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PRAC 6540 Week 6: Grand Rounds: Complex Case Study Presentation

PRAC 6540 Week 6: Grand Rounds: Complex Case Study Presentation PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationBased on your midterm evaluation, how do you feel about your progress toward your goals? Are you receiving a diversity of experiences at your practicum site to add to your clinical toolbox? What procedures are you confident in, and what do you need to hone as an advanced practice nurse? As you progress in your practicum, reach out to your Clinical Faculty and preceptor with questions you have.This week, you will continue to engage with Meditrek, recording your clinical hours and patient encounters. You will also participate in a grand rounds discussion.Learning ObjectivesStudents will:Complete a focused SOAP note for a clinical patient*Develop a case study presentation based on a clinical patient*Analyze cases involving advanced practice care of older adultsDescribe clinical hours and patient encounters*Presenter onlyPRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationORDER A PLAGIARISM-FREE PAPER HERELearning ResourcesRequired Readings (click to expand/reduce)Recommended Readings (click to expand/reduce)Grand Rounds Discussion: Complex Case Study PresentationPhoto Credit: [RGtimeline]/[iStock / Getty Images Plus]/Getty ImagesThis week you participate in the second of four clinical discussions called grand rounds. In one of these 4 weeks, you will be a presenter as well as help facilitate the online discussion; in the others you will be an active discussion participant. When it is your week to present, you will create a focused SOAP note and a short didactic (teaching) video presenting a real (but de-identified) complex patient case from your practicum experience.You should have received communication from your Instructor letting you know which week of the course you are assigned to present.To prepare:PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationReview this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.Select a patient from your clinical experience that presents with significant comorbidities. This should not be a patient with a single, straightforward condition, such as an ear infection, nor should it be a wellness visit. Create a focused SOAP note for this patient using the template in the Resources. All SOAP notes must be signed and each page must be initialed by your preceptor. When you submit your SOAP Note, you should include the complete SOAP Note as a Word document and pdf/images of each page that is initialed and signed by your preceptor. You must submit your SOAP Note using SafeAssign.Please Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationBased on this patient case, and using the focused SOAP note as a reference, develop a case study presentation that includes the history of present illness (HPI), appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.Your presentation should also include objectives for your audience (see the resource on Bloom’s Taxonomy), at least three possible discussion questions/prompts for your classmates to respond to, and at least five scholarly resources to support your diagnostic reasoning and treatment plan.Ensure that you have the appropriate lighting and equipment to record the presentation.Video Assignment for this week’s presenters:Record yourself presenting the complex case study for your clinical patient. In your presentation:Dress professionally with a lab coat and present yourself in a professional manner.Display your photo ID at the start of the video when you introduce yourself.Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationState 3–4 objectives for the presentation that are targeted, clear, use appropriate verbs from Bloom’s taxonomy, and address what the audience will know or be able to do after viewing.Present the full complex case study. Include the history of present illness, appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.Pose three questions or discussion prompts, based on your presentation, that your colleagues can respond to after viewing your video.Be succinct in your presentation, and do not exceed 8 minutes.A note on grading: Presenters: Review the Grand Rounds Presenter Rubric to ensure you meet the scoring criteria.Participants: Review the Grand Rounds Participant Rubric to ensure you meet the scoring criteria.Week 6 Presenters:PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationBy Day 3Post your video and your focused SOAP note to the grand rounds discussion forum. You must submit two files for the SOAP note, including a Word document and scanned pdf/images of each page that is initialed and signed by your preceptor. Then, actively respond to your colleagues as they post responses to your video.Week 6 Participants:By Day 7Respond at least two times each to both of your colleagues who presented this week. The goal is for the discussion forum to function as robust clinical conferences on the patients. Provide a response to one of the three discussion prompts that your colleague provided in his or her video presentation. You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient.## Rubric Detail Select Grid View or List View to change the rubric’s layout.ContentName: PRAC_6540_Week6_Grand_Rounds_Presenter_Discussion_RubricPRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationGrid ViewList ViewExcellentGoodFairPoorPhoto ID Display and Professional AttirePoints Range: 5 (5%) – 5 (5%)Photo ID is displayed. The student is dressed professionally with a lab coat.Points Range: 0 (0%) – 0 (0%)Points Range: 0 (0%) – 0 (0%)Points Range: 0 (0%) – 0 (0%)Photo ID is not displayed. Student must remedy this before grade is posted. The student is not dressed professionally with a lab coat.TimePoints Range: 5 (5%) – 5 (5%)The video does not exceed the 8-minute time limit.PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationPoints Range: 0 (0%) – 0 (0%)Points Range: 0 (0%) – 0 (0%)PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationPoints Range: 0 (0%) – 0 (0%)The video exceeds the 8-minute time limit. (Note: Information presented after the 8 minutes will not be evaluated for grade inclusion.)Objectives for the presentationPoints Range: 5 (5%) – 5 (5%)3-4 objectives provided and written in terms of what the audience will know or be able to do after viewing. Appropriate Bloom’s verbs are used. Objectives are targeted and clear.Points Range: 4 (4%) – 4 (4%)3-4 objectives provided and written in terms of what the audience will know or be able to do after viewing. Appropriate Bloom’s verbs are used.Points Range: 0 (0%) – 0 (0%)Points Range: 0 (0%) – 3 (3%)Fewer than 3 objectives provided. Objectives for the presentation are vague, unclear, or missing.Description of chief complaint and the 7 elements of the history of present illnessPoints Range: 5 (5%) – 5 (5%)The student provides an accurate, clear, and complete description of the chief complaint and the 7 elements of the History of Present Illness.Points Range: 4 (4%) – 4 (4%)The student provides an accurate description of the chief complaint and the 7 elements of the History of Present Illness.Points Range: 0 (0%) – 0 (0%)Points Range: 0 (0%) – 3 (3%)The student provides a vague, inaccurate, or incomplete description of the chief complaint and the 7 elements of the History of Present Illness, or description is missing.Description of past medical and surgical historyPoints Range: 5 (5%) – 5 (5%)The student provides an accurate, clear, and complete description of past medical and surgical history.PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationPoints Range: 4 (4%) – 4 (4%)The student provides an accurate description of past medical and surgical history.Points Range: 0 (0%) – 0 (0%)Points Range: 0 (0%) – 3 (3%)The student provides a vague, inaccurate, or incomplete description of past medical and surgical history, or description is missing.PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationDiscussion of current medicationsPoints Range: 5 (5%) – 5 (5%)The student provides an accurate, clear, and complete discussion of current medications.Points Range: 4 (4%) – 4 (4%)The student provides an accurate discussion of current medications.Points Range: 0 (0%) – 0 (0%)Points Range: 0 (0%) – 3 (3%)The student provides a vague, inaccurate, or incomplete discussion of current medications, or discussion is missing.Discussion of physical exam findingsPoints Range: 5 (5%) – 5 (5%)The student provides an accurate, clear, and complete discussion of physical exam findings, including both the positives and pertinent negatives.Points Range: 4 (4%) – 4 (4%)The student provides an accurate discussion of physical exam findings, including both the positives and pertinent negatives.Points Range: 0 (0%) – 0 (0%)Points Range: 0 (0%) – 3 (3%)The student provides a vague, inaccurate, or incomplete discussion of physical exam findings. The student may not address both positives and pertinent negatives. Or, the discussion is missing.Discussion of diagnostics with resultsPoints Range: 9 (9%) – 10 (10%)The student provides an accurate, clear, and complete discussion of diagnostics with results.PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationPoints Range: 8 (8%) – 8 (8%)The student provides an accurate discussion of diagnostics with results.Points Range: 7 (7%) – 7 (7%)The student provides a vague, inaccurate, or incomplete discussion of diagnostics with results.PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationPoints Range: 0 (0%) – 6 (6%)All or most of the discussion is missing.Diagnosis with differentialsPoints Range: 9 (9%) – 10 (10%)The student provides an accurate, clear, and complete diagnosis with differentials.Points Range: 8 (8%) – 8 (8%)The student provides an accurate diagnosis with differentials.Points Range: 7 (7%) – 7 (7%)The student provides a vague, inaccurate, or incomplete diagnosis with differentials.Points Range: 0 (0%) – 6 (6%)All or most of the discussion is missing.Treatment planPoints Range: 14 (14%) – 15 (15%)The student provides an appropriate, clear, and complete treatment plan.PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationPoints Range: 12 (12%) – 13 (13%)The student provides an appropriate treatment plan.Points Range: 11 (11%) – 11 (11%)The student provides a vague, inappropriate, or incomplete treatment plan.Points Range: 0 (0%) – 10 (10%)A treatment plan is mostly or entirely missing.PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationFocused SOAP NotePoints Range: 14 (14%) – 15 (15%)The response clearly, accurately, and thoroughly follows the SOAP format to document the selected patient case.Points Range: 12 (12%) – 13 (13%)The response accurately follows the SOAP format to document the selected patient case.Points Range: 11 (11%) – 11 (11%)The response follows the SOAP format to document the selected patient case, with some vagueness and inaccuracy.Points Range: 0 (0%) – 10 (10%)The response incompletely and inaccurately follows the SOAP format to document the selected patient case.Presentation stylePoints Range: 5 (5%) – 5 (5%)Presentation style is exceptionally clear, professional, and focused.Points Range: 4 (4%) – 4 (4%)Presentation syle is clear, professional, and focused.PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationPoints Range: 0 (0%) – 0 (0%)Points Range: 0 (0%) – 3 (3%)Presentation style is unclear, unprofessional, and/or unfocused.Discussion FacilitationPoints Range: 9 (9%) – 10 (10%)Presentors effectively lead, sustain, and engage the discussion from Day 4 through Day 7.PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationPoints Range: 8 (8%) – 8 (8%)Presentors lead, sustain, and engage the discussion from Day 4 through Day 7.Points Range: 7 (7%) – 7 (7%)Presentors lead, sustain, and engage the discussion at least three out of four days between Days 4 and 7.Points Range: 0 (0%) – 6 (6%)Presentors did not sustain and engage the discussion through Day 7. Total Points: 100Name: PRAC_6540_Week6_Grand_Rounds_Presenter_Discussion_RubricGrand Rounds Discussion: Complex Case Study Presentation This week you participate in the second of four clinical discussions called grand rounds. In one of these 4 weeks, you will be a presenter as well as help facilitate the online discussion; in the others you will be an active discussion participant. When it is your week to present, you will create a focused SOAP note and a short didactic (teaching) video presenting a real (but de-identified) complex patient case from your practicum experience.You should have received an assignment from your Instructor letting you know which week of the course you are assigned to present.To prepare:Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.Select a patient from your clinical experience that presents with significant comorbidities. This should not be a patient with a single, straightforward condition, such as an ear infection, nor should it be a wellness visit. Create a focused SOAP note for this patient using the template in the Resources.Based on this patient case, and using the focused SOAP note as a reference, develop a case study presentation that includes the history of present illness (HPI), appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationYour presentation should also include objectives for your audience (see the resource on Bloom’s Taxonomy), at least three possible discussion questions/prompts for your classmates to respond to, and at least five scholarly resources to support your diagnostic reasoning and treatment plan.Ensure that you have the appropriate lighting and equipment to record the presentation.Video Assignment for this week’s presenters:Record yourself presenting the complex case study for your clinical patient. In your presentation:Dress professionally with a lab coat and present yourself in a professional manner.Display your photo ID at the start of the video when you introduce yourself.Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).State 3–4 objectives for the presentation that are targeted, clear, use appropriate verbs from Bloom’s taxonomy, and address what the audience will know or be able to do after viewing.Present the full complex case study. Include the history of present illness, appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationReport normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.Pose three questions or discussion prompts, based on your presentation, that your colleagues can respond to after viewing your video.Be succinct in your presentation, and do not exceed 8 minutes.A note on grading: Presenters: Review the Grand Rounds Presenter Rubric to ensure you meet the scoring criteria.Participants: Review the Grand Rounds Participant Rubric to ensure you meet the scoring criteria.Week 6 Presenters:By Day 3Post your video and your focused SOAP note to the grand rounds discussion forum. Then, actively respond to your colleagues as they post responses to your video.Week 6 Participants:By Day 7 Respond at least two times each to both of your colleagues who presented this week. The goal is for the discussion forum to function as robust clinical conferences on the patients. Provide a response to one of the three discussion prompts that your colleague provided in his or her video presentation. You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient.PRAC 6540 Week 6: Grand Rounds: Complex Case Study Presentation    It seems to me your patient is suffering from aspiration pneumonia. He has a lot of comorbidities that make him at risk for aspiration such as neurological disorder (previous CVA), GERD. Although the usual clinical manifestation that should raise suspicion for aspiration pneumonia comprises dyspnea, hypoxemia and fever maybe he is in the early stage of pneumonia, and his body is trying to fight the infection. You mentioned that he is coughing out greenish to yellow thick sputum which is a good indicator of bacterial infection and that is usually seen when the patient is having aspiration pneumonia. Aspiration pneumonia happens when food, saliva, or fluid is breathed into the lungs or airways, instead of being swallowed into the esophagus and stomach causing inflammation or infection to the lungs or large airways. (Gamache,2021). Typical clinical manifestation is chest pain, coughing up foul-smelling, greenish or dark yellow phlegm (sputum), or phlegm that contains pus or blood. Its prevalence exists to those people who have people with other health conditions, such as stroke, asthma, cystic fibrosis, elderly people who have a low immune system. Prompt treatment with supplemental oxygen, antibiotic (Macrolide) is vital. Delays in diagnosis and treatment could result in hospitalization and additional complications. (Saniyarapu & Gibson,2020).PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationReferencesGamache, J. (2021). Aspiration Pneumonitis and Pneumonia. Advance online publication. https://doi.org/https://emedicine.medscape.com/article/296198Sanivarapu RR, Gibson J. Aspiration Pneumonia. [Updated 2020 Nov 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470459/I agree with you that one of the clinical manifestations of pneumonia is having a fever. But it’s possible for in elderly to have pneumonia without a fever.  It’s rare but it can happen. As a matter of fact, studies have shown that pneumonia in the elderly with the compromised immune system may have low temperature if they have pneumonia. That is why sometimes pneumonia in the elderly was described as painless and latent but fatal because some of its usual signs and symptoms such as chills, a mild cough, and sometimes without sputum are absent or even their WBC count may be normal or low. As a matter of fact, in several studies, it was found that elderly people who were diagnosed with pneumonia were found the absence of leukocytosis as well as leukopenia (Henig & Kaye,2017). Really, the only gold standard tool for diagnosing pneumonia from other respiratory infections is a chest X-ray (Moberg et al,2016). But since the chest Xray of your patient is still pending we cannot really tell.PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationReferencesHenig, O., & Kaye, K. S. (2017). Bacterial Pneumonia in Older Adults. Infectious disease clinics of North America, 31(4), 689–713. https://doi.org/10.1016/j.idc.2017.07.015Moberg, A. B., Taléus, U., Garvin, P., Fransson, S. G., & Falk, M. (2016). Community-acquired pneumonia in primary care: clinical assessment and the usability of chest radiography. Scandinavian journal of primary health care, 34(1), 21–27. https://doi.org/10.3109/02813432.2015.1132889Thank you for your case presentation!I just wanted to add a few diagnostic tests that can be helpful with diagnosing your patient. Spirometry and peak expiratory flow (PEF) are the preferred methods for monitoring pulmonary function in patients with asthma. Spirometry evaluates airflow limitation by measuring FEV1 and forced vital capacity (FVC) and is defined as a reduced FEV1/FVC ratio. In patients who present with symptoms or physical findings of asthma, spirometry can help detect uncontrolled asthma and the risk of a severe exacerbation (Fanta, 2020).Peak expiratory flow rate is a quick and safe test to measure the extent of asthma exacerbation. Average values vary with sex, age, and height. It can be calculated by measuring peak flow as a percentage of predicted or personal best. Mild/moderate asthma exacerbation if peak expiratory flow >50%, and severe if ≤50%. PEF can also be used to monitor the patient’s response to treatment (Fanta, 2020).PRAC 6540 Week 6: Grand Rounds: Complex Case Study PresentationA key element of effective asthma management is the identification and avoidance of asthma “triggers.” Focused questions can help identify specific triggers and avoiding them can help reducing exacerbation and the need for medication. Some triggers such as extreme emotion are difficult to avoid. In this case, patients should be educated on adjusting their asthma management to alleviate the potential exacerbation of their symptoms (Fanta, 2020).Also, looking at the list of medications that this patient is taking, I wanted to point out that cyclobenzaprine is classified in the Beers Criteria as a potentially inappropriate medication and must be avoided in patients 65 years and older. Muscle relaxants are poorly tolerated in older adults due to anticholinergic effects and sedation.  Cyclobenzaprine has strong anticholinergic properties and, in elderly patients, increases the risk for falls and fractures. Also, effectiveness is questionable at doses tolerated by geriatric patients (UpToDate, n.d.).ReferencesFanta, C. (2020). An overview of asthma management. UpToDate. https://www.uptodate.com/contents/an-overview-of-asthma-management?search=asthma&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H4259613637UpToDate. (n.d.). Cyclobenzaprine: Drug information. https://www.uptodate.com/contents/cyclobenzaprine-drug-information?search=cyclobenzaprine&source=panel_search_result&selectedTitle=1~40&usage_type=panel&kp_tab=drug_general&display_rank=1#F155281According to Sethi & Murphy (2021),  most exacerbations of chronic obstructive pulmonary disease (COPD) are caused by respiratory tract infections. Empiric antibiotic therapy is needed for patients who are likely to get a bacterial infection causing the COPD exacerbation and for patients who are sick most of the time. Additionally, Stoller (2021), indicate that COPD are associated with increased morbidity and mortality. A number of medications for COPD reduce the frequency of COPD exacerbation and physical activity when it safe help prevention of frequency of COPD exacerbation epsoid.PRAC 6540 Week 6: Grand Rounds: Complex Case Study Presentation ReferencesSethi, S., & Murphy, T.F.  (2021). Management of infection in exacerbations of chronic obstructive pulmonary disease. UpToDate. https://www.uptodate.com/contents/management-of-infection-in-exacerbations-of-chronic-obstructive-pulmonary-disease?search=copd%20exacerbation&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=3Stoller, J. (2021). COPD exacerbations: prognosis, discharge planning, and prevention. UpToDate. https://www.uptodate.com/contents/copd-exacerbations-prognosis-discharge-planning-and-prevention?search=copd%20exacerbation&source=search_result&selectedTitle=6~150&usage_type=default&display_rank=4PRAC 6540 Week 6: Grand Rounds: Complex Case Study Presentation

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