations when building a health history for patients with diverse
backgrounds.
Case 1
JC, an at-risk 86-year-old Asian male is physically and
financially dependent on his daughter, a single mother who has little time or
money for her father’s health needs. He has a hx of hypertension (HTN),
gastroesophageal reflux disease (GERD), b12 deficiency, and chronic
prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12
injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and
states “I came for my annual physical exam, but do not want to be a burden to
my daughter.”
Case 2
TJ, a 32-year-old pregnant lesbian, is being seen for an
annual physical exam and has been having vaginal discharge. Her pregnancy has
been without complication thus far. She has been receiving prenatal care from
an obstetrician. She received sperm from a local sperm bank. She is currently
taking prenatal vitamins and takes Tylenol over the counter for aches and pains
on occasion. She a strong family history of diabetes. Gravida 1; Para 0;
Abortions 0.
Case 3
MR, a 23-year-old Native American male comes in to see you
because he has been having anxiety and wants something to help him. He has been
smoking “pot” and says he drinks to help him too. He tells you he is
afraid that he will not get into Heaven if he continues in this lifestyle. He
is not taking any prescriptions medications and denies drug use. He has a positive
family history of diabetes, hypertension, and alcoholism.
To prepare:
Reflect on your experiences as a nurse and on the
information provided in this week’s Learning Resources on diversity issues in
health assessments.
Select one of the three case studies. Reflect on the
provided patient information.
Reflect on the specific socioeconomic, spiritual, lifestyle,
and other cultural factors related to the health of the patient you selected.
Consider how you would build a health history for the
patient. What questions would you ask, and how would you frame them to be
sensitive to the patient’s background, lifestyle, and culture? Develop five
targeted questions you would ask the patient to build his or her health history
and to assess his or her health risks.
Think about the challenges associated with communicating
with patients from a variety of specific populations. What strategies can you
as a nurse employ to be sensitive to different cultural factors while gathering
the pertinent information?
By Day 3
Post an explanation of the specific socioeconomic,
spiritual, lifestyle, and other cultural factors associated with the patient
you selected. Explain the issues that you would need to be sensitive to when
interacting with the patient, and why. Provide at least five targeted questions
you would ask the patient to build his or her health history and to assess his
or her health risks.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the “Post to Discussion Question” link
and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses
By Day 6
Respond on or before Day 6 to at least two of your
colleagues who selected a different patient than you, using one or more of the
following approaches:
Suggest additional socioeconomic, spiritual, lifestyle, and
other cultural factors related to the patient.
Critique your colleague’s targeted questions, and explain
how the patient might interpret these questions. Explain whether any of the
questions would apply to your patient, and why.
Week 3
discussion
Discussion: Assessment Tools and Diagnostic Tests in Adults
and Children
When seeking to identify a patient’s health condition,
advanced practice nurses can use a diverse selection of diagnostic tests and
assessment tools; however, different factors affect the validity and
reliability of the results produced by these tests or tools. Nurses must be
aware of these factors in order to select the most appropriate test or tool and
to accurately interpret the results.
Not only do these diagnostic tests affect adults, body
measurements can provide a general picture of whether a child is receiving
adequate nutrition or is at risk for health issues. These data, however, are
just one aspect to be considered. Lifestyle, family history, and culture-among
other factors-are also relevant. That said, gathering and communicating this
information can be a delicate process.
In this Discussion, you will consider the validity and
reliability of different assessment tools and diagnostic tests. You will
explore issues such as sensitivity, specificity, and positive and negative
predictive values. You will also consider examples of children with various
weight issues. You will explore how you could effectively gather information
and encourage parents and caregivers to be proactive about their children’s
health and weight.
To prepare:
Review this week’s learning resources and consider factors
that impact the validity and reliability of various assessment tools and
diagnostic tests. We will also review examples of pediatric patients and their
families as it relates to BMI.
This week you will be assigned one of the following DB by
your instructor.
Select one of the following assessment tools or diagnostic
tests to explore for the purposes of this Discussion:
Mammogram
Prostate-specific antigen (PSA) test
Body-mass index (BMI) using waist circumference for adults
Select one of the examples on which to focus for this
Discussion. What health issues and risks may be relevant to the child you
selected?
Overweight 5-year-old boy with overweight parents
5-year-old girl of normal weight with obese parents
Severely underweight 12-year-old girl with underweight
parents
Search the Walden Library and credible sources for resources
explaining the tool or test you selected. What is its purpose, how is it
conducted, and what information does it gather?
What does the literature discuss regarding the validity,
reliability, and are there any issues with sensitivity, specificity, predictive
values, ethical dilemmas, and controversies related to the test or tool?
Based on the risks you identified, consider what further
information you would need to gain a full understanding of the child’s health.
Think about how you could gather this information in a sensitive fashion.
Consider how you could encourage parents or caregivers to be
proactive toward the child’s health.
By Day 3
Post a description of how the assessment tool or diagnostic
test you selected is used in health care. Based on your research, evaluate the
test or the tool’s validity and reliability, and explain any issues with
sensitivity, reliability, and predictive values. Include references in
appropriate APA formatting.
OR
Post an explanation of the health issues and risks that are
relevant to the child you selected. Describe additional information you would
need in order to further assess his or her weight-related health. Taking into
account the parents’ and caregivers’ potential sensitivities, list at least
three specific questions you would ask about the child to gather more
information. Provide at least two strategies you could employ to encourage the
parents or caregivers to be proactive about their child’s health and weight.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the “Post to Discussion Question” link
and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues who selected a
different tool test, or child health example than you, using one or more of the
following approaches:
Critique your colleague’s evaluation of the validity and
reliability of the tool or test selected.
Suggest alternative or additional tools or tests that should
be considered when gathering information about specific conditions or symptoms.
Based on the risks you identified, consider what further
information you would need to gain a full understanding of the child’s health.
Think about how you could gather this information in a sensitive fashion.
Consider how you could encourage parents or caregivers to be
proactive toward the child’s health.
Suggest additional health risks or issues that could be
relevant to the child.
Critique your colleagues’ questions, and suggest how the parents
or caregivers might interpret these questions. Provide alternate or additional
questions.
Suggest an additional strategy for gathering patient
information or promoting proactivity
Week 5
discussion
Discussion: Assessing the Ears, Nose, and Throat
Most ear, nose, and throat conditions that arise in
non-critical care settings are minor in nature. However, subtle symptoms can
sometimes escalate into life-threatening conditions that require prompt
assessment and treatment. Nurses conducting assessments of the ears, nose, and
throat must be able to identify the small differences between life-threatening
conditions and benign ones. For instance, if a patient with a sore throat and a
runny nose also has inflamed lymph nodes, the inflammation is probably due to
the pathogen causing the sore throat rather than a case of throat cancer. With
this knowledge and a sufficient patient health history, a nurse would not need
to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would
probably perform a simple strep test.
In this Discussion, you consider case studies of abnormal
findings from patients in a clinical setting. You determine what history should
be collected from the patients, what physical exams and diagnostic tests should
be conducted, and formulate a differential diagnosis with several possible
conditions.
Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following specific case studies for this Discussion.
Also, your Discussion post should be in the Episodic/Focused SOAP Note format,
rather than the traditional narrative style Discussion posting format. Refer to
Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the
Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP
notes have specific data included in every patient case.
Case 1: Nose Focused Exam
Richard is a 50-year-old male with nasal congestion,
sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an
itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat
for redness and inflammation, you notice him touch his fingers to the bridge of
his nose to press and rub there. He says he’s taken Mucinex OTC the past two
nights to help him breathe while he sleeps. When you ask if the Mucinex has
helped at all, he sneers slightly and gestures that the improvement is only
minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with
clear thin secretions and enlarged nasal turbinates, which obstruct airway flow
but his lungs are clear. His tonsils are not enlarged but his throat is mildly
erythematous.
Case 2: Focused Throat Exam
Lily is a 20-year-old student at the local community
college. When some of her friends and classmates told her about an outbreak of flu-like
symptoms sweeping her campus over the past two weeks, Lily figured she
shouldn’t take her three-day sore throat lightly. Your clinic has treated a few
cases similar to Lily’s. All the patients reported decreased appetite,
headaches, and pain with swallowing. As Lily recounts these symptoms to you,
you notice that she has a runny nose and a slight hoarseness in her voice but
doesn’t sound congested.
Case 3: Focused Ear Exam
Martha brings her 11-year old grandson, James, to your
clinic to have his right ear checked. He has complained to her about a mild
earache for the past two days. His grandmother believes that he feels warm but
did not verify this with a thermometer. James states that the pain was worse
while he was falling asleep and that it was harder for him to hear. When you
begin basic assessments, you notice that James has a prominent tan. When you
ask him how he’s been spending his summer, James responds that he’s been
spending a lot of time in the pool.
To prepare:
With regard to the case study you were assigned:
Review this week’s Learning Resources and consider the
insights they provide.
Consider what history would be necessary to collect from the
patient.
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 10 possible conditions that may be
considered in a differential diagnosis for the patient.
Note: Before you submit your initial post, replace the
subject line (“Week 5 Discussion”) with “Review of Case Study ___,” identifying
the number of the case study you were assigned.
By Day 3
Post an episodic/focused note about the patient in the case
study to which you were assigned using the episodic/focused note template
provided in week 5 resources. Provide evidence from the literature to support
diagnostic tests that would be appropriate for each case. List five different
possible conditions for the patient’s differential diagnosis and justify why you
selected each.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the “Post to Discussion Question” link
and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different
days who were assigned different case studies than you. Analyze the possible
conditions from your colleagues’ differential diagnoses. Determine which of the
conditions you would reject and why. Identify the most likely condition and
justify your reasoning.
Week 7
discussion
Discussion: Assessing the Heart, Lungs, and Peripheral
Vascular System
Take a moment to observe your breathing. Notice the
sensation of your chest expanding as air flows into your lungs. Feel your chest
contract as you exhale. How might this experience be different for someone with
chronic lung disease or someone experiencing an asthma attack?
In order to adequately assess the chest region of a patient,
nurses need to be aware of a patient’s history, potential abnormal findings,
and what physical exams and diagnostic tests should be conducted to determine
the causes and severity of abnormalities.
In this Discussion, you will consider how a patient’s
initial symptoms can result in very different diagnoses when further assessment
is conducted.
Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following specific case studies for this Discussion.
Also, your Discussion post should be in the Episodic/Focused SOAP Note format,
rather than the traditional narrative style Discussion posting format. Refer to
Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the
Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP
notes have specific data included in every patient case.
To prepare:
With regard to the case study you were assigned:
Review this week’s Learning Resources and consider the
insights they provide.
Consider what history would be necessary to collect from the
patient.
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.
Note: Before you submit your initial post, replace the
subject line (“Discussion – Week 6”) with “Review of Case
Study” identifying the number of the case study you were assigned.
By Day 3
Post an episodic/focused note about the patient in the case
study to which you were assigned using the episodic/focused note template
provided in week 5 resources. Provide evidence from the literature to support
diagnostic tests that would be appropriate for each case. List five different
possible conditions for the patient’s differential diagnosis and justify why
you selected each.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the “Post to Discussion Question” link
and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different
days who were assigned different case studies than you. Analyze the possible
conditions from your colleagues’ differential diagnoses. Determine which of the
conditions you would reject and why. Identify the most likely condition, and
justify your reasoning.
Week 8
discussion
Discussion: Assessing Muscoskeletal Pain
The body is constantly sending signals about its health. One
of the most easily recognized signals is pain. Musculoskeletal conditions
comprise one of the leading causes of severe long-term pain in patients. The
musculoskeletal system is an elaborate system of interconnected levers that
provide the body with support and mobility. Because of the interconnectedness
of the musculoskeletal system, identifying the causes of pain can be
challenging. Accurately interpreting the cause of musculoskeletal pain requires
an assessment process informed by patient history and physical exams.
In this Discussion, you will consider case studies that
describe abnormal findings in patients seen in a clinical setting.
Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following specific case studies for this Discussion.
Also, your Discussion post should be in the Episodic/Focused SOAP Note format,
rather than the traditional narrative style Discussion posting format. Refer to
Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the
Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP
notes have specific data included in every patient case.
Case 1: Back Pain
A 42-year-old male reports pain in his lower back for the
past month. The pain sometimes radiates to his left leg. In determining the
cause of the back pain, based on your knowledge of anatomy, what nerve roots
might be involved? How would you test for each of them? What other symptoms
need to be explored? What are your differential diagnoses for acute low back
pain? Consider the possible origins using the Agency for Healthcare Research
and Quality (AHRQ) guidelines as a framework. What physical examination will
you perform? What special maneuvers will you perform?
spine
Case 2: Ankle Pain
A 46-year-old female reports pain in both of her ankles, but
she is more concerned about her right ankle. She was playing soccer over the
weekend and heard a “pop.” She is able to bear weight, but it is
uncomfortable. In determining the cause of the ankle pain, based on your
knowledge of anatomy, what foot structures are likely involved? What other
symptoms need to be explored? What are your differential diagnoses for ankle
pain? What physical examination will you perform? What special maneuvers will
you perform? Should you apply the Ottowa ankle rules to determine if you need
additional testing?
ankle
Case 3: Knee Pain
A 15-year-old male reports dull pain in both knees.
Sometimes one or both knees click, and the patient describes a catching
sensation under the patella. In determining the causes of the knee pain, what
additional history do you need? What categories can you use to differentiate
knee pain? What are your specific differential diagnoses for knee pain? What
physical examination will you perform? What anatomic structures are you
assessing as part of the physical examination? What special maneuvers will you
perform?
knee
To prepare:
With regard to the case study you were assigned:
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 you were assigned.
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.
Note: Before you submit your initial post, replace the
subject line (“Discussion – Week 8”) with “Review of Case Study
___.” Fill in the blank with the number of the case study you were
assigned.
By Day 3
Post an episodic/focused note about the patient in the case
study to which you were assigned using the episodic/focused note template
provided in week 5 resources. Provide evidence from the literature to support
diagnostic tests that would be appropriate for each case. List five different
possible conditions for the patient’s differential diagnosis and justify why
you selected each.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the “Post to Discussion Question” link
and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on 2 different
days who were assigned different case studies than you. Analyze the possible
conditions from your colleagues’ differential diagnoses. Determine which of the
conditions you would reject and why. Identify the most likely condition, and
justify your reasoning.
Week 9
discussion
Discussion: Assessing Neurological Symptoms
Imagine not being able to form new memories. This is the
reality patients with anterograde amnesia face. Although this form of amnesia
is rare, it can result from severe brain trauma. Anterograde amnesia
demonstrates just how impactful brain disorders can be to a patient’s quality
of living. Accurately assessing neurological symptoms is a complex process that
involves the analysis of many factors.
In this Discussion, you will consider case studies that
describe abnormal findings in patients seen in a clinical setting.
Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following specific case studies for this Discussion.
Also, your Discussion post should be in the Episodic/Focused SOAP Note format,
rather than the traditional narrative style Discussion posting format. Refer to
Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the
Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP
notes have specific data included in every patient case.
Case 1: Headaches
A 20-year-old male complains of experiencing intermittent
headaches. The headaches diffuse all over the head, but the greatest intensity
and pressure occurs above the eyes and spreads through the nose, cheekbones,
and jaw.
Case 2: Numbness and Pain
A 47-year-old obese female complains of pain in her right
wrist, with tingling and numbness in the thumb and index and middle fingers for
the past 2 weeks. She has been frustrated because the pain causes her to drop
her hair-styling tools.
Case 3: Drooping of Face
A 33-year-old female comes to your clinic alarmed about
sudden “drooping” on the right side of the face that began this
morning. She complains of excessive tearing and drooling on her right side as
well.
To prepare:
With regard to the case study you were assigned:
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 you were assigned.
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.
Note: Before you submit your initial post, replace the
subject line (“Discussion – Week 9”) with “Review of Case Study
___.” Fill in the blank with the number of the case study you were
assigned.
By Day 3
Post an episodic/focused note about the patient in the case
study to which you were assigned using the episodic/focused note template
provided in week 5 resources. Provide evidence from the literature to support
diagnostic tests that would be appropriate for each case. List five different
possible conditions for the patient’s differential diagnosis and justify why
you selected each.
Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the “Post to Discussion Question” link
and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different
days who were assigned different case studies than you. Analyze the possible
conditions from your colleagues’ differential diagnoses. Determine which of the
conditions you would reject and why. Identify the most likely condition, and
justify your reasoning.

To prepare:
Review this week’s media presentation, as well as Chapters 3
and 8 of the Resnick text.
Reflect on your personal experiences, observations, and/or
clinical practices from the last 5 years. Select a case from the last 5 years
that involves an elderly patient who has been in two different sites of care
such as home, assisted living, hospital, etc.
Note: When referring to your patient, make sure to use a
pseudonym or other false form of identification. This is to ensure the privacy
and protection of the patient.
Reflect on issues that occurred because of the change in the
patient’s sites of care. Think about the impact of differences in the settings
themselves, inherent cultures of the settings, and ethical practices of these
sites on the patient.
Consider whether the patient had an advanced directive in
place at the time of the change in sites of care. Reflect on whether any
difficult treatment decisions had to be made as a result.
Think about the impact of financial issues on site placement
and treatment decisions.
By Day 6
Respond to at least two of your colleagues on two different
days in one or more of the following ways:
Suggest community resources that may assist with related
cases in the future.
Recommend appropriate alternative site placements for your
colleagues’ patients based on your geographic location.
Provide insights on policy implications of your colleagues’
cases (i.e., Medicare, Medicaid, Veteran’s Affairs, etc.).
Week 2 discussion
Discussion: Assessment Tools
As geriatric patients age, their health and functional
stability may decline resulting in the inability to perform basic activities of
daily living. In your role as the advanced practice nurse, you must assess
whether the needs of these aging patients are being met. Comprehensive
geriatric assessments are used to determine whether these patients have
developed or are at risk of developing age-related changes that interfere with
their functional status. Since the health status and living situation of
geriatric patients often differ, there are a variety of assessment tools that
can be used to evaluate wellness and functional ability.
For this Discussion, consider which assessment tools would
be appropriate for the patients in the following three case studies:
Case Study 1
Mr. Smith, age 77, reports for an annual physical
examination. He says he is doing well. His only known problem is
osteoarthritis. He also requests a flu shot. He takes no medications other than
Tylenol for arthritis pain. When he walks into the exam room, you notice that
he is using a straight cane in his right hand. When you ask about the cane, he
says he began using the cane because the pain in his right hip had increased
significantly over the past 6 months.
Case Study 2
Mr. Jones, a 68-year-old man, was referred to your office
for a hearing evaluation. He continues to work in a printing company, although
he works only part-time. He has worked at the printing company for the past 35
years. He complains that he cannot hear much of the dialogue on the television.
He is accompanied by his wife, who states that her husband cannot hear her at
home. He has no history of dizziness, tinnitus, or vertigo. He has had cerumen
impactions removed from both ears in the past. Overall, his medical history is
quite benign. His only medications are aspirin 81 mg daily, a multivitamin
daily, and occasional ibuprofen for back pain
Case Study 3
Mrs. Roberts, an 83-year-old widow, is brought to the office
by her daughter. The daughter claims that her mother seems to be depressed.
There is a history of depression approximately five years ago, shortly after
Mrs. Roberts’ husband died. At that time, she was successfully treated with
antidepressants. Currently, the daughter states that her mother’s memory for
appointments and events has declined severely, and she can no longer drive
because she does not remember the route to the store or other familiar places.
The daughter also noted that her mother’s house seemed very disorganized and
dirty, there was a limited amount of food in the kitchen, and the checkbook had
not been balanced for several months. Mrs. Roberts appears slightly disheveled,
she has a flat affect, and she does not maintain eye contact during your
interview.
To prepare:
Review the Rosen and Reuben article in this week’s Learning
Resources. Consider how assessment tools are used to evaluate patients.
Select one of the three case studies. Based on the provided
information, think about a possible patient evaluation plan. As part of your
evaluation planning, consider where the evaluation would take place, whether
any other professionals or family members should be present, appropriate
assessment tools and guidelines, and any other relevant information you may
wish to address.
Consider whether the assessment tool you identified was
validated for use with this specific patient population and if this poses
issues. Think about additional factors that might present issues when
performing assessments, such as language, education, prosthetics, missing limbs,
etc.
Week 3 discussion
Discussion: Models of Interdisciplinary Geriatric Care Teams
With the growing population of frail elders, there is an
increase of geriatric patients requiring ongoing care for multiple medical
conditions. This creates the need for interdisciplinary geriatric care teams.
Often, the dynamics and culture of these teams differ across various sites of
care, such as assisted living, home care, hospitals, long-term care, and
rehabilitation facilities. As an advanced practice nurse, it is important to
understand your role in the care team as well as your potential impact on
patient care. In this Discussion, you explore models of interdisciplinary
geriatric care teams for different sites of care and the varying roles of the
advanced practice nurse.
Consider the following three case studies:
Case Study 1
Mrs. Martinez is an 83-year-old Mexican American widow who
lives in her own home and is cared for by her adult daughter. Mrs. Martinez
owns the home, and her daughter lives with her and provides the care. Her
daughter brought her mother to the clinic today to ask to speak to the social
worker. She requests that her mother be placed in a nursing home. The daughter
states that her mother has nothing to do during the day. The television is on
The Weather Channel most of the day because Mrs. Martinez has limited English
capability and is unable to read closed-captioning. Mrs. Martinez also has two
sons who do not live in the local area, but they do call regularly and check in
with their mother and sister. The two sons are opposed to moving their mother
to a nursing home because they had promised her that they would “never put her
away.”
Case Study 2
Mr. Williams, a 79-year-old African American widower,
resides in a foster care home. He has lived there for 4 years since his wife
died. He is a former minister. His medical history includes long-term diabetes,
high blood pressure, and benign prostatic hypertrophy. The home care provider
has requested a home visit to evaluate Mr. Williams’s ability to remain in the
home. The provider states that because Mr. Williams’s vision is seriously
compromised (he is nearly blind), and because he has been unable to get to the
toilet as quickly as necessary (he is very unsteady on his feet), his care is
becoming burdensome. According to the home care provider, for safety reasons,
Mr. Williams may not fit the criteria for remaining in the foster care home.
Case Study 3
Mrs. Randall is a 77-year-old female who resides in a
long-term care facility. She has a history of frequent falls and is severely
cognitively impaired. The nursing staff at the long-term care facility called
the nurse practitioner at the medical home office to report the recent
development of productive cough and high fever. There have been cases of flu in
the facility; however, Mrs. Randall has had a flu shot. The nurse practitioner
in the office requests a chest x-ray in the long-term care facility. The nurse
on duty in the facility states that there is no portable chest x-ray equipment
available. She further requests that Mrs. Randall be transferred to the
emergency room of the local hospital. Mrs. Randall’s daughter has durable power
of attorney for health care decisions for her mother. The long-term care
facility has notified the daughter of the change in her mother’s condition. The
daughter says whatever the nursing home wants is fine with her.
To prepare:
Review this week’s media presentation, as well as the
American Geriatrics Society and Arbaje et al. articles in the Learning
Resources.
Research models of interdisciplinary geriatric care teams
that are used at various sites, such as assisted living, home care, hospitals,
long-term care, and rehabilitation facilities.
Consider the model used for the interdisciplinary geriatric
care teams at your current practicum site. Compare this model to models used at
other sites.
Reflect on how the role of the advanced practice nurse
differs according to the site of care.
Select one of the three case studies. Consider how care
should be facilitated for the patient in the case you selected based on the
model used for the interdisciplinary geriatric care teams at your practicum
site.
Week 4 discussion
Discussion: Over-the-Counter Drugs
Pharmacokinetic and pharmacodynamic processes differ among
patients across their life spans. For geriatric patients, alterations due to
aging make them especially prone to adverse drug reactions. The various health
issues that affect many geriatric patients further complicate this, as the need
to treat these multiple health issues often results in polypharmacy. Although
treatments are frequently drugs prescribed by the health care provider, many
geriatric patients also take over-the-counter (OTC) drugs. While the provider
sometimes recommends these OTC drugs, patients often select the drugs on their
own. This makes patient education on pharmacology key when caring for geriatric
patients. Many patients assume that if drugs are available over the counter,
then they are safe to take. However, due to issues related to polypharmacy and
how their aging bodies process drugs, OTC drugs may have serious implications
for patients.
To prepare:
Review the American Geriatrics Society article and
interactive media piece in this week’s Learning Resources.
Select one of the following over-the-counter drugs commonly
used by geriatric patients:
Antacids or acid suppressants
Antidiarrheal
Antihistamines
Antimicrobial ointments
Antispasmodics for the bladder
Cough suppressants
Laxatives
Neutraceuticals (choose one; e.g., ginseng, St. John’s wart,
etc.)
Pain medications (choose one; e.g., acetaminophen,
ibuprofen, rub-on pain ointments/patches, etc.)
Supplements (choose one; e.g., calcium, iron, etc.)
Vaginal creams
Research the over-the-counter drug you selected. Visit a
local pharmacy and explore the types/varieties of the drug that are available.
Reflect on the ingredients in each type/variety, including additional active
ingredients.
Consult with the pharmacist about the ingredients in each
type/variety, including how to make safe and effective clinical decisions in
relation to this drug. Discuss potential interactions in frail elders and
precautions related to the drug based on Beers Criteria. If one is available,
you may consult with a pharmacist at your practicum site as an alternative to
visiting a pharmacy.
Consider ways to educate elders about the OTC drug you
selected.
Week 5 discussion
Discussion: Fall-Risk Assessment
Fall risks are very high for the geriatric population.
According to the Centers for Disease Control and Prevention (2013), one out of
every three adults aged 65 years and older falls each year. This can be
attributed to factors such as changes in aging, other health issues,
environment, and effects of prescribed drugs. When caring for geriatric
patients, it is important to screen them for risks and perform fall-risk
assessments. These assessment tools help to determine the level of risk for
patients so that preventive measures can be taken. The implications of falls
are very serious and range from fractures to mental health disorders and even
death. In this Discussion, you explore risk assessment tools for use with
patients at your practicum site.
To prepare:
Review the Kanis article in this week’s Learning Resources.
Consider a geriatric patient at your practicum site who is
at risk for falls. Coordinate an opportunity to assess this patient with your
Preceptor.
Note: When referring to your patient, make sure to use a
pseudonym or other false form of identification. This is to ensure the privacy
and protection of the patient.
In addition to the Fracture Risk Assessment Tool (FRAX),
select one of the following tools to assess this patient for falls:
Tinetti Performance Oriented Mobility Assessment (POMA)
Systems Approach
Berg Balance Scale
Elderly Mobility Scale
Timed Unsupported Stead Stand (TUSS)
Six-Minute Walk Test (6MWT)
Hendrich II Fall Risk Model
Consider why you selected the assessment tool for this
particular patient.
Assess the patient using the tool you selected under
Preceptor guidance. Reflect on the assessment, including any issues with the
patient and/or the effectiveness of the tool.
Think about strategies and interventions to reduce the risk
of falls for frail elders.
Week 6 discussion
Discussion: Patient Presentation of Dementia, Delirium, and
Depression
With the prevalence of dementia, delirium, and depression in
the growing geriatric population, you will likely care for elderly patients
with these disorders. While many symptoms of dementia, delirium, and depression
are similar, it is important that you are able to identify those that are
different and properly diagnose patients. A diagnosis of one of these disorders
is often difficult for patients and their families. In your role as the
advanced practice nurse, you must help patients and their families manage the
disorder by facilitating necessary treatments, assessments, and follow-up care.
Consider the patient presentations in the following case studies. What distinct
symptoms or factors would lead you to a diagnosis of dementia, delirium, or
depression?
Case Study 1
HPI: Mrs. Mayfield is a 75-year-old woman who is brought to
the emergency room by the police at 11 p.m. She was found wandering and
confused in a local neighborhood. The police were called when Mrs. Mayfield
tried to use her key on a neighbor’s door. When confronted by the police she
became abusive, confused, and frightened and looked very pale and agitated. The
police could not establish her correct address and they subsequently brought
her to the emergency room.
Review of Symptoms (ROS): Unable to obtain at this time.
Objective Data:
PE:
VS: Pulse 96 and regular; B/P 150/90; Axillary temperature
99°F.
General: She appears clean and well nourished, with no signs
of injury, trauma, or neglect.
Her physical exam is unremarkable except –
Neuro: No gross focal neurological signs, but she is only intermittently
cooperative. Her mental status fluctuates and a full neurological evaluation is
not possible at this time.
Psych: A & O x 1 to person only. She has episodes of
agitation and alternating withdrawal/somnolence. During the examination, it
takes several attempts to gain Mrs. Mayfield’s attention to answer questions,
but once focused, she rambles on in a disorganized and incoherent way.
Case Study 2
CC: “irritable and forgetful”
HPI: Mrs. White, a 78-year-old married woman, is brought to
the office of her primary care provider by her husband because of increasing
forgetfulness and irritability over the past 3 months. Mr. White claims that
his wife has had problems for several years now, but has just gotten “worse in
her memory” in the past few months. She recently misplaced her purse and
accused her son of stealing it.
On three occasions, she left the stove on and boiled a pot
dry, nearly causing a fire. She recently put a container of ice cream into the
washing machine instead of into the freezer and her husband did not discover it
for more than a week. Mrs. White claims her family wants to take her money and
leave her with nothing. “No matter what they say, there is nothing wrong with
me,” she states.
Past Medical History (PMH) includes: hypothyroidism, treated
with Synthroid, and successful treatment of breast cancer approximately 15
years prior. She also takes over-the-counter ibuprofen for chronic lower back
pain and occasional Benadryl to help her sleep at night.
Objective data: Her physical examination is within normal
limits.
Case Study 3
HPI: Mr. George is a 72-year-old male who has lived alone
since his wife died approximately 1 year ago. He has lived in the same house
for 45 years. He is brought in by his son who is concerned that his father has
lost more than 35 pounds over the past year. Mr. George admits to not eating
well because “I don’t know how to cook for myself.”
PMH: He has been in good health with the exception of
hypertension, which is well controlled.
Social history: He spends most of his time watching sports
on television. He occasionally drinks one or two cans of beer when he is
watching TV. He does go to his son’s house to visit with his grandchildren
about once a week, and he says he enjoys that. He does not receive any social
services, he still drives but only in the daytime, and he does not participate
in any other leisure activities.
Objective data: His physical examination is normal. He
responds correctly to questions, although he appears to have a flat affect.
To prepare:
Review Chapters 6–8 of the Holroyd-Leduc and Reddy text.
Select one of the three case studies. Reflect on the way the
patient presented in the case study you selected, including whether the patient
might be presenting with dementia, delirium, or depression.
Think about how you would further evaluate the patient based
on medical history, current drug treatments, and the patient’s presentation.
Consider whether you would modify drug treatments, use additional assessment
tools, and/or refer the patient to a specialist.
Week 7 discussion
Discussion: Nutrition and Hydration
Geriatric patients have many nutritional and hydration
concerns that impact their health and ability to acquire sufficient nutrients.
Advanced practice nurses evaluating these patients must be able to account for
all barriers that prevent elders from obtaining adequate nutrition, including
medical conditions, transportation, finances, physiologic changes, and
functional abilities. When evaluating patients, it is important to consider how
they eat, what their diet consists of, and whether they have any special dietary
needs that are not being met. Assessment tools, such as the Lawton Instrumental
Activities of Daily Living (IADL) Scale, are an integral part of this
evaluation process as they help providers identify potential obstacles for
patients. In this Discussion, you assess a patient at your current practicum
site and consider strategies for improving any nutrition or hydration issues.
To prepare:
Review this week’s media presentation, as well as 29 and 30
of the Resnick text.
Assess a patient using tools for inpatient and long-term
patient care, such as the Lawton IADL Scale.
Note: You should coordinate this opportunity with the
Preceptor at your practicum site.
Consider whether nutrition and/or hydration might be
impacted by the patient’s functional abilities. Reflect on whether the patient
is able to go out and get food to eat, cook meals, safely use the stove, etc.
Consider the patient’s diet and whether they have any
special dietary needs due to medical conditions, such as congestive heart
failure, end-stage kidney disease, diabetes, oral health issues, etc. Reflect
on whether or not the patient is attempting to compensate for a medical issue
and thus creating a deficiency or excess in his or her diet.
Based on your patient assessment, think about strategies for
improving any nutrition issues that might have presented (e.g., nutritional
supplements, community resources such as Meals on Wheels, referral to a
nutritionist or dietician, etc.).
Week 8 discussion
Discussion: Nursing Homes in Your Community and Neighboring
Communities
Nursing homes have become a viable option for geriatric
patients who require routine care and need help performing basic activities of
daily living, with about 3.3 million patients residing in nursing homes in the
United States (Centers for Medicare & Medicaid Services, 2013). While
nursing homes provide care and services to patients, problems can arise
resulting in reduced quality of care and, in some cases, illness and morbidity.
The severe implications of pressure ulcers make them a major concern for elders
residing in nursing homes. The Centers for Medicare & Medicaid Services
(2013) estimate that 7.5% of nursing home residents have pressure ulcers and
about 82,000 patients develop them each year. In your role as the advanced
practice nurse, you must understand factors that contribute to the incidence of
pressure ulcers in order to improve patient outcomes.
For this Discussion, you examine the prevalence of pressure
ulcers in nursing homes and develop strategies for increasing awareness and
reducing incidence.
To prepare:
Review Chapter 32 of the Resnick text and Chapter 12 of the
Holroyd-Leduc and Reddy text.
Select four nursing homes in your community and/or
neighboring communities. Research and locate reports on these nursing homes
through organizations such as Centers for Medicare & Medicaid Services.
Compare the four nursing homes you selected based on
reported cases of the development of new pressure ulcers.
Think about factors in the nursing home setting that
contribute to pressure ulcer issues, such as patient activity, nutrition, or
the number of staff available to care for patients.
Research guidelines for the prevention of pressure ulcers.
Think about how you might increase awareness among nursing home staff about the
incidence and consequences of pressure ulcers in patients.
Week 9 discussion
Discussion: Treating Patients in Specialized Areas of Care
When treating frail elder patients in specialized areas of
care, there are various dynamics that might impact patient care plans. From
questions about potential outcomes, benefits of treatment, and quality of life
to factors such as personal values, families, culture, and religion, decision
making can be difficult for patients and their families. As the advanced
practice nurse, you must support them through this process.
For this Discussion, you examine the following case studies
and consider how you might address the needs of the patients and their
families.
Case Study 1
Mr. Wiggins is a 78-year-old African American male with
chronic kidney disease, which requires dialysis. The etiology of his renal
disease was multifactorial—long-standing uncontrolled HTN and DM nephropathy.
He has been on hemodialysis for the past 10 years and has done relatively well.
Four weeks ago, he had a major CVA and is minimally responsive. His condition
is not expected to change, and the family is having a difficult time with his
recent health changes. Advanced directives were discussed with them, and his
wife is a durable power of attorney for his health care. The wife hates to see
her husband this way and understands this is not how he would want to go on,
but their children and many of the family members (his brothers and sisters)
think the patient will return to himself. They want everything done in terms of
life support measures—full code status. His family wanted a feeding tube
placed, and he is now receiving 24-hour tube feedings. You are the NP caring
for Mr. Wiggins. You have known and cared for him and his wife for several
years. The wife pulls you aside, shares her dilemma, and asks you to make the
decision regarding continuing medical care/support for her husband. How will
you respond?
Case Study 2
Mrs. Adams is a 96-year-old Caucasian female who has
recently been diagnosed with colon cancer. She was admitted to the hospitalist
service through the ED with dehydration and rectal bleeding. The bleeding
resolved, and she received 2 units of PRBs and fluid/electrolyte replacement.
She is stable and ready to be discharged home.
Mrs. Adams is in remarkably good health, and other than
arthritis and mild HTN, she has no significant medical or surgical history. She
is able to carry out all of her essential daily living activities. She pays her
own bills, is competent, and has good functional abilities. She was driving up
until last year. Now, she has neighbor’s assist with weekly shopping and
transportation to church. Her sensory, functional, and cogitative abilities
were evaluated this admission and remain intact. She has been offered
palliative surgical intervention, but deferred all treatment. Her only son is
in agreement with his mother’s decision. Her parents and husband are deceased.
You have been asked to obtain advanced directives. What will your discharge
treatment plan be for Mrs. Adams?
Case Study 3
Mr. Pierce is an 82-year-old East Indian male, recently
widowed 6 months ago. He fractured his left hip 2 months ago attempting to
climb his backyard fence to get his cat out of a tree. His children live
internationally and have been taking turns caring for him. His eldest son
brought him in through the ED last night because Mr. Pierce started having
shortness of breath and his lips turned blue. In addition, his son noticed his
left leg was very swollen compared to the right. The ED nurse practitioner
ordered a thin cut cat scan (CT) with pulmonary embolism (PE) protocol and deep
vein thrombosis (DVT) scan. Mr. Pierce has a large DVT that is obstructing
circulation and multiple pulmonary emboli. His condition is life threatening
and he is only expected to live a few weeks. He has a living will and advanced
directives and has requested to be able to die in the comfort of his home. “I
hate hospitals.” You have been consulted at the patient and family’s request
because you are Mr. Pierce’s primary care provider. What additional services
can be offered to ensure his care/comfort at home and to give him peace of mind
regarding his estate?
To prepare:
Select one of the three case studies. Reflect on the
provided patient information.
Think about potential outcomes for the patient in the case
study you selected.
Consider how care, treatment, and/or support might be
facilitated for the patient. Reflect on how you might also address the needs of
the family.
Week 10 discussion
Discussion: Community Advocacy Agencies
Having received a diagnosis of Alzheimer’s and encountering
the associated stigmas, Michael Ellenbogen encourages increased advocacy
efforts for the geriatric population struggling with this disease. He says, “We
did nothing wrong to get this disease, and we need to speak up to let our voice
be heard…There are no excuses for not wanting to help. The human cost factor is
too high, and we are all accountable to do something” (Ellenbogen, 2012). As an
advanced practice nurse caring for the geriatric population, it is important for
you to join in advocacy efforts within your community whether it is in support
of Alzheimer’s or another prevalent need such as abuse. You should be aware of
community agencies that advocate for the well-being and care of your local
geriatric population, as these agencies often provide resources and assistance
to the elderly in need. In your role of care, you are able to identify
prevalent needs and work with patients, their families, and agencies to promote
change and impact lives.
To prepare:
Review this week’s media presentation, as well as the
American Geriatric Society’s Public Policy and Advocacy website in the Learning
Resources.
Locate and research two agencies that advocate for the
elderly in your community. Consider their current advocacy actions and/or
campaigns.
Reflect on your experiences and observations at your
practicum site. Consider new advocacy actions you might suggest to the agencies
you selected. Based on these advocacy actions, think about new policies that
might improve the care of the population at your current practicum site.
Week 11 discussion
Discussion: Discussing End-of-Life Care
There is a human tendency to postpone uncomfortable or
unpleasant tasks.
—Nancy Kummer, geriatric patient
This human tendency to avoid the unpleasant makes
end-of-life care and hospice decisions difficult for many patients to discuss
with their families. Kummer is a former social worker who used to counsel
patients with terminal illnesses, yet she avoided discussing her own
end-of-life wishes with her children. While many Americans, like Kummer, agree
that these discussions need to take place, few have actually had these
conversations with their families (Lazar, 2012). Although initiating
conversations about end-of-life care and hospice might be difficult for
patients, as an advanced practice nurse, facilitating these conversations is an
integral part of your geriatric nursing practice. For this Discussion, consider
how you would facilitate care conversations with the patients and families in
the following case studies:
Case Study 1
Mrs. Sloan, a 69-year-old widow, is about to enter the
hospital for an elective cholecystectomy; she is being medically cleared by her
primary care provider. During the discussion, she requests to be placed on a no
code status during her hospitalization. Mrs. Sloan claims that besides her
gallbladder problem, her general health status is good. She wishes to have the
surgery to avoid any further attacks, which have been very painful. She states,
however, that if during surgery or her postoperative period, she undergoes a
cardiac arrest, she would prefer not to be resuscitated. She has read about the
chances of successful resuscitation, and has determined that the risk of brain
damage is too high. For this reason, she is requesting a no code status.
Case Study 2
Ms. Stearns is an 83-year-old nursing home resident with
hypertension, coronary artery disease, arthritis, renal insufficiency, hearing
impairment, and a previous history of stroke. She also has a foot deformity
from childhood polio. She is disoriented at times. She has lived in the nursing
home for 10 years and rarely leaves the chair beside her bed. She has recently
developed urinary incontinence, but has refused a bladder catheterization to
determine postvoid residual urine or possible bladder infection. She does not
have a diagnosis of dementia; however, current testing reveals that she
performs poorly on a standardized mental status examination. She can, however,
identify all the staff in the nursing home, and she can describe each patient
who has been in the bed next to hers over the past 10 years. When asked to
explain why she does not want bladder catheterization, she gives several
reasons. She states that the incontinence does not bother her, and that she has
always been a very private person. She particularly dislikes and objects to any
examination of her pelvic organs; in fact, she has never had a pelvic
examination nor has she ever had sexual intercourse. She realizes that she has
a number of medical problems and that any one of them could worsen at any time.
She states she is not willing to undergo any treatment for any of her current
problems should they become worse.
Case Study 3
Mr. Marley, age 91, is admitted to the intensive care unit
following a stroke. The stroke progressed from mild hemiparesis and difficulty
speaking to complete unresponsiveness and an inability to swallow. His daughter
feels certain, based on prior explicit conversations with her father, that he would
not want to have any treatment that would prolong his life and leave him in a
severely disabled state. Mr. Marley’s oldest son disagrees with his sister’s
assessment of their father. The son claims that their father still has a strong
desire to live, and that he has been very active in his church until this
stroke. Because Mr. Marley cannot swallow, he cannot be fed. The family is
asked about insertion of a feeding tube. It is explained to the family that
without food and fluids, their father will die fairly quickly. There are no
existing advance directives or a designated health care decision maker noted
for Mr. Marley.
To prepare:
Review Chapter 14 of the Holroyd-Leduc and Reddy text.
Reflect on the role of the advanced practice nurse in
facilitating the discussion of end-of-life care with patients and their
families.
Think about how you, as an advanced practice nurse, would
approach a family who wants “everything” done for a patient with only a limited
time to live.
Consider when it is appropriate to involve hospice and how
to approach patients and/or families who refuse hospice services.
Select one of the three provided case studies related to the
end-of-life care of the frail elderly. Reflect on potential patient outcomes
and how you would facilitate the discussion of care with this patient’s family.
Week 4
assignment 1
Assignment: Practicum – Week 3 SOAP Note
In addition to journal entries, SOAP Note submissions are a
way to reflect on your practicum experiences and connect these experiences to
your classroom experience. SOAP Notes, such as the ones required in this
course, are often used in clinical settings to document patient care. Refer to
this week’s Learning Resources for guidance on writing SOAP Notes.
Select a geriatric patient that you examined during the last
3 weeks. The patient you select should be currently taking at least five
prescription and/or over-the-counter drugs. With this patient in mind, address
the following in a SOAP Note:
Subjective: What was the patient’s subjective complaint?
What details did the patient provide regarding his or her personal and medical
history? Include a list of prescription and over-the-counter drugs the patient
is currently taking. Compare this list with the Beers Criteria and consider
alternative drugs if appropriate.
Objective: What observations did you make during the
physical assessment? What functional assessments were used?
Assessment: What were your differential diagnoses? Provide a
minimum of three possible diagnoses. List them from top priority to least
priority.
Plan: What was your plan for diagnostics and primary
diagnosis? What was your plan for treatment and management including
alternative therapies? What is your care plan for the patient? How would you
offer caregiver support?
Reflection notes: What would you do differently in a similar
patient evaluation? How might you improve your assessment, diagnosis, and/or
plan through interprofessional collaboration?
Refer to this week’s Learning Resources for guidance on
writing SOAP Notes.
By Day 7 of Week 4
This Assignment is due. You will submit this Week 3 SOAP
Note along with your Journal Entries (from Weeks 1, 2, and 4) by Day 7 of Week
4.
Week 4
assignment 2
Assignment: Practicum – Week 1 Journal Entry
As a future advanced practice nurse, it is important that
you are able to connect your classroom experience to your practicum experience.
By applying the concepts you study in the classroom to clinical settings, you
enhance your professional competency. Each week, you complete an Assignment
such as a Journal Entry or SOAP Note that prompts you to reflect on your
practicum experiences and relate them to the material presented in the
classroom. This week, you begin documenting your practicum experiences in your
Practicum Journal. Please use the Practicum Journal Template, located in this
week’s Learning Resources.
To prepare for this course’s Practicum Experience, address
the following in your practicum journal:
Select an aging theory to guide your practice.
Develop goals and objectives for the Practicum Experience in
this course. Be sure to consider geriatric competencies.
Create a timeline of practicum activities based on your
practicum requirements.
By Day 7 of Week 4
This Assignment is due. You will submit this Week 1 Journal
Entry along with the Week 2 and Week 3 Journal Entries and Week 3 SOAP Note by
day 7 of Week 4.
Assignment: Practicum – Week 2 Journal Entry
To prepare for this course’s Practicum Experience, reflect
on implications of age-related changes in geriatric patients. Explain how you
might differentiate between normal behaviors/disorders due to aging and
abnormal behavior/disorders that are not age related. Include how functional
assessments might help distinguish “normal” from “abnormal.”
By Day 7 of Week 4
This Assignment is due. You will submit this Week 2 Journal
Entry, the Week 1 and Week 4 Journal Entries, and the Week 3 SOAP Note by Day 7
of Week 4.
Assignment: Practicum – Week 4 Journal Entry
Reflect on medication adherence issues you have encountered
with geriatric patients in your practicum setting. Explain implications of
these issues on patient health, as well as strategies to improve medication
adherence for geriatric patients. If you did not have an opportunity to
evaluate a patient with this background during the last 4 weeks, you can select
a related case study or reflect on previous clinical experiences.
By Day 7 of Week 4
This Assignment is due. Please submit the Journal Entries
(Weeks 1, 2, and 4), and the Week 3 SOAP Note by Day 7 of Week 4 (this week).
Note: Be sure to submit your Assignment to the appropriate
submission link below.
Submissions should match the following:
Week 3 SOAP Note: Submit to the Week 4 Assignment – Part 1
submission link.
Weeks 1, 2, & 4 Journal Entry: Submit to the Week 4
Assignment – Part 2 submission link.
For the Journal Entries—which are assessed with a
Satisfactory (S) or Unsatisfactory (U) score—the numerical grade will show as 0
points and the “S” or “U” will be posted in the Feedback area by your
Instructor. These scores of 0 points do not affect your grade; they simply
allow for a placeholder to place the “S” or “U” scoring. This concept also
applies to Weeks 7 and 10.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: WK4AssgnPX+lastname+first initial.
Click the Assignment Week 4 – Part X link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK4AssgnPX+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
Week 6
assignment 1
Assignment 1: Application – PICO Analysis of Dementia,
Delirium, and Depression
A PICO analysis is used to pose a focused clinical question
to which you find appropriate evidence-based answers. The PICO question should
include the patient or population (P), anticipated intervention (I), comparison
group or current standard (C), and outcome desired (O). In this Assignment, you
develop a question related to dementia, delirium, or depression. Through your
PICO analysis, you explore various resources and examine current evidence to
answer the question you develop.
To prepare:
Select one of the following disorders as your topic:
dementia, delirium, or depression.
Review the guidelines in the “Literature Review Matrix”
document in this week’s Learning Resources.
Think about a research question around your issue as
indicated in Part I: PICO Analysis of Research Topic.
Consider the resources you will use, search terms and
criteria, and Boolean search strings as indicated in Part II: Search Strategy.
Using the Walden Library and other appropriate databases,
locate five articles related to your PICO question. At least one article must
be a systematic review. All of the articles should be primary sources.
Reflect on the five articles you selected as indicated in
Part III: Analysis of Literature. Consider the conceptual framework/theory,
main finding, research method, strengths of study, weaknesses, and level of
evidence for each article.
Consider how to use the summaries in Part III to create an
evidence table. Use this evidence table to determine appropriate treatment
options for patients who present with the disorder you selected as your topic.
To complete:
Formulate a question around the disorder you selected as
indicated in Part I: PICO Analysis of Research Topic.
Identify the resources you will use, search terms and
criteria, and Boolean search strings as indicated in Part II: Search Strategy.
Summarize the five articles you selected as indicated in Part
III: Analysis of Literature. Describe the conceptual framework/theory, main
finding, research method, strengths of study, weaknesses, and level of evidence
for each article.
Create an evidence table based on the article summaries in
Part III. Describe appropriate treatment options for patients based on this
evidence table.
By Day 7 of Week 6
This Assignment is due.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: “WK6Assgn1+lastname+first initial”.
Click the Week 6 Assignment 1 link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK6Assgn1+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
Week 7
assignment 1
Assignment: Practicum – Week 7 SOAP Note
Select a geriatric patient that you examined during the last
4 weeks. The patient you select should be currently taking at least five
prescription and/or over-the-counter drugs. With this patient in mind, address
the following in a SOAP Note:
Subjective: What was the patient’s subjective complaint?
What details did the patient provide regarding his or her personal and medical
history? Include a list of prescription and over-the-counter drugs the patient
is currently taking. Compare this list to the Beers Criteria and consider
alternative drugs if appropriate.
Objective: What observations did you make during the
physical assessment? What functional assessments were used?
Assessment: What were your differential diagnoses? Provide a
minimum of three possible diagnoses. List them from top priority to least
priority.
Plan: What was your plan for diagnostics and primary
diagnosis? What was your plan for treatment and management including
alternative therapies? What is your care plan for the patient? How would you
offer caregiver support?
Reflection notes: What would you do differently in a similar
patient evaluation? How might you improve your assessment, diagnosis, and/or
plan through interprofessional collaboration?
Refer to the Week 3 Learning Resources for guidance on
writing SOAP Notes.
By Day 7 of Week 7
This Assignment is due. You will submit this Week 7 SOAP
Note along with your Journal Entries (from Weeks 5 and 6) by Day 7 of Week 7
(this week).
Note: Be sure to submit your Assignment to the appropriate
submission link below.
Submissions should match the following:
Week 7 SOAP Note: Submit to the Week 7 Assignment – Part 1
submission link.
Weeks 5 and 6 Journal Entry: Submit to the Week 7 Assignment
– Part 2 submission link.
For the Journal Entries—which are assessed with a Satisfactory
(S) or Unsatisfactory (U) score—the numerical grade will show as 0 points and
the “S” or “U” will be posted in the Feedback area by your Instructor. These
scores of 0 points do not affect your grade; they simply allow for a
placeholder to place the “S” or “U” scoring. This concept also applies to Weeks
4 and 10.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: WK7AssgnPX+lastname+first initial.
Click the Assignment Week 7 – Part X link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK7AssgnPX+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
Week 7
assignment 2
Assignment: Practicum – Week 5 Journal Entry
Reflect on atypical presentations of disorders in geriatric
patients in your practicum setting. Many disorders manifest themselves in a way
that would be considered an atypical presentation—most likely different from
the way a textbook would describe the disorder’s possible presentations.
Consider geriatric patients that you have observed with atypical presentations
of disorders. Describe a patient case including how the patient was diagnosed
and strategies that were used to overcome the atypical presentation. If you did
not have an opportunity to evaluate a patient with this background during the last
5 weeks, you can select a related case study or reflect on previous clinical
experiences.
By Day 7 of Week 7
This Assignment is due. You will submit this Week 5 Journal
Entry along with the Week 6 and the Week 7 SOAP Note by Day 7 of Week 7.
Assignment 2: Practicum – Week 6 Journal Entry
Reflect on geriatric patients from your practicum site that
you may have assessed for dementia, delirium, or depression. Explain the impact
of these types of disorders on frail elders. Then, describe a patient case
including the care plan for assessment, diagnoses, treatment, management, and
patient education. Explain whether the patient’s care plan was effective.
Include how you might proceed differently in the future. If you did not have an
opportunity to evaluate a patient with this background during the last 6 weeks,
you can select a related case study or reflect on previous clinical
experiences.
By Day 7 of Week 7
This Assignment is due. You will submit this Week 6 Journal
Entry along with the Week 5 Journal Entry and the Week 7 SOAP Note by Day 7 of
Week 7.
Week 8
assignment
Assignment 1: Application – Diagnosing and Treating Skin
Wounds
Skin wounds are sometimes challenging for health care
providers to diagnose and treat as many have similar presentations. For
advanced practice nurses, being able to identify various types of skin wounds,
including whether a wound is a colonization or an infection, is critical
because it impacts recommended patient care. In your role, you must be able to
evaluate skin wounds, determine the diagnosis, and develop an appropriate
treatment and management plan according to current evidence-based guidelines.
To prepare:
Review Chapter 46 of the Resnick text, as well as the Burr
article in this week’s Learning Resources.
Consider how to properly diagnose skin wounds in frail
elders, including how to distinguish between a colonization and infection.
Select a type of skin wound, such as bumps, bruises,
shingles, herpes, bullous pemphigoid, Stevens-Johnson syndrome, etc. Research
the guidelines for treatment of the skin wound you selected. Reflect on how you
would treat and/or dress this wound.
Think about factors that might contribute to the development
of the skin wound you selected. Consider strategies for the prevention and
improvement of this type of wound.
To complete:
Write a 2- to 3-page paper that addresses the following:
Explain how to properly diagnose skin wounds in frail
elders, including how to distinguish between a colonization and infection.
Describe the type of skin wound you selected.
Explain how you would treat and/or dress this wound based on
guidelines for treatment.
Explain factors that might contribute to the development of
the skin wound you selected. Include strategies for the prevention and
improvement of this type of wound.
By Day 7
This Assignment is due.
Note: The School of Nursing requires that all papers
submitted include a title page, introduction, summary, and references. The
Sample Paper provided at the Walden Writing Center provides an example of those
required elements (available at
http://academicguides.waldenu.edu/writingcenter/templates). All papers
submitted must use this formatting.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: “WK8Assgn1+lastname+first initial”.
Click the Week 8 Assignment 1 link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK8Assgn1+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
Week 10
assignment
Assignment 2: Practicum – Week 8 Journal Entry
Reflect on geriatric patients from your practicum site.
Consider frail elder patients that you have assessed for skin wounds such as
bumps, bruises, shingles, herpes, bullous pemphigoid, Stevens-Johnson syndrome,
etc. Explain the consequences of these types of wounds for frail elders. Then,
describe a patient case including the care plan for assessment, diagnoses,
treatment, management, and patient education. Explain whether the patient’s
care plan was effective. Include how you might proceed differently in the
future. If you did not have an opportunity to evaluate a patient with this
background during the last 8 weeks, you can select a related case study or
reflect on previous clinical experiences.
By Day 7 of Week 10
This Assignment is due. Please submit the Journal Entries
(Weeks 8, 9 and 10) by Day 7 of Week 10.
Assignment: Practicum – Week 9 Journal Entry
An advance directive is a legal document that defines a
patient’s wishes for medical care. This document is a way for patients to share
their wishes with family members and health care providers when their illness
or mental capacity prevents them from making decisions. As an advanced practice
nurse who has care discussions with patients and their families, you need to
not only be familiar with the process of completing an advance directive, but
also understand how this document might impact your role in patient care and
treatment.
Journal Entry Part 1
For the first part of your journal entry, reflect on the
Five Wishes presented on the Five Wishes website and PDF and complete your Five
Wishes. Explain your state’s requirements for advance directives, including
whether your Five Wishes can be turned into a formal document. Then, explain
how your experience of completing your Five Wishes advance directive will help
you guide discussions with patients and their families. Finally, explain how
you might apply the Five Wishes advance directives to your nursing practice.
Include how this advance directive might benefit patients in decision making
for specialized areas of care.
Journal Entry Part 2
For the second part of your journal entry, reflect on
geriatric patients from your practicum site with disorders related to
specialized areas of care, such as oncology, nephrology, urology, gynecology,
and neurology. Describe a case of a frail elder patient who must make decisions
related to specialized areas of care. Then, explain potential patient outcomes
and include whether treatments would be beneficial and how they would impact
the patient’s quality of life. Finally, describe the patient’s wishes in terms
of treatments and interventions for the disorder (Was there an advanced
directive?) and how the patient might want to spend any remaining time. Include
how environmental factors, such as family, caregivers, ethnicity, culture,
religion, and/or personal values, might impact decision making for treatments
and interventions. If you did not have an opportunity to evaluate a patient
with this background during the last 9 weeks, you can select a related case
study or reflect on previous clinical experiences.
By Day 7 of Week 10
This Assignment is due. You will submit this Week 9 Journal
Entry, Week 8 Journal Entry and the Week 10 Journal Entry by Day 7 of Week 10.
Assignment: Practicum – Week 10 Journal Entry
Elder abuse is any intentional or negligent behavior that
results in physical, sexual, emotional, pharmacological, and/or financial
abuse. Unfortunately, abuse is sometimes difficult to identify, and elders are
often hesitant or unable to report abuse themselves (Administration on Aging,
n.d.). This makes it important for health care providers to regularly monitor
for signs of abuse and react according to local and state laws.
Journal Entry Part 1
For the first part of your journal entry, select and
describe one of the following types of elder abuse: physical, sexual,
mental/emotional/verbal, pharmacological, or financial. Explain strategies for
identifying this abuse. Then, explain how you would proceed based on your local
and state laws once you have identified this abuse in a patient. Describe
resources in your community that assist victims of this type of abuse and
explain how you, as the advanced practice nurse, might apply these resources
for abused elders who are identified in the clinical setting.
Journal Entry Part 2
For the second part of your journal entry, reflect on the
different cultures—ethnic, religious, regional, or generational—of the elder
patient population at your practicum site. Describe the cultures you have
observed and explain the influence of these cultures on the prevalence and
detection of elder abuse. Then, explain how culture might impact the way you
would implement resources for preventing or addressing abuse.
By Day 7 of Week 10
This Assignment is due. You will submit this Week 10 Journal
Entry, Week 8 Journal Entry and the Week 9 Journal Entry by Day 7 of Week 10.
For the Journal Entries —which are assessed with a
Satisfactory (S) or Unsatisfactory (U) score—the numerical grade will show as 0
points and the “S” or “U” will be posted in the Feedback area by your
Instructor. These scores of 0 points do not affect your grade; they simply
allow for a placeholder to place the “S” or “U” scoring. This concept also
applies to Weeks 4 and 7.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: WK10Assgn+lastname+first initial.
Click the Assignment Week 10 link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK10Assgn+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
Week 11
assignment
Assignment: Practicum – Week 11 SOAP Note
Select a geriatric patient that you examined during the last
3 weeks. The patient you select should be currently taking at least five
prescription and/or over-the-counter drugs. With this patient in mind, address
the following in a SOAP Note:
Subjective: What was the patient’s subjective complaint?
What details did the patient provide regarding his or her personal and medical
history? Include a list of prescription and over-the-counter drugs the patient
is currently taking. Compare this list to the Beers Criteria and consider
alternative drugs if appropriate.
Objective: What observations did you make during the
physical assessment? What functional assessments were used?
Assessment: What were your differential diagnoses? Provide a
minimum of three possible diagnoses. List them from top priority to least
priority.
Plan: What was your plan for diagnostics and primary
diagnosis? What was your plan for treatment and management including
alternative therapies? What is your care plan for patient? How would you offer
caregiver support?
Reflection notes: What would you do differently in a similar
patient evaluation? How might you improve your assessment, diagnosis, and/or
plan through interprofessional collaboration?
Please refer to the Learning Resources in Week 3 for
guidance on writing SOAP Notes.
By Day 7 of Week 11
This Assignment is due.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: “WK11AssgnPX+lastname+first initial”.
Click the Week 11 Assignment – Part X link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK11AssgnPX+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
</pclass=”msonormal”>

<pclass=”msonormal”>Week 1 discussion
Discussion: Changes in Sites of Care
Since the culture and practices of care settings are
inherently different, changes in sites of care are often difficult for
geriatric patients. Efforts should be made to limit changes to only those necessary;
however, sometimes a patient’s situation might require multiple changes in
sites of care. When selecting sites of care, such as home, assisted living,
rehabilitation facilities, and hospitals, many factors must be considered by
patients, their families, and their health care providers. Health status,
ability to perform self-care, financial limitations, and patient preferences
are all factors that might influence a patient’s site placement. As an advanced
practice nurse who recommends sites of care and facilitates changes, you must
evaluate factors and consider sites that limit the impact of these changes on
geriatric patients.
To prepare:
Review this week’s media presentation, as well as Chapters 3
and 8 of the Resnick text.
Reflect on your personal experiences, observations, and/or
clinical practices from the last 5 years. Select a case from the last 5 years
that involves an elderly patient who has been in two different sites of care
such as home, assisted living, hospital, etc.
Note: When referring to your patient, make sure to use a
pseudonym or other false form of identification. This is to ensure the privacy
and protection of the patient.
Reflect on issues that occurred because of the change in the
patient’s sites of care. Think about the impact of differences in the settings
themselves, inherent cultures of the settings, and ethical practices of these
sites on the patient.
Consider whether the patient had an advanced directive in
place at the time of the change in sites of care. Reflect on whether any
difficult treatment decisions had to be made as a result.
Think about the impact of financial issues on site placement
and treatment decisions.
By Day 6
Respond to at least two of your colleagues on two different
days in one or more of the following ways:
Suggest community resources that may assist with related
cases in the future.
Recommend appropriate alternative site placements for your
colleagues’ patients based on your geographic location.
Provide insights on policy implications of your colleagues’
cases (i.e., Medicare, Medicaid, Veteran’s Affairs, etc.).
Week 2 discussion
Discussion: Assessment Tools
As geriatric patients age, their health and functional
stability may decline resulting in the inability to perform basic activities of
daily living. In your role as the advanced practice nurse, you must assess
whether the needs of these aging patients are being met. Comprehensive
geriatric assessments are used to determine whether these patients have
developed or are at risk of developing age-related changes that interfere with
their functional status. Since the health status and living situation of
geriatric patients often differ, there are a variety of assessment tools that
can be used to evaluate wellness and functional ability.
For this Discussion, consider which assessment tools would
be appropriate for the patients in the following three case studies:
Case Study 1
Mr. Smith, age 77, reports for an annual physical
examination. He says he is doing well. His only known problem is
osteoarthritis. He also requests a flu shot. He takes no medications other than
Tylenol for arthritis pain. When he walks into the exam room, you notice that
he is using a straight cane in his right hand. When you ask about the cane, he
says he began using the cane because the pain in his right hip had increased
significantly over the past 6 months.
Case Study 2
Mr. Jones, a 68-year-old man, was referred to your office
for a hearing evaluation. He continues to work in a printing company, although
he works only part-time. He has worked at the printing company for the past 35
years. He complains that he cannot hear much of the dialogue on the television.
He is accompanied by his wife, who states that her husband cannot hear her at
home. He has no history of dizziness, tinnitus, or vertigo. He has had cerumen
impactions removed from both ears in the past. Overall, his medical history is
quite benign. His only medications are aspirin 81 mg daily, a multivitamin
daily, and occasional ibuprofen for back pain
Case Study 3
Mrs. Roberts, an 83-year-old widow, is brought to the office
by her daughter. The daughter claims that her mother seems to be depressed.
There is a history of depression approximately five years ago, shortly after
Mrs. Roberts’ husband died. At that time, she was successfully treated with
antidepressants. Currently, the daughter states that her mother’s memory for
appointments and events has declined severely, and she can no longer drive
because she does not remember the route to the store or other familiar places.
The daughter also noted that her mother’s house seemed very disorganized and
dirty, there was a limited amount of food in the kitchen, and the checkbook had
not been balanced for several months. Mrs. Roberts appears slightly disheveled,
she has a flat affect, and she does not maintain eye contact during your
interview.
To prepare:
Review the Rosen and Reuben article in this week’s Learning
Resources. Consider how assessment tools are used to evaluate patients.
Select one of the three case studies. Based on the provided
information, think about a possible patient evaluation plan. As part of your
evaluation planning, consider where the evaluation would take place, whether
any other professionals or family members should be present, appropriate
assessment tools and guidelines, and any other relevant information you may
wish to address.
Consider whether the assessment tool you identified was
validated for use with this specific patient population and if this poses
issues. Think about additional factors that might present issues when
performing assessments, such as language, education, prosthetics, missing limbs,
etc.
Week 3 discussion
Discussion: Models of Interdisciplinary Geriatric Care Teams
With the growing population of frail elders, there is an
increase of geriatric patients requiring ongoing care for multiple medical
conditions. This creates the need for interdisciplinary geriatric care teams.
Often, the dynamics and culture of these teams differ across various sites of
care, such as assisted living, home care, hospitals, long-term care, and
rehabilitation facilities. As an advanced practice nurse, it is important to
understand your role in the care team as well as your potential impact on
patient care. In this Discussion, you explore models of interdisciplinary
geriatric care teams for different sites of care and the varying roles of the
advanced practice nurse.
Consider the following three case studies:
Case Study 1
Mrs. Martinez is an 83-year-old Mexican American widow who
lives in her own home and is cared for by her adult daughter. Mrs. Martinez
owns the home, and her daughter lives with her and provides the care. Her
daughter brought her mother to the clinic today to ask to speak to the social
worker. She requests that her mother be placed in a nursing home. The daughter
states that her mother has nothing to do during the day. The television is on
The Weather Channel most of the day because Mrs. Martinez has limited English
capability and is unable to read closed-captioning. Mrs. Martinez also has two
sons who do not live in the local area, but they do call regularly and check in
with their mother and sister. The two sons are opposed to moving their mother
to a nursing home because they had promised her that they would “never put her
away.”
Case Study 2
Mr. Williams, a 79-year-old African American widower,
resides in a foster care home. He has lived there for 4 years since his wife
died. He is a former minister. His medical history includes long-term diabetes,
high blood pressure, and benign prostatic hypertrophy. The home care provider
has requested a home visit to evaluate Mr. Williams’s ability to remain in the
home. The provider states that because Mr. Williams’s vision is seriously
compromised (he is nearly blind), and because he has been unable to get to the
toilet as quickly as necessary (he is very unsteady on his feet), his care is
becoming burdensome. According to the home care provider, for safety reasons,
Mr. Williams may not fit the criteria for remaining in the foster care home.
Case Study 3
Mrs. Randall is a 77-year-old female who resides in a
long-term care facility. She has a history of frequent falls and is severely
cognitively impaired. The nursing staff at the long-term care facility called
the nurse practitioner at the medical home office to report the recent
development of productive cough and high fever. There have been cases of flu in
the facility; however, Mrs. Randall has had a flu shot. The nurse practitioner
in the office requests a chest x-ray in the long-term care facility. The nurse
on duty in the facility states that there is no portable chest x-ray equipment
available. She further requests that Mrs. Randall be transferred to the
emergency room of the local hospital. Mrs. Randall’s daughter has durable power
of attorney for health care decisions for her mother. The long-term care
facility has notified the daughter of the change in her mother’s condition. The
daughter says whatever the nursing home wants is fine with her.
To prepare:
Review this week’s media presentation, as well as the
American Geriatrics Society and Arbaje et al. articles in the Learning
Resources.
Research models of interdisciplinary geriatric care teams
that are used at various sites, such as assisted living, home care, hospitals,
long-term care, and rehabilitation facilities.
Consider the model used for the interdisciplinary geriatric
care teams at your current practicum site. Compare this model to models used at
other sites.
Reflect on how the role of the advanced practice nurse
differs according to the site of care.
Select one of the three case studies. Consider how care
should be facilitated for the patient in the case you selected based on the
model used for the interdisciplinary geriatric care teams at your practicum
site.
Week 4 discussion
Discussion: Over-the-Counter Drugs
Pharmacokinetic and pharmacodynamic processes differ among
patients across their life spans. For geriatric patients, alterations due to
aging make them especially prone to adverse drug reactions. The various health
issues that affect many geriatric patients further complicate this, as the need
to treat these multiple health issues often results in polypharmacy. Although
treatments are frequently drugs prescribed by the health care provider, many
geriatric patients also take over-the-counter (OTC) drugs. While the provider
sometimes recommends these OTC drugs, patients often select the drugs on their
own. This makes patient education on pharmacology key when caring for geriatric
patients. Many patients assume that if drugs are available over the counter,
then they are safe to take. However, due to issues related to polypharmacy and
how their aging bodies process drugs, OTC drugs may have serious implications
for patients.
To prepare:
Review the American Geriatrics Society article and
interactive media piece in this week’s Learning Resources.
Select one of the following over-the-counter drugs commonly
used by geriatric patients:
Antacids or acid suppressants
Antidiarrheal
Antihistamines
Antimicrobial ointments
Antispasmodics for the bladder
Cough suppressants
Laxatives
Neutraceuticals (choose one; e.g., ginseng, St. John’s wart,
etc.)
Pain medications (choose one; e.g., acetaminophen,
ibuprofen, rub-on pain ointments/patches, etc.)
Supplements (choose one; e.g., calcium, iron, etc.)
Vaginal creams
Research the over-the-counter drug you selected. Visit a
local pharmacy and explore the types/varieties of the drug that are available.
Reflect on the ingredients in each type/variety, including additional active
ingredients.
Consult with the pharmacist about the ingredients in each
type/variety, including how to make safe and effective clinical decisions in
relation to this drug. Discuss potential interactions in frail elders and
precautions related to the drug based on Beers Criteria. If one is available,
you may consult with a pharmacist at your practicum site as an alternative to
visiting a pharmacy.
Consider ways to educate elders about the OTC drug you
selected.
Week 5 discussion
Discussion: Fall-Risk Assessment
Fall risks are very high for the geriatric population.
According to the Centers for Disease Control and Prevention (2013), one out of
every three adults aged 65 years and older falls each year. This can be
attributed to factors such as changes in aging, other health issues,
environment, and effects of prescribed drugs. When caring for geriatric
patients, it is important to screen them for risks and perform fall-risk
assessments. These assessment tools help to determine the level of risk for
patients so that preventive measures can be taken. The implications of falls
are very serious and range from fractures to mental health disorders and even
death. In this Discussion, you explore risk assessment tools for use with
patients at your practicum site.
To prepare:
Review the Kanis article in this week’s Learning Resources.
Consider a geriatric patient at your practicum site who is
at risk for falls. Coordinate an opportunity to assess this patient with your
Preceptor.
Note: When referring to your patient, make sure to use a
pseudonym or other false form of identification. This is to ensure the privacy
and protection of the patient.
In addition to the Fracture Risk Assessment Tool (FRAX),
select one of the following tools to assess this patient for falls:
Tinetti Performance Oriented Mobility Assessment (POMA)
Systems Approach
Berg Balance Scale
Elderly Mobility Scale
Timed Unsupported Stead Stand (TUSS)
Six-Minute Walk Test (6MWT)
Hendrich II Fall Risk Model
Consider why you selected the assessment tool for this
particular patient.
Assess the patient using the tool you selected under
Preceptor guidance. Reflect on the assessment, including any issues with the
patient and/or the effectiveness of the tool.
Think about strategies and interventions to reduce the risk
of falls for frail elders.
Week 6 discussion
Discussion: Patient Presentation of Dementia, Delirium, and
Depression
With the prevalence of dementia, delirium, and depression in
the growing geriatric population, you will likely care for elderly patients
with these disorders. While many symptoms of dementia, delirium, and depression
are similar, it is important that you are able to identify those that are
different and properly diagnose patients. A diagnosis of one of these disorders
is often difficult for patients and their families. In your role as the
advanced practice nurse, you must help patients and their families manage the
disorder by facilitating necessary treatments, assessments, and follow-up care.
Consider the patient presentations in the following case studies. What distinct
symptoms or factors would lead you to a diagnosis of dementia, delirium, or
depression?
Case Study 1
HPI: Mrs. Mayfield is a 75-year-old woman who is brought to
the emergency room by the police at 11 p.m. She was found wandering and
confused in a local neighborhood. The police were called when Mrs. Mayfield
tried to use her key on a neighbor’s door. When confronted by the police she
became abusive, confused, and frightened and looked very pale and agitated. The
police could not establish her correct address and they subsequently brought
her to the emergency room.
Review of Symptoms (ROS): Unable to obtain at this time.
Objective Data:
PE:
VS: Pulse 96 and regular; B/P 150/90; Axillary temperature
99°F.
General: She appears clean and well nourished, with no signs
of injury, trauma, or neglect.
Her physical exam is unremarkable except –
Neuro: No gross focal neurological signs, but she is only intermittently
cooperative. Her mental status fluctuates and a full neurological evaluation is
not possible at this time.
Psych: A & O x 1 to person only. She has episodes of
agitation and alternating withdrawal/somnolence. During the examination, it
takes several attempts to gain Mrs. Mayfield’s attention to answer questions,
but once focused, she rambles on in a disorganized and incoherent way.
Case Study 2
CC: “irritable and forgetful”
HPI: Mrs. White, a 78-year-old married woman, is brought to
the office of her primary care provider by her husband because of increasing
forgetfulness and irritability over the past 3 months. Mr. White claims that
his wife has had problems for several years now, but has just gotten “worse in
her memory” in the past few months. She recently misplaced her purse and
accused her son of stealing it.
On three occasions, she left the stove on and boiled a pot
dry, nearly causing a fire. She recently put a container of ice cream into the
washing machine instead of into the freezer and her husband did not discover it
for more than a week. Mrs. White claims her family wants to take her money and
leave her with nothing. “No matter what they say, there is nothing wrong with
me,” she states.
Past Medical History (PMH) includes: hypothyroidism, treated
with Synthroid, and successful treatment of breast cancer approximately 15
years prior. She also takes over-the-counter ibuprofen for chronic lower back
pain and occasional Benadryl to help her sleep at night.
Objective data: Her physical examination is within normal
limits.
Case Study 3
HPI: Mr. George is a 72-year-old male who has lived alone
since his wife died approximately 1 year ago. He has lived in the same house
for 45 years. He is brought in by his son who is concerned that his father has
lost more than 35 pounds over the past year. Mr. George admits to not eating
well because “I don’t know how to cook for myself.”
PMH: He has been in good health with the exception of
hypertension, which is well controlled.
Social history: He spends most of his time watching sports
on television. He occasionally drinks one or two cans of beer when he is
watching TV. He does go to his son’s house to visit with his grandchildren
about once a week, and he says he enjoys that. He does not receive any social
services, he still drives but only in the daytime, and he does not participate
in any other leisure activities.
Objective data: His physical examination is normal. He
responds correctly to questions, although he appears to have a flat affect.
To prepare:
Review Chapters 6–8 of the Holroyd-Leduc and Reddy text.
Select one of the three case studies. Reflect on the way the
patient presented in the case study you selected, including whether the patient
might be presenting with dementia, delirium, or depression.
Think about how you would further evaluate the patient based
on medical history, current drug treatments, and the patient’s presentation.
Consider whether you would modify drug treatments, use additional assessment
tools, and/or refer the patient to a specialist.
Week 7 discussion
Discussion: Nutrition and Hydration
Geriatric patients have many nutritional and hydration
concerns that impact their health and ability to acquire sufficient nutrients.
Advanced practice nurses evaluating these patients must be able to account for
all barriers that prevent elders from obtaining adequate nutrition, including
medical conditions, transportation, finances, physiologic changes, and
functional abilities. When evaluating patients, it is important to consider how
they eat, what their diet consists of, and whether they have any special dietary
needs that are not being met. Assessment tools, such as the Lawton Instrumental
Activities of Daily Living (IADL) Scale, are an integral part of this
evaluation process as they help providers identify potential obstacles for
patients. In this Discussion, you assess a patient at your current practicum
site and consider strategies for improving any nutrition or hydration issues.
To prepare:
Review this week’s media presentation, as well as 29 and 30
of the Resnick text.
Assess a patient using tools for inpatient and long-term
patient care, such as the Lawton IADL Scale.
Note: You should coordinate this opportunity with the
Preceptor at your practicum site.
Consider whether nutrition and/or hydration might be
impacted by the patient’s functional abilities. Reflect on whether the patient
is able to go out and get food to eat, cook meals, safely use the stove, etc.
Consider the patient’s diet and whether they have any
special dietary needs due to medical conditions, such as congestive heart
failure, end-stage kidney disease, diabetes, oral health issues, etc. Reflect
on whether or not the patient is attempting to compensate for a medical issue
and thus creating a deficiency or excess in his or her diet.
Based on your patient assessment, think about strategies for
improving any nutrition issues that might have presented (e.g., nutritional
supplements, community resources such as Meals on Wheels, referral to a
nutritionist or dietician, etc.).
Week 8 discussion
Discussion: Nursing Homes in Your Community and Neighboring
Communities
Nursing homes have become a viable option for geriatric
patients who require routine care and need help performing basic activities of
daily living, with about 3.3 million patients residing in nursing homes in the
United States (Centers for Medicare & Medicaid Services, 2013). While
nursing homes provide care and services to patients, problems can arise
resulting in reduced quality of care and, in some cases, illness and morbidity.
The severe implications of pressure ulcers make them a major concern for elders
residing in nursing homes. The Centers for Medicare & Medicaid Services
(2013) estimate that 7.5% of nursing home residents have pressure ulcers and
about 82,000 patients develop them each year. In your role as the advanced
practice nurse, you must understand factors that contribute to the incidence of
pressure ulcers in order to improve patient outcomes.
For this Discussion, you examine the prevalence of pressure
ulcers in nursing homes and develop strategies for increasing awareness and
reducing incidence.
To prepare:
Review Chapter 32 of the Resnick text and Chapter 12 of the
Holroyd-Leduc and Reddy text.
Select four nursing homes in your community and/or
neighboring communities. Research and locate reports on these nursing homes
through organizations such as Centers for Medicare & Medicaid Services.
Compare the four nursing homes you selected based on
reported cases of the development of new pressure ulcers.
Think about factors in the nursing home setting that
contribute to pressure ulcer issues, such as patient activity, nutrition, or
the number of staff available to care for patients.
Research guidelines for the prevention of pressure ulcers.
Think about how you might increase awareness among nursing home staff about the
incidence and consequences of pressure ulcers in patients.
Week 9 discussion
Discussion: Treating Patients in Specialized Areas of Care
When treating frail elder patients in specialized areas of
care, there are various dynamics that might impact patient care plans. From
questions about potential outcomes, benefits of treatment, and quality of life
to factors such as personal values, families, culture, and religion, decision
making can be difficult for patients and their families. As the advanced
practice nurse, you must support them through this process.
For this Discussion, you examine the following case studies
and consider how you might address the needs of the patients and their
families.
Case Study 1
Mr. Wiggins is a 78-year-old African American male with
chronic kidney disease, which requires dialysis. The etiology of his renal
disease was multifactorial—long-standing uncontrolled HTN and DM nephropathy.
He has been on hemodialysis for the past 10 years and has done relatively well.
Four weeks ago, he had a major CVA and is minimally responsive. His condition
is not expected to change, and the family is having a difficult time with his
recent health changes. Advanced directives were discussed with them, and his
wife is a durable power of attorney for his health care. The wife hates to see
her husband this way and understands this is not how he would want to go on,
but their children and many of the family members (his brothers and sisters)
think the patient will return to himself. They want everything done in terms of
life support measures—full code status. His family wanted a feeding tube
placed, and he is now receiving 24-hour tube feedings. You are the NP caring
for Mr. Wiggins. You have known and cared for him and his wife for several
years. The wife pulls you aside, shares her dilemma, and asks you to make the
decision regarding continuing medical care/support for her husband. How will
you respond?
Case Study 2
Mrs. Adams is a 96-year-old Caucasian female who has
recently been diagnosed with colon cancer. She was admitted to the hospitalist
service through the ED with dehydration and rectal bleeding. The bleeding
resolved, and she received 2 units of PRBs and fluid/electrolyte replacement.
She is stable and ready to be discharged home.
Mrs. Adams is in remarkably good health, and other than
arthritis and mild HTN, she has no significant medical or surgical history. She
is able to carry out all of her essential daily living activities. She pays her
own bills, is competent, and has good functional abilities. She was driving up
until last year. Now, she has neighbor’s assist with weekly shopping and
transportation to church. Her sensory, functional, and cogitative abilities
were evaluated this admission and remain intact. She has been offered
palliative surgical intervention, but deferred all treatment. Her only son is
in agreement with his mother’s decision. Her parents and husband are deceased.
You have been asked to obtain advanced directives. What will your discharge
treatment plan be for Mrs. Adams?
Case Study 3
Mr. Pierce is an 82-year-old East Indian male, recently
widowed 6 months ago. He fractured his left hip 2 months ago attempting to
climb his backyard fence to get his cat out of a tree. His children live
internationally and have been taking turns caring for him. His eldest son
brought him in through the ED last night because Mr. Pierce started having
shortness of breath and his lips turned blue. In addition, his son noticed his
left leg was very swollen compared to the right. The ED nurse practitioner
ordered a thin cut cat scan (CT) with pulmonary embolism (PE) protocol and deep
vein thrombosis (DVT) scan. Mr. Pierce has a large DVT that is obstructing
circulation and multiple pulmonary emboli. His condition is life threatening
and he is only expected to live a few weeks. He has a living will and advanced
directives and has requested to be able to die in the comfort of his home. “I
hate hospitals.” You have been consulted at the patient and family’s request
because you are Mr. Pierce’s primary care provider. What additional services
can be offered to ensure his care/comfort at home and to give him peace of mind
regarding his estate?
To prepare:
Select one of the three case studies. Reflect on the
provided patient information.
Think about potential outcomes for the patient in the case
study you selected.
Consider how care, treatment, and/or support might be
facilitated for the patient. Reflect on how you might also address the needs of
the family.
Week 10 discussion
Discussion: Community Advocacy Agencies
Having received a diagnosis of Alzheimer’s and encountering
the associated stigmas, Michael Ellenbogen encourages increased advocacy
efforts for the geriatric population struggling with this disease. He says, “We
did nothing wrong to get this disease, and we need to speak up to let our voice
be heard…There are no excuses for not wanting to help. The human cost factor is
too high, and we are all accountable to do something” (Ellenbogen, 2012). As an
advanced practice nurse caring for the geriatric population, it is important for
you to join in advocacy efforts within your community whether it is in support
of Alzheimer’s or another prevalent need such as abuse. You should be aware of
community agencies that advocate for the well-being and care of your local
geriatric population, as these agencies often provide resources and assistance
to the elderly in need. In your role of care, you are able to identify
prevalent needs and work with patients, their families, and agencies to promote
change and impact lives.
To prepare:
Review this week’s media presentation, as well as the
American Geriatric Society’s Public Policy and Advocacy website in the Learning
Resources.
Locate and research two agencies that advocate for the
elderly in your community. Consider their current advocacy actions and/or
campaigns.
Reflect on your experiences and observations at your
practicum site. Consider new advocacy actions you might suggest to the agencies
you selected. Based on these advocacy actions, think about new policies that
might improve the care of the population at your current practicum site.
Week 11 discussion
Discussion: Discussing End-of-Life Care
There is a human tendency to postpone uncomfortable or
unpleasant tasks.
—Nancy Kummer, geriatric patient
This human tendency to avoid the unpleasant makes
end-of-life care and hospice decisions difficult for many patients to discuss
with their families. Kummer is a former social worker who used to counsel
patients with terminal illnesses, yet she avoided discussing her own
end-of-life wishes with her children. While many Americans, like Kummer, agree
that these discussions need to take place, few have actually had these
conversations with their families (Lazar, 2012). Although initiating
conversations about end-of-life care and hospice might be difficult for
patients, as an advanced practice nurse, facilitating these conversations is an
integral part of your geriatric nursing practice. For this Discussion, consider
how you would facilitate care conversations with the patients and families in
the following case studies:
Case Study 1
Mrs. Sloan, a 69-year-old widow, is about to enter the
hospital for an elective cholecystectomy; she is being medically cleared by her
primary care provider. During the discussion, she requests to be placed on a no
code status during her hospitalization. Mrs. Sloan claims that besides her
gallbladder problem, her general health status is good. She wishes to have the
surgery to avoid any further attacks, which have been very painful. She states,
however, that if during surgery or her postoperative period, she undergoes a
cardiac arrest, she would prefer not to be resuscitated. She has read about the
chances of successful resuscitation, and has determined that the risk of brain
damage is too high. For this reason, she is requesting a no code status.
Case Study 2
Ms. Stearns is an 83-year-old nursing home resident with
hypertension, coronary artery disease, arthritis, renal insufficiency, hearing
impairment, and a previous history of stroke. She also has a foot deformity
from childhood polio. She is disoriented at times. She has lived in the nursing
home for 10 years and rarely leaves the chair beside her bed. She has recently
developed urinary incontinence, but has refused a bladder catheterization to
determine postvoid residual urine or possible bladder infection. She does not
have a diagnosis of dementia; however, current testing reveals that she
performs poorly on a standardized mental status examination. She can, however,
identify all the staff in the nursing home, and she can describe each patient
who has been in the bed next to hers over the past 10 years. When asked to
explain why she does not want bladder catheterization, she gives several
reasons. She states that the incontinence does not bother her, and that she has
always been a very private person. She particularly dislikes and objects to any
examination of her pelvic organs; in fact, she has never had a pelvic
examination nor has she ever had sexual intercourse. She realizes that she has
a number of medical problems and that any one of them could worsen at any time.
She states she is not willing to undergo any treatment for any of her current
problems should they become worse.
Case Study 3
Mr. Marley, age 91, is admitted to the intensive care unit
following a stroke. The stroke progressed from mild hemiparesis and difficulty
speaking to complete unresponsiveness and an inability to swallow. His daughter
feels certain, based on prior explicit conversations with her father, that he would
not want to have any treatment that would prolong his life and leave him in a
severely disabled state. Mr. Marley’s oldest son disagrees with his sister’s
assessment of their father. The son claims that their father still has a strong
desire to live, and that he has been very active in his church until this
stroke. Because Mr. Marley cannot swallow, he cannot be fed. The family is
asked about insertion of a feeding tube. It is explained to the family that
without food and fluids, their father will die fairly quickly. There are no
existing advance directives or a designated health care decision maker noted
for Mr. Marley.
To prepare:
Review Chapter 14 of the Holroyd-Leduc and Reddy text.
Reflect on the role of the advanced practice nurse in
facilitating the discussion of end-of-life care with patients and their
families.
Think about how you, as an advanced practice nurse, would
approach a family who wants “everything” done for a patient with only a limited
time to live.
Consider when it is appropriate to involve hospice and how
to approach patients and/or families who refuse hospice services.
Select one of the three provided case studies related to the
end-of-life care of the frail elderly. Reflect on potential patient outcomes
and how you would facilitate the discussion of care with this patient’s family.
Week 4
assignment 1
Assignment: Practicum – Week 3 SOAP Note
In addition to journal entries, SOAP Note submissions are a
way to reflect on your practicum experiences and connect these experiences to
your classroom experience. SOAP Notes, such as the ones required in this
course, are often used in clinical settings to document patient care. Refer to
this week’s Learning Resources for guidance on writing SOAP Notes.
Select a geriatric patient that you examined during the last
3 weeks. The patient you select should be currently taking at least five
prescription and/or over-the-counter drugs. With this patient in mind, address
the following in a SOAP Note:
Subjective: What was the patient’s subjective complaint?
What details did the patient provide regarding his or her personal and medical
history? Include a list of prescription and over-the-counter drugs the patient
is currently taking. Compare this list with the Beers Criteria and consider
alternative drugs if appropriate.
Objective: What observations did you make during the
physical assessment? What functional assessments were used?
Assessment: What were your differential diagnoses? Provide a
minimum of three possible diagnoses. List them from top priority to least
priority.
Plan: What was your plan for diagnostics and primary
diagnosis? What was your plan for treatment and management including
alternative therapies? What is your care plan for the patient? How would you
offer caregiver support?
Reflection notes: What would you do differently in a similar
patient evaluation? How might you improve your assessment, diagnosis, and/or
plan through interprofessional collaboration?
Refer to this week’s Learning Resources for guidance on
writing SOAP Notes.
By Day 7 of Week 4
This Assignment is due. You will submit this Week 3 SOAP
Note along with your Journal Entries (from Weeks 1, 2, and 4) by Day 7 of Week
4.
Week 4
assignment 2
Assignment: Practicum – Week 1 Journal Entry
As a future advanced practice nurse, it is important that
you are able to connect your classroom experience to your practicum experience.
By applying the concepts you study in the classroom to clinical settings, you
enhance your professional competency. Each week, you complete an Assignment
such as a Journal Entry or SOAP Note that prompts you to reflect on your
practicum experiences and relate them to the material presented in the
classroom. This week, you begin documenting your practicum experiences in your
Practicum Journal. Please use the Practicum Journal Template, located in this
week’s Learning Resources.
To prepare for this course’s Practicum Experience, address
the following in your practicum journal:
Select an aging theory to guide your practice.
Develop goals and objectives for the Practicum Experience in
this course. Be sure to consider geriatric competencies.
Create a timeline of practicum activities based on your
practicum requirements.
By Day 7 of Week 4
This Assignment is due. You will submit this Week 1 Journal
Entry along with the Week 2 and Week 3 Journal Entries and Week 3 SOAP Note by
day 7 of Week 4.
Assignment: Practicum – Week 2 Journal Entry
To prepare for this course’s Practicum Experience, reflect
on implications of age-related changes in geriatric patients. Explain how you
might differentiate between normal behaviors/disorders due to aging and
abnormal behavior/disorders that are not age related. Include how functional
assessments might help distinguish “normal” from “abnormal.”
By Day 7 of Week 4
This Assignment is due. You will submit this Week 2 Journal
Entry, the Week 1 and Week 4 Journal Entries, and the Week 3 SOAP Note by Day 7
of Week 4.
Assignment: Practicum – Week 4 Journal Entry
Reflect on medication adherence issues you have encountered
with geriatric patients in your practicum setting. Explain implications of
these issues on patient health, as well as strategies to improve medication
adherence for geriatric patients. If you did not have an opportunity to
evaluate a patient with this background during the last 4 weeks, you can select
a related case study or reflect on previous clinical experiences.
By Day 7 of Week 4
This Assignment is due. Please submit the Journal Entries
(Weeks 1, 2, and 4), and the Week 3 SOAP Note by Day 7 of Week 4 (this week).
Note: Be sure to submit your Assignment to the appropriate
submission link below.
Submissions should match the following:
Week 3 SOAP Note: Submit to the Week 4 Assignment – Part 1
submission link.
Weeks 1, 2, & 4 Journal Entry: Submit to the Week 4
Assignment – Part 2 submission link.
For the Journal Entries—which are assessed with a
Satisfactory (S) or Unsatisfactory (U) score—the numerical grade will show as 0
points and the “S” or “U” will be posted in the Feedback area by your
Instructor. These scores of 0 points do not affect your grade; they simply
allow for a placeholder to place the “S” or “U” scoring. This concept also
applies to Weeks 7 and 10.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: WK4AssgnPX+lastname+first initial.
Click the Assignment Week 4 – Part X link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK4AssgnPX+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
Week 6
assignment 1
Assignment 1: Application – PICO Analysis of Dementia,
Delirium, and Depression
A PICO analysis is used to pose a focused clinical question
to which you find appropriate evidence-based answers. The PICO question should
include the patient or population (P), anticipated intervention (I), comparison
group or current standard (C), and outcome desired (O). In this Assignment, you
develop a question related to dementia, delirium, or depression. Through your
PICO analysis, you explore various resources and examine current evidence to
answer the question you develop.
To prepare:
Select one of the following disorders as your topic:
dementia, delirium, or depression.
Review the guidelines in the “Literature Review Matrix”
document in this week’s Learning Resources.
Think about a research question around your issue as
indicated in Part I: PICO Analysis of Research Topic.
Consider the resources you will use, search terms and
criteria, and Boolean search strings as indicated in Part II: Search Strategy.
Using the Walden Library and other appropriate databases,
locate five articles related to your PICO question. At least one article must
be a systematic review. All of the articles should be primary sources.
Reflect on the five articles you selected as indicated in
Part III: Analysis of Literature. Consider the conceptual framework/theory,
main finding, research method, strengths of study, weaknesses, and level of
evidence for each article.
Consider how to use the summaries in Part III to create an
evidence table. Use this evidence table to determine appropriate treatment
options for patients who present with the disorder you selected as your topic.
To complete:
Formulate a question around the disorder you selected as
indicated in Part I: PICO Analysis of Research Topic.
Identify the resources you will use, search terms and
criteria, and Boolean search strings as indicated in Part II: Search Strategy.
Summarize the five articles you selected as indicated in Part
III: Analysis of Literature. Describe the conceptual framework/theory, main
finding, research method, strengths of study, weaknesses, and level of evidence
for each article.
Create an evidence table based on the article summaries in
Part III. Describe appropriate treatment options for patients based on this
evidence table.
By Day 7 of Week 6
This Assignment is due.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: “WK6Assgn1+lastname+first initial”.
Click the Week 6 Assignment 1 link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK6Assgn1+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
Week 7
assignment 1
Assignment: Practicum – Week 7 SOAP Note
Select a geriatric patient that you examined during the last
4 weeks. The patient you select should be currently taking at least five
prescription and/or over-the-counter drugs. With this patient in mind, address
the following in a SOAP Note:
Subjective: What was the patient’s subjective complaint?
What details did the patient provide regarding his or her personal and medical
history? Include a list of prescription and over-the-counter drugs the patient
is currently taking. Compare this list to the Beers Criteria and consider
alternative drugs if appropriate.
Objective: What observations did you make during the
physical assessment? What functional assessments were used?
Assessment: What were your differential diagnoses? Provide a
minimum of three possible diagnoses. List them from top priority to least
priority.
Plan: What was your plan for diagnostics and primary
diagnosis? What was your plan for treatment and management including
alternative therapies? What is your care plan for the patient? How would you
offer caregiver support?
Reflection notes: What would you do differently in a similar
patient evaluation? How might you improve your assessment, diagnosis, and/or
plan through interprofessional collaboration?
Refer to the Week 3 Learning Resources for guidance on
writing SOAP Notes.
By Day 7 of Week 7
This Assignment is due. You will submit this Week 7 SOAP
Note along with your Journal Entries (from Weeks 5 and 6) by Day 7 of Week 7
(this week).
Note: Be sure to submit your Assignment to the appropriate
submission link below.
Submissions should match the following:
Week 7 SOAP Note: Submit to the Week 7 Assignment – Part 1
submission link.
Weeks 5 and 6 Journal Entry: Submit to the Week 7 Assignment
– Part 2 submission link.
For the Journal Entries—which are assessed with a Satisfactory
(S) or Unsatisfactory (U) score—the numerical grade will show as 0 points and
the “S” or “U” will be posted in the Feedback area by your Instructor. These
scores of 0 points do not affect your grade; they simply allow for a
placeholder to place the “S” or “U” scoring. This concept also applies to Weeks
4 and 10.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: WK7AssgnPX+lastname+first initial.
Click the Assignment Week 7 – Part X link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK7AssgnPX+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
Week 7
assignment 2
Assignment: Practicum – Week 5 Journal Entry
Reflect on atypical presentations of disorders in geriatric
patients in your practicum setting. Many disorders manifest themselves in a way
that would be considered an atypical presentation—most likely different from
the way a textbook would describe the disorder’s possible presentations.
Consider geriatric patients that you have observed with atypical presentations
of disorders. Describe a patient case including how the patient was diagnosed
and strategies that were used to overcome the atypical presentation. If you did
not have an opportunity to evaluate a patient with this background during the last
5 weeks, you can select a related case study or reflect on previous clinical
experiences.
By Day 7 of Week 7
This Assignment is due. You will submit this Week 5 Journal
Entry along with the Week 6 and the Week 7 SOAP Note by Day 7 of Week 7.
Assignment 2: Practicum – Week 6 Journal Entry
Reflect on geriatric patients from your practicum site that
you may have assessed for dementia, delirium, or depression. Explain the impact
of these types of disorders on frail elders. Then, describe a patient case
including the care plan for assessment, diagnoses, treatment, management, and
patient education. Explain whether the patient’s care plan was effective.
Include how you might proceed differently in the future. If you did not have an
opportunity to evaluate a patient with this background during the last 6 weeks,
you can select a related case study or reflect on previous clinical
experiences.
By Day 7 of Week 7
This Assignment is due. You will submit this Week 6 Journal
Entry along with the Week 5 Journal Entry and the Week 7 SOAP Note by Day 7 of
Week 7.
Week 8
assignment
Assignment 1: Application – Diagnosing and Treating Skin
Wounds
Skin wounds are sometimes challenging for health care
providers to diagnose and treat as many have similar presentations. For
advanced practice nurses, being able to identify various types of skin wounds,
including whether a wound is a colonization or an infection, is critical
because it impacts recommended patient care. In your role, you must be able to
evaluate skin wounds, determine the diagnosis, and develop an appropriate
treatment and management plan according to current evidence-based guidelines.
To prepare:
Review Chapter 46 of the Resnick text, as well as the Burr
article in this week’s Learning Resources.
Consider how to properly diagnose skin wounds in frail
elders, including how to distinguish between a colonization and infection.
Select a type of skin wound, such as bumps, bruises,
shingles, herpes, bullous pemphigoid, Stevens-Johnson syndrome, etc. Research
the guidelines for treatment of the skin wound you selected. Reflect on how you
would treat and/or dress this wound.
Think about factors that might contribute to the development
of the skin wound you selected. Consider strategies for the prevention and
improvement of this type of wound.
To complete:
Write a 2- to 3-page paper that addresses the following:
Explain how to properly diagnose skin wounds in frail
elders, including how to distinguish between a colonization and infection.
Describe the type of skin wound you selected.
Explain how you would treat and/or dress this wound based on
guidelines for treatment.
Explain factors that might contribute to the development of
the skin wound you selected. Include strategies for the prevention and
improvement of this type of wound.
By Day 7
This Assignment is due.
Note: The School of Nursing requires that all papers
submitted include a title page, introduction, summary, and references. The
Sample Paper provided at the Walden Writing Center provides an example of those
required elements (available at
http://academicguides.waldenu.edu/writingcenter/templates). All papers
submitted must use this formatting.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: “WK8Assgn1+lastname+first initial”.
Click the Week 8 Assignment 1 link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK8Assgn1+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
Week 10
assignment
Assignment 2: Practicum – Week 8 Journal Entry
Reflect on geriatric patients from your practicum site.
Consider frail elder patients that you have assessed for skin wounds such as
bumps, bruises, shingles, herpes, bullous pemphigoid, Stevens-Johnson syndrome,
etc. Explain the consequences of these types of wounds for frail elders. Then,
describe a patient case including the care plan for assessment, diagnoses,
treatment, management, and patient education. Explain whether the patient’s
care plan was effective. Include how you might proceed differently in the
future. If you did not have an opportunity to evaluate a patient with this
background during the last 8 weeks, you can select a related case study or
reflect on previous clinical experiences.
By Day 7 of Week 10
This Assignment is due. Please submit the Journal Entries
(Weeks 8, 9 and 10) by Day 7 of Week 10.
Assignment: Practicum – Week 9 Journal Entry
An advance directive is a legal document that defines a
patient’s wishes for medical care. This document is a way for patients to share
their wishes with family members and health care providers when their illness
or mental capacity prevents them from making decisions. As an advanced practice
nurse who has care discussions with patients and their families, you need to
not only be familiar with the process of completing an advance directive, but
also understand how this document might impact your role in patient care and
treatment.
Journal Entry Part 1
For the first part of your journal entry, reflect on the
Five Wishes presented on the Five Wishes website and PDF and complete your Five
Wishes. Explain your state’s requirements for advance directives, including
whether your Five Wishes can be turned into a formal document. Then, explain
how your experience of completing your Five Wishes advance directive will help
you guide discussions with patients and their families. Finally, explain how
you might apply the Five Wishes advance directives to your nursing practice.
Include how this advance directive might benefit patients in decision making
for specialized areas of care.
Journal Entry Part 2
For the second part of your journal entry, reflect on
geriatric patients from your practicum site with disorders related to
specialized areas of care, such as oncology, nephrology, urology, gynecology,
and neurology. Describe a case of a frail elder patient who must make decisions
related to specialized areas of care. Then, explain potential patient outcomes
and include whether treatments would be beneficial and how they would impact
the patient’s quality of life. Finally, describe the patient’s wishes in terms
of treatments and interventions for the disorder (Was there an advanced
directive?) and how the patient might want to spend any remaining time. Include
how environmental factors, such as family, caregivers, ethnicity, culture,
religion, and/or personal values, might impact decision making for treatments
and interventions. If you did not have an opportunity to evaluate a patient
with this background during the last 9 weeks, you can select a related case
study or reflect on previous clinical experiences.
By Day 7 of Week 10
This Assignment is due. You will submit this Week 9 Journal
Entry, Week 8 Journal Entry and the Week 10 Journal Entry by Day 7 of Week 10.
Assignment: Practicum – Week 10 Journal Entry
Elder abuse is any intentional or negligent behavior that
results in physical, sexual, emotional, pharmacological, and/or financial
abuse. Unfortunately, abuse is sometimes difficult to identify, and elders are
often hesitant or unable to report abuse themselves (Administration on Aging,
n.d.). This makes it important for health care providers to regularly monitor
for signs of abuse and react according to local and state laws.
Journal Entry Part 1
For the first part of your journal entry, select and
describe one of the following types of elder abuse: physical, sexual,
mental/emotional/verbal, pharmacological, or financial. Explain strategies for
identifying this abuse. Then, explain how you would proceed based on your local
and state laws once you have identified this abuse in a patient. Describe
resources in your community that assist victims of this type of abuse and
explain how you, as the advanced practice nurse, might apply these resources
for abused elders who are identified in the clinical setting.
Journal Entry Part 2
For the second part of your journal entry, reflect on the
different cultures—ethnic, religious, regional, or generational—of the elder
patient population at your practicum site. Describe the cultures you have
observed and explain the influence of these cultures on the prevalence and
detection of elder abuse. Then, explain how culture might impact the way you
would implement resources for preventing or addressing abuse.
By Day 7 of Week 10
This Assignment is due. You will submit this Week 10 Journal
Entry, Week 8 Journal Entry and the Week 9 Journal Entry by Day 7 of Week 10.
For the Journal Entries —which are assessed with a
Satisfactory (S) or Unsatisfactory (U) score—the numerical grade will show as 0
points and the “S” or “U” will be posted in the Feedback area by your
Instructor. These scores of 0 points do not affect your grade; they simply
allow for a placeholder to place the “S” or “U” scoring. This concept also
applies to Weeks 4 and 7.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: WK10Assgn+lastname+first initial.
Click the Assignment Week 10 link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK10Assgn+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
Week 11
assignment
Assignment: Practicum – Week 11 SOAP Note
Select a geriatric patient that you examined during the last
3 weeks. The patient you select should be currently taking at least five
prescription and/or over-the-counter drugs. With this patient in mind, address
the following in a SOAP Note:
Subjective: What was the patient’s subjective complaint?
What details did the patient provide regarding his or her personal and medical
history? Include a list of prescription and over-the-counter drugs the patient
is currently taking. Compare this list to the Beers Criteria and consider
alternative drugs if appropriate.
Objective: What observations did you make during the
physical assessment? What functional assessments were used?
Assessment: What were your differential diagnoses? Provide a
minimum of three possible diagnoses. List them from top priority to least
priority.
Plan: What was your plan for diagnostics and primary
diagnosis? What was your plan for treatment and management including
alternative therapies? What is your care plan for patient? How would you offer
caregiver support?
Reflection notes: What would you do differently in a similar
patient evaluation? How might you improve your assessment, diagnosis, and/or
plan through interprofessional collaboration?
Please refer to the Learning Resources in Week 3 for
guidance on writing SOAP Notes.
By Day 7 of Week 11
This Assignment is due.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: “WK11AssgnPX+lastname+first initial”.
Click the Week 11 Assignment – Part X link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK11AssgnPX+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.

Week 4
assignment 1
Assignment: Practicum – Week 3 SOAP Note
In addition to journal entries, SOAP Note submissions are a
way to reflect on your practicum experiences and connect these experiences to
your classroom experience. SOAP Notes, such as the ones required in this
course, are often used in clinical settings to document patient care. Refer to
this week’s Learning Resources for guidance on writing SOAP Notes.
Select a geriatric patient that you examined during the last
3 weeks. The patient you select should be currently taking at least five
prescription and/or over-the-counter drugs. With this patient in mind, address
the following in a SOAP Note:
Subjective: What was the patient’s subjective complaint?
What details did the patient provide regarding his or her personal and medical
history? Include a list of prescription and over-the-counter drugs the patient
is currently taking. Compare this list with the Beers Criteria and consider
alternative drugs if appropriate.
Objective: What observations did you make during the
physical assessment? What functional assessments were used?
Assessment: What were your differential diagnoses? Provide a
minimum of three possible diagnoses. List them from top priority to least
priority.
Plan: What was your plan for diagnostics and primary
diagnosis? What was your plan for treatment and management including
alternative therapies? What is your care plan for the patient? How would you
offer caregiver support?
Reflection notes: What would you do differently in a similar
patient evaluation? How might you improve your assessment, diagnosis, and/or
plan through interprofessional collaboration?
Refer to this week’s Learning Resources for guidance on
writing SOAP Notes.
By Day 7 of Week 4
This Assignment is due. You will submit this Week 3 SOAP
Note along with your Journal Entries (from Weeks 1, 2, and 4) by Day 7 of Week
4.
Week 4
assignment 2
Assignment: Practicum – Week 1 Journal Entry
As a future advanced practice nurse, it is important that
you are able to connect your classroom experience to your practicum experience.
By applying the concepts you study in the classroom to clinical settings, you
enhance your professional competency. Each week, you complete an Assignment
such as a Journal Entry or SOAP Note that prompts you to reflect on your
practicum experiences and relate them to the material presented in the
classroom. This week, you begin documenting your practicum experiences in your
Practicum Journal. Please use the Practicum Journal Template, located in this
week’s Learning Resources.
To prepare for this course’s Practicum Experience, address
the following in your practicum journal:
Select an aging theory to guide your practice.
Develop goals and objectives for the Practicum Experience in
this course. Be sure to consider geriatric competencies.
Create a timeline of practicum activities based on your
practicum requirements.
By Day 7 of Week 4
This Assignment is due. You will submit this Week 1 Journal
Entry along with the Week 2 and Week 3 Journal Entries and Week 3 SOAP Note by
day 7 of Week 4.
Assignment: Practicum – Week 2 Journal Entry
To prepare for this course’s Practicum Experience, reflect
on implications of age-related changes in geriatric patients. Explain how you
might differentiate between normal behaviors/disorders due to aging and
abnormal behavior/disorders that are not age related. Include how functional
assessments might help distinguish “normal” from “abnormal.”
By Day 7 of Week 4
This Assignment is due. You will submit this Week 2 Journal
Entry, the Week 1 and Week 4 Journal Entries, and the Week 3 SOAP Note by Day 7
of Week 4.
Assignment: Practicum – Week 4 Journal Entry
Reflect on medication adherence issues you have encountered
with geriatric patients in your practicum setting. Explain implications of
these issues on patient health, as well as strategies to improve medication
adherence for geriatric patients. If you did not have an opportunity to
evaluate a patient with this background during the last 4 weeks, you can select
a related case study or reflect on previous clinical experiences.
By Day 7 of Week 4
This Assignment is due. Please submit the Journal Entries
(Weeks 1, 2, and 4), and the Week 3 SOAP Note by Day 7 of Week 4 (this week).
Note: Be sure to submit your Assignment to the appropriate
submission link below.
Submissions should match the following:
Week 3 SOAP Note: Submit to the Week 4 Assignment – Part 1
submission link.
Weeks 1, 2, & 4 Journal Entry: Submit to the Week 4
Assignment – Part 2 submission link.
For the Journal Entries—which are assessed with a
Satisfactory (S) or Unsatisfactory (U) score—the numerical grade will show as 0
points and the “S” or “U” will be posted in the Feedback area by your
Instructor. These scores of 0 points do not affect your grade; they simply
allow for a placeholder to place the “S” or “U” scoring. This concept also
applies to Weeks 7 and 10.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: WK4AssgnPX+lastname+first initial.
Click the Assignment Week 4 – Part X link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK4AssgnPX+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
Week 6
assignment 1
Assignment 1: Application – PICO Analysis of Dementia,
Delirium, and Depression
A PICO analysis is used to pose a focused clinical question
to which you find appropriate evidence-based answers. The PICO question should
include the patient or population (P), anticipated intervention (I), comparison
group or current standard (C), and outcome desired (O). In this Assignment, you
develop a question related to dementia, delirium, or depression. Through your
PICO analysis, you explore various resources and examine current evidence to
answer the question you develop.
To prepare:
Select one of the following disorders as your topic:
dementia, delirium, or depression.
Review the guidelines in the “Literature Review Matrix”
document in this week’s Learning Resources.
Think about a research question around your issue as
indicated in Part I: PICO Analysis of Research Topic.
Consider the resources you will use, search terms and
criteria, and Boolean search strings as indicated in Part II: Search Strategy.
Using the Walden Library and other appropriate databases,
locate five articles related to your PICO question. At least one article must
be a systematic review. All of the articles should be primary sources.
Reflect on the five articles you selected as indicated in
Part III: Analysis of Literature. Consider the conceptual framework/theory,
main finding, research method, strengths of study, weaknesses, and level of
evidence for each article.
Consider how to use the summaries in Part III to create an
evidence table. Use this evidence table to determine appropriate treatment
options for patients who present with the disorder you selected as your topic.
To complete:
Formulate a question around the disorder you selected as
indicated in Part I: PICO Analysis of Research Topic.
Identify the resources you will use, search terms and
criteria, and Boolean search strings as indicated in Part II: Search Strategy.
Summarize the five articles you selected as indicated in Part
III: Analysis of Literature. Describe the conceptual framework/theory, main
finding, research method, strengths of study, weaknesses, and level of evidence
for each article.
Create an evidence table based on the article summaries in
Part III. Describe appropriate treatment options for patients based on this
evidence table.
By Day 7 of Week 6
This Assignment is due.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: “WK6Assgn1+lastname+first initial”.
Click the Week 6 Assignment 1 link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK6Assgn1+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
Week 7
assignment 1
Assignment: Practicum – Week 7 SOAP Note
Select a geriatric patient that you examined during the last
4 weeks. The patient you select should be currently taking at least five
prescription and/or over-the-counter drugs. With this patient in mind, address
the following in a SOAP Note:
Subjective: What was the patient’s subjective complaint?
What details did the patient provide regarding his or her personal and medical
history? Include a list of prescription and over-the-counter drugs the patient
is currently taking. Compare this list to the Beers Criteria and consider
alternative drugs if appropriate.
Objective: What observations did you make during the
physical assessment? What functional assessments were used?
Assessment: What were your differential diagnoses? Provide a
minimum of three possible diagnoses. List them from top priority to least
priority.
Plan: What was your plan for diagnostics and primary
diagnosis? What was your plan for treatment and management including
alternative therapies? What is your care plan for the patient? How would you
offer caregiver support?
Reflection notes: What would you do differently in a similar
patient evaluation? How might you improve your assessment, diagnosis, and/or
plan through interprofessional collaboration?
Refer to the Week 3 Learning Resources for guidance on
writing SOAP Notes.
By Day 7 of Week 7
This Assignment is due. You will submit this Week 7 SOAP
Note along with your Journal Entries (from Weeks 5 and 6) by Day 7 of Week 7
(this week).
Note: Be sure to submit your Assignment to the appropriate
submission link below.
Submissions should match the following:
Week 7 SOAP Note: Submit to the Week 7 Assignment – Part 1
submission link.
Weeks 5 and 6 Journal Entry: Submit to the Week 7 Assignment
– Part 2 submission link.
For the Journal Entries—which are assessed with a Satisfactory
(S) or Unsatisfactory (U) score—the numerical grade will show as 0 points and
the “S” or “U” will be posted in the Feedback area by your Instructor. These
scores of 0 points do not affect your grade; they simply allow for a
placeholder to place the “S” or “U” scoring. This concept also applies to Weeks
4 and 10.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: WK7AssgnPX+lastname+first initial.
Click the Assignment Week 7 – Part X link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK7AssgnPX+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
Week 7
assignment 2
Assignment: Practicum – Week 5 Journal Entry
Reflect on atypical presentations of disorders in geriatric
patients in your practicum setting. Many disorders manifest themselves in a way
that would be considered an atypical presentation—most likely different from
the way a textbook would describe the disorder’s possible presentations.
Consider geriatric patients that you have observed with atypical presentations
of disorders. Describe a patient case including how the patient was diagnosed
and strategies that were used to overcome the atypical presentation. If you did
not have an opportunity to evaluate a patient with this background during the last
5 weeks, you can select a related case study or reflect on previous clinical
experiences.
By Day 7 of Week 7
This Assignment is due. You will submit this Week 5 Journal
Entry along with the Week 6 and the Week 7 SOAP Note by Day 7 of Week 7.
Assignment 2: Practicum – Week 6 Journal Entry
Reflect on geriatric patients from your practicum site that
you may have assessed for dementia, delirium, or depression. Explain the impact
of these types of disorders on frail elders. Then, describe a patient case
including the care plan for assessment, diagnoses, treatment, management, and
patient education. Explain whether the patient’s care plan was effective.
Include how you might proceed differently in the future. If you did not have an
opportunity to evaluate a patient with this background during the last 6 weeks,
you can select a related case study or reflect on previous clinical
experiences.
By Day 7 of Week 7
This Assignment is due. You will submit this Week 6 Journal
Entry along with the Week 5 Journal Entry and the Week 7 SOAP Note by Day 7 of
Week 7.
Week 8
assignment
Assignment 1: Application – Diagnosing and Treating Skin
Wounds
Skin wounds are sometimes challenging for health care
providers to diagnose and treat as many have similar presentations. For
advanced practice nurses, being able to identify various types of skin wounds,
including whether a wound is a colonization or an infection, is critical
because it impacts recommended patient care. In your role, you must be able to
evaluate skin wounds, determine the diagnosis, and develop an appropriate
treatment and management plan according to current evidence-based guidelines.
To prepare:
Review Chapter 46 of the Resnick text, as well as the Burr
article in this week’s Learning Resources.
Consider how to properly diagnose skin wounds in frail
elders, including how to distinguish between a colonization and infection.
Select a type of skin wound, such as bumps, bruises,
shingles, herpes, bullous pemphigoid, Stevens-Johnson syndrome, etc. Research
the guidelines for treatment of the skin wound you selected. Reflect on how you
would treat and/or dress this wound.
Think about factors that might contribute to the development
of the skin wound you selected. Consider strategies for the prevention and
improvement of this type of wound.
To complete:
Write a 2- to 3-page paper that addresses the following:
Explain how to properly diagnose skin wounds in frail
elders, including how to distinguish between a colonization and infection.
Describe the type of skin wound you selected.
Explain how you would treat and/or dress this wound based on
guidelines for treatment.
Explain factors that might contribute to the development of
the skin wound you selected. Include strategies for the prevention and
improvement of this type of wound.
By Day 7
This Assignment is due.
Note: The School of Nursing requires that all papers
submitted include a title page, introduction, summary, and references. The
Sample Paper provided at the Walden Writing Center provides an example of those
required elements (available at
http://academicguides.waldenu.edu/writingcenter/templates). All papers
submitted must use this formatting.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: “WK8Assgn1+lastname+first initial”.
Click the Week 8 Assignment 1 link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK8Assgn1+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
Week 10
assignment
Assignment 2: Practicum – Week 8 Journal Entry
Reflect on geriatric patients from your practicum site.
Consider frail elder patients that you have assessed for skin wounds such as
bumps, bruises, shingles, herpes, bullous pemphigoid, Stevens-Johnson syndrome,
etc. Explain the consequences of these types of wounds for frail elders. Then,
describe a patient case including the care plan for assessment, diagnoses,
treatment, management, and patient education. Explain whether the patient’s
care plan was effective. Include how you might proceed differently in the
future. If you did not have an opportunity to evaluate a patient with this
background during the last 8 weeks, you can select a related case study or
reflect on previous clinical experiences.
By Day 7 of Week 10
This Assignment is due. Please submit the Journal Entries
(Weeks 8, 9 and 10) by Day 7 of Week 10.
Assignment: Practicum – Week 9 Journal Entry
An advance directive is a legal document that defines a
patient’s wishes for medical care. This document is a way for patients to share
their wishes with family members and health care providers when their illness
or mental capacity prevents them from making decisions. As an advanced practice
nurse who has care discussions with patients and their families, you need to
not only be familiar with the process of completing an advance directive, but
also understand how this document might impact your role in patient care and
treatment.
Journal Entry Part 1
For the first part of your journal entry, reflect on the
Five Wishes presented on the Five Wishes website and PDF and complete your Five
Wishes. Explain your state’s requirements for advance directives, including
whether your Five Wishes can be turned into a formal document. Then, explain
how your experience of completing your Five Wishes advance directive will help
you guide discussions with patients and their families. Finally, explain how
you might apply the Five Wishes advance directives to your nursing practice.
Include how this advance directive might benefit patients in decision making
for specialized areas of care.
Journal Entry Part 2
For the second part of your journal entry, reflect on
geriatric patients from your practicum site with disorders related to
specialized areas of care, such as oncology, nephrology, urology, gynecology,
and neurology. Describe a case of a frail elder patient who must make decisions
related to specialized areas of care. Then, explain potential patient outcomes
and include whether treatments would be beneficial and how they would impact
the patient’s quality of life. Finally, describe the patient’s wishes in terms
of treatments and interventions for the disorder (Was there an advanced
directive?) and how the patient might want to spend any remaining time. Include
how environmental factors, such as family, caregivers, ethnicity, culture,
religion, and/or personal values, might impact decision making for treatments
and interventions. If you did not have an opportunity to evaluate a patient
with this background during the last 9 weeks, you can select a related case
study or reflect on previous clinical experiences.
By Day 7 of Week 10
This Assignment is due. You will submit this Week 9 Journal
Entry, Week 8 Journal Entry and the Week 10 Journal Entry by Day 7 of Week 10.
Assignment: Practicum – Week 10 Journal Entry
Elder abuse is any intentional or negligent behavior that
results in physical, sexual, emotional, pharmacological, and/or financial
abuse. Unfortunately, abuse is sometimes difficult to identify, and elders are
often hesitant or unable to report abuse themselves (Administration on Aging,
n.d.). This makes it important for health care providers to regularly monitor
for signs of abuse and react according to local and state laws.
Journal Entry Part 1
For the first part of your journal entry, select and
describe one of the following types of elder abuse: physical, sexual,
mental/emotional/verbal, pharmacological, or financial. Explain strategies for
identifying this abuse. Then, explain how you would proceed based on your local
and state laws once you have identified this abuse in a patient. Describe
resources in your community that assist victims of this type of abuse and
explain how you, as the advanced practice nurse, might apply these resources
for abused elders who are identified in the clinical setting.
Journal Entry Part 2
For the second part of your journal entry, reflect on the
different cultures—ethnic, religious, regional, or generational—of the elder
patient population at your practicum site. Describe the cultures you have
observed and explain the influence of these cultures on the prevalence and
detection of elder abuse. Then, explain how culture might impact the way you
would implement resources for preventing or addressing abuse.
By Day 7 of Week 10
This Assignment is due. You will submit this Week 10 Journal
Entry, Week 8 Journal Entry and the Week 9 Journal Entry by Day 7 of Week 10.
For the Journal Entries —which are assessed with a
Satisfactory (S) or Unsatisfactory (U) score—the numerical grade will show as 0
points and the “S” or “U” will be posted in the Feedback area by your
Instructor. These scores of 0 points do not affect your grade; they simply
allow for a placeholder to place the “S” or “U” scoring. This concept also
applies to Weeks 4 and 7.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: WK10Assgn+lastname+first initial.
Click the Assignment Week 10 link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK10Assgn+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.
Week 11
assignment
Assignment: Practicum – Week 11 SOAP Note
Select a geriatric patient that you examined during the last
3 weeks. The patient you select should be currently taking at least five
prescription and/or over-the-counter drugs. With this patient in mind, address
the following in a SOAP Note:
Subjective: What was the patient’s subjective complaint?
What details did the patient provide regarding his or her personal and medical
history? Include a list of prescription and over-the-counter drugs the patient
is currently taking. Compare this list to the Beers Criteria and consider
alternative drugs if appropriate.
Objective: What observations did you make during the
physical assessment? What functional assessments were used?
Assessment: What were your differential diagnoses? Provide a
minimum of three possible diagnoses. List them from top priority to least
priority.
Plan: What was your plan for diagnostics and primary
diagnosis? What was your plan for treatment and management including
alternative therapies? What is your care plan for patient? How would you offer
caregiver support?
Reflection notes: What would you do differently in a similar
patient evaluation? How might you improve your assessment, diagnosis, and/or
plan through interprofessional collaboration?
Please refer to the Learning Resources in Week 3 for
guidance on writing SOAP Notes.
By Day 7 of Week 11
This Assignment is due.
Submission and Grading Information
To submit your completed Assignment for review and grading,
do the following:
Please save your Assignment using the following naming
convention: “WK11AssgnPX+lastname+first initial”.
Click the Week 11 Assignment – Part X link.
Next, from the Attach File area, click on the Browse My
Computer button. Find the document you saved as “WK11AssgnPX+last name+first
initial.(extension)” and click Open. If you are submitting multiple files,
repeat until all files are attached.
Click on the Submit button to complete your submission.

week_3_discussion.docx (136.74 KB)

Week 3
discussion
Discussion: The Impact of Ethnicity on Antidepressant
Therapy
Major depressive disorder is one of the most prevalent
disorders you will see in clinical practice. Treatment for this disorder,
however, can vary greatly depending on client factors, such as ethnicity and
culture. As a psychiatric mental health professional, you must understand the
influence of these factors to select appropriate psychopharmacologic
interventions. For this Discussion, consider how you might assess and treat the
individuals in the case studies based on the provided client factors, including
ethnicity and culture.
Learning Objectives
Students will:
Assess client factors and history to develop personalized
plans of antidepressant therapy for adult and geriatric clients
Analyze factors that influence pharmacokinetic and
pharmacodynamic processes in adult and geriatric clients requiring
antidepressant therapy
Analyze the impact of ethnicity on antidepressant therapy
Evaluate efficacy of treatment plans
Apply knowledge of providing care to adult and geriatric
clients presenting for antidepressant therapy
Learning Resources
Note: To access this week’s required library resources,
please click on the link to the Course Readings List, found in the Course
Materials section of your Syllabus.
Required Readings
Note: All Stahl
resources can be accessed through the Walden Library using this link. This link
will take you to a log-in page for the Walden Library. Once you log into the
library, the Stahl website will appear.
Stahl, S. M. (2013).
Stahl’s essential psychopharmacology: Neuroscientific basis and practical
applications (4th ed.). New York, NY: Cambridge University Press.
Note: To access the following chapters, click on the
Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select
the appropriate chapter. Be sure to read all sections on the left navigation
bar for each chapter.
Chapter 7, “Antidepressants”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New
York, NY: Cambridge University Press.
Note: To access the following medications, click on the The
Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the
appropriate medication.
Review the following medications:
amitriptyline
bupropion
citalopram
clomipramine
desipramine
desvenlafaxine
doxepin
duloxetine
escitalopram
fluoxetine
fluvoxamine
imipramine
ketamine
mirtazapine
nortriptyline
paroxetine
selegiline
sertraline
trazodone
venlafaxine
vilazodone
vortioxetine
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Note: Retrieved from Walden Library databases.
Howland, R. H. (2008a). Sequenced treatment alternatives to
relieve depression (STAR*D). Part 1: Study design. Journal of Psychosocial
Nursing and Mental Health Services, 46(9), 21–24.
doi:10.3928/02793695-20080901-06
Note: Retrieved from Walden Library databases.
Howland, R. H. (2008a). Sequenced treatment alternatives to
relieve depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial
Nursing and Mental Health Services, 46(19), 21–24.
doi:10.3928/02793695-20081001-05
Note: Retrieved from Walden Library databases.
Yasuda, S.U., Zhang,
L. & Huang, S.-M. (2008). The role of ethnicity in variability in response
to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology &
Therapeutics, 84(3), 417–423. Retrieved from
/orders/web.archive.org/web/20170809004704//orders/www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf
To prepare for this Discussion:
Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following case studies to review for this
Discussion. To access the following case studies, click on the Case Studies tab
on the Stahl Online website and select the appropriate volume and case number.
Case 1: Volume 1, Case #1: The man whose antidepressants
stopped working
Case 2: Volume 1, Case #7: The case of physician do not heal
thyself
Case 3: Volume 1, Case #29: The depressed man who thought he
was out of options
Review this week’s Learning Resources and reflect on the
insights they provide.
Go to the Stahl Online website and examine the case study
you were assigned.
Take the pretest for the case study.
Review the patient intake documentation, psychiatric
history, patient file, medication history, etc. As you progress through each
section, formulate a list of questions that you might ask the patient if he or
she were in your office.
Based on the patient’s case history, consider other people
in his or her life that you would need to speak to or get feedback from (i.e.,
family members, teachers, nursing home aides, etc.).
Consider whether any additional physical exams or diagnostic
testing may be necessary for the patient.
Develop a differential diagnoses for the patient. Refer to the
DSM-5 in this week’s Learning Resources for guidance.
Review the patient’s past and current medications. Refer to
Stahl’s Prescriber’s Guide and consider medications you might select for this
patient.
Review the posttest for the case study.

week_7_discussion.docx (162.56 KB)

Week 7 discussion
Discussion: Sleep/Wake Disorders
It is not uncommon to experience a night or two of disrupted
sleep when there is something major going on in your life. However, sleep/wake
disorders are much more than an occasional night of disrupted sleep. A recent
report from the Centers for Disease Control and Prevention estimated that
between 50 and 70 million American have problems with sleep/wake disorders
(CDC, 2015). Although the vast majority of Americans will visit their primary
care provider for treatment of these disorders, many providers will refer
patients for further evaluation. For this Discussion, you consider how you
might assess and treat the individuals based on the provided client factors.
Learning Objectives
Students will:
Assess client factors and history to develop personalized
therapy plans for clients with sleep/wake disorders
Analyze factors that influence pharmacokinetic and
pharmacodynamic processes in clients requiring therapy for sleep/wake disorders
Evaluate efficacy of treatment plans for clients presenting
for sleep/wake therapy
Apply knowledge of providing care to adult and geriatric
clients presenting for sleep/wake disorders
Learning Resources
Note: To access this week’s required library resources,
please click on the link to the Course Readings List, found in the Course
Materials section of your Syllabus.
Required Readings
Note: All Stahl
resources can be accessed through the Walden Library using this link. This link
will take you to a log-in page for the Walden Library. Once you log into the
library, the Stahl website will appear.
Stahl, S. M. (2013).
Stahl’s essential psychopharmacology: Neuroscientific basis and practical
applications (4th ed.). New York, NY: Cambridge University Press.
To access the following chapters, click on the Essential
Psychopharmacology, 4th ed tab on the Stahl Online website and select the
appropriate chapter. Be sure to read all sections on the left navigation bar
for each chapter.
Chapter 11, “Disorders of Sleep and Wakefulness and Their
Treatment”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New
York, NY: Cambridge University Press.
To access information on the following medications, click on
The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the
appropriate medication.
Review the following medications:
For insomnia
alprazolam
amitriptyline
amoxapine
clomipramine
clonazepam
desipramine
diazepam
doxepin
flunitrazepam
flurazepam
hydroxyzine
imipramine
lorazepam
nortriptyline
ramelteon
temazepam
trazodone
triazolam
trimipramine
zaleplon
zolpidem
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Note: Retrieved from Walden Library databases.
Davidson, J. (2016).
Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines.
British Journal of Psychiatry, 2(6), e16-e18. doi:10.1192/bjpo.bp.116.003707.
Retrieved from http://bjpo.rcpsych.org/content/2/6/e16
To prepare for this Discussion:
Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following case studies to review for this
Discussion. To access the following case studies, click on the Case Studies tab
on the Stahl Online website and select the appropriate volume and case number.
Case 1: Volume 2, Case #16: The woman who liked late-night
TV
Case 2: Volume 2, Case #11: The figment of a man who looked
upon the lady
Case 3: Volume 1, Case #5: The sleepy woman with anxiety
Review this week’s Learning Resources and reflect on the
insights they provide.
Go to the Stahl Online website and examine the case study
you were assigned.
Take the pretest for the case study.
Review the patient intake documentation, psychiatric
history, patient file, medication history, etc. As you progress through each
section, formulate a list of questions that you might ask the patient if he or
she were in your office.
Based on the patient’s case history, consider other people
in his or her life that you would need to speak to or get feedback from (i.e.,
family members, teachers, nursing home aides, etc.).
Consider whether any additional physical exams or diagnostic
testing may be necessary for the patient.
Develop a differential diagnoses for the patient. Refer to
the DSM-5 in this week’s Learning Resources for guidance.
Review the patient’s past and current medications. Refer to
Stahl’s Prescriber’s Guide and consider medications you might select for this
patient.
Review the posttest for the case study.