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NR603 Discussions and Assignments Paper

NR603 Discussions and Assignments Paper


Advanced Clinical Diagnosis and Practice Across the Lifespan

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Week 1

Compare and Contrast Assignment

Compare and contrast the following diagnoses as assigned:

Student Last Name -Topic

(Find the corresponding first letter of your last name to
find your topic assignment for this discussion)

A-I – Compare and Contrast Dementia and Delirium

J-Q = Compare and Contrast Post Concussive Syndrome and
Traumatic Brain Injury

R-Z = Migraine Headache and Post Concussive Syndrome NR603 Discussions and Assignments Paper


Advanced Clinical Diagnosis and Practice Across the Lifespan

Week 2

Case Discussion: Pulmonary Part One

Setting: A free medical clinic that provides health care for
the under-insured.

Your next patient, Michelle G., age 40, is a regular of the
clinic and the last patient of the day. The chart states she is here for recent
episodes of shortness of breath.

You enter the room and Michelle G is dressed in work
clothes, standing up looking at a health poster on the wall. You introduce
yourself and ask her what brings her to the clinic today. “I think I may
have a cold. I’ve been having a hard time breathing on and off lately.“

HPI: “I notice I’m short of breath mostly at work but
by the time I get home feel fine. No episodes of shortness of breath on the
weekends that I can recall. But a few hours back at work and I start to feel
like I cannot catch my breath again. A few months ago this happened and it was
so bad I left work and went to urgent care where they gave me a breathing
treatment of some kind and sent me home on an antibiotic. I would like you to
give me another antibiotic. She denies sputum. No new allergy triggers noted.
She denies heartburn NR603 Discussions and Assignments Paper.


PMHx: Michelle G. reports her overall health as good.

Childhood/previous illnesses: eczema as a child

Chronic illnesses: Has seasonal allergies, spring is her
worst season. Was seen by an allergy specialist ten years ago, Took allergy
shots for five years with great results, now only takes Zyrtec when needed.

Surgeries: Tonsillectomy, Cholecystectomy

Hospitalizations: childbirth x 3.

Immunizations: up-to-date on all vaccinations.

Allergies: Strawberries-Rash; erythromycin- severe GI upset.

Blood transfusions: none

Drinks alcohol socially, smoked 1 pack per week for 3 years
in her 20’s. Denies illicit drug use.

Sleeps 6 to 7 hours a night. Exercises four to five days per

Current medications: Multivitamin, Zyrtec

Social History: Married, lives with husband and 3 children.
Worked in advertising up until 18 months ago when she got laid off. In order to
help with the household finances she took a job as a Baker’s assistant at an
Artisan Bread Bakery. She arrives at 4 a.m. every morning to begin baking
breads/pastries for the day.

Family History: Children are healthy- daughter currently has
a sinus infection. Parents are deceased. Mother at age 80 from congestive heart
failure. Father died at age 82 from lung cancer, diagnosed when metastasized to
brain. PGM: died from unknown causes, PGF: Stroke at age 82. MGM: died at 83,
had HTN, atherosclerosis and many heart attacks. PGF: died at 71 from
complications of COPD.

PE: Height 5’10”, Weight 140 pounds

Vital signs : BP 130/70, T 98.0, P 75, R 18 Sao2 98% on RA

General: 40-year-old Caucasian female appears stated age in
no apparent distress. Alert, oriented, and cooperative. Able to speak in full
sentences and does not appear breathless. Skin: Skin warm, dry, and intact.
Skin color is pale pink, no cyanosis or pallor.

HEENT: Head normo-cephalic. Hair thick and distribution even
throughout scalp.

Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact.

Ears: Tympanic membranes gray and intact with light reflex
noted. Pinna and tragus non-tender

Nose: Nares patent with thin white exudate noted. Mucosa
appears boggy and pale. Deviated septum noted. Sinuses non-tender to palpation.

Throat: Oropharynx pink, moist, no lesions or exudate.
Tonsils 1+ bilaterally. Teeth in good repair, no cavities noted. Tongue smooth,
pink, no lesions, protrudes in midline. Neck supple. No cervical
lymphadenopathy or tenderness noted. Thyroid midline, small and firm without
palpable masses.

Lungs: Lungs clear to auscultation bilaterally. Respirations
unlabored. Slight wheezing noted inspiration and on forced expiration. Wheezing
does not clear with forced cough.

CV: Heart S1 and S2 noted, RRR, no murmurs noted, no
displaced PMI. Peripheral pulses equal bilaterally, no peripheral edema

Abdomen: Abdomen round, soft, with bowel sounds noted in all
four quadrants. No organo-megaly noted.

Diagnostic Testing:

Review of the patient’s EMR reveals an old CXR from last
winter when she had Bronchitis.

CXR Report: 11/7/2016

This is a PA and lateral chest radiograph on Ms. Michelle X,
performed on 11/7/16. Clinical information: low grade fever, productive cough,

Findings: Cardio-mediastinal silhouette is normal. B/L lung
fields are clear. There are no effusions. The bony thorax appears normal. No
opacities or fluid. Diaphragm normal.

Impression: Normal chest radiograph without pathology.

Click here to view CXR (Links to an external site.)Links to
an external site.

You suspect an obstructive/restrictive process and order
Pulmonary Function Testing

Pre-Bronchodilator Challenge- FEV1/FVC 60%, FVC decreased

Post Bronchodilator Challenge- FEV1/FVC 75%

Discussion Questions Part One:

What is your primary diagnosis for Michelle given the
pattern of occurrence of symptoms, exam results, and recent history? Include
the rationale and a reference for your diagnoses.

What is your first-line treatment plan for Michelle
including medications, labs, education, referrals, and follow-up? Identify the
drug class of each medication you prescribe and exactly what symptom it is
targeted to address.

Address Michelle’s request for an antibiotic.


Advanced Clinical Diagnosis and Practice Across the Lifespan

Week 3

Case Discussion: Cardiovascular Part One

Week 3: PBL Case Discussion: Cardiovascular

Setting: large rural clinic; family practice clinic that
employs physicians and nurse practitioners

You open the chart to review for your next patient, and you
see it is Larry M. Larry is a 60 year-old African American male with a history
of hypertension. You note he is not due for a follow up at this time, so you
look at the chief complaint NR603 Discussions and Assignments Paper.

CC: chest pain three days ago

You enter the room and introduce yourself. Larry M. is
sitting in the chair. You ask what brings him in today. Larry M. smiles,
shaking his head and says “My wife made me come, I feel fine.” Three days ago
Larry M. felt short of breath, had this heavy feeling in his chest, and he got
kind of nauseous and sweaty. It lasted only about 3 minutes, and it has not
happened again, but he does feel a little more tired. “It could be that I have
not worked out since it happened.”

PMHx: Reports general health as good. He had been feeling
great since starting to work out and lost weight. Had lots of energy and felt
great until this episode three days ago.
Now he is a little concerned because he feels a little more tired when
he works out. He has not done as much strenuous running and has not worked out
since the episode.

Childhood/previous illnesses: chicken pox.

Chronic illnesses: Hypertension- lifestyle changes
recommended. Elevated cholesterol, lifestyle management was initiated.

Surgeries: T and A, cholecystectomy, vasectomy

Hospitalizations: None aside from surgeries listed above

Immunizations: Does not receive the flu shot.

Allergies: NKDA

Blood transfusions: None

Enjoys a beer or a glass of whiskey and the occasional cigar
when playing poker with his buddies

Current medications: None

Social History: Married for 20 years, works as an architect.

Family History: Parents are deceased. Father had lung cancer
and mother died from complications of a stroke. Brother died at 44 from
malignant melanoma. Other sister and brother are healthy.


Height: 5’8” weight: 220 pounds; BMI 33.5 vital signs: BP
146/90 P 70 Sao2 97%

General: African American male in NAD. Alert, oriented, and
cooperative. Pain: 0/10 at present

Skin: Skin warm, dry, and intact. Skin color is light
skinned brown, no cyanosis or pallor.

HEENT: Head normo-cephalic. Hair thick and distribution even
throughout scalp.

Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact.
No AV nicking noted.

Ears: Tympanic membranes gray and intact with light reflex
noted. Pinna and tragus non-tender

Nose: Nares patent without exudate. Sinuses non-tender to
palpation, Right-sided Deviation

Throat: Oropharynx moist, no lesions or exudate. Teeth in
poor repair, gums reddened and receding, filled cavities noted. Tongue smooth,
pink, no lesions, protrudes in midline.

Neck supple. No cervical lymphadenopathy or tenderness
noted. Thyroid midline, small and firm without palpable masses. Mild JVD in
recumbent position

Lungs: Lungs clear to auscultation bilaterally. Respirations
unlabored. No rashes or vesicles noted on chest. CV: Heart S1 and S2 noted,
RRR, no murmurs, noted. No parasternal lifts, heaves, and thrills. Peripheral
pulses equally bilaterally. PMI 5th ICS displaced 4cm laterally. No edema in
lower extremities.

Abdomen: Abdomen round, soft, with bowel sounds noted in all
four quadrants. No organomegaly noted.

Labs from 3 months ago:

Total Cholesterol: 230

Ldl 180

Hdl 38

EKG In office TODAY: ST depression

Click here to access the EKG
(Links to an external site.)Links to an external site.

Discussion Questions:

What is your primary diagnosis causing Larry M.’s chest
pain? Include ICD 10 codes (no differentials)

List any relevant labs/diagnostic tests and link them to
Larry’s specific case. Remember to include evidence-based support for any
testing you order along with rationale if you feel no testing is warranted.

What leads demonstrate the ST depression?

What other secondary diagnoses does Larry M. have that need
to be addressed?

Include the rationale and a reference for your diagnoses

Based on JNC 8 guidelines, is Larry M. hypertensive?

Review the ACA 2017 Recommendations for Antihypertensive
Therapy and design a plan for Larry M. Please discuss the pharmacological
properties of the therapy you chose including rationale for why this is the
best choice for Larry M.

Plan for your primary diagnosis (Include referral, education
and follow up) based on one current evidence-based journal article.

Further diagnostic work-up not included above

Medications NR603 Discussions and Assignments Paper



Advanced Clinical Diagnosis and Practice Across the Lifespan

Week 5

DQ1 APEA Predictor Assignment Part One

Step 1. Review your Week 4 APEA Predictor Exam Results and
focus on the “Percent Correct By Knowledge Area” Choose a Knowledge
Area on which you scored the lowest to work on this week.

Step 2. Once you’ve chosen the subject, research and work up
a common chief complaint from that system and present your findings in the
discussion by Wednesday, 11:59 p.m. MT of Week 5.

Work up includes:

-Chief complaint

-Associated risk factors/demographics that contribute to the
chief complaint

-Three common differential diagnoses represented by the CC
including pathophysiology and rationale

-Discuss how the 3 diff dx differ from each other in:
occurrence, pathophysiology and presentation (NOTE: Simply listing the
diagnoses and their occurrence, patho and presentations separately does not
confer an understanding of how they differ. Your discussion should compare and
contrast these items against each other among the three differentials chosen)

-relevant testing required to diagnose/evaluate severity of
the three differential diagnoses

-Review of relevant National Guidelines related to the
Diagnosis, Diagnostic testing and/or treatment of the final diagnosis.

DQ2 APEA Predictor Part Two

Post the first line treatment plan based on one diagnosis
from your differential list in SOAP format.


Advanced Clinical Diagnosis and Practice Across the Lifespan

Week 6

Mental Health Clinical Presentation Part 1

The purpose of this assignment is for learners to:

Have the opportunity to integrate knowledge and skills
learned throughout all core courses in the FNP track and previous clinical

Demonstrate an advancing understanding of the patient with a
mental health disorder in primary care.

Demonstrate the ability to analyze the literature/ previous
patients seen in the clinical setting be able to perform an evidenced-based
review of their case, diagnosis, and plan, while guiding and taking feedback
from peers regarding the case

Demonstrate professional communication and leadership, while
advancing the education of peers.

Course Outcomes

4 Develop management plans based on current scientific
evidence and national guidelines.

6 Prioritize treatment based on relevant clinical
presentation NR603 Discussions and Assignments Paper.


For Week 6 of the course there will not be a case study
given to you by the faculty. Instead you will be assigned a mental health
disorder commonly seen in primary care and you will create a case study based
on that disorder. You may create a case study either from a previous clinical
patient experience or if you have not had a patient in clinical that represents
your assigned topic you may research your disease using the week’s classroom
material and the evidence-based literature in the field. The case should be clear
and include all elements of a normal case that might be presented in class
(subjective, objective, assessment, and full 5 point plan). The clinical practicum documentation will be
helpful for this process, or notes you have taken in clinical regarding cases. The case should be clear, organized, and meet
the following guidelines:

Week 6 Part One:

This part goes in part one and should begin with subjective
and objective data just like we do in your weekly case study discussion. Do not put diagnosis until your peers

WEEK 6 Part One: The case should lead the class toward the
mental health diagnosis assigned to you by your instructor.

WEEK 6 Part One Specific Guidelines:

If this is an actual patient from clinical- Include their
actual chief complaint, demographic data, HPI, PMHX, PSHX, medications,
allergies, subjective and objective findings without identifying the patient’s

If this is a fictitious case you’ve created from the
literature/readings you should design an example patient and include chief
complaint, demographic data, HPI, PMHX, PSHX, medications and allergies,
subjective and objective findings. Be mindful that the background data for the
case should bear some relevance to the diagnosis.

The case should not be overly simple. Like your weekly case
studies, it should include subjective data that loosely represents the
diagnosis you have been given, but includes some elements of the
pathophysiology/presentation of the disease.

You must include the following elements in part one: subjective:
chief complaint/HPI, demographic data, HPI, PMHX, PSHX, subjective and
objective findings.


Leading the discussion in part one: You must respond to any student who posts
regarding your case with a substantial response, either answering their
questions or noting their response and acting as leader. You also must respond
to any faculty responses to your initial posting. Use references to support
your responses. Remember: Your response to your peers is part of where you
demonstrate your knowledge of the disease you were assigned. You should be
discussing hallmark symptoms, diagnostic tools etc along with discussing the
student’s impressions and conclusions.
Once your peers respond you can share the primary diagnosis and
treatment plan that actually occurred if it is a live patient, and the ideal
treatment plan if it is an invented case. Your treatment plan should address
any national guidelines as appropriate for the diagnosis.

Participating in part one: As a student you will be required
to respond to at least one other student, whom has no responses to their
posting**. In your response to your peer you must include the following: Your
top three (3) differentials based on the information provided, the primary
diagnosis you are leaning toward, and first line treatment for how you would
treat that diagnosis. Use references to support your response. *DEADLINE – YOUR
SO THAT THE STUDENT CAN INTERACT WITH YOU AS WE DO IN OTHER CASES. **If all students have a response, then
choose the student with the least responses to their posting NR603 Discussions and Assignments Paper.

Advanced Clinical Diagnosis and Practice Across the Lifespan

Week 8


Reflect back over the past eight weeks and describe how the
achievement of the course outcomes in this course have prepared you to meet the
MSN program outcome #4, the MSN Essential IV, and the Nurse Practitioner Core
Competencies # 7.

Program Outcome #4:
Integrate professional values through scholarship and service in health
care. (Professional identity)

MSN Essential IV: Translating and Integrating Scholarship
into Practice Recognize that the master’s-prepared nurse applies research
outcomes within the practice setting, resolves practice problems, works as a
change agent, and disseminates results.


Nurse Practitioner Core Competencies # 7

Health Delivery System Competencies

1. Applies knowledge of organizational practices and complex
systems to improve health care delivery.

2. Effects health care change using broad based skills
including negotiating, consensus-building, and


3. Minimizes risk to patients and providers at the
individual and systems level.

4. Facilitates the development of health care systems that
address the needs of culturally diverse

populations, providers, and other stakeholders.

5. Evaluates the impact of health care delivery on patients,
providers, other stakeholders, and the


6. Analyzes organizational structure, functions and
resources to improve the delivery of care.

7. Collaborates in planning for transitions across the
continuum of care NR603 Discussions and Assignments Paper.

Advanced Clinical Diagnosis and Practice Across the Lifespan

Week 2 Case
Study Summary Discussion Pulmonary Part Two

Write up the full SOAP note, including the final treatment
plan for Michelle incorporating all the learning and guidance from faculty
during the week as you would in clinic in SOAP format.

The treatment plan should include:

Specific Diagnosis

ICD 10 code




Follow up



Advanced Clinical Diagnosis and Practice Across the Lifespan

Week 3 Case
Study Summary Cardiovascular Part Two
NR603 Discussions and Assignments Paper

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