NR661 Syllabus – This may change depending on when you are registered to the class.
I initially didn’t want to go to the review session as I didn’t plan to take the board exam. I am continuing to another school for PMHNP. Hence, I actually started to work on the Alternative assignment. Thankfully my procrastination saved me as I only did the first 3 pages of the entire assignment.
At the last moment, I decided to go because the flight was only $115 to Chicago from LAX! I couldn’t believe the price. Maybe because of the Coronavirus? Hum… Anyhow, with 20 hours of clinical hour credit and not doing the alternative assignment which could be 50-100 pages of typing, going to the review session sounded more appealing than when the ticket price was $400+.
*For April 2020 review session, the event has been canceled due to COVID-19.
But for those who are considering the alternative assignment, here is the info.
Here is the rubric (NR661 W8 Alternative Assignment_V2) for the alternative assignment.
Anyhow, here goes my NR661 journey.
Intensive review
Below is the agenda. Dates will be different but the event starts on Sunday. Here is the Review session fact sheet.
Saturday – Travel Day
All Day
Out of Town Student Travel Day *No planned Chamberlain Activities
*If you live locally, you do not need to be at the Q Center until Sunday morning
Sunday
9:00am – 10:00am
Arrivals & Registration at your leisure
10:00am
APEA Review Begins
12:30pm – 1:30pm
Lunch
7:00pm
APEA Review Day 1 Concludes
Monday, April 20
7:45am – 8:30am
Arrivals & Registration at your leisure
8:30am
APEA Review Begins
12:30pm – 1:30pm
Lunch
6:00pm
APEA Review Day 2 Concludes
Tuesday – Optional Session
9:00am – 11:00am
Optional Session – Join Chamberlain Career Services professionals to learn: Professionalism & Social Media – Too often we fall back into thinking that the only time we should maintain a positive online presence is when we are looking for a new opportunity or job. Instead, we need to remember that at all times in your career, there is chance you will meet, talk or connect online with someone and get a chance to enlarge your networking group. Learn about developing your professional online presence through social media. Career Management – Several great professional development resources are available to you as Chamberlain students, learn how to access job leads, connect with employers and attend upcoming events resources. Interviewing- Strategies to successfully prepare for and execute a nurse practitioner interview.
If you are not staying in Q Center, then your DayPass is $81.40/day. So, you are paying $162.80 for the pass, that is if you are not staying for the optional day.
Practicum logging
I just clarified with my instructor regarding the expectation of practicum logging, and according to the instructor, as long as I see 2 patients/hour, he is ok with it. I think I have an angel for the last class! Make sure to check with your instructor before you start to log any hours. In NR661, you are only required to log 105 hours instead of 125 hours. This is because you get 20 hour-credits for attending the APEA review sessions.
APEA Review Schedule Note: You can watch the review video up to two times.
Make sure to reach your instructor regarding QBank. Some instructors will come up with their own and require you to get 100% on QBank in the exam mode. Below is one of the students whose instructor requiring QBank.
Yes, my professor said all qbank questions must be completed in each subject in exam mode or it is an automatic fail at the end if we cannot get our completion certificate.
My instructor stated that QBank is “recommended but not required”. Below is my instructor’s response regarding QBank.
The QBank questions are not required per se, but recommended. But you have to submit your first 150 question practice exam you take each week for a grade starting in Week 2.
APEA QBank practice questions – Random practice exam
Random Practice Exams
APEA exam score x 0.3 = course score
Week 2 to 7, APEA practice exam worth 30 points each with 150 questions, and it doesn’t have to be done in one sitting.
You will have to complete the 2 practice questions and the evaluation at the end in order for you to get to completion certificate.
Week 1: Certification Review Plan Assignment Trust me. After you read the assignment guideline, you will be amazed by how tedious and useless the assignment is. I would rather spend the time actually studying for the board exam rather than doing the assignment. Enough of my rant… =p
In the NR603, you took the APEA exam and based on the result of the exam, you will be doing the assignment. You will pick 4 weakest topics from the APEA exam and 2 concentration areas. The concentration area is on the bottom of your exam score page (assessment, diagnostic, etc.).
You will be making a table for the assignment shown below.
Good luck with working on the “Learning Activities” part where you are not supposed to repeat the same contents on different “Learning Goal” part. 6 learning goals and 6 learning activities. That’s 36 different ways that you have to come up with “Learning Activities”. lol
Nothing but just time-consuming…
Don’t forget to capture the score from the APEA exam and add it to the assignment at the end.
You know. That’s not the end of week 1. lol
I am more amazed! For 10 points, you are not only required to post a video presentation of your self-introduction video + writing something about PCMH but also need to post replies to 3 peers and answer all the questions posted by the instructor. For 10 POINTS! Wow… I really am amazed.
Week 2-3
Nothing specific besides the QBank.
Once you log in to the Qbank, you will see above. Blue one is the 150 question quiz that you need to turn in once a week. Some questions tend to repeat week after week so it would be good idea to practice through the other sections besides blue.
Week 4: VISE Assignment This VISE assignment is quite different than before. You will be given 25 diagnoses list and the instructor will randomly select one. You are expected to be in front of a camera and use another person (husband, child, etc) in front of a camera to do the VISE. Be natural as if you are in your clinic and seeing a patient. When the VISE starts, your instructor will give you a scenario and you will begin the assessment. In my case, my instructor answered all my assessment questions. I utilized my wife and I assessed her according to what I believe the diagnosis is. Don’t be too alarmed as the scenario was very obvious for what the diagnosis was. As soon as my instructor completed the 1st sentence of the scenario, I knew what the diagnosis was. This may differ depending on your instructor. I heard from some people that their instructor asked many questions. The followings are some tips.
Depending on your instructor, he/she may let you use the internet for you to reference Epocrates.
As you will be able to take a note of the scenario on a paper, write the note on the 25 diagnoses list. This will make sure that you are getting correct medication and diagnostic tests. I would say this would also depend on your instructor.
Get a stethoscope, a penlight, a thermometer, and etc as you may need them while you are assessing.
Relax! You will be fine. =]
Week 5: APN Capstone Portfolio Part 1
I initially thought the assignment was given by mistake, and I actually questioned the assignment to my instructor. lol. The assignment was about reflection on DNP. Huh? DNP? I am not even considering that path and I am writing about DNP? Well, yes. The assignment is about writing DNP, how wonderful and exciting career it would be in a “complex healthcare system”. Well, don’t hold your breath yet, that’s not all.
The second part is writing a resume. There is an FNP Sample Resume. Pretty straight forward.
The third part is making a profile on LinkedIn. I had a LinkedIn that I had for a long time. I asked if I can use the LinkedIn as is, my instructor was fine with it. Done!
Here is the link to my LinkedIn so that you can see how it looks like. My LinkedIn may change in time so… be aware. =p
I asked my instructor that I need to build LinkedIn as if I already am NP. My instructor said no. I think they just wanted to see LinkedIn account with the school name and related content.
Week 6: APN Capstone Portfolio Part 2
This is the assignment that will kill all other assignments in terms of the time and effort you have to invest in. I have been hearing from the previous classes that they were able to breeze through in a day. I couldn’t believe it. Later, I found out that the guideline for the assignment has been changed starting from my class. yay…..
Basically, you are going to do the following.
Copy and paste your prior essay as an examplar.
Write a paragraph or so of Chamberlain Program Outcomes, AACN MSN Essentials, NONPF Core Competencies, and Reflection.
On the Connect part, you will come up with 2 keywords and define them. This is where you will find some scholarly resources for definitions.
Do above 10x and you are done.
It would look like above on the table of contents.
Below is the program outcome, AANC MSN Essentials, and NONPF Core Competencies.
To be honest, I don’t really know what I wrote. I don’t think I never BSed more than this assignment. I saw some other portfolios which were completed before my cohort and many had grammar errors and run-on sentences. Most of them told me that they got full credit. Many of them had somewhere 60 to 100 pages of portfolio. Out of all those pages, what you actually write is about 15 to 20 pages. I don’t care and I am done. Not going to look back! Turn that thing in and be free!!!!! No, the paper doesn’t go through the Turn-it-in system.
Week 7
Due to COVID-19 outbreak, the review session at Chicago was canceled. It was replaced with the online review session.
In week 7, you will see an assignment titled “Onground Intensive Review or Alternative Assignment”. This is where you will submit intensive review assignment or alternative assignment. For the intensive review assignment, you just need to write 3 paragraph or so about the intensive review. I don’t think anyone will copy and paste other person’s work on this but this is only one that will go through Turn-It-In. 200 points for this. However, it’s not due until week 8 as you won’t complete your intensive review until week 8.
Week 8
The final exam is the APEA exam. No, there is no specific study guide and exam questions are harder than very different from what you practiced from the QBank.
There are 2 completion certificates.
The first is for the video review session and the second is for the intensive review. For the video review session cerficiate, you can see those 2 practice exams from the beginning of the class.
The intensive review session certificate, you won’t see it until week 8. Around week 8, you will receive an email with below message.
To activate your Online Review Course Certificate ( this is the one that must be uploaded into the Week 8: APEA Review Modules Completion Certificate Assignment)
· Each CE video must have one viewing completed
· The 2 sets of questions must be completed
· The Evaluation must be completed to activate and download the certificate of completion
For the separate certificate for the Intensive Review
· The 2 sets of questions must be completed
· The Evaluation must be completed to activate and download the certificate of completion
Email message saying that the 2nd cerficiate has to be completed. I was told by my instructor that the 2nd certificate is an optional, however, I also heard from some people that their instructor required them. So, check with your insturtor. There is no specific section in the module to submit the 2nd certificate.
Yes, there are 4 practice questions total. Good new is that the 2 sets of practice questions from online review and the 2 sets of practice questions from intensive review are exactly the same. Even better news, score doesn’t matter. =p
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2 more classes… and I heard my instructor is one of the horrible ones. lol. yay… -_-
Clinical Hours NR603 is expecting 3 patients “face-to-face” encounter time/hour. You can still log longer than 20 mins/pt as long as the pt has enough complexity. In general, physical assessment for the annual wellness check or women’s wellness check can be logged up to an hour. (Check with your instructor.)
Week 1: Compare and contrast discussion If you look at the assignment page, there are preset topics depending on your last name.
A-E – Benign Positional Vertigo and Meniere’s Disease F-J – Dementia and Delirium K-O – Trigeminal Neuralgia and Giant Cell Arteritis P-T – Post Concussive Syndrome and Traumatic Brain Injury U-Z – Migraine Headache and Tension Headache
The assignment is to address similarities and differences of 2 diagnoses of presentation, pathophysiology, assessment, diagnosis, and treatment.
The initial post has to be turned in by Wednesday. We have to post at least one peer response that “presents diseases together and responds substantively”. To me, that sounded as if I need to do another compare and contrast discussion post other than my assigned topics. For those who might be curious, my initial post was almost 3 pages without references, single-spaced, and font size 10. My response to a peer’s initial post was 1 page without references, single-spaced, and font size 10. My instructor posted 3 questions… (i think they have pre-formatted questions and randomly picks 2~3 questions). By this time, I was burned out. My response to the instructor was a 3/4 page without references, single-spaced, and font size 10.
Week 1 quiz is not proctored! Yay!
Week 2: Case discussion Did you think that you are pretty used to discussion assignments? Think again! Ha! First of all, there are 2 parts. Part 1, you need post by Tuesday and part 2 by Sunday.
Your initial post of Part 1 will be based on the scenario given in the assignment. You will be writing about your primary diagnosis of the scenario, how you would treat, and so on. Then your instructor will post a reply with at least 3 or more follow-up questions. There was no specific deadline for the reply. One strategy that I can tell you is that you don’t want to reply too early. Why? Because some instructors will ask additional questions on top of the initial follow-up questions. My suggestion is that you post your reply on the deadline date so that you don’t get asked more than once!
Don’t be surprised to have a few more questions posted by your instructor once you post your initial post. What do I mean? As you know, you don’t get to see the other people’s responses until you post your initial post. When you get to see the posts, you will also see some announcement posts with the yellow boxes by your instructor in the assignment reply posts. Read them very carefully. One of them is actually a post with additional questions that you also need to reply to.
So, you got your initial post, you made a response to your instructor’s additional questions from the announcement, and you also posted a response to the questions that your instructor replied to your initial post. You are not done yet! You also need to post a response to at least one peer.
A pretty hefty amount of work! But I have good news for you now. Nowhere in the assignment stated for you to post summary. lol.
Congratulation! Now you are done with part 1.
Part 2 is about the scenario follow-up of part 1 for treatment plans. This one is due by Thursday. The assignment didn’t state posting more replies but who knows…
Well, the instructor posted questions which you are obligated to answer. But no replies to peers. Make sure to include GINA (Global Initiative for Asthma – https://ginasthma.org/wp-content/uploads/2019/04/GINA-2019-main-Pocket-Guide-wms.pdf) guideline in your content. I also included some references from AAFA (Asthma and Allergy Foundation of America) and good old CDC. You would also want to mention about PEF (peak expiratory flow), possible nebulizer, and other necessary medicine/equipment.
VISE – Referral to dietician or ER is not allowed. Must be psych, cardiology, orthopedics, urology, gastroenterology, dermatology, rheumatology, nephrology, endocrinology, and neurology.
Week 3: Case discussion Well, another case discussion. Noting different than week 2. It has EKG trip and brings out a lot of uncertain readings from it depending on how each student sees it. You would definitely mention about each lead and what each lead would interpret into the patient’s symptoms. You would definitely want to mention about ACA and JNC guidelines. When you are stating your primary diagnosis, make sure to have a reference source also. That would be the same for secondary diagnoses also. Do not forget ICD-10 codes!
Week 3 Quiz is not proctored. *hint, hint*
Week 4: Open Forum Discussion Why is this needed? No clue. Just blah out whatever. This is what I posted.
I have been trying to focus on the Leik and questions from APEA certification practice questions. I studied by going over the rationals and get details when I got wrong on any of the questions. I also read Hollier’s clinical guidelines book. I am considering to jump on the QBank questions and review the rationals.
I just need to focus more on the genitourinary system which tends to be my weakest topic since NCLEX.
We are going to be fine! Good luck all!
Eric
Not graded, who cares. =p
Week 4: APEA Predictor Exam About week 3, you will get an email regarding your login and password. This is something that you cannot just study over a weekend and ace it. You just have to know the general knowledge of overall content. This is the reason why I suggested to work on the Leik and APEA review exams since the beginning of the program. It’s 150 questions and your % multiply by 2 will be your point for the class. Good luck!
Week 5: APEA Predictor Assignment Part 1 This is an assignment for you to reflect on the APEA exam result. You will pick an area where you scored the lowest and either make a scenario or find a patient from your clinical log and discuss the disease. My weakest part was orthopedics and I found a patient who had ortho related diagnosis from my previous clinical logs and discussed the case. You will upload the content up to work-up without giving out any diagnosis and treatment. That’s what peers are going to post on your reply.
As all other discussion assignments, you will need to reply to peers and to your instructor.
Week 5: APEA Predictor Part 2 This is where you are going to post the actual diagnosis of the part 1 scenario. Yes, you are going to have questions from instructor which you will have to post a reply. Just a tip. I would wait for the reply to your instructor as late as possible as your instructor may as even more questions. I heard several horror stories about an instructor keep asking with replies…
Week 6: Mental Health Clinical Presentation Part 1 Again like week 5, you are going to come up with a senario either from your clinical logs or make up a story. I strongly suggest you obtaining the entire chart of a patient without HIPPA contents from the patient’s chart for you to do the assignment. Trust me. It will make your life easier.
You will post your initial post without diagnosis and treatment like Week 5 assignment. You will be paired up with another student to respond to each other rather than get to pick which one you want to respond to. You will also have questions from instructors that you have to respond to.
Week 6: Mental Health Final Treatment Plan/Analysis Part 2 This one, you get to submit the assignment. So, no discussion. Thank GOD!!!
Week 7: Open Forum Discussions – Inflammatory Disorders Honestly, I don’t know why they make this no point assignment. Just another BS post about inflammatory stuff. I posted about one of the inflammatory diseases with a summary of the disease emphasizing the inflammatory part.
Probably the most relaxing week of the program.
Week 7: Quiz Non-proctored, random questions… There are 5 questions for 50 points! Geeez.
Week 8: Reflection Just kiss up…
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I am listing assignments from the class I completed. Your actual assignment COULD be different from what I had. Make sure that you check your course. Check the updated date!!!
Updated: 01/2020
Week 1: Compare and Contrast Assignment
Purpose
The purpose of this assignment is for learners to:
Improve their knowledge base and understanding of disease processes in Neurology
Have the opportunity to integrate knowledge and skills learned throughout all core courses in the FNP track and previous clinical courses.
Demonstrate the ability to analyze the literature be able to perform an evidenced-based review of disease presentation, diagnosis and treatment.
Demonstrate professional communication and leadership, while advancing the education of peers.
Demonstrate the ability to take information from assigned readings and translate it into the way you would describe it to a patient or family member in your own words.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Interpret subjective and objective data to develop appropriate diagnoses and evidence based management plans for patients and families with complex or multiple diagnoses across the lifespan. (CO 1)
Develop management plans based on current scientific evidence and national guidelines. (CO 4)
Due Date:Wednesday by 11:59 pm MT of Week 1
A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday of Week 1 at 1159PM MT, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).
A 10% penalty will be imposed for not entering the minimum number/type of interactive dialogue posts OR not posting on the minimum required number of days (3 days). NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0)
Total Points Possible: 100 points
Requirements:
For Week 1 of the course there is no case study given to you by the Faculty. Instead you will be assigned two diseases to compare and contrast based on the first letter of your last name. This information will be posted in the Course Announcements under Week 1 Welcome as well as the “Assignment” portion of the Week 1 module and will change every session.
A comparison and contrast assignment’s focus is to identify and explore similarities and differences between two similar diseases. The goal of this exploration is to bring about a better understanding of both diseases.
Week 1 Part 1: Due Wednesday by 11:59PM MT MN
You will research the two areas of content assigned to you and compare and contrast them in a discussion post. NOTE: A comparison and contrast assignment is not about listing the info regarding each disease separately but rather looking at each disease side by side and discussing the similarities and differences given the categories below. Consider how each patient would actually present to the office. Paint a picture of how that patient would look, act, what story they would tell. Consider how their history would affect their diagnosis, etc. Evaluation of mastery is focused on the student’s ability to demonstrate specific understanding of how the diagnoses differ and relate to one another. Address the following topics below in your own words:
Presentation
Pathophysiology
Assessment
Diagnosis
Treatment
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-E Benign Positional Vertigo and Meniere’s Disease
F-J – Dementia and Delirium
K-O- Trigeminal Neuralgia and Giant Cell Arteritis
P-T = Post Concussive Syndrome and Traumatic Brain Injury
U-Z = Migraine Headache and Tension Headache
Week 2: Case Discussion Pulmonary – Part 1
Purpose
The purpose of this assignment is for students to:
Improve their ability to formulate diagnoses based on clinical presentation of patients
Improve their ability to understand and apply National Guidelines for the diagnosis and treatment of Pulmonary disorders
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Utilize healthcare delivery system resources in a fiscally responsible manner in the diagnosis and treatment of patients and families across the lifespan. (PO 5)
Develop management plans based on current scientific evidence and national guidelines. (PO 5)
Educate patients on treatment decisions (WO1)
Select an evidence-based article to support the plan of care for the case study patient. (WO2)
Analyze national guidelines and apply them to specific case study situations. (WO3)
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.
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: 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 week.
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.
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, malaise.
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.
Week 2: Case Discussion Pulmonary – Part 2 Follow up Visit
Purpose
The purpose of this assignment is for students to:
Improve their ability to formulate diagnoses based on clinical presentation of patients
Improve their ability to understand and apply National Guidelines for the diagnosis and treatment of Pulmonary disorders
Design a relevant treatment plan
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Utilize healthcare delivery system resources in a fiscally responsible manner in the diagnosis and treatment of patients and families across the lifespan. (PO 5)
Develop management plans based on current scientific evidence and national guidelines. (PO 5)
Educate patients on treatment decisions (WO1)
Select an evidence-based article to support the plan of care for the case study patient. (WO2)
Analyze national guidelines and apply them to specific case study situations. (WO3)
NOTHING will be accepted after 11:59 pm MT on Sunday (i.e., student will receive an automatic 0).
Total Points Possible: 40
Requirements:
Michelle continues to work in the bakery and her asthma has been well controlled on a low-dose inhaled corticosteroid inhaler, Singular 10mg daily, and Albuterol prn which she uses 1-2 times per week. Michelle presents to the clinic with an acute illness that developed 2 days ago and has a respiratory rate of 24, mild SOB with exertion, O2 saturation of 94%, and complaint of inspiratory and expiratory wheezing. She is able to speak and states her temperature over the last 2 days has been 101 to 102 F. Cough is productive of white sputum. Influenza A is going around the bakery. Exam findings show a woman who appears her stated age and is alert and oriented and though calm, is having mild work of breathing. AR 110 BPM, BP is 150/85, RR: 24, Temp 101.4. She has a nonproductive, dry cough, is mildly short of breath, fair chest expansion, + inspiratory/expiratory wheezes, no rales, no rhonchi. Auscultation reveals no thrills, gallops or extra heart sounds. Apical rate is elevated at 110. Physical exam is otherwise unremarkable. The MA has swabbed her for Influenza A- test is positive.
Discussion Questions Part Two:
Determine appropriate treatment plan for Michelle. Discuss medications, doses, Durable Medical Equipment, and any testing, and apply these directly to her case. Provide your rationale with evidence.
Decide whether she is safe to return home, include any prescriptions, or if a referral to a higher level of care is required. Discuss the criteria used to make your decision, how a referral is made and defend your position.
Discuss relevant education and follow up plan.
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Week 3: Case Discussion: Cardiovascular
Purpose
The purpose of this assignment is for students to:
Improve their ability to formulate diagnoses based on clinical presentation of patients
Improve their ability to understand and apply National Guidelines for the diagnosis and treatment of cardiovascular disorders
Design relevant treatment plan
Link pathophysiologic concepts to medication choices
Collaborate without outside providers and resources
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Utilize healthcare delivery system resources in a fiscally responsible manner in the diagnosis and treatment of patients and families across the lifespan. (PO 5)
Develop management plans based on current scientific evidence and national guidelines. (PO 5)
Educate patients on treatment decisions (WO1)
Select an evidence-based article to support the plan of care for the case study patient. (WO2)
Analyze national guidelines and apply them to specific case study situations. (WO3)
A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday 1159PM MT of Week 3, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).
Requirements:
Setting: large rural clinic; family practice clinic that employs physicians, physician assistants and nurse practitioners.
You open the chart to review for your next patient, and you see it is Lorene M. Lorene is a 60 year-old African American female with a history of hypertension and known documented metabolic syndrome following lifestyle changes per her request. You note she is not due for a follow up at this time, so you look at the chief complaint.
CC: Shoulder discomfort and SOB with exercise 3 days ago.
You enter the room and introduce yourself to Lorene who is sitting in the chair. You ask what brings her in today. She smiles, shaking her head and says “My daughter made me come, I feel fine. I am way too busy to be here today. Since my last visit, three months ago, I joined a gym and with the support of my daughter, we are going two days a week.” However, three days ago Lorene felt short of breath while in dance class. She developed what she calls as “a discomfort” that radiated back and up between her shoulder blades while at the peak of her exercise routine. She also felt a little nauseous and sweaty. Once she stopped dancing, all symptoms resolved in about 3 minutes and they have not re-occurred.
PMHx: Reports general health as good. She has been trying to lose weight through exercise and avoiding processed foods. She admits that food is a large part of her background and heritage in social activities and so it is difficult to make healthy choices. She had been feeling great since starting to work out and has lost 2 inches around the abdomen. She describes having lots of energy until this episode three days ago. Now she is a little concerned because she feels a little more tired than usual. She has not participated in anything strenuous and has not worked out since
Childhood/previous illnesses: chicken pox.
Chronic illnesses: Hypertension, Metabolic Syndrome, and Dyslipidemia.(Lifestyle management was initiated per patient preference) Gestational Diabetes with 3 pregnancies managed with Insulin
Surgeries: T and A, cholecystectomy
Hospitalizations: None aside from surgeries listed above
Immunizations: Does not receive the flu shot.
Allergies: Reports remote Hx allergy to metformin. Describes a GI disturbance.
Blood transfusions: None
Current medications: None. Stopped Lisinopril one month ago as she read that it can cause a cough as one if its side effects. Prefers to get the BP under control with diet and exercise.
Social History: Married for 20 years. Children are grown and have moved out of the house but all live locally and are close to their parents. Lorene works full time as a CEO of a successful marketing company and travels often for work. She eats out a lot while entertaining business clients. She enjoys beer and wine and the occasional “social” cigarette when she gets together once weekly with her girlfriends.
Family History: Parents are deceased. Father had lung cancer and mother died from complications of a stroke due to complications of diabetes type 2. Brother died at 44 from malignant melanoma. Other sister and brother are healthy but they also have diagnoses of metabolic syndrome.
PE:
Height: 5’8″ weight: 220 pounds; BMI 33.5 vital signs: BP 146/90 P 70 Sao2 97% Random glucose finger stick in office: 130mgs/dl
General: African American female 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. Trace edema in lower extremities.
Abdomen: Abdomen round, soft, with bowel sounds noted in all four quadrants. No organomegaly noted.
Labs from 3 months ago:
AIC 6.4%
Fasting glucose 135mgs/dl
Total Cholesterol: 230
Triglycerides 180mgs/dl Ldl 180 Hdl 38
EKG today in office
Week 3 Discussion Questions:
What Leads Demonstrate the ST Depression?
Is Lorene Hypertensive per ACA 2017 Guidelines? Compare the ACA guidelines to JNC 8 guidelines and discuss what treatment you recommend for her BP and why.
What is the Primary diagnosis causing Lorene’s chest pain? Include ICD 10 codes (no differentials)
What other secondary diagnoses does Lorene have that should be addressed? (Include the rationale and a reference for your diagnoses)
Design a treatment plan and discuss how each intervention is applicable to Lorene’s case. Consider the following interventions:
Labs
Durable Medical Equipment Diagnostic tests- discuss the goal/purpose
Any consultation with outside providers/services
Medications- discuss why you chose each specific medication
Referrals- who and why
Follow up- why and when
Education- specific and measureable
Lifestyle Changes- specific to her cultural preferences, values and beliefs
Week 4: Clinical VISE Assignment
Due Feb 2 by 11:59pm
Points 0
Purpose: The VISE assignment (Virtual Interactive Student Evaluation) is to evaluate student progress in clinical, based on per course clinical objectives. This will be a mid-term check to identify and assist students who may be struggling with clinical critical thinking and communication. Students who do not pass the VISE on the first attempt will be placed on a clinical PIP and given a second attempt at passing the VISE prior to course end. The student must successfully pass the VISE to pass clinical within a course.
Directions: These will be done by phone between the VP and the student sometime between the beginning of week 3 and the end of week 5. Immediately following the VISE the VP and student will do the mid-term phone call check in and review of clinical. VPs should have clinical logs pulled up to review with the student.
603 – Referral to specialist – The student reviews their logs and picks one patient seen in clinical in the last two weeks with a complex chronic illness who needs specialist referral. The VP will act as specialist taking the call. The student is to do the following:
Pick the correct specialty to refer to
Give a SNAPPS summary to the specialist
Answer the specialists questions about the patient
VISE Assignment Process and Expectations
The NR603 Virtual Interactive Student Evaluation is an exercise for student’s to demonstrate their communication and critical thinking skills in the clinic environment. VISE in NR603 focuses on the student’s ability to refer a patient to a consultant for ongoing care. Students need to come to the call thoroughly prepared to meet the criteria for a successful referral. A successful VISE call is where the student is prepared and presents the information without needing prompting by the Faculty. Faculty may then ask any pertinent follow up questions after the patient is presented by the student.
Process:
– Faculty will reach out to students via email to schedule the VISE phone call
– Student identifies a patient from their clinical logs who needed a referral to a consulting provider. Student sends the patient’s Initials and date of the clinical log to their Faculty member in advance of the call so the Faculty can prepare for the interaction
– The Faculty will initiate the call according to the scheduled time.
– Student will address the faculty as the consulting provider and begin the referral communication process.
– Faculty will ask any follow-up questions
– Faculty will debrief with student
Criteria for Successful Presentation of Referral:
-Thorough HPI
-Physical Exam completed by student
-Diagnostic tests completed with results, any treatment that has already taken place
-Outcome of the existing treatment plan
-Specialty patient is being referred to
-Reason for referral i.e., evaluate for Rheumatoid arthritis, etc…
-Actions you are looking to have the Consultant take
Sample Script of Successful VISE call:
Faculty: “Good morning/afternoon/evening Sandra, This is Dr. Deering calling to complete your VISE assignment. If you don’t have any questions you may begin whenever you are ready.”
Student: “Good Morning Dr. Deering, I am calling you because you are a Mental Health Specialist and I need to refer a patient to you for evaluation of possible ADHD including treatment recommendations. The patient is a 12 year old male whose mom brought him in to our clinic 3 months ago because teachers at school stated he was struggling to focus on instruction and was not completing assignments. The patient has never had reports of inattentiveness at school until this year. Birth, growth and development have been normal without delays. We completed a physical exam at that time and ruled out sleep disorders, abuse at home, anxiety, bullying, thyroid issues and learning problems. BP and VSS were normal on that visit. Physical exam revealed no abnormal pathology to support the symptoms. The patient also scored high on the Vanderbilt Assessment Scale. We worked with the school to develop behavioral strategies which the patient has been using for 3 months without success. He presents for follow up today with the same symptoms and no improvement. I know that ADHD cannot thoroughly be diagnosed in primary care and since we have ruled out a medical cause for his symptoms we are referring the patient to you for a thorough testing to rule in/rule out ADHD and anxiety and a recommendation of treatment plan including behavior, therapy and medication, if indicated.”
Faculty: “Thank you for referring this patient. I agree ADHD needs further evaluation before treatments such as medications should be started. Please send a copy of the Vanderbilt Assessment scale with you.” Follow-up questions may include further detail about patient history or verifying other testing or data.
Debrief:
Faculty will share feedback with the student on successes achieved during the call, along with opportunities for improvement.
Week 5: APEA Predictor Assignment – Part 1
Purpose
The purpose of this assignment is for learners to:
Identify opportunities for improvement in their knowledge base.
Improve their knowledge base and understanding of a disease process identified as an opportunity area on the APEA predictor exam.
Have the opportunity to integrate knowledge and skills learned throughout all core courses in the FNP track and previous clinical courses.
Demonstrate the ability to analyze the literature 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.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Interpret subjective and objective data to develop appropriate diagnoses and evidence based management plans for patients and families with complex or multiple diagnoses across the lifespan (CO 1).
Develop management plans based on current scientific evidence and national guidelines (CO 4).
Due Date:
Part 1: Tuesday by 11:59pm MT of Week 5
A 10% late penalty will be imposed for discussions posted after the deadline on Tuesday 1159PM MT of Week 5, regardless of the number of days late.
Total Points Possible: 130
Requirements
For Week 5 of the course the faculty will not be providing a case study. Instead you will choose from an area that you have an opportunity for improvement that was identified on your APEA predictor exam. You will research that area of content in relation to complaints and disorders that commonly occur in family practice. Please work up a case study that begins with a chief complaint commonly seen in primary care based on that body system. The case should be clear and include all elements of a normal case that might be presented in class (subjective, objective, assessment, diagnostic testing and 5 point plan in part 2.The clinical logs 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 5 Part 1: Due by Tuesday 11:59 p.m. MT
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 complaintfrom that system that you haven’t learned already in the program and present your findings in the discussion threads. Push yourself to explore diagnoses in this area that are still common to primary care, but not a repeat of content learned in this or other courses.
Step 3. Respond to at least one other student’s CC work up as well as any questions posed to you by faculty.
Associated risk factors/demographics that contribute to the chief complaint and differential diagnoses
Three common differential diagnoses represented by the CC including pathophysiology and rationale in the identified body system i.e., if pulmonary was your body system than a chief complaint could be persistent cough and three pulmonary differentials;
Discuss how the three differential diagnoses differ from each other in: occurrence, pathophysiology and presentation (NOTE: Simply listing the diagnoses and their occurrence, pathophysiology 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; and
Review of relevant National Guidelines related to the Diagnosis and Diagnostic testing for these diagnoses
Respond to at least one Student’s CC write up and all faculty questions posed directly to you.
Week 5: APEA Predictor – Part 2
Purpose
The purpose of this assignment is for learners to:
Identify opportunities for improvement in their knowledge base.
Improve their knowledge base and understanding of a disease process identified as an opportunity area on the APEA predictor exam.
Have the opportunity to integrate knowledge and skills learned throughout all core courses in the FNP track and previous clinical courses.
Demonstrate the ability to analyze the literature 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.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Interpret subjective and objective data to develop appropriate diagnoses and evidence based management plans for patients and families with complex or multiple diagnoses across the lifespan (CO 1).
Develop management plans based on current scientific evidence and national guidelines (CO 4).
Due Date:
Part 2: Thursday by 11:59pm MT of Week 5
A 10% late penalty will be imposed for discussions posted after the deadline on Thursday 11:59PM MT of Week 5, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).
Total Points Possible: 70
Requirements
Part 2- Due By Thursday 11:59 p.m. MT at the end of Week 5
Submit your First line treatment plan based on one dx from your differential list to the Case Study Submission area by 11:59pm MT Thursday night.
Respond to at least one Student’s CC write up and all faculty questions posed directly to you.
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Week 6: Mental Health Clinical Presentation – Part 1
Purpose
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 courses.
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.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Develop management plans based on current scientific evidence and national guidelines. (CO4)
Prioritize treatment based on relevant clinical presentation. (CO6)
Due Date:
Leading the Discussion: Wednesday by 11:59pm MT of Week 6
Peer Response: Thursday by 11:59pm MT of Week 6
A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday 1159PM MT of Week 6, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).
Total Points Possible: 60
Requirements:
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 respond.
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 name.
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.
NEXT:
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 ONE REPSONSE TO A STUDENT IN DISCUSSION #1 IS DUE BY THURSDAY AT 11:59 p.m. MT 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.
Week 6: Mental Health Final Treatment Plan/Analysis – Part 2
Due Feb 16 by 11:59pm
Points 40
Submitting a file upload
Purpose
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 courses.
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.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Interpret subjective and objective data to develop appropriate diagnoses and evidence based management plans for patients and families with complex or multiple diagnoses across the lifespan. (CO 1)
Develop management plans based on current scientific evidence and national guidelines. (CO 4)
Due Date:
Sunday 11:59PM MT
NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).
Total Points Possible: 40
Requirements:
Part 2- Turning in your final treatment plan and Analysis
The final treatment plan will include the primary diagnosis, diagnostic testing recommended by National Guidelines. Medications, interventions, education, labs, follow up, referrals. After completing the treatment plan include the following sections in a large area called ANALYSIS:
Pathophysiology and Pharmacology: For the primary diagnoses in the case, write a brief summary of the underlying pathophysiology and tie pharmacological treatment chosen in the reversal or control of that pathology.
Additional analysis of the case: This includes national guidelines that were or should have been used to make diagnosis or treatment and review how they applied or how care was unique but based in guidelines.
Follow-up/Referrals: This means how the patient was doing when seen a second time if this applies. This would be their response to your plan of care. OR when Follow up will occur and what actions will be taken on the follow up visit. Referrals if indicated.
Quality: Include anything that should have been considered in hindsight or changes you would make in seeing similar patients in the future with the same complaint, history, exam, or diagnosis. Add anything you learned from discussion in the class that shed new light on this patient.
Coding and Billing. Any or all CPT and ICD-10 codes that should have been used (List them and name them only.
Written in a word document and submitted in the Week 6 case study summary submission box.
Week 7: Open Forum Discussions- Inflammatory Disorders
This is a required but not graded open forum discussion. An open forum encourages you to post freely without the requirements of traditional discussion posts. What questions/insights do you have about inflammatory disorders? Are you comfortable with your knowledge of pathophysiology, risk factors, and diagnosis? How about diagnostic testing? What types of inflammatory disorders have you encountered in clinical? The floor is open to reinforce your learning.
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Week 8: Reflection
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
partnering.
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
environment.
6. Analyzes organizational structure, functions and resources to improve the delivery of care.
7. Collaborates in planning for transitions across the continuum of care.