Well. Such a day actually comes! Oh my… never thought this would end but it actually does!
There is one last step that you need to do for graduation that is clear as mud. lol.
For me, I didn’t receive an email from school until I called them for it but you should be getting an email for an instruction that a student needs to follow for graduation application. According to the email, steps are following.
Click on the Resources icon in the left navigation toolbar.
Click the Support Services icon and select Ask Student Services. A new window will appear.
Select the Cases link on the top left of the screen, and then click New Case.
Under the Department drop-down menu, select Student Finance/Academic Advising. Under the Request Detail drop-down menu, select Online Graduation Application.
Fill in all of the information in the blank fields and click Submit.
Then you will see the below page.
Currently employer: Yes, they want you to put your current employer in.
Session: This is the month and year you started the very last class. I ended my last class in April 2020 but the class started in March 2020. So, I am putting March 2020.
The school will take about 10-12 weeks for them to deliver the actual paper form of a diploma. However, if you need something quicker for going to another school before that 12 weeks, then you can request for program completion letter about a week after you submitted the graduation application. The school will send the program completion letter following 2~3 days.
And… YOU ARE DONE!!! YAY!!! Congratulation to you! =]
No. I am attending the graduation ceremony. Done with school, got the paper with MSN on it. I don’t care. =p
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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.
Let me start off with this statement. You won’t have a “life” while in the program. If you were told that the program is designed for working people, you heard it right with conditions. You can work but you won’t have life. Forget about family dinner, being with kids as usual, going to family gatherings on every holiday/weekend, and going out with friends. Forget it! I believe ALL online programs would be the same, not just CU. The program itself is not so hard, it’s just time-consuming to the max!!! Remember how you were during your nursing school? CU MSN program would be somewhat close to that without going classes and a bit more free time. Assignments won’t let you rest but doable with time investment. That being said… now you are ready to read the rest. =p
If you didn’t come from FB (Facebook) CU (Chamberlain University) page, I suggest you join them (CU MSN-FNP Students). Tons of peers, who suffer, cry, and laugh together with you, are there to support each other. For each cohort, there is a separate FB group. For me, I am in a FB group which ends the program in April 2020. Go to the CU MSN-FNP Students and shout out for your end program date, then someone will pick you up.
If you found this in the earlier stage of CU FNP program, critically before NR511, I would say you are somewhat lucky as I will tell you how I would have done it differently if I started all over again.
Until NR509, there is no way you would worry about failing class unless you slack off or get caught cheating. Starting from NR511 is a totally different ball game. In the CU MSN-FNP Students FB group, you will often see people worrying about failing classes. The majority of them are in NR511 and on. Why does this occur? Well, some of the problems that CU has is the design of each class from NR511. They crammed so much content into 8 weeks that your life will start to get miserable. You will have case study discussions that would take a couple of hours to complete, quizzes/mid-term/final exams that do not have a clear guide to study with, and presentation which will take a day or two to complete. That’s not all. You will have to fulfill 125 hours of practicum which excludes all the commute time you spend on the road. Think as if you have 1 full-time job that pays your bill, 1 half-time job without pay (your practicum), and you are in full-time school, not to mention your family duties. I have seen people changing to a part-time or even to a per-diem position if their finances are met. I personally changed working from ER to case management so that I don’t have too much physical stress on top of all the workloads. Yes, expect life modification as if you were in the BSN program. Balancing lifestyle will be a huge challenge for you especially with kids.
So, how would I do it differently?
I would start to study ahead of time. The majority of the lectures from NR511 and on are generally the same contents of the Hollier review book and Hollier Clinical Guidelines. These books are designed to prepare you for the board exam so you are preparing the exam way ahead of the time. Up to NR509, you can easily find time to do an extra study with these books. By preparing ahead, when you are in the NR511, you won’t need to worry too much about the learning contents which are mainly tested by midterm and final exams. Be aware that the midterm+final exams would be about 30%~40% of your total grade. It will impact a lot on your grade and GPA. However, as long as you get perfect scores on the assignment, you can “pass” the class with a quite horrible midterm and final exam scores. All the classes are out of 1000 points. You just need 800 to pass the class. In general, the midterm is 100 points and the final is 200 points. Think about it. You can miss EVERYTHING from the final and still pass the class. Yes, it is horrible but doable. =]
How would I aim for the study? After you join the CU MSN-FNP Students, ask the peers about the syllabus of NR511 and on (I will post them on my blog as I go onward with the program). You will see the general topics that they cover each week. You look for the topics that each week covers and study off of those two Hollier books. Another popular book would be FNP Certification Intense Review book.
Up until the epidemiology, pharmacology, and pathophysiology, the classes prior to these classes are mainly focused on essays. If you like to get things done quicker, double up the classes. It’s doable as many, including myself, did it.
Textbook? I didn’t buy one physical textbook as I rarely read. I purchased pdf versions starting from the epidemiology, pharmacology, and pathophysiology classes. Prior to that, I do not recall even thinking of purchasing one.
Always get ahead of the class in terms of assignments. Do it ahead of time when time is there and get over with it. I currently am in the preview week for NR601 (as of Sep 1, 2019) and I started working on the Week 5 case study assignment (200 points!!!).
Do you have a hard time finding a scholarly reference? This is what I usually do. Go to google and type your search word. For example, I am looking for some articles for osteoarthritis. When I type in google, I would type “osteoarthritis ncbi”. Then, I will see all the articles that are published by NCBI which is a good resource for scholarly articles. Of course, you can always use the school online library.
Find your practicum clinic as early as possible! Do not procrastinate on this as it could delay your graduation until forever. Finding one is already a headache but sometimes dealing with practicum coordinator is another headache. Be on top of them and check on them if they did follow up with your practicum clinic. I was lucky to have a practicum coordinator who was on schedule with everything but I heard bad stories about how their practicum coordinators forgot to submit a form and they have no idea what and who to contact. If you don’t hear from them within 1~2 weeks of your last contact, call or email them. Also, you don’t have to be stuck with the assigned practicum coordinator. If he/she is slow and delayed, contact student services and have them changed. It will make your life so much smoother. *(If you are near OC in S. Cali area, let me know. I have a clinic that would be approved for the entire 5 practicum classes! The doctor is willing to accept students most of the time.)
People often ask about a number of sites needed to complete the practicum. It could be from 1 to 5. I am lucky to have a clinic that the school approved for the entire 5 practicum classes. The clinic has enough flow of pediatric patients to fulfill the required pediatric hours (120 hr or so). Some students like or prefer to have separate pediatric and women health clinic. If you can find each, then go for it! You will have a chance to see and learn a lot more than staying at one site. The downside of having 1 clinic for the entire 5 classes is that you cannot learn the different ways of practice besides your preceptor. The best part is that you don’t have to worry about your preceptor being absent when it’s your time for that specific site. Especially if your preceptors are MDs, for my case, they will never quit on you unless he/she has to go on a vacation. Because, most of the time, the MD owns the clinic or the MD is partnered with another MD to run the clinic. It’s their own business, hence, they are always there. Some PAs and NPs, change the job while you are in the practicum with them. Once they are gone, your practicum site is gone. Be mindful when you find clinics.
Talking about some of the insufficient practicum coordinators, another insufficiency comes from Complio. Oh my… whoever is evaluating the documents that we submit, I am very sure that they are not educated in terms of healthcare. In my case, I had TB that I don’t even remember. I must have had it when I was a very young age. Whenever I have a TB test, it always results in positive. So, I skip all the steps and go straight to X-ray to prove that I am either completely healed, no active TB, or negative, whichever soothes their wordings. I uploaded the X-ray result showing no TB and it got rejected. Why? The reason showed that I still needed to do the skin test. What?? I am NEGATIVE per X-ray! X-ray result is much more specific and sensitive than skin test! I fought over email and phone call and they kept insisted on me to complete the skin test. I educated the representative and that didn’t matter. So, I called the school that takes care of compliance then the TB was cleared. I also heard a story about how they required a student to take extra boost immunization… the list goes on… So, your solution is to call the school. They will clarify.
While you are in the FB group, ask people for the “Rate your professor” file. If possible, avoid the mean ones. I have the link but I think it should only be shared among the students. Your life is already hard enough as is, avoid as much as possible if there is away. Some professors can be very nitpicking on papers especially APA format and deduct points. It could lead to pass or fail because of that a few points cut out from the NR511. *As of Jan 2020, you no longer have choice of instructor. But I heard from some that they were able to pick or change. So, I guess it depends on who you talk to.
How to get full credit on the discussion?
I have not gotten points off from the discussion to this date. Of course, you need to stick to the rubric. But from my point of view, many people miss their points because they miss mentioning the details. These instructors have been teaching similar or the same classes for years. They know all the details that they are looking for in a discussion posting. As long as you do not miss little details, you won’t miss a point. Here is how I do it.
When I read discussion instruction, I highlight what seems to be important to mention. I copy and paste the discussion instruction on a Word. As I read, I highlight in red what I would mention in a discussion. This way, I do not forget what I need to address while writing a discussion.
References You will be heavily graded on APA starting from NR509. You may not lose a point from the contents but you would be surprised how much points you could lose from the reference section. I am listing a few that you will come across.
How to reference Epocrates
Lovastatin. (2019). In Epocrates Essentials for Apple iOS (Version 12.1.2) [Mobile application software]. Retrieved from http://www.epocrates.com/mobile/iphone/essentials
Bicillin L-A. (2010). In Epocrates Medical Reference App (Version 19.1) [Mobile application software]. Retrieved from: https://www.epocrates.com
How to reference Hollier Clinical Guidelines book
Hollier, A (2018). Clinical guidelines in primary care (3rd ed.) Advanced Practice Education Associates
Can you get CEUs credit for renewing RN license? Yes! Every state is different but at least for CA (where I live), you get 15 CEUs for 1 unit/semester. (1 quarter unit = 10 CEUs) So a 3 unit class would be 45 ECUs. You can check detail from RN.CA.GOV.
What is the difference between ANCC vs AANP?
Take a look at this video!
Another part to consider for ANCC vs AANP.
To be continued…
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Let me tell you this first. If you are computer savvy, this is going to be a breeze through class beside the Immersion. I have a separate page specifically written for the Immersion.
This class is heavily focused on virtual health assessment called Shadow Health. Among peers, you will talk about this one particular person a lot, Tina Jones. She is the virtual patient that you will encounter most of the time. Here is how you get there.
In the Week 1 module, you will see this. Then, this will show up. Click the blue bar. Then, this shows up. Then this… Walla~ you finally arrived! The rest of the part is quite self-explanatory. I will skip that.
Starting from Week 1, you will be doing the following for almost every week.
Shadow Health – Physical assessment
Weekly quiz
Debriefing or Alternate assignment
APEA 3P Exam
Shadow Health As I mentioned, Shadow Health is a virtual health assessment program that you get to practice prior to the practicum. Let me tell you from the beginning. It’s a quite dragging assignment that repeats over and over again. Once you get hang of it, it’s easy. It’s just time-consuming.
In order to do the assignment, you should have a microphone since you will be talking to the virtual patient, Tina Jones. If you don’t have a microphone, I strongly suggest you get one as you do not want to type the conversation.
Of course, you will need a computer that could run the Shadow Health. I am a computer geek guy and have a computer with a high powered graphics card and I had no trouble running the program. Many of you will run the Shadow Health with a laptop. It will run but many of them will have their computer fan going crazy and your computer will get hot. I recommend you get a laptop fan while you are doing the Shadow Health on your laptop. It will save your laptop’s life. Now, you are ready to do the assignment.
When you talk to Tina, you may want to talk very clearly to the microphone as the program may pick up totally different words than what you said.
As you go through the Shadow Health, you will fill in the right side of the box with Subjective, Objective, Assessment, and Plan.
Subjective This is where you are going to use SOAP note. Start with the chief complaint (CC), HPI, social hx, family hx, and ROS. As you go week by week, you will notice that you will see yourself repeating the same thing over and over again beside the CC. No, you cannot copy and paste. You would have to type all over again with the same family hx and social hx. This is where I felt a waste of time.
Objective Most of the major points that you will be getting are from the Objective part. Be very specific about the Objective part. For example, when asked Tina “Do you have any pain?”, she may answer, “I have a stomachache.” Then, you would want to go every detail about a stomachache. Which part is hurting, since when did it get hurt, what made it hurt, what aggravates, and so on. Every single detail part you get in to and ask the right question, you get credit for it. Make sure that you also empathize Tina whenever she reports pain like “I am sorry to hear that.”
Assessment Depending on your instructor, you will be required to come up with 3 or more differential diagnosis including ICD-10 code for each diagnosis.
Plan This where you input any diagnostics, medication, education, referral/consultation, and follow-up planning.
Once you complete the exam, you think you will go to the score page. Haha! You wish! Now, here comes a few T/F, multiple-choice questions, and short discussions. Then in the end, you will write self-reflection. Bah… -_-
Now, you will get to the score. If I remember correctly, your DCE (Digital Clinical Experience) score has to be greater than 93% for you to pass the assignment. % score is not equal to your grade score. If you got lower than the cutline score, then you can repeat the ENTIRE process again 2 more times. haha… Trust me, you don’t want to do more than once on each Shadow Health assignment. Get it done right on the first trial, get over with it. But the good (?) part is that you get to see what you missed and you can literally do it over again by looking at it.
Be warned! So, some people use “trick” for this. Because you get to see the entire “answers” after the first trial, some people would start and end the 1st trial right away. It will result in 0% DCE score and a very short time you spent will be recorded. Then they use that “answer” to do the 2nd trial. This considered academic dishonesty. So, be aware. The time you spent on it is also recorded.
Once you are done with the assignment, you will see this page. On the upper right-hand corner, you see the “Lab Pass”. Click on it and you will download a pdf file that looks like this. This is the pdf file that you will turn in on each Physical Assessment Assignment.
Debriefing Session or Alternative Writing Assignment Your instructor will hold a live conference over the phone and computer. I strongly suggest you attend it every week as you do not want to do much lengthy Alternative Writing Assignment. You get a basic attendance score but also how active you are with discussion. I know you would be eager to talk and participate but give others to speak also. It shouldn’t last longer than an hour.
Weekly Quiz To me, it didn’t feel that hard at all. I did read the entire book (Jarvis – Physical Examination and Health Assessment) which helped. I read cover to cover and getting A from quizzes was easy.
APEA 3P Exam This is something else. Let me tell you this. There is NO WAY you can prepare for this. If you are reading this post much earlier than NR509 class, then I guess you can prepare this exam by reviewing entire pharmacology, pathophysiology, and epidemiology. Again, there is no way you can prepare for it. So, just relax and let the exam begin. The black stuff is the letters and white around it is the background. Read through as if you are flipping through a magazine and get it over with. Score? It’s either you get full 85 points if you pass or 0 if you don’t pass. I believe the cut score is 75% (73%?). It’s the only exam that is not proctored.
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So… the notorious 602 begins. You probably heard the horrible story about this class due to the amount of workload. I am currently on the preview week and I am going to start today!
Clinic log
The program requires you to log 2 pt/hr. So far, I included chart time to the clinical hour but starting from this, your logging equal to facetime with pt. At least for my case, my instructor allowed me to log more than 30 mins/pt when pt has multiple diagnoses. The following logging has been approved by my instructor.
– 60 mins for a wellness exam
– 40~50 mins for 3 or more diagnoses
– 45 mins for 2 diagnoses with a procedure (ex. ear lavage, splint, etc)
– 30 mins for a single diagnosis (ex. cold symptom, abdominal pain, etc)
Remember that no two instructors are the same. I strongly suggest you send an email to your instructor on Week 1 or even preview week regarding your instructor’s expectation.
Week 1
Week 1 begins very nicely. Just need to post an introduction of yourself with the lovely Kaltura… (really… I hate that program. Out of all the nice programs out there… why Kaltura… -_-)
As you posted Clinical Goals in NR601, we post the same also. But this time, it’s worth 10 points! Here is the rubric for it.
2.0 pts
Student lists weekly schedule for clinical, including days and hours. Both (days and hours) must be present on the weekly schedule for full credit.
1.0 pts
Student partially meets the criteria. For example student lists weekly schedule but only include one of the following: days or hours
0.0 pts
No MarksThe student does not list days and hours of weekly schedule or fails to submit weekly schedule criteria by the due date.
5.0 pts
Student lists a minimum of 2 clinical goals for the week.
1.0 pts
Student lists 1 clinical goal for the week.
0.0 pts
Student lists 0 clinical goals for the week or fails to submit this criterion by the due date.
3.0 pts
Student discusses barriers and opportunities specific to the clinical site or preceptor.
1.0 pts
Student partially meets the criteria. For example Student discusses barriers specific to clinical site or opportunities specific to the clinical site but fails to address both.
0.0 pts
The student does not discuss barriers and opportunities or fails to submit this criterion by due date
This is what I posted.
Weekly schedule
Every Fri from 8 AM to 7 PM
Every Sat from 9 AM to 6 PM
Clinical goal
I am trying to encounter as much as peds and women’s health as possible. It’s hard to see infant patients as most parents tend to take their infants to the ER rather than a clinic.
I will also try to see 2 patients/hour.
Anticipated barriers or opportunities
As a male student, it’s hard to see female patients especially their chief complaints are related to genitourinary and/or sexual activities. I had several female patients, especially younger age, specifically ask to be seen by female providers. It’s understandable but it is a barrier from a learning perspective.
Some others typed in essay form. My instructor gave me 10 points with the above post.
That is it for Week 1! But don’t wait for Week 2 to come. You better start on your Week 2 assignment!
Week 2: Grand Rounds Presentation & Discussion
Here we go… the notorious Grand Rounds assessment. There are 4 parts to it.
1. Presentation (due by Wednesday) – Video presentation of an assigned disease using Kaltura. Must wear lab coat with name tag/badge showing. Minimal 6 references. Also, you need to make 3 open-ended questions and either post along with your presentation or include in the ppt. These 3 open-ended questions “should not be questions that can easily be answered by watching your presentation.”
2. 2 replies to peers in 2 different days (due by Friday) – In each peer response, you must answer all 3 open-ended questions.
3. 3 replies to the instructor (by Sunday) – One from your post, two more replies to the instructor that was posted on peers.
4. Summary post (by Sunday but you cannot post before Saturday) – My summary was more or less rewording of presentation and answering my own 3 questions.
In my case, the topic was given on Week 1 Wednesday. I heard from other students that they had the topic at the beginning of Week 1, and some students didn’t get the topic until Saturday of Week 1. So, I guess this is by the mercy of each instructor. There are tons of postings that you have to do. I honestly think this is nothing more than busywork… -_- sigh…
If possible, please do not wait until the due date to post your initial post so that others can do replies early. I posted mine on Sunday and there were no other posts by other students until the due date… please…
I cannot believe I have to do this again on Week 6… lol
Anyhow, starting from Week 2, you need to do QBank questions. Unsure of the reason why but the access code for QBank won’t be given to students until the end of Week 2. I don’t see that it’s graded but the due date is the date when the QBank access is given. What?!
During the beginning of Week 2, you will receive an email from APEA that would look like this.
No. You don’t have access to the QBank yet. They will send another email with login information. If you didn’t get the access to the QBank by Thursday of Week 2, place a call to APEA (not your instructor) for support.
Until Saturday, I didn’t get login information from APEA, so I emailed them. I got a reply from APEA. They told me to go to www.apeaqbank.com then use the forgot password link. Then ID and password will be sent to you. Maybe I should have done this earlier… -_-
In Week 2, the QBank assignment is to complete Dermatology, Cardiovascular, and Orthopedics. This is not a required assignment. Not graded.
For Week 2 quiz, I studied off of the NR602 pediatric Topics. Pretty simple and straight forward.
The last task of Week 2 is CEAP-FNP Survey. You will receive an email to your CU email.
The survey asks about your general characteristics and school issues. Once completed, you will receive a confirmation email. Now, you are done! It took me about 10 mins or so to complete the survey.
I lost 3 points out of the assignment due to not posting the permalink for the references that I searched from Chamberlain library. Make sure to get the permalink included in the references. You need at least 3 of them.
Week 3: Sick Child Clinical Case Presentation Another busy work ahead!
There are 3 parts to the assignment.
1. Initial post (due by Wednesday) – Initial post must include SOAP note but do not use OLDCART in the HPI. You will only post SO of the SOAP note.
Start with the patient information (name initials, age, gender, and race).
Subjective: I listed CC, HPI (narrate), current med, allergies, PMHx, PSHx, immunization hx, soc hx, fam hx, and ROS.
Objective: I listed vital signs, height, weight, BMI, head to toe physical exam and diagnostic data, if any. Include, in the objective data, growth chart percentiles (example: 98%) for height, weight, and BMI, and tanner staging.
Then, do not write the assessment and plan part in the initial post. No reference needed on the initial post.
2. Minimum 2 replies to peers (due by Friday) – Each reply must contain 3 differential diagnoses and reasons for each. Then discuss which one of 3 is the primary diagnosis and why. Discuss your treatment plan with references.
3. Summary post (due by Sunday) – Discuss primary and secondary diagnoses. Discuss the treatment plan for each diagnosis with references. Eliminate the differential diagnosis. Lastly, summarize peer replies to your post.
Week 4 Well, my midterm was the worst of all the exams I took in the history of CU. lol. If I look back, I shouldn’t have studied or should I say I should have studied since the beginning of Week 1. lol. So random. Unless you started to study for the midterm since Week 1, go ahead and get over with. Start work on Week 5 assignment and recoup the lost points from the midterm.
Those who would like to start ahead, here is the study guide.
Midterm study guide (602 Midterm study guide 1, 2)
Week 5 Week 5 quiz was not proctored! *Hint, hint!*
For the Evaluation of Marginalized Women Paper… I don’t know what to say besides to follow the rubric and you should be golden. I just BSed the entire essay and I got full credit. Make sure that your TII score is below 24%!
Week 6: Grand Rounds Presentation & Discussion Here we go again. Another Grand Grounds… the assignment is exactly the same as Week 2.
1. Presentation (due by Wednesday) – Video presentation of an assigned disease using Kaltura. Must wear lab coat with name tag/badge showing. Minimal 6 references. Also, you need to make 3 open-ended questions and either post along with your presentation or include in the ppt. These 3 open-ended questions “should not be questions that can easily be answered by watching your presentation.”
2. 2 replies to peers in 2 different days (due by Friday) – In each peer response, you must answer all 3 open-ended questions.
3. 3 replies to the instructor (by Sunday) – One from your post, two more replies to the instructor that was posted on peers.
4. Summary post (by Sunday but you cannot post before Saturday) – My summary was more or less rewording of presentation and answering my own 3 questions.
Week 6 quiz was also not proctored.
Week 7: STD Healthy People 2020 Discussion Your instructor should have given you a topic with a link to HP2020 website at least a week before.
1. Initial Presentation (due by Wednesday): The initial post should include the following.
signs and symptoms
treatments per current clinical guidelines
follow-up
possible psychological issues that may present
side effects of medication or the disease itself
find and identify your local or state statistics for your assigned STD from the CDC website
I began the post with the topic and the link that was assigned to me. Below is the snapshot of the post.
In the background information, I also added statistical data and a few graphs. Some graphical insertion make the post look much nicer and my instructor liked it also. If you are going to post a graph or a picture, make sure to post the source link below the picture.
Then I went ahead with my post by discussing local statistic data, signs & symptoms, treatments, side effects of medication, follow-up care, long-term health outcomes (if left untreated), and psychosocial effect.
2. Response to Peer Presentation (due by Friday) – 2 posts to peers that have to contain following.
local statistics (from your area) for your peer’s assigned STI
at least one evidence-based action plan that is measurable and could be implemented at the community level/population level or at the individual level for your peer’s assigned STI
at least one opposition or barrier they may come across with the proposed action plan
evidence from appropriate, scholarly sources
As you might have noticed that you will be posting exactly the same local statistics to 2 different students. I just copied and pasted. Then, evidence-based action plan and barriers to expedited partner therapy. For evidence-based action plan can be easily found from either CDC, ACOG (American College of Obstetricians and Gynecologists), or other peer-review journals.
3. Interactive Dialogue with Faculty (due by Sunday) – 3 posts including your post and 2 of other students.
respond to all faculty question(s) posted to student’s initial discussion post
respond to two (2)faculty questions that are posted to a peer’s initial posts
respond to all general questions posted to the class by faculty
evidence from appropriate, scholarly sources
The reply would be different depending on your instructor’s question. Most of my answers came from CDC.
4. Summary Criteria (due by Sunday) – But, cannot post before Saturday.
present a STD summary in a logical, meaningful, and understandable sequence
create three (3) evidence-based action plans that you can apply in your practice/community that will help to decrease the incidence of the STD you were assigned; you may create all three evidence-based action plans or you may create one on your own and use two of the evidence action plans that were recommended to you by your peers
each action plan must include an evidence-based in-text citation
discuss at least one opposition or barrier they may come across with the proposed action plans
include a summary of your peers’ responses to your initial post
The first body part of the Summary started with regurgitation of my initial post. I just did condensed version of the initial post with an overview of the disease, statistical data which I compared with other student’s replies to my post, treatment, and etc. My last part was the three evidence-based action plans.
Week 8: Reflection It’s that time again… reflection. I don’t know what else to say. I typed up some clinical examples in the reflection. The instruction/rubric didn’t state anything about references and I did not post any references. I didn’t lose points.
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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: 11/2019
Week 1: Weekly Clinical Goals
Students should post Weekly Clinical Goals before they attend clinical for the week.
Weekly schedule for clinical. Please include days and hours.
Using your clinical competency checklist to guide you, please share two clinical goals for the week.
What barriers and opportunities do you anticipate specific to your clinical site and/or preceptor?
Week 2: Pediatric Grand Rounds Presentation and Discussion
Purpose
The purpose of this discussion is to enhance the student’s clinical reasoning, confidence and learning of various pediatric and women health topics through virtual presentation and facilitated discussion. This assignment is completed in weeks 2 and 6.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
Apply advanced preventative and ill visit knowledge to the care of children and women (CO 1, 2, 4).
Apply appropriate pharmacologic and non-pharmacologic interventions in the care of children and women (CO 1, 2, 4).
Apply advanced preventive and routine exam knowledge to the care of women and children (CO 1, 2, 4).
Explore health promotion or disease prevention specific to the child-bearing family (CO 1, 2, 4).
Locate and apply current guidelines for specialized exams and care in women and children (CO 1, 2, 4).
Discuss common issues of women’s health (CO 1, 4).
Summarize patient findings into an organized oral presentation (CO 1, 2, 4).
Due Date:
Pediatric Grand Rounds due Week 2 by Wednesday, 11:59 p.m. MT
Women’s Health Grand Rounds due Week 6 by Wednesday, 11:59 p.m. MT
A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, 11:59pm 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)
Total Points Possible: 110
PRESENTATION REQUIREMENTS:
In Weeks 2 & 6, you will create a video Powerpoint presentation, narrated in Kaltura, on a select topics assigned to you by your professor in week.
Please refer to the “How to use Kaltura” recording below. If you have technical issues, please contact your faculty or Tech Support. Make sure you click on the Screen & Webcam box to record in Kaltura. For more information on Kaltura, see Resources.
In each presentation, a student must discuss the following:
Pathophysiology, epidemiology, risk factors, and clinical assessment findings for the assigned topic
A minimum of three (3) differential diagnoses, listed
Typical clinical assessment findings for each assigned topic, in detail
Any applicable diagnostic studies to confirm the diagnosis of the assigned topic. If not applicable, discuss why)
Prevention (if not applicable, discuss why)
Treatment including non-pharmacologic management and pharmacologic management (if not applicable, discuss why)
Patient and/or family education
Discuss best practices for optimal outcomes
The overall presentation must meet the following requirements:
The presentation should be interesting, professional, and focused to the topic
Lab coat and name tag/badge must be worn
Visual aids should be included (i.e., pictures, charts, graphics, mindmap, algorithm, etc.)
Utilize a minimal of six peer-reviewed scholarly articles from Chamberlain Online Library and/or current evidence-based clinical guidelines to support your findings.
Upload your presentation to the discussion board by Wednesday, 11:59 p.m. MT.
Begin facilitating discussion and continue to lead it throughout the week by posting three (3) open-ended questions on your topic. These should not be questions that can easily be answered by watching your presentation. The questions should add additional information to the discussion.
PARTICIPATION REQUIREMENTS:
Interactive Dialogue with Peers (due by Friday 11:59 p.m. MT)
Post a response to the presentation questions of at least two (2) peers on two (2) different days.
Responses to peer presentation question should be insightful and substantive.
Interactive Dialogue with Faculty (due by Sunday 11:59 p.m. MT)
Students must respond substantively to all faculty-directed question on three (3) separate posts. You must answer all questions from faculty directed at you on your presentation as well as answer the faculty questions on a minimal of two peer posts).
Ground Rounds Summary Criteria (due by Sunday 11:59 p.m. MT)
Starting on Saturday, add summary post to the original grand rounds presentation that summarizes the discussion. Includes conclusions from the collective group discussion on the topic. Summary post is due Sunday before 11:59 p.m. MT, ** Do Not Post a Summary before Saturday** Peers need time to review presentations and respond. Summaries posted before Saturday will receive a zero for the Summary requirement criteria/category
Week 3: Sick Child Clinical Case Presentation
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 care of women and children.
Demonstrate the ability to analyze previous patients seen in the clinical setting be able to perform an evidenced-based review of their case, diagnosis, and plan, while guiding and taking feedback from peers regarding the case
Demonstrate professional communication and leadership, while advancing the education of peers.
Course Outcomes
Integrate current evidence based clinical practice guidelines in the care of childbearing and childrearing families.
Appropriately apply anticipatory guidance and health promotion in the care of childbearing and childrearing families.
Assess growth and developmental milestones in the care of childbearing and childrearing families.
Construct an evidence based reproductive health management plan.
Identify and address healthcare needs of marginalized childbearing and childrearing families
Requirements
For Week 3 of the course you will be presenting your own case from clinical. The case should be clear, organized, and meet the following guidelines:
Initial Case Presentation:
Present only the subjective and objective data only on the patient organized as you would organize them in a SOAP (CC, HPI (no OLDCART for HPI); ROS, PE findings, and any lab or diagnostic findings for your patient.
**Do not put the diagnosis or plan in initial post. No Assessment/Plan in the initial post. No citations or references are required for your initial post, you will post references in your summary post.
WEEK 3: The case should be pediatric (a patient age 17 years or younger).
WEEK 3 specific guidelines: The case must not be something overly simple. The list of things that should not be covered include sore throat, URI, UTI, ear infection, or contact dermatitis (poison ivy). You need to present a case that intrigued you or presents new content in a different light. *One of the above diagnosis can be presented if the findings were unusual and you clear such case with your course faculty prior to posting (at least 2 days before posting). In the pediatric case you must also include in the objective data growth chart percentiles for height, weight, and BMI, and tanner staging. A patient you saw both for initial complaint and follow-up would be ideal, but not required.
Leading the Discussion: Post your subjective, objective, and diagnostic data for your patient by Wednesday at 11:59 PM MT.
Interactive Dialogue: As a student you will also be required to respond to at least two (2) other students initial case presentation. In your responses, you must include the following: Your top three (3) differentials based on the information provided and why (rationale based on presentation findings), the primary diagnosis you are leaning toward, how you would treat that diagnosis. Use references to support your response. *DEADLINE – YOUR RESPONSES TO 2 STUDENTS ARE DUE BY FRIDAY AT 11:59 p.m. (MT). **If all students have a response, then choose the student with the least responses to their posting.
Clinical Case Presentation Summary Criteria:
By Sunday 11:59 p.m. MT, post a summary reply to your initial post and respond to any faculty questions to your initial posting or question(s) posed to the general class. Use references to support all of your responses.
Criteria for Summary Post should include all of the following required elements: Summary post written in paragraph(s) type format (NoSOAP note for Summary Post); discuss primary and any applicable secondary diagnoses along with treatment plan for each diagnosis. Scholarly and evidence based in-text citation support for all of the listed diagnoses; Scholarly and evidence based in-text citation for each treatment plan. Differential diagnoses are eliminated. Summarize your peer’s posts to your presentation.
*Remember not to use any patient identifiers in your posting (this would be full names or disclosure of clinic name, preceptor name, et cetera). Please include age, gender, and race.
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Week 4: Weekly Clinical Goals
Students should post Weekly Clinical Goals before they attend clinical for the week.
Weekly schedule for clinical. Please include days and hours.
Using your clinical competency checklist to guide you, please share two clinical goals for the week.
What barriers and opportunities do you anticipate specific to your clinical site and/or preceptor?
Week 5: Evaluation of Marginalized Women Paper
DueDec 1, 2019 by 11:59pm
Points150
Submittinga file upload
Purpose
The purpose of this assignment is to
Provide learners with the opportunity to integrate knowledge and skills learned throughout this course
Directly apply principles and knowledge learned in the course to problem solving of population health problems in marginalized women.
Course Outcomes
This assignment enables the student to meet the following course outcomes:
Integrate current evidence based clinical practice guidelines in the care of childbearing and childrearing families.
Appropriately apply anticipatory guidance and health promotion in the care of childbearing and childrearing families.
Assess growth and developmental milestones in the care of childbearing and childrearing families.
Construct an evidence based reproductive health management plan.
Identify and address healthcare needs of marginalized childbearing and childrearing families
Due Date
Submit by Sunday 11:59 p.m. MT at the end of Week 5.
Note: This assignment will follow the late assignment guidelines specified in the course syllabus. It is a TurnItIn assignment.
Total Points Possible: 150
Requirements
This paper should clearly and comprehensively identify the disease or population health problem chosen. The problem must be an issue in your geographic area and a concern for the population you will serve upon graduation with your degree. The paper should be organized into the following sections:
Introduction with a clear presentation of the marginalized group as well as significance and a scholarly overview of the paper.
Background of the marginalized group/problem including description, current incidence and/or prevalence statistics current state, local, and national statistics pertaining to the problem.
Discuss the economic aspects of the marginalized group
Discuss social justice and its relationship to health disparities and health care of marginalized group.
Discuss ethical issues on marginalized group
Provide a brief plan of how you will address this marginalized group in your practice once you are finished with school. Provide three actions you will take along with how you will measure outcomes of your actions.
Conclude in a clear manner with a brief overview of key points of the entire problem
Preparing the Paper
Choose one topic from the following list:
Female Veterans
Incarcerated Women
Lesbians
Transgender Women
Women with HIV
Women Sex Workers
Women with Mental Illness
Women Immigrants
Women with Past Sexual Assault
Paper Length: 5-6 pages, excluding title/cover and reference pages
Week 6: Women’s Health Grand Rounds Presentation and Discussion
Purpose
The purpose of this discussion is to enhance the student’s clinical reasoning, confidence and learning of various pediatric and women health topics through virtual presentation and facilitated discussion. This assignment is completed in weeks 2 and 6.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
Apply advanced preventative and ill visit knowledge to the care of children and women (CO 1, 2, 4).
Apply appropriate pharmacologic and non-pharmacologic interventions in the care of children and women (CO 1, 2, 4).
Apply advanced preventive and routine exam knowledge to the care of women and children (CO 1, 2, 4).
Explore health promotion or disease prevention specific to the child-bearing family (CO 1, 2, 4).
Locate and apply current guidelines for specialized exams and care in women and children (CO 1, 2, 4).
Discuss common issues of women’s health (CO 1, 4).
Summarize patient findings into an organized oral presentation (CO 1, 2, 4).
Due Date:
Pediatric Grand Rounds due Week 2 by Wednesday, 11:59 p.m. MT
Women’s Health Grand Rounds due Week 6 by Wednesday, 11:59 p.m. MT
A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, 11:59pm 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)
Total Points Possible: 110
PRESENTATION REQUIREMENTS:
In Weeks 2 & 6, you will create a video Powerpoint presentation, narrated in Kaltura, on a select topics assigned to you by your professor in week.
Please refer to the “How to use Kaltura” recording below. If you have technical issues, please contact your faculty or Tech Support. Make sure you click on the Screen & Webcam box to record in Kaltura. For more information on Kaltura, see Resources.
In each presentation, a student must discuss the following:
Pathophysiology, epidemiology, risk factors, and clinical assessment findings for the assigned topic
A minimum of three (3) differential diagnoses, listed
Typical clinical assessment findings for each assigned topic, in detail
Any applicable diagnostic studies to confirm the diagnosis of the assigned topic. If not applicable, discuss why)
Prevention (if not applicable, discuss why)
Treatment including non-pharmacologic management and pharmacologic management (if not applicable, discuss why)
Patient and/or family education
Discuss best practices for optimal outcomes
The overall presentation must meet the following requirements:
The presentation should be interesting, professional, and focused to the topic
Lab coat and name tag/badge must be worn
Visual aids should be included (i.e., pictures, charts, graphics, mindmap, algorithm, etc.)
Utilize a minimal of six peer-reviewed scholarly articles from Chamberlain Online Library and/or current evidence-based clinical guidelines to support your findings.
Upload your presentation to the discussion board by Wednesday, 11:59 p.m. MT.
Begin facilitating discussion and continue to lead it throughout the week by posting three (3) open-ended questions on your topic. These should not be questions that can easily be answered by watching your presentation. The questions should add additional information to the discussion.
PARTICIPATION REQUIREMENTS:
Interactive Dialogue with Peers (due by Friday 11:59 p.m. MT)
Post a response to the presentation questions of at least two (2) peers on two (2) different days.
Responses to peer presentation question should be insightful and substantive.
Interactive Dialogue with Faculty (due by Sunday 11:59 p.m. MT)
Students must respond substantively to all faculty-directed question on three (3) separate posts. You must answer all questions from faculty directed at you on your presentation as well as answer the faculty questions on a minimal of two peer posts).
Ground Rounds Summary Criteria (due by Sunday 11:59 p.m. MT)
Starting on Saturday, add summary post to the original grand rounds presentation that summarizes the discussion. Includes conclusions from the collective group discussion on the topic. Summary post is due Sunday before 11:59 p.m. MT, ** Do Not Post a Summary before Saturday** Peers need time to review presentations and respond. Summaries posted before Saturday will receive a zero for the Summary requirement criteria/category
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Week 7: STD Healthy People 2020 Discussion
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 using the Healthy People 2020 goals.
Demonstrate an advancing understanding of Sexual Transmitted Infections (STD’s)
Demonstrate the ability to create an action plan that can be implemented as an FNP
Demonstrate professional communication and leadership, while advancing the education of peers.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Demonstrate care for women with sensitive health issues (CO 1, 4)
Explore Approaches to Sexual Transmitted Diseases screening and detection (CO 1, 4)
Due Date:
Initial discussion due by Wednesday, 11:59pm MT Week 7
Peer Responses due by Friday, 11:59 pm MT Week 7
Faculty Responses due by Sunday, 11:59pm MT Week 7
A 10% late penalty will be imposed for EACH discussion posted after the deadline, 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 for that section).
Total Points Possible: 110
Requirements:
Initial Presentation (by Wednesday 11:59 p.m. MT)
List the STD standard that you were assigned and give a complete background of your STD including:
signs and symptoms
treatments per current clinical guidelines
follow-up
possible psychological issues that may present
side effects of medication or the disease itself
find and identify your local or state statistics for your assigned STD from the CDC website
Response to Peer Presentations (by Friday 11:59 p.m. MT)
Post to two (2) peer’s discussions which must include:
local statistics (from your area) for your peer’s assigned STI
at least one evidence-based action plan that is measurable and could be implemented at the community level/population level or at the individual level for your peer’s assigned STI
at least one opposition or barrier they may come across with the proposed action plan
evidence from appropriate, scholarly sources
Interactive Dialogue with Faculty (by Sunday 11:59 p.m. MT)
respond to all faculty question(s) posted to student’s initial discussion post
respond to two (2)faculty questions that are posted to a peer’s initial posts
respond to all general questions posted to the class by faculty
evidence from appropriate, scholarly sources
Summary Criteria(by Sunday 11:59 p.m. MT)
present a STD summary in a logical, meaningful, and understandable sequence
create three (3) evidence-based action plans that you can apply in your practice/community that will help to decrease the incidence of the STD you were assigned; you may create all three evidence-based action plans or you may create one on your own and use two of the evidence action plans that were recommended to you by your peers
each action plan must include an evidence based in-text citation
discuss at least one opposition or barrier they may come across with the proposed action plans
include a summary of your peers’ responses to your initial post
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 #1, the MSN Essential VII, and the Nurse Practitioner Core Competencies # 8.
Program Outcome #1: Provide high quality, safe, patient-centered care grounded in holistic health principles. (holistic health & patient-centered care)
MSN Essential VII: Interprofessional Collaboration for Improving Patient and
Population Health Outcomes
Recognizes that the master’s-prepared nurse, as a member and leader of interprofessional teams, communicates, collaborates, and consults with other health professionals to manage and coordinate care.
Nurse Practitioner Core Competencies
# 8 Ethics Competencies
Integrates ethical principles in decision making.
Evaluates the ethical consequences of decisions.
Applies ethically sound solutions to complex issues related to individuals, populations and systems of care.
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Practicum logging
This topic would be depending on your instructor. You are expected to see more patients with less time spent per patient. During my NR601, most of my patients were about 50 minutes (about 10 minutes decreased from NR511). Some of the elder female patients came in for an annual physical exam, I filed up to 65 minutes and my instructor didn’t bother about it. If a patent came with simple issues such as cold symptoms or otitis externa, I logged about 30 mins to 40 mins per patient. However, some instructors can be very difficult. I have heard peers posting on FB about 50 mins/patient is too long for NR601. So, contact your instructor and ask for their expectations at the beginning of the class.
Starting from this class, there is a new 0 point assignment (so wonderful…. -_-). It’s called Weekly Clinical Goal. Basically, you are posting your target clinical schedule and what you are trying to achieve and what you may lack. If there is an issue with lacking part, how would you improve it… Yes, you have to post this EVERY week. I posted exactly the same every week. My instructor didn’t care. I don’t see the point of this assignment. At least it’s a short post. I am not sure if this is considered a weekly attendance.
Here is my example.
Weekly schedule
Every Wed/Fri from 8AM to 7PM
Every Sat from 9AM to 3PM
Clinical goal
I am trying to encounter as much as peds and women’s health as possible. It’s hard to see infant patients as most parents tend to take their infants to the ER rather than a clinic.
Anticipated barriers or opportunities
As a male student, it’s hard to see female patients especially their chief complaints are related to genitourinary and/or sexual activities. I had several female patients, especially younger age, specifically ask to be seen by female providers. It’s understandable but it is a barrier from a learning perspective.
Week 1: PFT Quiz
Don’t make yourself more complicated than what it is. I saw the school lecture and it was so horrible, I had to make this.
Here is my version of the lecture. Download it and follow through with the example questions. PFT Lecture
These questions are from the lecture.
The quiz is nothing more than the simple steps of 1, 2, 3. I don’t know why they make it so much more difficult than it is. -_-
If you want to know more about PFT (which we should), I personally like the following YouTube video for the overall review of PFT.
Week 2: Polypharmacy Discussion
Initial post – Due: Wednesday of Week 2
Peer response – 2 or more responses to peer and instructor
Week 2: ACC/AHA Guidelines Discussion
Initial post – Due: Wednesday of Week 2
Peer response – 2 or more responses to peer and instructor
Week 2 Quiz
Pretty straight forward compared to NR511. If you have pretty good knowledge about cardiology, it would be easy to pass. I used work in the ER so I dealt with a lot of CAD, HF, and A.Fib. I felt very comfortable taking the quiz with general nursing knowledge. However, make sure to know in detail about the HF guideline.
Week 3 discussions are the same as week 2 discussions in terms of due dates.
Week 4 Midterm and VICE
Compared to NR511, this class midterm is much more forgiving. It is a lot of content just like any other exams but like Week 2 Quiz, this isn’t that bad at all. Make sure to know the guidelines for HF.
Yes, we do, again, have the VICE assignment. By week 3, your instructor should have given you a time frame for you to schedule the VICE assignment. This is also very dependent on your instructor how difficult or easy it can be. So far, I have been winning the lottery with instructors.
Week 5 Case study
This assignment is such a dragging one. The guide directed to complete the paper with 15 pages without counting the reference and cover page but I ended up passing 15 pages. 16 pages to be exact and I tried to condense. The rubric asked so much in detail and I actually had a hard time shortening it to close to 15 pages.
I started on the case study at the starting of week 2 and worked on it progressively. Some people did complete it within a day, but I couldn’t see myself doing that in one day. I would say start as early as possible and have some breathing room up to week 5.
Be aware that your similarity score from TII would be much higher than usual. Thinks about it. There were 1000s of students who took NR601 and done the same case study using the exact same guideline and same clinical presentation. You will have a high similarity score. My similarity score was 36% and I saw 45% among my cohort. Instructors are aware of the similarity score for this particular assignment. What they do not want to see is the similarity of the main contents. SOAP note and list of clinical presentation of the patient cannot be any different from the assignment. Hence, you will have very high similarity in that section. Do not be alarmed! As long as you know you created your assignment, you don’t need to worry about the similarity score at all.
Remember that you can submit the assignment up to 3 times if you intend to lower the similarity score. My initial post was 37%. I did some fix and uploaded, 36%. I would touch it after the 1st submission. Waste of time trying to lower the score. TII would even highlight “Mrs. Wong”. lol
Week 6 Quiz and 2 discussions Initial post – Due: Wednesday of Week 2
Peer response – 2 or more responses to peer and instructor
The quiz was not too bad. I cannot say anything about content but just stick with the contents in the reading. You should be solid.
Week 7 Reflection
I honestly don’t know what to say on this… every class, I am trying to squeeze out something for this essay. This is one of the discussions and, yes, you need to have 2 replies on 2 different days.
Week 8 Final Exam
Here is the prefilled study guide.
As the other quizzes and midterm, questions are pretty straight forward.
Overall, NR601 is much more relaxed compared to NR511. Start the Week 5 discussion as early as possible. I started on Week 1 and completed by the end of Week 3. It will make your life whole a lot easier.
Well, on to NR602! 3 more classes!!! I am done!!!
Oh by the way… I have decided not to practice as FNP. I am going to carry on to the next step toward PMHNP. I won’t be taking the board exam for FNP as I will not practice FNP though I technically can in CA. =]
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Probably one of the most asked question at the beginning of this class is logging MyEvaluations and where the MyEvaluations is.
Log in to https://portal.chamberlain.edu/login.
On the left column, you will see “Resources” Then “My degree and course” Then, under the “Practicum/Clinical Logging tool – MyEvaluations” Then you will be directed to another website that would like this. Finally, you are at the logging website.
Why did they make it so complicated? lol. Tell me about it… -_-
You are ok to log 1 hour/pt in NR511 and gradually decrease the time/pt. I had a few pt with slightly more than an hour due to the pt’s complexity. As long as your documentation supports, then you can log more than an hour. For some instructors, they get very picky and will ask you to start decreasing time/pt sometime around Week 5 or so. Yes, you are allowed to log 1 hr/pt but to some instructors, such rules do not apply to them. Welcome to CU. -_-
Toward the end of the practicum, I started to log some 50 min/pt for simple cold-like symptoms and 30 min/pt for sports physicals. As long as your time is reasonable, you shouldn’t have a problem.
When you go to the clinic, you will need this stuff for you to fill in the logs easily and get through the day.
Epocrates could be useful and here is the 50% discount code (Student50percentoff) for 1-year subscription. No, I am not affiliated. If it doesn’t work, you can call them and ask for one. They will be happy to give you a new code.
Take your stethoscope, preferably a cheap one. I have been using the disposable one from my ER. No one cares. Don’t lose your expensive one.
Once you get used to it, you won’t need the clinical log template.
FAQ/Tips
How many hours? You must have at least 125 hours by the middle of Week 8, which is about 18 hours/week logged.
Can you log more than 125 hours in 1 term? No.
Logging tip – Remember that it took you about 20~25 mins to complete the head-to-toe assessment during the Immersion. Then you come up with DDx (differential diagnosis), discuss with the preceptor, then treat/educate pt, then you document. So, 1 hour/pt is reasonable. In order to encounter as much pt as possible, you should log MyEvaluations later. Sometimes, your clinic would let you chart on their charting program and some don’t. I got to chart on their charting system. So, I got to copy and paste the chart on a note pad or email WITHOUT PT’S PERSONAL INFORMATION then logged on MyEvaluations later. More detail it is, the better for your SNAPP presentation.
Make sure to go to the clinic as much as possible at the beginning of the term so that you can have some time later for making up more hours if your instructor somehow does not approve some of the logged hours. (Yes, it does happen to some students.) I aimed to complete the 125 by the end of Week 5.
Peds/Women health – Log as much as you can when you get a chance. You must have 15% (about 110 hours) on each peds and women health.
How can I handle work/practicum/study? Well, I must say, shush! lol I had 1 full-time job, 1 part-time teaching job, my wife in nursing school with tons of questions, and this class. Some people handle with 5 kids with a full-time job. You may not have a “quality” life but it can be done. Just prioritize what you must do vs what you want to do.
Hours in the clinic doesn’t not equal to hours you can log. It’s all about hours you spend with pt + charting + discussion with the preceptor.
Make sure to include CPT code.
Log your hours diligently. Do not get behind. You will regret it! =p
Remind your preceptor for midterm/final evaluations. If these are not done on time, you may fail the class!
Shadowing counts for the practicum hour? Absolutely not! There are 15 alternative hours for reviewing med, making calls to pt, and going over labs but those are pretty much no use. I have 0 on that. Just focus on seeing the pt and chart those hours.
What happens if you cannot fulfill 125 hours? You fail the class entirely and you must retake NR511. Get it done early!!
Below is one of my sample logs. I have not had any rejection from all of the clinical evaluations by all instructors. I once had an opinion of being too detailed by an instructor but she was ok with that much of detail. Of course, the below content goes to the “comment” section of MyEval and all the selecting parts are also completed.
38LW
CPT: 99214
Chief Complaint(s): 1. Follow up on ER visit for right arm numbness and loss of vision, referral to neurologist. 2. Discuss checking thyroid and iron for fatigue and dizziness x few months, hx of low iron.
Pt denies over the past 2 weeks of feeling down, depressed or having little interest or pleasure in doing things. (per PHQ-2 screening tool)
History of Present Illness: 1. Dizziness
Pt was recently seen in ED due to acute onset right arm numbness and “floaters”/ loss of vision bilaterally. Pt had a HR of 49 and otherwise Head CT, EKG, aPTT, CMP, CBC were WNL. Pt admits to increased stress and anxiety around ED visit. Pt is still having dizziness and lightheadedness upon standing for 5 days. All other presenting symptoms in including paresthesia, anxiety, and change in vision have not returned since 1 episode leading to ED visit. Of note, pt is very active in exercise and sport. Pt confirms quality hydration status. Denies palpitations, SOB.
Allergies: No Known Allergies Family History: Brother 1: Thyroid Disease Father: Hypertension, Hypothyroidism Paternal Grandfather: Thyroid Disease Social History: Alcohol: 1 drinks/week Exercise: Daily Caffeine: Coffee 1x/day Smoking: Never smoker Review of Systems: General Fatigue. Denies fever, chills, night sweats Skin Denies skin changes; itching; rashes; sores Head Denies trauma; headache, nausea, vomiting, visual changes Cardiac Denies chest pain, palpitations, hypertension, dyspnea on exertion, edema Respiratory Denies shortness of breath, wheeze, cough, sputum Neurologic Dizziness upon standing. Denies headaches, loss of sensation, numbness, tingling, tremors, weakness/paralysis, fainting/blackouts, seizures Hematologic Denies anemia Endocrine Denies excessive sweating, polyuria, polydipsia
OBJECTIVE Vitals: Systolic: On examination – Systolic BP reading: 118 Diastolic: On examination – Diastolic blood pressure reading: 80
T: 97.8 F. Pulse: 64 / min Resp: 16 / min BP: 118 / 80 mmHg WT: 150 lbs HT: 5’10” BMI: 21.52
Exams: General Alert and oriented, In no acute distress, well developed, well nourished Head/Face NC/AT Eyes PERRLA, EOMI, No injection or icterus Resp CTA bilaterally, no wheezes, rhonchi, or rales Cardio RRR, normal S1, S2, no murmurs, rubs, or gallops (S3, S4) Neuro Motor/Sensation grossly normal, Non-focal Musculo No muscle atrophy or weakness, No focal areas of tenderness Extremities No clubbing, cyanosis, or edema Skin Warm, dry, no rashes Psych Alert and cooperative, Normal affect, Thoughts appear congruent and appropriate
ASSESSMENT Assessment for this encounter: Unspecified visual loss(H54.7) Paresthesia of skin(R20.2) Dizziness and giddiness(R42) Other fatigue(R53.83)
1. Re-occuring Dizziness/ Recent ED visit
–Pt referred to Cardiology for further assessment
–Pt referred to Neurology for paresthesias, vision loss in absence of cause of CVA workup
–LABS TSH, T4, T3 due to family history
–Will call patient with abnormal lab results
–Pt educated on maintaining adequate fluid intake
–ED precautions reviewed with patient
–RTC as needed
Week 1 exam – Content of the exam is not hard at all but the way the questions worded are very confusing! Make sure that you know every bit of words from the video lectures. Questions are very nitpicking!
VICE Call – Phone call assignment. Around week 3, you should be getting an email from your professor for arranging time/date for the VICE call. The call will last less than 30 minutes (mine lasted about 25 minutes including chit-chatting for ice breaker) and you have 2nd chance to call if you miss the 1st scheduled date/time.
Depending on your professor, some professor would let you pick your patient or professor will pick a patient from the logged patients from “My Evaluation”.
You are basically going to do SNAPPS. In my case, I was allowed to pick a patient prior to the call. (If you get to pick your own pt, make sure that you pick easy pt.) I reviewed the patient’s report prior to the call and practiced SNAPPS. I pre-typed what I wanted to present on a screen and went through one by one. At the time of scheduled date/time, you will call you professor that professor provided you and do the SNAPPS. Only one part that was different from me was, I did the P (Probe) part at the end. The phone on the professor’s side was left mute while I was presenting until I went down the list of SNAPS (Probe “P” was done after all other parts were done.)
Summary – Make sure to present the chief complaint with age and gender.
Narrow differential – Get 3 differential with reasoning for each.
Analyze differential – Explain why you think the main diagnosis is and why other diagnoses are not.
Plan management – Start from conservative measure to invasive.
Self-learning – This part is not very important but you need to be ready with some legitimate questions. This part somewhat overlaps with the second “P” (Probe). I asked something like “how would I really know which dx to treat in the real situation?”, “how can I distinguish very small differences between two different compelling dx?”, and etc.
Week 3/6 Case study – There are 2 parts for this assignment. My tip of advice on these case study assignments is to be very detailed. Follow the rubrics, word for word and nail every bit of rubric. I think I was blessed with the professor. I did get 50/50 for both Week 3 case study postings. I did follow exactly what the rubric stated. However, I have heard that many people didn’t get full credit not because they missed contents but not doing the APA references. I have seen people getting their points off down to 42 due to references. Yes, really. Make sure that you follow exactly how APA should be.
Part 1 Discussion
H&P findings and summary – A narrative form of the overall status of the pt.
DDx and patho – Come up with at least 3 ddx and list the S&S of each ddx. Then, either underline or bold the S&S that is presented by the pt. Make sure to put ICD-10 code for each ddx.
Analyze Dx – For each ddx, explain what ddx is and why you think one dx would apply to the pt or not as if you are doing a self discussion.
Rank ddx – List from most likely to least likely ddx. I just had 1 sentence or a table for this section.
Tests and rationals – List some of the diagnostic tests that would need in order for you to confirm the primary dx.
Yes, you will need to put references in APA format.
Your initial post has to be done by Tuesday of the week and you need to reply to 1x to peer and at least 1x to your instructor if he/she asks any question.
Part 2 Discussion
Primary dx – Simply discuss the primary diagnosis with S&S listed that the pt presented and any family hx.
Identify ICD-10 code – Just put the IDC-10 code
Treatment plan – Include medication, diagnostic tests, patient education, and referral. Make sure that each part is backed up with resource articles.
Active problem list – You will identify the presence of any active problems that the pt showed.
Any changes? – This part seemed very unnecessary to me as you will treat the pt with the best possible treatments. You would just have to come up with something that you can BS.
F/U plan – Similar to the Part 1 Discussion. Make sure to have references.
Your initial post has to be done by Tuesday of the week and you need to reply to 1x to peer and at least 1x to your instructor if he/she asks any question.
Week 4 – Midterm – Hum. I don’t want to scare you but I want you to be ready for this. It’s poorly written exam with typos and confusing wordings. I don’t think I ever had an exam with that many NOT questions (Which one of these are NOT the right answer). You know, until this exam, I never knew these NOT questions were more difficult than the other way around. I felt as if those NOT questions were semi-SATA (select all that apply) questions. Unless you know all other 3 right answers, you cannot get them right! Not to mention these questions were also nitpicking just like Week 1 exam. Did the exams follow the study guide? Well, I would have to say yes but the study guide is nothing but huge headlines of topics. No more, no less. I also did see some questions that were not part of the coverage. Yes, it does cover the 1st-week exam contents. At least those were less annoying than the actual 1st exam questions. There were a few true/false questions too.
How should you study? Just like the week 1 exam, know EVERYTHING in the lecture. There were some questions that were not covered by the lecture and came out. You may have to fight for that. Did questions come out from the Youtube video lectures? You bet! I heavily focused on the lecture scripts. If you have leftover time, then go after the textbook. I also used Hollier review book and Hollier Clinical Guidelines. Some of the lecture contents are almost exactly the same as the Hollier review book. Um… makes me wonder… =p
SNAPP assignment – This assignment is done over the phone just like the YouTube video that was in the Week 1 module (SNAPPS #1, #2). Your instructor will send you an email regarding the schedule of time. You will get to pick on what time/date you would like to do the presentation. The email will also have instructions. Your instructor will either let you pick your patient from the patients that you logged to the MyEvaluations or your instructor will pick for you. Some nicer instructors will let you pick ahead of time so that you are prepared. Some “not so good” instructors will pick just before the call.
During the call (lasts about 15~20 mins), you are going to present a patient that you saw during your clinic by using SNAPP. I prepared the presentation by writing out SNAPP form on Word program and almost literally read it (make sure to write as if you are just talking by mixing “and…, um…”). I did put the Probe part in the last part of the presentation and make sure to have a few legit questions.
I heard that some instructors asked very detailed questions. So be prepared with diagnosis, treatment plans and so on.
Tip for this assignment is to have MyEvaluations is done in detail. I literally have entire chart copy-pasted on the MyEvaluations without sensitive personal information.
CPG (Clinical Practice Guideline) – This assignment can be very confusing. Again, follow the rubric in detail. By Week 4, you should have received email from your instructor with a topic and an article. If the topic that you received is something that you didn’t get to treat at the practicum, let your instructor know so that you can change your topic. In my case, I initially got the hyperlipidemia. I did have HTN pt but no one really comes to a clinic just for the hyperlipidemia. So, I changed the topic to something else. There are several parts to this assignment.
PPT – With your assigned disease, you will make a ppt that you will later present with Kaltura.
On Week 7: Clinical Practice Guideline Presentation (0 pts) section – you will post your recorded presentation and the article that you got from your instructor. Due by Wednesday of Week 7.
On Week 7: Clinical Practice Guideline Assignment (150 pts) section – you will post the narrated transcript of the presentation. Due by Wednesday of Week 7.
On Week 7: Clinical Practice Guideline Peer Review (50 pts) section – You will post your peer review. There is a template (NR511_Peer Reviewer Template (May2018)) for this. Make sure you have the right version as yours may differ from mine. Once you post the peer review, you also need to email it to the peer that you reviewed.
What is the use of the article that the instructor gave it to you? It supposed to be the treatment guideline for the diagnosis that you were assigned. The article should have several statements regarding the treatment. You will be picking up to 5 of them and present them. Some may have less than 5 statements. Make sure to find that the article that was given to you is most updated by searching google.
Final exam – Yes, you made it! Probably you want to know how to study for the final. Well, simple answer, know everything. I focused on the lecture scripts (I stopped watching the videos. Many of the just read straight off of the ppt without any explanation. No point of watching.) I also used Hollier review book and Hollier Clinical Guidelines.
Reflection – I don’t know what to say about this one. Just … all the way. -_-
Do not lose any points from assignments. Every point will be very crucial for you to keep the grade as high as you can. Midterm and final exam questions are quite random. Some of them are very detailed and some are stupidly easy. Any final exam is never designed to raise grade up! You need to keep your grade up as high as you can so that even if you fail your final exam, you can still pass the class. I was lucky enough to have all assignments with full credit and I needed no more than 50 points on the finals for me to pass the class.
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Week 3 – Lecture note – Skin disease – I feel bad posting this note as it’s literally verbatim of the ppt. The professor literally reads ppt. No explanations what so ever…
Sorry guys. It became pointless to write weekly notes after realizing that the lectures are just pure reading off of ppt. I don’t think we will be graded well if we presented as to how they did lecture. =p
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I would like to share commonly asked questions about Immersion for students in the Chamberlain University FNP Program.
It’s 2 nights and 3 days program over the weekend from Friday to Sunday (some cohorts may go from Thursday to Saturday) on the 7th weekend of NR509. Sometimes on a different weekend if the weekend overlaps with holidays. Check with your student advisor!
Here is the Fact Sheet for the Immersion. The Fact Sheet is the same as what I am about to present here. I just wrote with my personal touch to it. =]
Otoscope ($15 to infinity) this is totally up to you what you want to buy. (No, you don’t need ophthalmoscope. You can use otoscope light to test pupil constriction – CN2!!!)
A small notebook (Post-It was sufficient for me) and a pen
Whitecoat (I would say optional as you are not required to wear as long as you are not wearing a pair of jean. You should be wearing semi-casual.) I am a male, 5’7″ and 135 lb. I ordered size small and felt about right or slightly bigger.
Name tag that school makes you order. You will get an email regarding this from school. I didn’t feel like it was really needed as you will be receiving another name tag when you get there. But I heard some instructors did check when you take the Immersion exam.
Dress code: As long as you are not wearing jeans and T-shirts with open-toe shoes, you are fine. Semi-casual is what I wore and that was more than sufficient. For the day 3 exam, you need to wear something that you can show your tummy easily as you will need to expose your tummy for the assessment exam.
You must purchase the DayPass in order for you to enter Q-Center. Adding meal plans or not is up to your decision.
Some people buy a set of items in a bulk pack that has everything in it. So, it will be all depending on your preference. *Price may differ.
Where to stay?
You can stay at the Q Center. It will cost you about $400 for 2 nights including dinner on day 1, 3 meals on day 2, and breakfast on day 3. The $400 package also includes a ride from/to airport.
The Q Center standard room looks like this.
Doesn’t look too bad? Well, this is “very” well-taken picture with the stretched lens. I felt like the bed was smaller than a single bed size. I felt like it was a sofa seating size or slightly bigger. The room width is the size of a closet width. Don’t get disguised by their pictures. =p
This is the restroom and shower. The restroom felt like the size of a closet or a little bigger. More detailed pictures are here.
I have heard that some rooms didn’t have AC or AC didn’t work. You can also pay more to get a bigger room with a queen-size bed. I didn’t see it but you are only going to be sleeping there. I don’t think extra money to be in the bigger room matters.
I did Airbnb ($75 for 2 nights) and stayed about 20 minutes away from the Q Center. I rented a car for driving back and forth. I love exploring new areas and looking at houses. That’s why I decided not to stay in the Q Center. It ended up saving about $100 including food. (I am not a big eater at all.) This particular host had 2 rooms that he rents out. 1 room with a queen bed and the other room with a single bed. If 2 of you go there, half the price!
The Immersion event is in the Q Center of St. Charles, IL. (Click for google map) The Q Center is about 35 minutes to the east of O’Hare airport. The Q Center is quite of size “hotel” with event halls. It’s a maze to get around the Q Center. So, use their “Q Center” app on the phone. The app icon looks like below.
When you are at the Q Center, open the app and it will prompt you to turn on the Bluetooth. The app uses Bluetooth to navigate inside of the Q Center. They have gift shops, restaurants, and etc.
The Immersion Agenda
So, what happens during the event? You can download the Immersion Agenda.
For Friday – Sunday: Day 1 is Friday, day 2 is Saturday, day 3 is Sunday.
For Thursday – Saturday: Day 1 is Thursday, day 2 is Friday, day 3 is Saturday.
Day 1 – Trip day. Basically, you can arrive at the Q Center on any date prior to day 2 by 0800. I strongly suggest you get there on day 1 and meet with classmates to practice the head to toe assessment each other. It feels very different when you practice with your family members compared to some random strangers. Day 1 is just simply a free day. No specific Immersion activity.
Day 2 – You will be asked to gather at a hall at 0800 and you will see about 450 students. Professors come out to and welcome you and generally go over the Immersion event. Then in small groups, students will gather up in classrooms for the hands-on learning experience of several different stations. I really felt that I learned something from the classes for the first time during the entire CU classes! Lunch will be provided for all students. Their food is not bad actually. Classes are completed around 1630 and you will be hanging out with all the students at the Reception event. Some finger food and beverages are offered there. Yes, some alcohol too. Each person will be given a “drink” ticket. Then you are free. I ended up meeting with a few students and practiced head to toe.
Day 3 – Gathering is at 0745 at the hall where you met all 450 students on day 2 morning. You will be called out with your partner for the Head-to-toe Physical exam. I was the 1st one to be called out and I was done by 0900. My flight was not until 2230 later that day. Hearing from others, the exam ended around 1400. But do not buy a ticket too close to 1400 as you will not know when you will be called out for the exam until the morning of day 3. I have seen people changing their flights on day 3 morning.
Suggestions/tips
Start viewing the head-to-toe assessment early. You don’t need to watch the entire video. Just watch section by section and repeat while you are driving to/from work from the 1st day of the NR509. I did the same and I never really spent extra time to memorize it at home.
When the exam starts, your examiner will have a timer on a table. The examiner will tell you to push on the start button whenever you are ready to start. Before you start, I suggest you lay out the exam equipment (otoscope, stethoscope, Taylor Hammer, and Snellen chart) on the table. This way, you know what equipment you used or not and remind you to use each equipment. Some examiners would let you write a note once the timer start. Ask your examiner if you can write stuff on a paper once the timer starts. If the examiner is ok with your writing, then write what you usually miss. I wrote CN 1~12 and checked off one by one as I completed each. This would be another check-off system. Remember that you only need 104 out of 124 for you to pass. That’s 20 points and missing 10 sections. 10 sections are a lot you can miss.
Book tickets early for a cheaper flight. I flew LAX to ORD for $214 round trip! And I only paid $14 for it by using AAdvantage credit card. When you sign up, at least when I sighed up, you get $200 credit for purchases. I used Hopper app on the phone to track the lowest price. Once you are done with the trip, you can cancel the credit card to avoid the $99 annual fee. 1st year AAdvantage credit card membership is free. (I am going back to Chicago for 661 review class and I actually saw $144 round trip on April 2020 from LAX!!)
Most of all, just relax and practice. Worrying about the Immersion exam isn’t going to help with the study. We all did it. You can do it!!!
Expect flight delays! OMG. Flight delay in/out of Chicago was crazy! I had many classmates get stuck in the airport for over 12 hours due to delays by the weather condition.
What I would do differently? I would have gathered up a couple of people and rent an entire house from Airbnb near the Q Center and stay together. I could have practiced the head-to-toe among the roommates and have an amazing time. Of course, you can also do it in the Q Center too. You will see people gathering in small to large groups to practice all over the Q Center. Transportation in Chicago was not cheap via Uber, especially as single travelers. (*If you are staying in the Q Center, the transport to/from airport and Q Center is provided.) But, if you are in a group of 4 or so, Uber can be much cheaper as you will share the cost with among others. I would rent a decent size car and fit 4 or more and share the cost for Airbnb, food, and car rental. As you go through the Immersion, you will find your “favorite” people. Since you will be returning to the Q Center again for NR661, it would be a good idea to plan for a group Airbnb rental.
You rented a car? Rental companies will scare you with “toll road” and make you purchase the toll pass scanner for about $10/day + tax. The toll fee supposed to be about $2.5 or so on each pass and it can definitely add up. However, from ORD to the Q Center, it will take about 40 minutes or so without going through the toll roads. Just make sure that you place “off” on the toll roads on the google map or GPS, and go through local streets. You will find amazing Chicago pizza places! It will probably take 10~15 minutes more to get to the Q Center from the ORD. I wouldn’t mind driving that. So, don’t get the toll pass.
June 2019, the gas price at Costco was about $2.79/gal. The rental car companies will charge you $2.99/gal for not filling up.
Yes, please share this post with anyone. If you have any questions, do not hesitate to contact me. =]
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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.
Read them very carefully. One of them is actually a post with additional questions that you also need to reply to.
I copy and paste the discussion instruction on a Word. As I read, I highlight in red what I would mention in a discussion. This way, I do not forget what I need to address while writing a discussion.
Then, this will show up.
Click the blue bar. Then, this shows up.
Then this…
Walla~ you finally arrived! The rest of the part is quite self-explanatory. I will skip that.
Then “My degree and course”
Then, under the “Practicum/Clinical Logging tool – MyEvaluations”
Then you will be directed to another website that would like this.
Finally, you are at the logging website.
Sol 