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NSG6440 Practicum IV: Family Health Evidence-Based Clinical Intervention

NSG6440 Practicum IV: Family Health Evidence-Based Clinical Intervention NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionRunning head: CLINICAL INTERVENTION 1CLINICAL INTERVENTION 2Evidence-Based Clinical InterventionNSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionAcute BronchitisAcute Bronchitis affects patients of all ages and is common complaint in the outpatient setting (Goolsby & Grubbs, 2015). It is often a self-limiting inflammation of the trachea and bronchi due to a viral infection of the upper airway that is characterized by a cough that last one to three weeks, without the presence of pneumonia (Kinkade, 2016).NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionTypical Presenting Signs and SymptomsPatients that present with Bronchitis have a complaint of cough that has lasted more than five days and may also have associated sputum production during the acute phase of the illness. Patients may also report associated symptoms of fever, malaise, chest discomfort, chills, and headache (Goolsby & Grubbs, 2015). The complaints of chest discomfort and chills will be mild compared to these same symptoms seen in pneumonia (Goolsby & Grubbs, 2015). Wheezes or rhonchi may be heard when the lungs are auscultated but will clear when patient coughs (Goolsby & Grubbs, 2015). This is no egophony and fremitus will be equal (Goolsby & Grubbs, 2015). Patients may report chest wall tenderness related to cough causing muscle strain (Buttaro et al., 2013).ORDER A PLAGIARISM-FREE PAPER HEREIt is important to for the provider to distinguish acute bronchitis from chronic bronchitis, which is often a condition found in patients with chronic obstructive pulmonary disease that has a cough that last for at least three months in two successive years (Kinkade, 2016).Pathophysiology of the ProblemEdematous changes to the mucous membrane of the tracheobronchial tree, cell damage to the epithelial, proinflammatory mediators releasing, and having an increase of secretions results in acute bronchitis. Obstruction of the airway may occur causing a transient airway and bronchial hyperresponsiveness. Smoking cigarettes and chemical irritants can increase the severity of the viral infection causing worsening of symptoms (Buttaro, Trybulski, Bailey, & Sandberg-Cook, 2013).NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionDifferential DiagnosesInfluenza (J11.1))Influenza symptoms abruptly appear after an incubation period of 1 to 2 days. Fever, chills, headache, malaise, myalgia, and loss of appetite are symptoms commonly seen. Respiratory symptoms can also appear with influenza which can include a dry cough, nasal congestion, clear nasal drainage, and sore throat. Fever will often rapidly increase between 100o F to 104o F within 12 hours of onset of symptoms. The fever will usually start to decline by the second or third day but has the potential to last four to eight days. Once the febrile stage has passed the patient will have a convalescent phase for about 2 weeks after, which includes a cough and feelings of malaise and fatigue (Buttaro et al., 2013).NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionAcute Nasopharyngitis (J00)Patients will complain of feelings of malaise and fever with initial onset but will otherwise feel well except for complaints of nasal congestion. Symptoms resolve by days 5 to 7. Physical exam findings will be negative for fever, sinus pain/tenderness, or chest congestion (Goolsby & Grubbs, 2015).Pneumonia (J18.9)Common clinical symptoms of pneumonia are cough, fever, pleuritic chest pain, chills, dyspnea, and sputum production. When mucopurulent sputum is seen it is most often associated with a bacterial pneumonia, whereas a scant and watery sputum appearance is more suggestive of an atypical pathogen. Other features commonly seen in are gastrointestinal symptoms (such as, nausea, vomiting, diarrhea) and mental status changes. Chest x-ray can confirm suspicion for pneumonia (Cash & Glass, 2014).Evidence-Based Practice TreatmentProper diagnosing of acute bronchitis is done by performing a detailed history and physical exam that focuses on ruling out pneumonia as the primary diagnosis. Providers need to pay attention to complaints of symptoms that are systematic, such as fever, myalgia, and dyspnea. In acute bronchitis lungs sounds auscultated should be without signs of lung consolidation, such as crackles, egophony, increased fremitus, and/or dullness to percussion. If there is an absence of signs and symptoms patients do not need diagnostic testing completed (Hart, 2014).NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionThe mainstay treatment for acute bronchitis is symptom management and supportive care. This includes over-the-counter (OTC) medications for treatment of the patient’s cough, such as Mucinex DM. Nasal saline spray will help nasal congestions symptoms. Ibuprofen or acetaminophen can be given per directions on packing to relieve fever symptoms. In a randomized control trial ibuprofen was shown to have no benefit compared with a placebo in relieving cough or congestion symptoms for patients with acute bronchitis. Antihistamines, such as Claritin 10mg oral daily, can be used in combination with decongestants to treat the patients acute cough but are not recommended by the U.S. Food and Drug Administration due to warnings for adverse effects with no benefit found when compared to placebo in relieving acute cough symptoms (Kinkade, 2016).NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionMultiple studies have been completed on antibiotic use in acute bronchitis and have found no improvement in symptoms when patients are prescribed antibiotics. Patients who smoke have been shown to have a significant reduction in their cough with antibiotic treatment by 0.6 days. Due to this knowledge antibiotics can play a minor role with the management of acute bronchitis in these patients (Hart, 2014).Expected OutcomesPatients with acute bronchitis are expected to have positive outcomes. It is important that they receive realistic education on the expectation of the duration for their cough that could last up to 3 weeks. Patients can use OTC medications for symptoms control and should be educated to rest, increase their fluids, and use a clean air humidifier for moist air to assist with symptoms. Avoidance of irritants, such as air pollution and smoke will help to decrease symptoms (Buttaro et al., 2013).NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionAlgorithm for Acute BronchitisAlgorithms are used in the clinical setting for delivery of treatment that is safer and more effective. It is important to appropriately manage initial treatment strategies to prevent complications that could have a negative effect on the patient’s quality of life (Hongo et al., 2017). According to Kinkade (2016) a good algorithm for acute bronchitis is the following:Family Health Soap NoteName (Initials): B.B.Date: 11/21/2021  Age: 20Sex: Female SUBJECTIVE Data   Chief Complaint (CC): “I’m coughing and I am having congestion for the last week.” History of Present Illness (HPI):  NSG6440 Practicum IV: Family Health Evidence-Based Clinical Intervention Patient is a 20-year-old female that presents to the clinic for complaints dry cough and nasal congestion for the last 6 days. Patient stated coughing is worse when first waking up in the morning but seems the same throughout the rest of the day and night. Patient denies any complaints of fever, chills, or headache. Patient reports she works at grocery store as a cashier and has had several sick contacts coughing around her. Patient denies anyone in the home with the same symptoms. Medications: (Name of the medication, route, dosage, and reason for med NoneMedication Intolerances:None Past Medical History (PMH) Allergies (Drugs, Food, and Environmental): NKDA.Tobacco, alcohol, or illicit drug use in the past:Denies smoking.Denies alcohol use.Denies drug or substance abuse.Chronic Illnesses/Major traumas:Denies any chronic illness or major traumas. History of any illness: Childhood: Negative for anything acute-per admits to normal childhood coughs/coldsAdult: NoneGenital/Urinary: NonePsychiatric: Denies any psychiatric history.NSG6440 Practicum IV: Family Health Evidence-Based Clinical Intervention Hospitalizations/Surgeries:None Family History Father: Alive age 52-HealthyMother: Alive age 48-HealthySiblings: 1 Sister -Healthy, 1 Brother -Healthy Social History Currently works as a cashier part time ,Single and lives in home with parents and siblings. Patient stated she participates in track every year and softball. Patient stated she enjoys spending time with friends at the beach for relaxation.ROSGeneral: No fever, chills, night sweats, non-purposeful weight changes or extreme fatigue.Cardiovascular: No chest pain, palpitations, no orthopnea, no edema to lower legs.Skin: No abnormality identified. Appears well hydrated for age, skin color within normal, pink warm and dry.NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionRespiratory: Positive for non-productive cough. No shortness of breath, hemoptysis, or wheezing.Eyes: No lenses, no other visual changes reportedGastrointestinal: No abdominal pain, epigastric pain, no nausea, no vomiting, no diarrhea, no black tarry stools, no flank pain.Ears: No hearing loss, no ringing in ears, no discharge or drainageGenitourinary: Denies urgency, frequency, burning, or change in urine color. Not sexually active, denies any history of STD’s.Nose/Mouth/Throat: Positive for nasal congestion. No sinus drainage, no throat painMusculoskeletal: No joint swelling, no gait disturbances, no back pain, no other weakness to extremities.Breast: No mass, no bumps, no nipple discharge.Neurological: No syncope, no dizziness, no seizures, no weakness, no paresthesias or black out spellsHeme/Lymph/Endo: No bruising, no blood transfusion history, no night sweats, no swollen glands, no increase thirstPsychiatric: No personal history of anxiety and depression. No sleeping difficulties, no suicidal ideation/attempts.NSG6440 Practicum IV: Family Health Evidence-Based Clinical Intervention OBJECTIVE Data Weight 135 lbs BMI 21.8Temp 98.8 oralBP 124/70Height 5 ft 6 inchPulse 78Resp 18 O2: 100% RA General Appearance Healthy adult, appears stated age in no acute distress. Independent 20-year-old who is very pleasant. Alert and oriented to person, place, time, and situation. Answering questions without hesitation and appropriately. Appears well kempt and clean.SkinPink, warm, and dry. Intact, no lesions or masses. No bruising noted on bilateral arms, wrists, hands, or lower extremities.HEENTHead: Appears normal for size and shape, hair evenly distributed. Eyes: Pupils are equal, round and reactive to light, normal conjunctiva. Ears: EACs patent and non-erythematous bilaterally. No mastoid/tragus tenderness. TM’s dull grey bilaterally. No excess cerumen is identified. Nose: No erythema, septum midline, no sinus tenderness, no nasal drainage. Neck: No palpable nodes. Oral mucosa: pink and moist. Teeth: Good dentition. Pharynx: No redness, no exudate or vesicles observed.CardiovascularRegular rate and rhythm, S1, S2 heard on auscultation, no rubs, clicks, murmurs, or extra sounds identified. No thrills, heaves, or lifts with palpitation. Capillary refill less than 2 seconds, pulses bilateral radials 2+, bilateral dorsal pedis 2+. No carotid bruits heard. No edema.NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionRespiratoryThorax is symmetric with good expansion. Lungs resonant. Breath sounds clear throughout all lung fields. Chest wall in non-tender. Respirations are non-labored. GastrointestinalFlat, soft, and non-distended. Normal bowel sounds. Non-tender, no suprapubic tenderness, no bladder distention. No rebound tenderness. No masses or hepatosplenomegaly. Spleen and kidneys are non-palpable. No CVA tenderness.BreastDeferred at time of exam.GenitourinaryDeferred at time of exam.MusculoskeletalFull ROM seen in all four extremities. Radial pulses 2+ bilaterally. No tenderness of the bilateral elbows, or shoulders. No crepitus. Normal gait.NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionNeurological Speech is clear, good tone, no difficulty swallowing or articulating words. Balance stable with a normal gait. Mental status AAOx3. Reflexes intact 2+. Symmetrical strength in upper and lower extremities. Sensation to light touch and pinprick intact bilateral side of body.PsychiatricAlert and oriented to person, place, time, and situation. Clothes are clean. Maintains good eye contact, speech is soft, thoughts organized and clear. Normal rate and cadence when speaking.Lab TestsInfluenza swab-NegativeSpecial TestsNone Differential Diagnoses and Diagnosis  Primary diagnosis Bronchitis (J20.9)This diagnosis is supported by complaints non-productive cough for longer than 5 days,complaints of nasal congestion, physical exam findings of clear lung sounds, andnegative influenza swab. Patients that present with Bronchitis have a complaint of coughthat has lasted more than five days and may also have associated sputum productionduring the acute phase of the illness. Patients may also report associated symptoms offever, malaise, chest discomfort, chills, and headache (Goolsby & Grubbs, 2015).NSG6440 Practicum IV: Family Health Evidence-Based Clinical Intervention Differential diagnosis Influenza (J11.1)This is a differential diagnosis that is supported by the patient complaints of cough and congestion for one week and increase of influenza cases throughout Influenza symptoms abruptly appear after an incubation period of 1 to 2 days. Fever, chills, headache, malaise, myalgia, and loss of appetite are symptoms commonly seen. Respiratory symptoms can also appear with influenza which can include a dry cough, nasal congestion, clear nasal drainage, and sore throat. Fever will often rapidly increase between 100o F to 104o F within 12 hours of onset of symptoms. The fever will usually start to decline by the second or third day but has the potential to last four to eight days. Once the febrile stage has passed the patient will have a convalescent phase for about 2 weeks after, which includes a cough and feelings of malaise and fatigue (Buttaro et al., 2013). Acute nasopharyngitis (J00)This is a differential diagnosis due to patient complaints of cough with nasal congestion, physical exam findings of clear lungs, and negative influenza. Patients will complain of feelings of malaise and fever with initial onset but will otherwise feel well except for complaints of nasal congestion. Symptoms resolve by days 5 to 7. Physical exam findings will be negative for fever, sinus pain/tenderness, or chest congestion (Goolsby & Grubbs, 2015).NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionPneumonia (J18.9)This is a differential diagnosis due to patient complaints cough and congestion. Common clinical symptoms of pneumonia are cough, fever, pleuritic chest pain, chills, dyspnea, and sputum production. When mucopurulent sputum is seen it is most often associated with a bacterial pneumonia, whereas a scant and watery sputum appearance is more suggestive of an atypical pathogen. Other features commonly seen in are gastrointestinal symptoms (such as, nausea, vomiting, diarrhea) and mental status changes. Chest x-ray can confirm suspicion for pneumonia (Cash & Glass, 2014). Final Diagnosis: Bronchitis (J20.9)- This is the final diagnosis to negative influenza findings, cough occurring for 7 days with nasal congestion, several public sick contacts and no fever, chest congestion, or abnormal lung sounds (Kinkade, 2016).  PLAN including education Plan: Prescription for Benzonatate 100mg PO TID as needed for cough. Antitussive agents can be used when the patients cough is causing a significant discomfort to suppress the protective mechanism the body has for airway clearance (Hart, 2014). Flonase, nasal inhalation, 2 sprays BID for nasal congestion (Cash & Glass, 2014). Tylenol or Motrin (OTC) for fever above 101.0o F to reduce fever discomfort (Cash & Glass, 2014)NSG6440 Practicum IV: Family Health Evidence-Based Clinical Intervention· Laboratory tests ordered-None.· Diagnostic tests ordered-None.· Patient education included: Avoid exposure to sick contacts with possible respiratory illnesses. Stay away from secondhand smoke and don’t smoke or go to areas that are smoke filled. Cover mouth and nose when coughing or sneezing to prevent spread of germs. Use good hand washing methods with soap and water. Use disposable tissues when blowing nose and throw them away right after use. Get a influenza vaccination yearly (Cash & Glass, 2014).· Non-medication treatments-Rest, increase fluids, and use moist air humidifier for symptoms management (Cash & Glass, 2014).· Follow-up with patient in 48 hours if symptoms not improving (Cash & Glass, 2014).  NSG6440 Practicum IV: Family Health Evidence-Based Clinical Intervention  References 20180120221728462566137Buttaro T M Trybulski J Bailey P P Sandberg-Cook J 2013 Primary care: a collaborative practiceButtaro, T. M., Trybulski, J., Bailey, P. P., & Sandberg-Cook, J. (2013). Primary care: a collaborative practice (4th ed.). St. Louis, MO: Elsevier Mosby.Cash J C Glass C A 2014 Family practice guidelinesCash, J. C., & Glass, C. A. (2014). Family practice guidelines (3rd ed.). New York, NY: Springer Publishing Company. 201709272249431543380022 201709201958051206435442Driver C 2012 Pneumonia part 2: signs, symptoms, and vaccinations.201712192239401698832155Goolsby M J Grubbs L 2015 Advanced AssessmentGoolsby, M. J., & Grubbs, L. (2015). Advanced assessment (3rd ed.). Philadelphia, PA: F.A. Davis Company.Hart A M 2014 Evidence-based diagnosis and management of acute bronchitis.Hart, A. M. (2014). Evidence-based diagnosis and management of acute bronchitis. The Nurse Practitioner, 39(9), 32-39. doi:10.1097/01.NPR.0000452978.99676.2b 201801210126081136131644Hongo H Kikuchi E Matsumoto K Yazawa S Kanao K Kosaka TMiyajima A 2017 Novel algorithm for management of acute epidiymitis.Hongo, H., Kikuchi, E., Matsumoto, K., Yazawa, S., Kanao, K., Kosaka, T.,…Miyajima, A. (2017). Novel algorithm for management of acute epididymitis. International Journal of Urology, 24(1), 82-87. doi:doi: 10.1111/iju.13236 201801201915351447158098Kinkade S 2016 Acute Bronchitis.Kinkade, S. (2016). Acute Bronchitis. American Family Physician, 94(7), 560-565. Retrieved January 20, 2018, from http://www.aafp.org 20180120235619941551566McCance K L Huether S E 2014 Pathohysiology: the biologic basis for disease in adults and childrenMcCance, K. L., & Huether, S. E. (2014). Pathophysiology: the biologic basis for disease in adults and children (7th ed.). St. Louis, MO: Elsevier Mosby. 201801202030081369347096NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionDiscussion QuestionsYou are a Family Nurse Practitioner working in a community health center. You are seeing a 14-year-old adolescent patent for an annual visit. The patient’s mother is also present during the visit and notes that the patient’s grades in school have been declining. Her son is also hanging out with a group of kids that she has concerns about. The mother has concerns for what is going on with her son. Answer the following questions using course resources (texts) and two other evidence-based sources (current guidelines and/or scholarly articles that are within a 3-5 year time frame).What are the components of an annual exam for an adolescent patient?Is the mother required to be present during your exam?Describe 1 health promotion idea that you would discuss with your middle adolescence patient. Why is this idea important?What are some screening tools that might be of importance in this situation? (hint: do you suspect drug or alcohol abuse here?)Week 2 Project 2 SOAP Note and eMedley EntriesEach week, you are required to enter your patient encounters into eMedley. Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience. You will also need to include a minimum of one complete SOAP note using this template . The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Submissions Area. When submitting your note, be sure to include the reference number from eMedley.NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionSubmission Details:By the end of the week enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.Name your SOAP note document SU_NSG6440_W2_SOAPLastName_FirstInitial.doc.Include the reference number from eMedley in your document.Submit your document to the Submissions Area by the due date assigned.NSG 6440 Week 2 DiscussionThis week you learned about common conditions in the adolescent client.  Please review the following case study and answer the following questions.A fifteen-year-old female presents to your clinic complaining of shortness of breath and a nonproductive nocturnal cough. She states she used to feel this way only with extreme exercise, but lately, she has felt this way continuously. She denies any other upper respiratory symptoms, chest pain, gastrointestinal symptoms, or urinary tract symptoms. Her past medical history is significant only for seasonal allergies, for which she takes a nasal steroid spray but is otherwise on no other medications. She has had no surgeries. Her mother has allergies and eczema, and her father has high blood pressure. She is the only child. She denies smoking and illegal drug use. On examination, she is in no acute distress and her vital signs are: T 98.6, BP 120/80, pulse 80, and respirations 20. Her head, eyes, ears, nose, and throat examinations are essentially normal. Inspection of her anterior and posterior chest shows no abnormalities. On auscultation of her chest, there is decreased air movement and high-pitched whistling on expiration in all lobes. Percussion reveals resonant lungs.NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionWhat is the chief complaint?Based on the subjective and objective information provided what are your 3 top differential diagnosis listing the presumptive final diagnosis first?What treatment plan would you consider utilizing current evidence based practice guidelines?NSG 6440 Week 3 DiscussionIn week 3 you learned about other common adolescent health conditions.  Review the following case study and answer the following questions:An 18 year old white female presents to your clinic today with a 2 week history of intermittent abdominal pain.  She also is positive forperiodic cramping and diarrhea as well as low grade fever.  She also notes reduced appetite. She notes that She admits smoking ½ PPD for the last 2 years. Denies any illegal drug or alcohol use. Does note a positive history of Crohn’s Disease.  Based on the information provided answer the following questions:What are the top 3 differentials you would consider with the presumptive final diagnosis listed first?What focused physical exam findings would be beneficial to know?What diagnostic testing needs completed if any to confirm diagnosis?Using evidence based treatment guidelines note a treatment plan.Submission Details:Post your response to the Discussion Area by the due date assigned. Respond to atleast two posts by the end of the week.NSG 6440 Practicum IV Family Health Primary CareNSG 6440 Week 3 Midweek Assignment Aquifer Case Study #1For this assignment, you will complete a Aquifer case study based on the course objectives and weekly content. Aquifer cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the Aquifer case studies to promote the development of clinical reasoning through the use of ongoing assessment and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionAfter you complete the Aquifer case study for the week, please print out the summary of your case session and submit as a PDF file to the Submissions Area. Note that the summary of your case session has your name on the top right hand corner. You need to submit this document as evidence that you have completed the case.The Aquifer assignments are highly interactive and a dynamic way to enhance your learning. Material from the Aquifer cases will be present in the weekly quizzes, midterm, and final exam. You must have all Aquifer assignments completed in order to successfully pass the course.NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionUse this link for information on how to access and navigate Aquifer.This week complete the case entitled “Case #22: 70-year-old male with new-onset unilateral weakness – Mr. Wright.”NSG 6440 Practicum IV Family Health Primary CareSubmission Details:Name your document SU_NSG6440_W3_MidWeekProject_LastName_FirstInitial.pdf.Submit your document to the Submissions Area by the due date assigned.NSG 6440 Week 4 DiscussionThis week’s content addressed common chronic diseases.  Please review the case study below and answer the following questions:A sixty-year-old baker presents to your clinic, complaining of increasing shortness of breath and nonproductive cough over the last month. She feels like she can’t do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is significant for high blood pressure and coronary artery disease. She had a hysterectomy in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She denies any tobacco, alcohol, or drug use. Her mother died of a stroke, and her father died from prostate cancer. She denies any recent upper respiratory illness, and she has had no other symptoms. On examination, she is in no acute distress. Her blood pressure is 160/100, and her pulse is 100. She is afebrile, and her respiratory rate is 16. With auscultation, she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination, the S1 and S2 are distant and an S3 is heard over the apex.NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionWhat is the chief complaint?Based on the subjective and objective information provided what are your 3 top differential diagnosis listing the presumptive final diagnosis first?What treatment plan would you consider utilizing current evidence based practice guidelines?NSG 6440 Practicum IV Family Health Primary CareSubmission Details:Post your response to the Discussion Area by the due date assigned. Respond to atleast two posts by the end of the week.NSG 6440 Week 4 Project 2 SOAP Note and eMedley EntriesEach week, you are required to enter your patient encounters into eMedley. Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience. You will also need to include a minimum of one complete SOAP note using this template .  The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Submission Area. When submitting your note, be sure to include the reference number from eMedley.NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionSubmission Details:By the end of the week, enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.Name your SOAP note document SU_NSG6440_W4_SOAPLastName_FirstInitial.doc.Include the reference number from eMedley in your document.Submit your document to the Submissions Area by the due date assigned.NSG 6440 Week 5 DiscussionDiscussion QuestionsThe discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, go to the Discussion Area and post a response to one question in the Discussion Area by the due date assigned. You may respond to your classmates’ posts for either question.NSG 6440 Practicum IV Family Health Primary CareTo support your work, use your course and text readings and also use the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite sources in your responses to other classmates. Complete your participation for this assignment by the end of the week.NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionAs a family nurse practitioner you are working in a rural health clinic. You are evaluating a 16-year-old adolescent patient who comes in complaining of having a difficulty concentrating in school. On exam you also note that the patient is very thin and frail in appearance and is asking you for diet pills.What are some initial areas for concern? What screening tools can help lead you closer to your diagnosis?Describe 1 health promotion strategy you can discuss with the patient.Be sure to address the following in your plan of care: pharmacological and non-pharmacological (OTC) interventions, labs, follow-up, teaching, and referral/s.Your work should integrate course resources (text/s) as well as a minimum of two (2) other evidence-based guidelines and/or articles published within 3-5 years.NSG 6440 Practicum IV Family Health Primary CareReference:Centers for Disease Control and Prevention. (2013). Youth risk behavior surveillancesystem (YRBSS). Retrieved from http://www.cdc.gov/healthyyouth/data/yrbs/index.htmNSG 6440 Week 6 DiscussionDiscussion:This week’s content discussed common psychiatric disorders in the Adult and Older Adult client.  Often times a secondary diagnosis is masked due to their psychiatric disorder.  Review the following case study and answer the following questions.Mr. White is a 72-year-old man, with a history of hypertension, COPD and moderate dementia, who presents with 4 days of increased confusion, nighttime restlessness, visual hallucinations, and urinary incontinence. His physical exam is unremarkable except for tachypnea, a mildly enlarged prostate, inattentiveness, and a worsening of his MMSE score from a baseline of 18 to 12 today.NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionMr. White’s presentation is most consistent with an acute delirium (acute change in cognition, perceptual derangement, waxing and waning consciousness, and inattention).What is the most likely diagnosis to frequently cause acute delirium in patients with dementia?What additional testing should you consider if any?What are treatment options to consider with this patient?Submission Details:Post your response to the Discussion Area by the due date assigned. Respond to atleast two posts by the end of the week.NSG 6440 Week 6 Project Aquifer Case StudyFor this assignment, you will complete a Aquifer case study based on the course objectives and weekly content. Aquifer cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the Aquifer case studies to promote the development of clinical reasoning through the use of ongoing assessment and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.After you complete the Aquifer case study for the week, please print out the summary of your case session and submit as a PDF file to the Submissions Area. Note that the summary of your case session has your name in the top-right corner. You need to submit this document as evidence that you have completed the case.The Aquifer assignments are highly interactive and a dynamic way to enhance your learning. Material from the Aquifer cases will be present in the weekly quizzes, the midterm exam, and the final exam. You must have all Aquifer assignments completed in order to successfully pass the course.NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionUse this link for information on how to access and navigate Aquifer.This week, complete the case entitled “Case #26: 55-year-old male with fatigue – Mr. Cunha.”Submission Details:Name your document SU_NSG6440_W6_Project1_LastName_FirstInitial.pdf.Submit your document to the Submissions Area by the due date assigned.NSG 6440 Week 6 Project 3 SOAP Note and eMedley EntriesEach week, you are required to enter your patient encounters into eMedley. Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience. You will also need to include a minimum of one complete SOAP note using this template . The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Submissions Area. When submitting your note, be sure to include the reference number from eMedley.NSG 6440 Practicum IV Family Health Primary CareSubmission Details:By the end of the week, enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.Name your SOAP note document SU_NSG6440_W6_SOAPLastName_FirstInitial.doc.Include the reference number from eMedley in your document.Submit your document to the Submissions Area by the due date assigned.NSG 6440 Week 7 Assignment 1 DiscussionThis week’s content addressed common techniques and testing that can be prescribed by the Nurse Practitioner.  Review ONE of the following videos and post for the class what you have learned this week:NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionWatch the following video on suturingSuture Skills Course – Learn Best Suture TechniquesWatch the following video on EKG rhythmsSkillstatSubmission Details:Post your response to the Discussion Area by the due date assigned. Respond to atleast two posts by the end of the week.NSG 6440 Week 8 DiscussionComplete The Growth and Development APEA module. Pick one of the following topics that were reviewed: Newborn assessment, Nutrition, Child, Adolescent, or Immunization. Please choose on that has not been previously covered by a peer.What is an area that you may have forgotten?Explain the specific growth and development concept in detail and describe strategies that you will undertake to assist in retaining that information?NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionNSG 6440 Week 8 ProjectAquifer Case StudyFor this assignment, you will complete a Aquifer case study based on the course objectives and weekly content. Aquifer cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the Aquifer case studies to promote the development of clinical reasoning through the use of ongoing assessment and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.After you complete the Aquifer case study for the week, please print out the summary of your case session and submit as a PDF file to the Submissions Area. Note that the summary of your case session has your name in the top-right corner. You need to submit this document as evidence that you have completed the case.The Aquifer assignments are highly interactive and a dynamic way to enhance your learning. Material from the Aquifer cases will be present in the weekly quizzes, the midterm exam, and the final exam. You must have all Aquifer assignments completed in order to successfully pass the course.NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionUse this link for information on how to access and navigate Aquifer.This week, complete the case entitled “Case #18: 24-year-old female with headaches – Ms. Payne.”NSG 6440 Week 8 SOAP Note and eMedley EntriesEach week, you are required to enter your patient encounters into eMedley. Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience. You will also need to include a minimum of one complete SOAP note using this template. The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Submissions Area. When submitting your note, be sure to include the reference number from eMedley.Submission Details:By the due date assigned, enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionName your SOAP note document SU_NSG6440_W8_SOAPLastName_FirstInitial.doc.Include the reference number from eMedley in your document.Submit your document to the Submissions Area by the due date assigned.NSG 6440 Week 9 DiscussionThis week’s content addressed professional and legal issues, state boards of nursing, advanced practice licensure, regulations, scope of practice, and national certification as an advanced practice nurse. It is your responsibility to look at your individual board of nursing and remain up to date with the changes that are carried out in your state.  For this week’s discussion review your states scope of practice and address 3 areas that you were not aware you can do as a licensed provider in your state.NSG 6440 Week 10 Discussion Evidence-Based Clinical InterventionBy the due date assigned, submit your Evidence-Based Clinical Intervention to the Discussion Area.Your Evidence-Based Clinical Intervention should be submitted in a Microsoft Word document following APA style and should include the following:NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionThe medical problem/diagnosis/disease.Typical presenting signs and symptoms including:Onset, Characteristics, Location, Radiation, Timing, Setting, Aggravating factors, Alleviating factors, Associated symptoms, Course since onset, Usual age group affectedConcomitant disease states associated with the diagnosisThe pathophysiology of the problem.Three differential diagnoses and the usual presenting signs and symptoms in priority sequence with rationales.Reference to at least two current journal articles that show evidence-based practice as how to best treat this disorder related to the primary differential.The expected outcomes of the intervention.Algorithms if available.A typical clinical note in SOAP format.NSG 6440 Practicum IV Family Health Primary CareNSG 6440 Week 10 Project 3 SOAP Note and eMedley EntriesEach week, you are required to enter your patient encounters into eMedley. Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience. You will also need to include a minimum of one complete SOAP note using this template. The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Submissions Area. When submitting your note, be sure to include the reference number from eMedley.NSG6440 Practicum IV: Family Health Evidence-Based Clinical InterventionSubmission Details:By the end of the week, enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.Name your SOAP note document SU_NSG6440_W10_SOAPLastName_FirstInitial.doc.Include the reference number from eMedley in your document.Submit your document to the Submissions Area by the due date assigned.NSG 6440 Week 10 Project APEA Postpredictor ExaminationPlease submit your proof of completion of the APEA postpredictor exam to the Submissions Area by the due date assigned.Name your document SU_NSG6440_W10_Project1_LastName_FirstInitial.doc.NSG6440 Practicum IV: Family Health Evidence-Based Clinical Intervention

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