Category: Nursing

Family structures discussion NRS-429VN Topic 2 DQ 1

What is a definition of family that encompasses the different family structures prevalent today? Discuss the importance of acknowledging nontraditional family structures. Explain how family systems theory can be used to better understand the interactions of a modern family (traditional or nontraditional).

Re: Topic 2 DQ 1

What is a definition of family that encompasses the different family structures prevalent today?The definition of a family that encompasses the different family structures in modern times is the family of choice. According to Green (2018), this type of family is unique in that the individual chooses the individual to care, love and trust for them rather than their family or origin.Discuss the importance of acknowledging nontraditional family structures Family structures discussion NRS-429VN Topic 2 DQ 1.It’s important for the nurse to acknowledge the non- traditional family structure so that health promotion can be implemented according to their family structure. The concerns of a nontraditional family might be different than a traditional family unit. As mentioned in the chapter on health promotion, for the nurse to understand what “family,” is, it’s important to assess so that proper interventions can be placed (Green, 2018). Proper assessment of the family structure of the individual will aid the nurse to promote health and behavioral changes. It’s also important to note that an individual’s illness affects the family’s health as well. The family unit can have a negative or positive impact on each other.

Explain how family systems theory can be used to better understand the interactions of a modern family (traditional or nontraditional)

The family systems theory can be used when interacting with any type of family whether traditional or non-traditional as the approach is the same. In family systems theory, the family is a whole and each member of the unit affect each other. The family member is independent, has personal goals, roles, functions, and individual characteristic, but is interdependent of the family unit. Understanding the importance of each person in the patient’s family unit is crucial to engage the family in promoting changes to improve health outcomes Family structures discussion NRS-429VN Topic 2 DQ 1. The family systems theory helps to aid the Nurse in health promotion to understanding the patient’s behaviors. Among family systems theories the main theme is that they all empower the individual to make decisions that will make them feel valued, loved, and accepted. Individual want others attention, approval, and support as well as feel connected to their family unit. The family unit is an emotional unit that is very emotionally connected (Devlin, 2021).

References

Devlin, K. (2021). Family Systems Theory Definition & What is it? Retrieved October 11, 2021from 
https://www.regain.us

Green, S.Z. (2018). 
Health Promotion: Health and Wellness Across the Continuum. 
Retrieved from

URL:
https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-promotion_health-and-wellness-across-the-continuum_1e.php
sample 2

Family systems is defined as “The theory that has every individual or subsystem of relatives or system influences other parts of the system; therefore, a person can’t be studied apart from the family.” (Edelman et al., 2014). So, a standard family might be, a family that has parents male and female and offspring inhabitation with the identical ancestry as a social or grouping, which is traditional. Now nontraditional can consist of a pair and their children is now, families are more complex, multicultural, and dynamic unit consisting of legal, biological, or emotionally linked parents and kids. it’s important to include nontraditional families because family is a component of the care process, as their involvement and opinions often help and encourage the patient to succeed in treatment. The family dynamic plays a will be a template an give the nurse insight about the patient and members of the family and using knowledge about values, beliefs, and cultural background to boost the delivery of care and corresponding plans. Families are invited to figure alongside healthcare leaders to partake in everything from the advancement and implementation of programs to the delivery of care. Especially during time when home health is being turn over to families more delivering care Family structures discussion NRS-429VN Topic 2 DQ 1.

Edelman, C. L., Kudzma, E. C., & Mandle, C. L. (2014). 
Health 
p
romotion 
t
hroughout the 
l
ife 
s
pan
 (8th ed.). St. Louis, MO: Elsevier Mosby.

Wright, Lorraine M, and Maureen Leahey. 
Nurses and Families A Guide to Family Assessment and Intervention : A Guide to Family Assessment and Intervention
, F. A. Davis Company, 2012.
 ProQuest Ebook Central
, http://ebookcentral.proquest.com/lib/gcu/detail.action?docID=1069220.

Created from gcu on 2021-10-12

Green, S. Grand Canyon University (Ed). (2018). 
Health promotion: Health & wellness across the continuum.
Retrieved from https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/

sample 3

Re: Topic 2 DQ 1

Family is a collection of folks that are associated through blood or via marriage. Family now no longer best includes best own circle of relatives however additionally buddies who’re near us and that they too come to be our own circle of relatives. In modern there are numerous kinds of devices found in our society.

The U.S. Census Bureau (2015) considers own circle of relatives to be the ones dwelling in a housing unit associated with the aid of using birth, marriage, or adoption; however, those definitions of own circle of relatives with the aid of using bloodline or family can’t embody the additives of contemporary-day families, main to a number of terminology in use Family structures discussion NRS-429VN Topic 2 DQ 1.

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The family structures approach to people and their houses provides a way to better understand the interactions of a society own circle of relatives unit (Huffman, Mathews, & Irving, 2017). Family members have an impact on each other as well as their own circle of relatives as a whole. The own circle of relatives is categorized as a whole machine of interacting and interdependent own circle of relatives participants, as well as man or woman participants (Huffman et al., 2017). Family structures speak within to the person or girl subsystems and out of doors the appliance with even massive structures or suprasystem that embody the community or community. One instance is Bowen’s own circle of relatives structures plan or model, whole} totally on trendy structures idea, could be a ancient technique to analyzing own circle of relatives techniques and issues (Bitter & Carlson, 2017; Yoder, Ruch, & Hodge, 2016).

According to Dr. Bowen’s Family Theory and Study, even for disconnected family members, Bowen’s Family Systems Theory suggests that the family unit or family center in general always has a profound impact on their emotions. and their actions. Although the degree of interdependence may vary between different families depending on the functioning of their family emotional system or unique family center or human relationship systems, all families have some level of interdependence among family members. their family. Understanding family conditions and theory help the nurses to talk and communicate to the families. Cause families are important to patient Family structures discussion NRS-429VN Topic 2 DQ 1

References:

Green, S. (2018). 
CCC Web Books by AWS & CDD
. Gcumedia.com. https://lc.gcumedia.com/nrs429vn/health-promotion-health-and-wellness-across-the-continuum/v1.1/#/chapter/4 Family structures discussion NRS-429VN Topic 2 DQ 1

cluster headache essays

Module 11: Discussion

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Bob, a 38 year old male, has been experiencing severe intermittent headaches for about 10 years. When they occur, he experiences intense burning pain on one side of his head, tearing in his eye, congestion and a runny nose. These headaches generally occur several times a day and last approximately one hour. The headaches are episodic; Bob can be headache free for several months but then experience an attack.

Based on the case scenario, provide a diagnosis for Bob. Provide the pathophysiology for this type of headache and discuss current treatment options.

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to grading rubric for online discussioncluster headache essays.

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Candice Russell posted Mar 30, 2021 5:09 PM

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            “Headache is a common neurologic disorder and is usually a benign symptom” (Boss & Huether, 2020, p. 400). There are times when headaches are associated with serious illness or disease. “Headaches can be so severe that patients and doctors often fear life-threatening underlying cerebral pathologies” (Michl & Michl, 2017, para. 1). There are many different types of headaches, chronic headaches can occur constantly, for many days out of the month. “The constant nature of chronic daily headaches makes them one of the most disabling headache conditions” (Mayo Clinic, 2019). Trigeminal autonomic cephalalgia (TAC) is a primary headache disorder “characterized by pain in the distribution of the first division of the trigeminal nerve in parallel with cranial autonomic features on the same side of the head” (Ljubisavljevic & Jasana, 2019, p. 1059). Cluster headaches (CH) are said to be the most common TAC, “headaches involving the autonomic division of the trigeminal nerve” (Boss & Huether, 2020, p. 401). Cluster headaches are one of the most studied forms of TAC, however, “the pathophysiology of cluster headache is complex and the underlying mechanisms are not fully elucidated” (Wei et al., 2018, para. 11). Neurovascular and chronobiological headache disorder, TAC can be broken down into three major features: trigeminal pain, rhythmicity (particularly in cluster headache), and autonomic signs. Various structures within the peripheral nervous system and central nervous system (CNS) are associated with the causation of CH.Figure 1(Wei et al., 2018) documents a detailed description of the pathophysiology in CH:Due to the severe pain caused by CH, it has earned the nickname “suicide headache”, “and a suicidal risk exists in this condition” (Rozen & Fishman, 2012, as cited by Rossi et al., 2018, p. 57). CH can have a rapid onset without warning, some individuals experience aura and nausea. Some common symptoms include rapid intense pain, usually one-sided head pain, restlessness, tearing, eye redness on the affected side, nasal congestion and runny nose on the affected side, sweating of the face or forehead on the affected side, eye swelling of the affected side. Pallor and dropping of the eye on the affected side may be present, pain is usually continuous. Men between the ages of 20 and 50 are more commonly affected. Episodic headaches may alternate sides, severe stabbing and throbbing pain may be present (Boss & Huether, 2020, p. 401) cluster headache essays. Individuals typically experience 1-3 headaches a day, however, as many as 8 attacks are possible. Another nickname earned by CH is “alarm clock headaches”, as they are linked to circadian rhythm. Attacks can happen around the same time each day, nighttime attacks can be more severe than daytime attacks. CH attacks can last from minutes to hours, for several days, followed by remission.  Huether, S. E., McCance, K. L., & Brashers, V. L. (2020). 
Understanding pathophysiology / Sue E. Huether, Kathryn L. McCance ; section editor, Valentina L. Brashers
 (7th ed.). Elsevier.Ljubisavljevic, S., & Jasna, Z. T. (2019). Cluster headache: pathophysiology, diagnosis and treatment.
 Journal of Neurology, 266
(5), 1059-1066. http://dx.doi.org.wilkes.idm.oclc.org/10.1007/s00415-018-9007-4Michl, M., & Michl, G. M. (2017). headaches.
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View profile card for Amandeep Kaur

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 by Amandeep Kaur

Wei, D. Y., Yuan Ong, J. J., & Goadsby, P. J. (2018). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. 
Annals of Indian Academy of Neurology
, 
21
(Suppl 1), S3–S8. https://doi.org/10.4103/aian.AIAN_349_17

Rossi, P., PhD., Little, P., De La Torre, Elena Ruiz, & Palmaro, A., PhD. (2018). If you want to understand what it really means to live with cluster headache, imagine… fostering empathy through European patients’ own stories of their experiences.
 Functional Neurology, 33
(1), 57-59. https://wilkes.idm.oclc.org/login?url=https://www-proquest-com.wilkes.idm.oclc.org/scholarly-journals/if-you-want-understand-what-really-means-live/docview/2045245091/se-2?accountid=62703

Mayo Foundation for Medical Education and Research. (2019, April 9). 
Chronic daily headaches
. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/chronic-daily-headaches/symptoms-causes/syc-20370891 cluster headache essays.

Hoffmann, J., & May, A. (2018). Diagnosis, pathophysiology, and management of cluster headache.
 The Lancet Neurology, 17
(1), 75-83. http://dx.doi.org.wilkes.idm.oclc.org/10.1016/S1474-4422(17)30405-2 cluster headache essays

Reference:

            Based on symptoms and hx described by our patient, a diagnosis of Cluster Headaches seems appropriate. There is no existing cure for cluster headaches. The goal of treatment is to reduce pain, decrease the time of each headache and prevent CH attacks (Mayo Clinic, 2019). Acute treatment includes oxygen therapy, administration of triptans, octreotide, the use of local anesthetics, and administration of dihydroergotamine. Each of the treatment options has varying effects on CH. For individuals with new-onset cluster headaches, preventive measures are available.  Preventive measures, which should be implemented at the onset of CH episodes. The goal of preventive therapy is to suppress attacks (Mayo Clinic, 2019). Some prevention treatment includes the use of CCB, corticosteroids, Lithium carbonate, and administration of nerve blocking agents. Surgery is rarely used, however, may be recommended for those suffering from chronic cluster headaches who experience no relief from other forms of treatment. Lifestyle modifications may be effective in avoiding attacks.

Pain afferents from the trigeminovascular system traverse the ophthalmic division of the trigeminal nerve, taking signals from the cranial vessels and dura mater (shown by purple fibers). These inputs synapse in the TCC and project to higher brain structures such as the thalamus (T) and cortex resulting in pain perception (shown in blue fibers). Activation of the trigeminovascular system by stimulation of dural structures also causes neuronal activation in the SSN within the pons, which is the origin of cells for the cranial parasympathetic autonomic vasodilator pathway cluster headache essays. There is subsequent activation of this parasympathetic reflex through the outflow from the SSN and is relayed through the SPG (shown by pink fibers), but also through the facial (VII
th
 cranial) nerve (not shown). Activation of both trigeminal and autonomic nerves defines the trigeminal autonomic reflex arc, which is integral to the pathophysiology of cluster headache and the other TACs. The HT is functionally connected to the ipsilateral trigeminal system and other brain areas of the pain matrix. Red dashed lines indicate the pathways by which the HT controls or triggers pain. A third-order sympathetic nerve lesion thought to be caused by vascular changes to the ICA in the cavernous sinus with subsequent irritation of the local plexus of nerve fibers, can give rise to sympathetic symptoms (incomplete Horner syndrome). (Wei et al., 2018, para. 11)

For a sequence of attacks to take place, three key structures need to interact: the trigeminovascular system, the parasympathetic nerve fibers (trigeminal autonomic reflex), and the hypothalamus. Only if all three systems are involved can cluster headache attacks be initiated, and subsequently cortical areas of the CNS—known to be involved in the processing and perception of pain—will be activated. (Hoffmann & May, 2018, p. 77)

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Hilary Szpara posted Mar 30, 2021 8:12 PM

Contains unread posts cluster headache essays.

Based on the case scenario, I would diagnose Bob with cluster headaches. Cluster headaches are characterized by being unilateral, last on average 45 minutes to 90 minutes, happen multiple times during the day, and often include eye discomfort and nasal symptoms such as congestion and/or runny nose (Wei et al., 2018). There are many other symptoms of cluster headaches including aural fullness, throat swelling. Flushing, agitation and restlessness, and ptosis (Wei et al., 2018). The pathophysiology of cluster headaches is complex and not fully understood. They are neurovascular headaches, rather than vascular headaches. Vascular cerebral changes that occur are driven by the effects of trigeminal-autonomic reflex activation (Wei et al., 2018). The cranial autonomic symptoms that arise during cluster headaches, come from the reflex activation of the trigeminal-autonomic reflex pathway through parasympathetic outflow which results in vasodilation and parasympathetic activation (Wei et al., 2018). Due to the clinical presentation of cluster headaches, some believe that the hypothalamus may be involved and that cluster headaches occur more often when the clocks change during daylight savings, which suggests and inability to synchronize internal circannual pacemaker with external environmental light cues (Wei et al., 2018). Since cluster headaches come on quickly and don’t last long, they require fast-acting treatment. The acute treatment drugs of choice are currently subcutaneous sumatriptan and/or high flow oxygen (Brandt et al., 2020). Sumatriptan is thought to be the most effective abortive treatment, with pain relief occurring in 75% of patients within 15 minutes (Brandt et al., 2020). There are also prophylactic treatments available, including verapamil, lithium, and topiramate (Brandt et al., 2020). These pharmacologic treatments require more research but have so far found to be effective in preventing cluster headache attacks.Brandt, R. B., Doesborg, P., Haan, J., Ferrari, M. D., & Fronczek, R. (2020). Pharmacotherapy for Cluster Headache. 
CNS drugs
, 
34
(2), 171–184. https://doi.org/10.1007/s40263-019-00696-2Wei, D. Y., Yuan Ong, J. J., & Goadsby, P. J. (2018). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. 
Annals of Indian Academy of Neurology
, 
21
(Suppl 1), S3–S8. https://doi.org/10.4103/aian.AIAN_349_17less1 UnreadUnread3 ViewsViews cluster headache essays

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View profile card for Steven Bartos

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 by Steven Bartos

Cluster Headaches
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Aina Oluwo posted Mar 31, 2021 11:20 AM

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Headaches are generally known to be benign but when it becomes more persistent it is associated with chronic conditions. Based on the few symptoms being experienced by this patient, a diagnosis to consider will be cluster headache (CH). According to Huether et al., (2017), cluster headaches occurs primarily in men between ages 20 and 50 years of age. It occurs in breaks throughout the day and lasts minutes to hours. It is also associated congestion of the mucosa, tearing of the eye and unilateral intense pain. All these symptoms are currently being experienced by Bob. CH is characterized by an alternation of excruciatingly painful attacks and pain‐free periods (Pohl et al., 2020). The recommended treatments are based on an update to the 2010 American Academy of Neurology (AAN) review. Robbins et al., (2016) illustrated the treatment plan for acute CH and maintenance. Acute treatment involves subcutaneous sumatriptan, zolmitriptan nasal spray, high flow oxygen and newly introduced sphenopalatine ganglion stimulation which is not currently practiced in the US. Lithium and verapamil are considered the best for maintenance and prophylactic management of CH.Barloese, M., Jürgens, T., May, A., Lainez, J., Schoenen, J., Gaul, C., Goodman, A., Caparso,stimulation: Experiences in chronic cluster headache patients through 24 months.
 Journal
Pohl, H., Gantenbein, A., Sandor, P., Schoenen, J., & Andrée, C. (2020). Interictal burden ofbased, cross-sectional study of people with cluster headache. 
Headache
, 60(2), 360-369.Robbins, M., Starling, A., Pringsheim, T., Becker, W., & Schwedt, T. (2016). Treatment ofguidelines.
 Headache, 56
(7), 1093-1106. 
https://doi.org/10.1111/head.12866
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View profile card for Hilary Szpara

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 by Hilary Szpara

cluster headache: The american headache society Evidence‐Based

https://doi.org/10.1111/head.13711

cluster headache: Results of the EUROLIGHT cluster headache project, an internet-

of Headache and Pain, 17
(1), 1-8. 
https://doi.org/10.1186/s10194-016-0658-1

A., & Jensen, R. (2016). Cluster headache attack remission with sphenopalatine ganglion

References

The pathophysiology can be attributed to activation of a trigemino-autonomic reflex that is mediated through the sphenopalatine ganglion (SPG). The SPG connects directly and indirectly with the hypothalamus, superior salivatory nucleus (SSN), trigeminovascular system, meninges, and somatic and autonomic nerves innervating cranial structures (Barloese et al., 2016).

Module 11
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Joanne Hogan posted Mar 30, 2021 4:37 PM

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Module 11Cluster headache is considered one of the more rare headache disorders, only affecting roughly 0.1% of the population and typically affects males more than females (Ljubisavljevic & Trajkovic, 2018). People who suffer from cluster headache typically have an increased level of calcitonin gene related peptide (CGRP) (Ljubisavljevic & Trajkovic, 2018). Not enough is known regarding the mechanism of CGRP to know the specifics regarding why this causes cluster headache, but this is generally what therapy is targeted to in treatment (Buture et al., 2019). Most research suggests that the parasympathetic nervous system goes into a type of overdrive and causes disturbances in the hypothalamus which leads to vasodilation (Ljubisavljevic & Trajkovic, 2018).   Ljubisavljevic, S., & Trajkovic, J. Z. (2018). Cluster headache: Pathophysiology, diagnosis and treatment. 
Journal of Neurology
, 
266
(5), 1059–1066. 
https://doi.org/10.1007/s00415-018-9007-4
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View profile card for Tallona Boddy

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 by Tallona Boddy

Buture, A., Boland, J. W., Dikomitis, L., & Ahmed, F. (2019). Update on the pathophysiology of cluster headache: Imaging and neuropeptide studies. 
Journal of Pain Research
, 
Volume 12
, 269–281. 
https://doi.org/10.2147/jpr.s175312

References

High flow oxygen is typically used for patients who are in the midst of an attack and often times reduces the need for rescue medications as traditional rescue medications can be ineffective in providing comfort (Ljubisavlejevic & Trakjovic, 2018). Triptans can be useful in the midst of an attack if parentally administered but does not always work effectively so the main goal in treatment of cluster headaches lies with preventative treatment (Ljubisavelejevic & Trakjovik, 2018). Preventative treatment includes corticosteroids which has been proven effective in reducing the reoccurrence of the frequency of attacks and lithium or verapamil can be effective in reducing the frequency of attacks in patients who suffer from chronic cluster headaches (Ljubisavelejevic & Trakjovik, 2018).

Based on the information given in the case study this week, Bob appears to be suffering from cluster headaches. According to Ljubisavljevic & Trajkovic (2018), cluster headache is noted to be severe pain that occurs unilaterally to either the orbital, supraorbital, or temporal area. The duration of pain can last anywhere from 15 minutes to up to 3 hours and can occur up to 8 times a day in some cases (Buture et al., 2019). Cluster headache effects trigeminal nerve and is the most common type of trigeminal autonomic cephalgia headache disorders (Ljubisavljevic & Trajkovic, 2018). Like Bob, people who suffer from cluster headache can have rhinorrhea, nasal congestion, and ptosis alongside the severe unilateral pain (Buture et al., 2019). Additional symptoms include eyelid edema, agitation, and facial sweating (Buture et al., 2019) cluster headache essays.

Bob
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Tallona Boddy posted Mar 30, 2021 6:43 PM

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Bob most likely is experiencing a cluster headache. A cluster headache can occur unilaterally, it can last for 15 minutes to 3 hours.  Runny nose, excessive tearing and restlessness are all signs and symptoms of a cluster headache. Episodes of recurrent headaches throughout the day can happen for days, weeks or months at time. Cluster headaches can have periods of no signs or symptoms, this can last for up to 12 months at a time. The cause of cluster headaches is not yet known, a current theory is a disruption in the body’s hypothalamus as a contributing factor (Mayo Clinic, 2019). 
References
University of Michigan Medicine. (4 August, 2020). 
Medicines for cluster headaches
. 
https://www.uofmhealth.org/health-library/abk7653
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View profile card for Dennies Jones

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Mayo Clinic. (04 June, 2019).
 Cluster headaches
. 
https://www.mayoclinic.org/diseases-conditions/cluster-headache/symptoms-causes/syc-20352080

High-flow oxygen has been shown to stop a cluster headache for seven out of 10 people, within 15 minutes. Triptans can be used via injection, oral, or nasal spray, for relief of the pain and pressure from a cluster headache. Lithium has been shown to help prevent cluster headaches. Ergotamine can be used at night to prevent cluster headaches. Opioids are not recommended for use to alleviate a cluster headache (University of Michigan Medicine, 2020).  Understanding the person’s severity and pattern of their cluster headaches will help the provider determine the best medication regimen.

Week 11 Discussion Post – Cluster Headaches
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Gisselle Mustiga posted Mar 30, 2021 8:05 PM

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The symptoms experienced by the patient are an indication of cluster headaches. The disease is associated with symptoms that include strictly unilateral headaches, excruciating pain precisely on one side of the head, commonly referred to as proximal hemicrania (Huether et al. 2020). The headaches are short-lasting, typically lasting from minutes up to one hour. There is also a recurrence of headaches during the day. A patient also may have redness of the face and nasal congestion. Other symptoms are autonomic, which entails lacrimation. Tearing and ptosis of the eye on the affected side is also another indication. The disease is prevalent in males. The descriptions in the case study match cluster headaches symptoms. As such, the client should be given urgent medical attention to counter its effects.
References
Huether, S. E., McCance, K. L. & Brashers, V. L. (2020). 
Understanding  
May, A., Schwedt, T. J., Magis, D., Pozo-Rosich, P., Evers, S., & Wang, S. J. (2018). Cluster headache. 
Nature Reviews Disease Primers
, 
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View profile card for Candice Russell

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April 4 at 6:18 PM
 by Candice Russell

     Pathophysiology 7
th
 ed. 
 Elsevier Mosby.

Hoffmann, J., & May, A. (2018). Diagnosis, pathophysiology, and management of cluster headache. 
The Lancet Neurology
, 
17
(1), 75-83.

Cluster headaches are associated with regions of the brain, specifically the hypothalamus. Abnormal activity of this region causes both pain and autonomic symptoms. The pain is also a result of the release of vasoactive substances and neurogenic inflammation formation (May et al., 2018). The other key player is the trigeminovascular system which induces episodic headaches. For the treatment, abortive drugs like triptans and sumatriptan are used since they are the most effective in countering the consequences of the symptoms (Hoffmann & May 2018). To prevent a recurrence, verapamil and lithium carbonate should be administered. However, the clinician should be worried about the side effects. In a case where the side effects are adverse, topiramate is considered the preventative drug. For transitional treatment, the acute attacks are managed with oxygen inhalation, and occipital nerve stimulation. Patients have an important role to play by adopting a regular sleep schedule and avoiding alcohol intake.

Bob’s cluster headaches
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Jennifer Bryant posted Mar 31, 2021 12:45 AM

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Bob’s symptoms meet the International Classification of Headache Disorders classification for cluster headaches. Diagnostic criteria include more than 5 attacks, severe unilateral pain, lacrimation, congestion and frequency occurring between one every other day and 8 per day (IHS, 2018). The duration of 10 years of episodic episodes would put Bob at 28 for age of onset. Typical age of onset is 20-40 and men are afflicted three times often than women (IHS, 2018).ReferencesInternational Classification of Headache Disorders, 3rd edition. 
Cephalalgia
 
38
, 1–211.headache, 
The Lancet Neurology, 
17(1) 75-83.May, A., Schwedt, T., Magis, D., Pozo-Rosich, P., Evers, S., Wang, S.J. (2018). Clusterless1 UnreadUnread3 ViewsViews

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headache. 
Nat Rev Dis Primers
 
4
. https://doi.org/10.1038/nrdp.2018.6

https://doi.org/10.1016/S1474-4422(17)30405-2.

Hoffmann, J & May, A., (2018) Diagnosis, pathophysiology, and management of cluster

Headache Classification Committee of the International Headache Society (2018). The

The pathophysiology of cluster headache is not fully understood but includes alterations in both the central and peripheral nervous systems, including activation of the trigeminovascular system (May et al, 2018). Treatment options include management of acute attacks, prophylaxis and trigger avoidance. Triptans, oxygen and lidocaine are effective in aborting acute attacks (Hoffman & May, 2018). Prevention has been effective with verapamil and lithium (Hoffman & May, 2018). Future treatments include clinical trials for monoclonal antibodies and botulinum toxin and other medications suggest effectiveness in uncontrolled trials (Hoffman & May, 2018) cluster headache essays.

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Melissa Morgan posted Mar 27, 2021 9:46 PM

The patient in this case study, Bob, is experiencing cluster headaches. According to Huether, et al., this type of headache occurs primarily in men who are 20-50 years old, has a rapid onset, can last for minutes to hours and up to 8 attacks per day, and patients can experience lacrimation and rhinorrhea (2020). The patient who has cluster headaches can experience spontaneous remission, which Bob is noted in the case study to have also. 
Treatment. 
Cluster headaches affect only about 1% of the population, but it represents one of the most painful conditions (Kingston & Didick, 2018).
 
Treatment for this disorder includes prophylactic drugs; avoidance of triggers; and managing acute attacks with oxygen inhalation, sumatriptan, or inhaled ergotamine administration, and nerve stimulation (Huether, et al., 2020). Delivering oxygen via a nonrebreather face mask has been shown to be an effective treatment (Kingston & Didick, 2018). A drawback to using oxygen is that it can be cumbersome for people to carry oxygen around all day. However, unlike triptans, there is no set limit of how many times a person can use oxygen, especially for those who experience multiple attacks per day. Preventative drugs used to treat cluster headaches are verapamil and lithium. They are the most widely used in first-line preventive treatment, and if they are not effective or contraindicated then topiramate can be used (Brandt, et al., 2020).  Brandt, R. B., Doesborg, P., Haan, J., Ferrari, M. D., & Fronczek, R. (2020). Pharmacotherapy for Cluster Headache. 
CNS drugs
, 
34
(2), 171–184. https://doi.org/10.1007/s40263-019-00696-2Kingston, W. S., & Dodick, D. W. (2018). Treatment of Cluster Headache. 
Annals of Indian Academy of Neurology
, 
21
(Suppl 1), S9–S15. https://doi.org/10.4103/aian.AIAN_17_18less0 UnreadUnread

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View profile card for Gisselle Mustiga

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April 3 at 5:53 PM
 by Gisselle Mustiga

Huether, S., McCance, K., and Brashers, V. (2020).  
Understanding Pathophysiology
 (7
th
 ed.).  Elsevier

References

Pathophysiology. 
Cluster headaches involve the autonomic division of the trigeminal nerve and are one of a group of disorders called trigeminal autonomic cephalalgias (Huether, et al., 2020). The mechanism for trigeminal activation is unknown, but “The pathogenic mechanism for pain is related to the release of vasoactive substances and the formation of neurogenic inflammation” (Huether, et al., 2020, p. 401). This disorder is characterized by sympathetic underactivity and parasympathetic activation with unilateral trigeminal distribution and ipsilateral autonomic manifestations (Huether, et al., 2020).

Module 11, Eleany Yasein
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Eleany Yasein posted Mar 31, 2021 12:17 PM

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          Based on the symptoms that are described, Bob is experiencing cluster headaches. Cluster headaches are rare, but are considered one of the most severe types of headache (Kandel & Mandiga, 2020). Cluster headaches are described as a unilateral headache that can happen anywhere from every other day, to eight times a day. Although they occur mainly during night time, they also occur around the same time during the day as well. There is not a clear understanding of cluster headaches, but there are different research studies suggesting the root of this headache. Trigeminovascular system and the parasympathetic nerve fibers are involved. There is a defect in the central pathway that controls pain and dysregulation in the autonomic nervous system. The supraspinal control of pain does not function normally and cognitive processing is affected. Studies also state that there is a dysfunction of intracellular signaling pathways of neurotransmitters, ion channels, and inflammation related molecules (Kandel & Mandiga, 2020).ReferenceWei, Y. D., Yuan Ong, J. J., & Goadsby, J. P. (2018, April). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. 
Annals of Indian Academy of Neurology
, 
21
(1), S3–S8. 
https://doi.org/10.4103/aian.AIAN_349_17
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View profile card for Jazmin Jerez-Rivera

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April 3 at 4:44 PM
 by Jazmin Jerez-Rivera

Kandel, A. S., & Mandiga, P. (2020, June 30). Cluster Headache. 
StatPearls. 
https://www.ncbi.nlm.nih.gov/books/NBK544241/

Moreover, there is activation of the posterior hypothalamus during cluster headache attacks (Wei et al., 2018). The involvement of the hypothalamus provides support for clinical presentation and treatments (Wei et al., 2018). Acute treatment for cluster headaches includes 100% oxygen therapy, triptans, intranasal lidocaine, octreotide and ergotamine (Kandel & Mandiga, 2020). Preventative treatments include verapamil, lithium, valproic acid and oral steroids (Kandel & Mandiga, 2020).  Electrical stimulation including deep brain stimulation of the hypothalamus has also been effective (Wei et al., 2018).

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Amandeep Kaur posted Mar 29, 2021 12:19 PM

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Based on the case scenario one can infer that Bob’s symptoms are consistent with cluster headaches. Cluster headaches have a clinical manifestation of severe unilateral pain, with agitation and restlessness (Wei et al., 2018) cluster headache essays. These attacks can last anywhere from 15 minutes to a couple of hours, up to eight times a day. These headaches can also cause eye redness, tearing and discomfort, nasal congestion, aural fullness, throat swelling, and flushing. These types of headaches occur predominantly in males, age of onset being 20-49 years old. The pathophysiology of these headaches is not fully understood. The symptoms and imaging lead to the theorization that the hypothalamus may be involved (Blanda, 2021). This is due to the nature of the attacks being intermittent and the hypothalamus controls circadian rhythm (biologic clock). There is also involved with central disinhibition of the nociceptive and autonomic pathways, specifically the trigeminal nociceptive pathways. Vascular dilation is also cited as possible causation for these headaches; however, studies show inconsistent results. The extracranial blood flow is increased but only after the initiation of pain. These cluster headaches also seem to initiate after the release of histamines, antihistamines have no effect in stopping these headaches. There are two forms of treatment for these headaches, symptomatic and prophylactic. Symptomatic treatments can include administration of oxygen, anesthetics, etc. NSAIDs have proven to give some pain relief in these headaches. Galcanezumab is one drug that has gotten FDA approval for prophylactic usage. It is cited to decrease the frequency of these headaches. Depending on the individual there are procedures that can be performed on the trigeminal nerve or the autonomic pathways. These include alcohol injections or even avulsion of nerves for chronic refractory cases.Wei, D. Y., Yuan Ong, J. J., & Goadsby, P. J. (2018). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. 
Annals of Indian Academy of Neurology
, 
21
(Suppl 1), S3–S8. https://doi.org/10.4103/aian.AIAN_349_17 less1 UnreadUnread3 ViewsViews

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View profile card for Joanne Hogan

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 by Joanne Hogan

Blanda, M. (2021, March 01). Cluster headache. Retrieved March 29, 2021, from https://emedicine.medscape.com/article/1142459-overview

References

Cluster Headaches
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Caroline Otto posted Apr 1, 2021 7:44 AM

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Pathophysiology of the Cluster Headache.They occur in one side of the head, and men between the ages of 20 and 50 years old are mostly affected. The source may alternate sides with each headache episode, and they are commonly described as stabbing and throbbing (Huether, S. E., McCance, K.L. & Brashers, V.L. 2020).The triggers are like those that cause migraine headaches, and these involve triggers that decrease the threshold for a migraine. They may be genetic, or associated with fatigue, oversleeping, missed meals, overexertion, weather change, stress or relaxation from stress, hormonal changes, or over stimulation from either bright lights, strong smells, and chemicals such as alcohol or nitrates.Current Treatment options for Patients who present with Cluster headaches.The medical treatment relies on prophylactic drugs.According to the American Headache Society evidenced based guidelines; Sumatriptan subcutaneous, zolmitriptan nasal spray, and high flow oxygen remain the treatments with a level A recommendation. For prophylactic therapy suboccipital steroid injections have emerged as the only treatment to received Level A recommendation. Notably what did receive a Level C recommendation – meaning a positive study was warfarin, I would personally not want to take warfarin ever, unless I absolutely had to.There has been some success noted with Zolmitriptan 5mg and 10mg, however it has been identified that these patients remain undertreated if treated at all. The main goal and focus should adhere to evidence based practice guidelines, as in all other areas of Medicine.References:7
th
 ed. Elsevier MosbyRobbins, M. S., Starling, A. J., Pringsheim, T. M., Becker, W. J., & Schwedt, T. J. (2016). Treatment of Cluster Headache: The American Headache Society Evidence-Based Guidelines. 
Headache
, 
56
(7), 1093–1106. https://doi.org/10.1111/head.12866less1 UnreadUnread5 ViewsViews

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View profile card for Sheryl Dixon

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April 2 at 8:53 PM
 by Sheryl Dixon

Kingston, W. S., & Dodick, D. W. (2018). Treatment of Cluster Headache. 
Annals of Indian Academy of Neurology
, 
21
(Suppl 1), S9–S15. https://doi.org/10.4103/aian.AIAN_17_18

Huether, S. E., McCance, K.L. & Brashers, V.L. (2020). Understanding Pathophysiology.

According to another source, Oxygen at 6-15 L/min by a nonrebreather face mask has been shown to improve headaches in these clients. This continues to be the mainstay of treatment with much debate surrounding other options.

Acute Cluster headache attacks are treated with oxygen inhalation, sumatriptan or inhaled ergotamine administration and nerve stimulation.

Overall, the patient’s main goal should be to identify and become aware of what triggers these attacks and avoiding those triggers, such as caffeine, tyramine, fluorescent lighting, and alcohol.

When a Cluster headache develops there is trigeminal activation, but the mechanism of action is unclear. The pathogenic mechanism for pain is related to the release of vasoactive substances and the formation of neurogenic inflammation. Autonomic dysfunction is characterized by sympathetic underactivity and parasympathetic activation. There is unilateral trigeminal distribution of severe with ipsilateral autonomic manifestations, including tearing and ptosis of the eye on the affected side, and congestion of the nasal passages.

These headaches occur in clusters, thereby getting its name, and individuals may have up to 8 attacks per day, and they often last for minutes to hours for a period of days, followed by a long period of spontaneous cessation. These headaches are episodic and chronic varying between extreme pain intensity and short duration. If these headaches present without spontaneous cessation, they are referred to as; chronic cluster headaches which involve 10% to 20% of cases.

Cluster headaches are commonly referred to as trigeminal autonomic cephalalgias, meaning headaches that involve the autonomic division of the trigeminal nerve.

Cluster headache
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Jazmin Jerez-Rivera posted Mar 30, 2021 9:55 PM

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After analyzing the patient’s symptoms further, it looks like Bob is suffering from Cluster Headaches. The pathophysiology can be complex and underlying causes are not fully clarified. The headache is neurovascular in nature and it stems from the trigeminal-autonomic reflex activation. This pathway “consists of a brainstem connection between the trigeminal nerve and facial cranial nerve parasympathetic outflow” (Wei et. al., 2018, p. 4). It is triggered by the stimulation of the trigeminovascular pathways. Pain afferents cross the ophthalmic division and receive signals from cranial vessels and dura mater. These synapse in the Trigeminocervical complex (TCC) and projects to brain structures that trigger pain, including the thalamus, cortex and hypothalamus (Wei et. al., 2018). The hypothalamus is connected to the ipsilateral trigeminal system which causes associated symptoms of tearing, ptosis of the eye, and nasal congestion (Huether et. al. 2020). Treatments for cluster headaches include oxygen therapy, and sumatriptan (Imitrex) injectable and nasal spray, which is frequently used for migraines. Another fast-acting nasal spray used is zolmitriptan (Zomig). Other injectables prescribed are ocreotide and dihydroergotamine (MFMER, 2019).ReferencesMayo Foundation for Medical Education and Research. (2019). Cluster headache. Retrieved from https://www.mayoclinic.org/diseases-conditions/cluster-headache/symptoms-causes/syc-20352080less1 UnreadUnread1 ViewsViews

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View profile card for Jennifer Bryant

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April 2 at 1:34 AM
 by Jennifer Bryant

Wei, D. Y., Yuan Ong, J. J., & Goadsby, P. J. (2018). Cluster Headache: Epidemiology, Pathophysiology, Clinical Features, and Diagnosis. 
Annals of Indian Academy of Neurology
, 
21
(Suppl 1), S3–S8. https://doi.org/10.4103/aian.AIAN_349_17

Huether, S. E., McCance, K. L., Brashers, V. L. (2020). Understanding Pathophysiology (7 Ed.).  Elsevier.

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Sheryl Dixon posted Mar 31, 2021 6:13 PM

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A cluster headache is an uncommon type of headache “Cluster” is a descriptive term that refers to the way the attacks occur in groups, bursts or clusters, which can last from days to months and then go into remission, often for years at a time. The clusters occur with some seasonal regularity, most often in the spring or fall. During a cluster period, a patient may have one or several headaches in a day. The attacks frequently occur at night, waking the patient from a sound sleep. The pain is of short duration, lasting from a few minutes to several hours, though most often for 30 to 45 minutes. The pain is rarely present longer than four hours (Phelps, 2008).Cluster headaches may be triggered by alcohol and cigarette smoking, high altitudes (trekking and air travel), bright light (including sunlight), exertion (physical activity), heat (hot weather or hot baths), foods high in nitrites (bacon and preserved meats), certain medicines and cocaine (Medlineplus, 2020).Medications to improve quality of life. Prescription medications can shorten a headache cycle. They can also make the headaches less severe. Calcium channel blockers, verapamil, lithium carbonate, divalproex sodium, melatonin or topiramate may help. There is a new preventive therapy that is a calcitonin gene-related peptide (CGRP) monoclonal antibody.                                                                                                           ReferencesMedlineplus, (2020).
Cluster headache
. Retrieved from https://medlineplus.gov/ency/article/000786.htmless1 UnreadUnread6 ViewsViews

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View profile card for Cassie Fritzinger

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April 1 at 11:04 AM
 by Cassie Fritzinger

Phelps. P. (2008), 
Case Studies in Headache: Cluster Headache
. Retrieved from https://headaches.org/2008/05/06/case-studies-in-headache-cluster-headache/

Clevelandclinic, (2018).
Cluster Headaches
. Retrieved from https://my.clevelandclinic.org/health/diseases/5003-cluster-headaches

Other options when needed Surgeons have tried operations for cluster headaches. But they haven’t had much success preventing them. Researchers are now testing newer therapies to see if they can work. One option uses mild electrical stimulation on the neck. Another creates electrical stimulation by placing a medical device through the upper gums (Clevelandclinic, 2018).

Unfortunately, there is no cure for cluster headaches. But you do have treatment options that can make them a little less painful. Treatment options include Abortive treatment to stop attacks: Often, a headache will stop before you have a chance to see a healthcare provider. But if you get there in time, there are several effective ways to stop a cluster headache. A healthcare provider may give you injected medications or a nasal spray. These include sumatriptan, dihydroergotamine and zolmitriptan. The provider may also give you oxygen through a mask.

Doctors do not know exactly what causes cluster headaches. They seem to be related to the body’s sudden release of histamine (chemical in the body released during an allergic response) or serotonin (chemical made by nerve cells) in the area of a nerve in the face called the trigeminal nerve. A problem in a small area at the base of the brain called the hypothalamus may be involved. More men than women are affected. The headaches can occur at any age, but are most common in the 20s through middle age cluster headache essays. They tend to run in families.

Dennies Jones
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Dennies Jones posted Mar 31, 2021 6:38 PM

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Bob is suffering from clustered headaches. According to Huether et al. (2020), “cluster headaches are part of a group of disorders known as trigeminal autonomic cephalalgias, headaches involving the autonomic division of the trigeminal nerve. CH headache is usually felt on one side of the head and is seen primarily in males between the age of 20 and 50” (p. 970. The headaches occur in clusters and can last from minutes to hours for several days, followed by months of nonrecurrence (Huether et al., 2020). Signs and symptoms are lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating miosis, ptosis, eyelid edema, and restlessness or agitation.       less1 UnreadUnread6 ViewsViews

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View profile card for Cassie Fritzinger

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April 1 at 10:44 AM
 by Cassie Fritzinger

Ljubisavljevic, S., & Zidverc Trajkovic, J. (2019). Cluster headache: pathophysiology, diagnosis, and treatment. Journal of neurology, 266(5), 1059–1066. https://doi.org/10.1007/s00415-018-9007-4

Huether, S., McCance, K., & Brashers, V. (2020). 
Understanding Pathophysiology
 
(7th ed.). Elsevier.

Guo, X. N., Lu, J. J., Ni, J. Q., Lu, H. F., Zhao, H. R., & Chen, G. (2019). The role of oxygen in cluster headache. Medical gas research, 9(4), 229–231. https://doi.org/10.4103/2045-9912.273961

References

            According to (Huether et al., 2020), “prophylactic drugs are used to treat CH. Avoiding things that trigger headaches is essential; acute attacks are treated with oxygen inhalation, sumatriptan, or inhaled ergotamine administration and nerve stimulation” (p. 971). High flow oxygen has been recommended for alleviating acute attacks of CH and is one of the first-line acute treatments. Oxygen is better when compared to other acute medications, such as sumatriptan and zolmitriptan; oxygen causes very few side effects or long-term harm (Guo et al., 2019).

Module 11
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Steven Bartos posted Mar 31, 2021 11:02 PM

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Based on this week’s scenario, I would provide a diagnosis of Cluster Headaches. Bob met the following diagnostic criteria for cluster headaches, which includes having severe unilateral orbital, supraorbital, and/or temporal pain lasting 15 – 180 min, up to eight times a day, if left untreated. Furthermore, Bob had at least one of the following: conjunctival injection and/or lacrimation, nasal congestion and/or rhinorrhea, eyelid edema, forehead and facial sweating, and miosis and/or ptosis (Ljubisavljevic & Trajkovic, 2019).            Acute cluster headaches are typically treated with inhaled oxygen, recommended at 12 – 15 L/min for 15 – 20 min through a non-rebreathing facemask. Parenteral treiptans have also been shown to be effective, however, oral triptans have not. Sumatriptan subcutaneously is the most effective triptan. Sumatriptan and Zolmitriptan nasal spray have both been proven to be effective. If these interventions are ineffective or contraindicated, Lidocaine has been effective in approximately one third of patients (Hoffmann & May, 2018). Preventative options include verapamil 360 mg and lithium 900 mg doses have been shown effective in research. Research into neurostimulation of the hypothalamus and occipital nerve also shows promise for treating cluster headaches (Ljubisavljevic & Trajkovic, 2019).Hoffmann, J., & May, A. (2018) cluster headache essays. Diagnosis, pathophysiology, and management of cluster headache. 
Lancet Neurology, 17
(1), 75 – 83. 
https://dx.doi.org/10.1016/S1474-4422(17)30405-2
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View profile card for Caroline Otto

Last post 
April 1 at 8:15 AM
 by Caroline Otto

Ljubisavljevic, S., & Trajkovic, J.Z. (2019). Cluster headache: Pathophysiology, diagnosis and treatment. 
Journal of Neurology, 266
(5), 1059 – 1066. 
https://dx.doi.org/10.1007/s00415-018-9007-4

References

Cluster headaches involve the autonomic division of the trigeminal nerve. The exact mechanism in the pathophysiology of cluster headaches remains unclear, but it is believed to involve several structures of the peripheral nervous system and central nervous system. When the trigeminovascular system is activated, and the pain associated with cluster headaches is related to the release of CGRP, a vasodilator that regulates the nociceptive trigeminal neurons. Furthermore, the parasympathetic system is connected to the trigeminal nerve through the superior salivatory nucleus, via the facial nerve; this regulates conjunctival injection, lacrimation and rhinorrhea, and cranial and extracranial vasodilation. Recently, research with MRI’s and animal studies has also shown that the hypothalamus may be involved as well, possibly related to melatonin, the GABAergic, and the glutamatergic receptor systems (Hoffmann & May, 2018).

Fritzinger, Discussion wk 11
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Cassie Fritzinger posted Mar 28, 2021 11:41 PM

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Based on Bob’s presentation I would diagnosis him with Cluster Headaches. According to Heuther, McCance & Brasher (2020), cluster headaches are also known as trigeminal autonomic cephalalgias. The usual presentation of these types of headaches includes pain on one side of the head such as stabbing and throbbing (which can alternate sides with each episode), unilateral tearing of the eye, ptosis, as well as nasal congestion. Cluster headaches typically present in males between the ages of 20 and 50 (Heuther, McCance, Brasher, 2020). Bob is exhibiting typical signs/symptoms of cluster headaches and does have periods of remission when he is headache free for several months thus he does not have chronic cluster headaches which occurs in a small percentage of cases (Heuther, McCance, & Brasher, 2020).Cluster headaches have also been seen to be related to abnormal melatonin levels. These patients have a low nocturnal melatonin level, thus have had some success with supplementation. However, Wei & Jensen (2018) report that those with chronic cluster headaches did not have relief with the melatonin treatments, and those with episodic cluster headaches had minimal relief. Although with the low potential adverse effects one may suggest adding melatonin to other treatments as an adjunctive therapy (Wei & Jensen, 2018). ReferencesChrisholm-Burns, M. A., Schwinghammer, T.L., Malone, P.M., Kolesar, J.M., Lee, K.C., Bookstaver, P.B. (2019). Pharmacotherapy: Principles and practices (5th ed.) McGraw-Hill Education.Wei, D. & Jensen, R. (2018) Therapeutic Approaches for the Management of Trigeminal Autonomic Cephalalgias. Neurotherapeutics. 15(2): 346-360. 
10.1007/s13311-018-0618-3

Heuther, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding Pathophysiology (7th ed.). Elsevier.

Barloese, M.C.J. (2018) cluster headache essays. The pathophysiology of the trigeminal autonomic cephalalgias, with clinical implications. 
Clin Autonomic Research
 28, 315–324. 
https://doi.org/10.1007/s10286-017-0468-9

While there are different views on the treatments of headaches, it would be important for the patient to evaluate their headaches and start a headache journal to document any triggers. Knowing triggers will assist the patient in attempting to avoid these triggers potentially lessening the frequency of their headaches. Chrisholm-Burns, Schwinghammer, Malone, Kolesar, Lee & Bookstaver (2019), recommend the treatment for cluster headaches begin with the administration of 100% oxygen via a high glow nonrebreather mask at 12-15L/min for a time of 15 minutes. This is suggested secondary to the reported increased amount of cluster headaches with high-altitude exposure suggesting hypoxemia as a cause of cluster headaches (Chrisholm-Burns, Schwinghammer, Malone, Kolesar, Lee & Bookstaver, 2019). Should the administration of oxygen be ineffective to the treatment of these cluster headaches, another suggestion would be to begin adjunctive therapy using triptan class medications. For the acute cluster headache, it is suggested to use intranasal or subcutaneous sumatriptan for a more rapid onset of relief of symptoms. The oral use of triptans may play a better role in the limiting of recurrence cluster attacks secondary to their delayed onset. A caution with triptans is the vasoconstrictive property which should be avoided in patients with underlying ischemic vascular disease. For these patients, octreotide a somatostatin analogue administered subcutaneously, can be used. Octreotide does not have the vasoconstrictive properties (Chrisholm-Burns, Schwinghammer, Malone, Kolesar, Lee & Bookstaver, 2019).

Cluster headaches or trigeminal autonomic cephalalgias are poorly understood in means of pathology. The presentation of these headaches is only a portion of the complex symptoms associated with the pathophysiology of this type cephalalgia. There is an activation of the trigeminal-autonomic reflex, this reflex which is controlled by higher centers in an important part of the wide range of symptoms likely indicating a homeostatic disturbance. It has been suggested that the hypothalamus plays a key role in these headaches (Barloese, 2018). Unique symptomology of cluster headaches is the “circannual and circadian tendency, as well the neurohormonal changes in testosterone, cortisol, and melatonin”, supporting the hypothalamus as being a part of these symptoms (Wei & Jensen, 2018) cluster headache essays. Wei & Jensen (2018), also report that Nitric oxide also plays a part in cluster headaches, and it was found that patients with cluster headaches have a higher level of nitric oxide in their plasma. Because of this the use of nitroglycerin has been found to trigger cluster headaches. While indomethacin is classified as a nonsteroidal anti-inflammatory drug (NSAIDs) it is not equal to all other NSAIDs and has been found to affect the Nitric Oxide mechanism associated with cluster headaches. This treatment is part of a Nitric Oxide-cyclic guanosine monophosphate (NO-cGMP) cascade which is a therapeutic target for treatment cluster headache essays.

Elizabeth Walker iHuman Reflection NRP/563: Management Of Women’s Health Issues

iHuman Patient Elizabeth Walker Reflection

 
iHuman Patient Elizabeth Walker Reflection

Steps to Differential Diagnosis

Acute pelvic pain in women is a high-intensity pain in the lower body quadrants existing not more than 3 months. For the case of Elizabeth, differential diagnoses for acute pelvic pain could be due to gynecologic and non-gynecologic causes. Differential diagnosis of the cause, as explained by Brady & Carusi (2016), is usually based on proper history taking and physical examination. A proper history taking from the patient gave pain characteristics, the sexual and social history of the patient, age and review of systems that guided the differential diagnoses Elizabeth Walker iHuman Reflection NRP/563: Management Of Women’s Health Issues.

Steps to Final Diagnosis

To reach the final diagnosis, a thorough physical examination is needed to rule out the other differential diagnoses. According to Hecht et al. (2019), clinical examination and blood tests are essential; in complementing patient history in the diagnosis of pelvic pain causes. The presence of fever and chills and vaginal discharges in the patient could suggest a systemic infection like Pelvic inflammatory disease. Elizabeth does not show inappetence, vomiting or worsening pain during bowel movement, which rules out chances of digestive tract disorders like appendicitis. Lack of vaginal bleeding and negative HCG test rule out ectopic pregnancy. Ultrasonography remains the modality of choice in making the final diagnosis after a thoroughly complete and systemic clinical and physical examination (Hecht et al., 2019). Enlargement of the right ovary without blood flow on ultrasound exam is definitive for ovarian torsion.

Application of Watson Theory

Proper management of the condition involves educating the patient on causative factors and assure her of being well again. The Watson theory explains the importance of self-healing when the patient’s emotional needs are met by providing a caring attitude and a healing environment. The nurse can listen to the patient to appreciate her beliefs about the condition, and maintain a trusting and respectful interpersonal relationship with her. Nurses can also attend to the spiritual needs of the patient, and respond to all her fears raised during management, like the possibility of developing infertility after surgery (Pajnkihar et al., 2017). In this case, the patients’ needs to know about the corrective surgical procedure, and the effect of that on her overall health. The patient’s spiritual needs should be explored, and let her know that she will be well after the surgical correction.

Management

Ovarian torsion occurs when the ovary twists over the supporting ligaments, obstructing the flow of blood to the ovary and causing local inflammation. Diagnosis of the condition is important to prevent ischemia of the ovary and associated infertility issues. Treatment of the condition is usually surgical detorsion with adnexal sparing (Guile & Mathai, 2021). Proper analgesia controls tachycardia and helps in relieving the acute pain before surgery Elizabeth Walker iHuman Reflection NRP/563: Management Of Women’s Health Issues.

Conclusion

Acute pelvic pain can be caused by both gynecologic and non-gynecologic factors. In most cases, an immediate diagnosis is important to prevent further injuries which may complicate the condition and predispose patients to secondary conditions. A proper clinical and physical examination is important in the effective diagnosis of causes of acute pelvic pain in women, and management should be taken into keen consideration of patients’ needs and values.

References

Brady, P. C., & Carusi, D. (2016). Acute Pelvic Pain. 
Handbook of Consult and Inpatient Gynecology
, 3-29.
https://link.springer.com/chapter/10.1007/978-3-319-27724-0_1

Guile, S. L., & Mathai, J. K. (2021). Ovarian Torsion. 
StatPearls [Internet]
.
https://www.ncbi.nlm.nih.gov/books/NBK560675/

Hecht, S., Meissnitzer, M., & Forstner, R. (2019). Acute Pelvic pain in women-gynaecological causes.
Der Radiologe
, 
59
(2), 126-132.
https://doi.org/10.1007/s00117-018-0475-4

Pajnkihar, M., Štiglic, G., & Vrbnjak, D. (2017). The concept of Watson’s carative factors in nursing and their (dis) harmony with patient satisfaction. 
PeerJ
, 
5
, e2940.
 
https://dx.doi.org/10.7717%2Fpeerj.2940

 
SOAP Note Template

Abdominal pain RLQ one hour with nausea. Reports pain is stabbing, sharp, strong, feels deep, rates pain 8 on scale 0-10.

HPI

History (including PMH, surgical, family, and social)

Elizabeth Walker is a 34-year-old married female who presents for evaluation of acute onset of RLQ abdominal pain with nausea for one hour. She characterizes the pain as sharp, constant, and worse with any movement. She reports associated nauseas, denies vomiting, fevers/chills, diarrhea, abnormal vaginal bleeding or discharge, lower urinary tract symptoms, or flank discomfort. PMH is notable for her currently undergoing hormonal stimulation fertility treatments (G0P0). The physician exam is significant for tachycardia, RLQ pain with guarding and rebound, as well as a tender right adnexal mass per pelvic examination. Other active problems: Infertility – takes HCG injections and FSH. Obstetric History: Gravida 0, Para 0, Abortus 0. Surgical History: 1. Tonsillectomy – @ age 14. Preventive: Flu immunization recommended yearly. BMI to 22.3 Seat belts – uses regularly. Texting while driving – never. Current on immunizations:1) up to date on Tdap. 2) up to date on influenza vaccination. Family History: Mother – 62 with HTN, alive and well. Father – 65 with diabetes, alive and well. Sister – 36 with two children, alive and well. Grandparents – deceased unknown causes. Social History: Tobacco – none. Alcohol – no. Recreational drugs – none. Married – monogamous. Education – college graduate. Job – elementary-school principal. Travel – none recently. Pets – none. Home safety – no guns in household Elizabeth Walker iHuman Reflection NRP/563: Management Of Women’s Health Issues.

ROS (general, skin, HEENT, neck, breasts, resp, CV, GI, peripheral vascular, urinary, genital/LMP, MSK, psych, neuro, hematologic, endocrine)

General: No evidence of fever, chills, fatigue, malaise, night sweats, excessive or unexplained weight gain or loss. Skin/Breasts: No rashes, bruising, jaundice, pruritis, acne, sores, ulcers, changes in moles, hair loss or brittleness, nails. No pain from her breasts. No lumps on bilat breasts. Does monthly self-breast exam. No discoloration near nipples or breasts. No nipple discharge. Periods are regular every 26-28 days. LMP three weeks ago. Uses three pads or tampons per day. HEENT/Neck: Denies vision changes, blurred vision; eye pain, discharge, itching, or redness. Denies ear pain, ear discharge, hearing difficulty, vertigo, nasal congestion, epistaxis, sinus pain or pressure, sore throat, swollen glands in neck, tooth pain. Cardiovascular: No complaints of chest pain/pressure, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, palpitations, ankle swelling. Resp: Denies shortness of breath, wheezing, cough/ sputum, hemoptysis, tightness in chest, pleuritic chest pain (pain with deep breath or cough). Abd/GI: C/o nausea and RLQ abdominal pain for last hour. No problems with appetite changes, dysphagia, vomiting, hematemesis, heartburn, diarrhea, constipation, melena. GU: No menstrual irregularities, amenorrhea, dysmenorrhea, dyspareunia.  Denies dysuria, urinary frequency, nocturia, hematuria, incontinence, urgency, hesitancy, difficulty starting or stopping stream. MSK: No joint or muscle pains, joint stiffness and swelling, limitations in movement, functionality. Neuro: No problems with headaches, syncope, presyncope, dizziness, weakness, paralysis, numbness/tingling, or balance. Allergic/Immunologic: Denies food allergies, hives, or rashes. Lymphatic/Endocrine: Denies polyuria, polydipsia, polyphagia, tremor, heat or cold intolerance, hot flashes. Hematologic: Denies excess bruising or bleeding, swollen glands/lymphadenopathy. Psychological: No problems with mood changes, feeling depressed, manic behaviors, auditory or visual hallucinations, anxiety, insomnia, suicidal or homicidal ideations Elizabeth Walker iHuman Reflection NRP/563: Management Of Women’s Health Issues.

Allergies

Penicillin. NKFA.

Current Medications

FSH and HCG injections.

Objective

Vital Signs:

BP
106/70 mmHg – sitting.

RR
14 unlabored

Pain
8

Height
5’ 4”

Weight
130 lbs. (59.1kg)

BMI
22.3

Temp
98.6 oral

Pulse Ox
99% room air

Physical exam (general, HEENT, neck/lymph, breasts, chest/respiratory, CV, GI/abdomen, GU/rectal, back, MSK, skin, neuro, psych)

Weight:  130.0 pounds. Skin/Breasts: Atraumatic, good skin turgor, skin, and scalp normal, no evidence of suspicious pigmented lesions. Normal symmetrical breast contour bilat. No overt inflammatory signs. No previous incisions or trauma. Left and right breast with no abnormalities. No axillary adenopathy. No expressible nipple discharge. HEENT: Eyes: Sclera and conjunctiva normal. Pupils and irises size symmetrical and shows normal reaction to light and accommodation bilaterally. Ears: no external scars or lesions. Otoscopic exam normal with only minimal wax, no masses or foreign bodies, good light reflex bilaterally. Nose: External without abnormality. Normal nasal mucosa, septum, turbinate’s. Mouth: Good dental hygiene. Neck supple, no adenopathy, trachea midline, no carotid bruits, thyroid size 25 gm, no masses or tenderness. Cardiovascular: No JVD. No thrills, heaves, or lifts. PMI normal size and location.  Heart RRR Normal S1 and S2, no murmurs appreciated. No carotid bruits, abdominal aorta normal size no bruits, pedal pulses present and symmetrical, no evidence of peripheral edema or varicosities. Respiratory: Normal chest shape, normal respiratory movement, no tenderness, and percussion normal. Auscultation found normal breath sounds throughout without wheezing, rales or ronchi. Abdomen/GI: Flat contour. No scars. Normal bowel sounds present. No hepatosplenomegaly. Severe tenderness to RLQ palpation below McBurney’s point, with associated guarding and rebound; no palpable mass. Mild tenderness to RUQ and LLQ palpations. No CVA tenderness. Liver edge felt below the coastal margin, span normal to percussion. Spleen normal size. GU/GYN: No lesions on external exam. Speculum exam: no blood or discharge present, cervix appears normal. Bimanual exam: right adnexal tenderness with palpable mass. No cervical motion tenderness. Normal genitalia, no evidence of infection. MSK: Normal ROM and muscle tone throughout. Muscle strength and flexibility throughout axial and appendicular skeleton normal. Motor 5/5 all extremities. Neurological: A & O x 4, good attention, memory, normal gait, CN 2-12 intact, reflexes 4/4 throughout. Normal cerebellar exam with finger to nose (FTN), rapid alternating movements (RAM), heal to shin (HTS) bilaterally. Allergic/Immunologic: No worrisome preauricular, posterior auricular, anterior cervical, posterior cervical, submandibular, supraclavicular lymph nodes. Lymphatic/Endocrine: Thyroid normal to palpation, 25 gm, no masses or tenderness. Hematologic: Normal capillary refill. No evidence of anemia Elizabeth Walker iHuman Reflection NRP/563: Management Of Women’s Health Issues.

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Assessment

Problem List:

Right Ovarian Torsion

 

Differential diagnoses:

Differential Diagnoses

How Was This Diagnosis Ruled Out?

Ectopic pregnancy

Tubo-ovarian abscess

Ovarian cyst rupture

Appendicitis

Ovarian torsion

Plan

Include the following:

Medications to be prescribed (drug-dose directions)

Instructions to continue, discontinue, or start medications, including changes to routine medications.

Diagnostic tests in the proper order and reason for the order (e.g., CT abdomen and pelvis with and without contrast, Dx, LLQ abdominal pain)

Labs, including appropriate serum panels (e.g., BMP, CBC with diff., TSH, T4, UA, C&S)

Patient education pertinent to health condition

Follow-up plan

Referrals

Plan

Rationale and/or results

Pelvic Ultrasound

Results show an enlarged right ovary with no blood flow is diagnostic for ovarian torsion.

Right ovary 11cm x 4cm with small cyst. No blood flow to right ovary seen.

Left ovary 4cm overall size. No pathology identified.

CBC

Name

Value

Units

Reference Range

White blood cells (WBCs)

11200

mm3

4,000-10,000

Red Blood Cell Count (RBC)

4.9

million/µl

4.5-5.9(♂), 4.0-5.2(♀), adults

Hemoglobin (Hgb)

12.2

g/dl

14-18(♂), 12-16(♀), adults

Hematocrit (Hct)

38.4

%

42-54(♂), 37-47(♀), adults

Mean corpuscular volume (MCV)

91

fl

82-103, adults

Mean corpuscular hemoglobin (MCH)

28

µm3

26-34, adults

Mean corpuscular hemoglobin concentration (MCHC)

31

%

30-37, adults

Platelets (thrombocytes)

280

k/dL

150-399, adults

Red cell distribution width (RDW)

12.0

%

11.5-14.5, adults

Neutrophils

74

%

46-78, adult

Lymphocytes

23

%

18-52, adult

Monocytes

1

%

3-10, adult

Eosinophils

1

%

0-6, adult

Basophils

1

%

0-3, adult

Segmented neutrophils

72

%

36-72, adult

Band Cells

2

%

0-6, adult

hCG, urine

Name

Value

Units

Reference Range

Human chorionic gonadotropin (HCG), urine

Negative

None (♂ and non-pregnant ♀); detectable (pregnant ♀)

UA

Name

Value

Units

Reference Range

Color

Amber

Interpreted by physician

Clarity

Clear

clear

Odor

Normal

slightly nutty

pH

5.4

4.5-8

Protein

1

mg/dL

0-8

Specific gravity

1.019

1.002-1.030

Osmolarity

> 400

mOsm/L

>400

Leukocyte esterase

Negative

negative

Nitrites

Negative

0

Ketones

Negative

negative

Bilirubin

Negative

negative

Blood (heme)

Negative

negative

Urobilinogen

0.5

EU/dL

0.2-1.0

Crystals

None

Interpreted by physician

Casts

0-1

hyaline casts/lpf

0-4

Glucose, urine

Negative

negative

White blood cells (WBCs)

0-1

hpf

0-5

Red blood cells (RBCs)

0-1

hpf

0-5

Red blood cell casts

None

none

SQEP

0-1

lpf

<5 Bacteria Negative negative on spun specimen Creatinine 8 5-19 Occult blood Negative negative STAT GYN surgical referral for removal of right torsed ovary STAT. Start IV access to provide for analgesia. Order blood work for chemistries and coagulation studies as part Of the preoperative workup. Monitor vital signs. Patients’ tachycardia will most likely improve with Analgesia and pain control. Prep for emergent laparoscopy to detorse the ovary and thereby restore Perfusion. Referral for education, counseling, supported decision making and support groups for infertility and loss of ovary. Name Value Units Reference Range Human chorionic gonadotropin (HCG), urine Negative None (♂ and non-pregnant ♀); detectable (pregnant ♀) NRP/563: Management Of Women’s Health Issues Wk 7 – iHuman Patient Elizabeth Walker Reflection See attached SOAP note for Elizabeth Walker. Write a 500-word summary (7 th edition APA format) regarding your patient encounter with Elizabeth Walker. Include the following in your summary: Explain how you arrived at your differential diagnoses. Explain the steps you used to determine the final diagnosis. Give examples of how you can integrate cultural preferences, values, health beliefs, and behaviors into the treatment plan using Watson’s theory Elizabeth Walker iHuman Reflection NRP/563: Management Of Women’s Health Issues. Describe the appropriate management (e.g. health maintenance, diagnostics, medications/treatment) and support with evidence. Critique your overall case evaluation, highlighting 2 to 3 takeaways to improve your clinical skills now that the diagnosis has been revealed. Cite a minimum of 3 peer-reviewed journal references within the last 5 years supporting your responses according to 7th edition APA guidelines. Course Textbooks: Schuiling, K. D., Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Jones & Bartlett Learning. Dunphy, L. (2019). Primary care: The art and science of advanced practice nursing (5th ed.). F.A. Davis Elizabeth Walker iHuman Reflection NRP/563: Management Of Women’s Health Issues.

NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection

SOAP Note Template

Subjective

ID

First Name
Betty

Last Name
Burns

Gender
Female

Age
48

CC

Lump on left breast for about one month NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

HPI

History (including PMH, surgical, family, and social)

Other active problems: Hypertension – well controlled on Hydrochlorothiazide. Asthma – childhood diagnosis; occasional flares requiring oral steroids. Seasonal allergies – controlled. Mild fibrocystic disease. Obstetric History: Gravida 2, Para 2, Abortus 0. 1st child at age 36. 2nd child at age 38. Surgical History: 1. Appendectomy – > 20 years ago. 2. Tubal ligation after birth of second child. Hospitalizations: 1.  Births of children. 2.  Appendectomy. 3.  Tubal ligation. Preventive: Flu immunization recommended yearly. Weight loss recommended to 150 lbs. to bring her BMI to 24.2. Yearly mammograms. Seat belts – uses regularly. Texting while driving – never. Current on immunizations:1) up to date on Tdap. 2) up to date on influenza vaccination. 3) pneumovax administered at age 42 due to her asthma. Recommend shingles vaccination when turns 60. Family History: Mother – breast cancer age 55, alive and well. Father – medical history unknown. Sisters – none. Brothers – both alive and healthy. Grandparents – deceased unknown causes. Social History: Tobacco – none; secondhand smoke exposure minimal. Alcohol – social (once to twice monthly). Recreational drugs – none. Married – monogamous; two daughters, ages 8 and 10. Education – college graduate. Job – elementary-school principal. Travel – none recently. Pets – none. Home safety – no guns in household. Eating/Exercise:  eats most meals at  home, fast food only once per week, walks 1-2 times per week for exercise NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

ROS (general, skin, HEENT, neck, breasts, resp, CV, GI, peripheral vascular, urinary, genital/LMP, MSK, psych, neuro, hematologic, endocrine)

General: No evidence of fever, chills, fatigue, malaise, night sweats, excessive or unexplained weight gain or loss. Skin/Breasts: No rashes, bruising, jaundice, pruritis, acne, sores, ulcers, changes in moles, hair loss or brittleness, nails. No pain from her breasts. Reports lump on left breast x 1 month. Found during self-breast exam last month. Discoloration near nipple on left breast. Lump on left breast thickened area over lump with indentations. Occasional bloody discharge in left breast cup of bra. Last mammogram 15 months ago and normal per patient. No movement with lump. Periods are regular every 26-28 days. HEENT/Neck: Denies vision changes, blurred vision; eye pain, discharge, itching, or redness. Denies ear pain, ear discharge, hearing difficulty, vertigo, nasal congestion, epistaxis, sinus pain or pressure, sore throat, swollen glands in neck, tooth pain. Cardiovascular: No complaints of chest pain/pressure, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, palpitations, ankle swelling. Resp: Denies shortness of breath, wheezing, cough/ sputum, hemoptysis, tightness in chest, pleuritic chest pain (pain with deep breath or cough). Abd/GI: No problems with appetite changes, dysphagia, nausea, vomiting, hematemesis, heartburn, abdominal pain, diarrhea, constipation, melena. GU: No menstrual irregularities, amenorrhea, dysmenorrhea, dyspareunia.  Denies dysuria, urinary frequency, nocturia, hematuria, incontinence, urgency, hesitancy, difficulty starting or stopping stream NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection. MSK: No joint or muscle pains, joint stiffness and swelling, limitations in movement, functionality. Neuro: No problems with headaches, syncope, presyncope, dizziness, weakness, paralysis, numbness/tingling, or balance. Allergic/Immunologic: Denies food allergies, hives, or rashes. Lymphatic/Endocrine: Denies polyuria, polydipsia, polyphagia, tremor, heat or cold intolerance, hot flashes. Hematologic: Denies excess bruising or bleeding, swollen glands/lymphadenopathy. Psychological: No problems with mood changes, feeling depressed, manic behaviors, auditory or visual hallucinations, anxiety, insomnia, suicidal or homicidal ideations.

Allergies

Seasonal hay fever. NKDA. NKFA.

Current Medications

Fluticasone (Flonase) – one spray each nostril Q AM as needed for seasonal allergies. Fluticasone/salmeterol 250/50  – one puff BID for asthma. Hydrochlorothiazide (HCTZ) – 25 mg PO daily for hypertension.

Objective

Vital Signs:

HR
80 RRR

BP
128/80 mmHg – supine/sitting. 126/72 mmHg – upon standing.

Pulse
80 RRR

RR
16 unlabored

Pain
0

Height
5’ 6”

Weight
165 lbs. (75kg)

BMI
26.26

Temp
98.6 oral

Pulse Ox
99% room air

Physical exam (general, HEENT, neck/lymph, breasts, chest/respiratory, CV, GI/abdomen, GU/rectal, back, MSK, skin, neuro, psych)

Weight:  165.0 pounds. Skin/Breasts: Atraumatic, good skin turgor, skin, and scalp normal, no evidence of suspicious pigmented lesions NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection. Breast exam consistent with known mild fibrocystic disease, left breast with subtle skin dimpling (peau d’orange appearance). Normal symmetrical breast contour bilat. No overt inflammatory signs. No previous incisions or trauma. Left breast and axilla: subtle skin dimpling (peau d’orange appearance), firm fixed, 3 cm mass palpated at the 9 o’clock position. No other suspicious mass lesions; smaller palpable nodules consistent with prior exams and consistent with history of fibrocystic disease. Expressible bloody nipple discharge. Solitary, nontender, mobile, 2 cm left axillary lymph node. Right breast small palpable nodules consistent with prior exams and known fibrocystic disease. No axillary adenopathy. No expressible nipple discharge. HEENT: Eyes: Sclera and conjunctiva normal. Pupils and irises size symmetrical and shows normal reaction to light and accommodation bilaterally. Ears: no external scars or lesions. Otoscopic exam normal with only minimal wax, no masses or foreign bodies, good light reflex bilaterally. Nose: External without abnormality. Normal nasal mucosa, septum, turbinate’s. Mouth: Good dental hygiene. Neck supple, no adenopathy, trachea midline, no carotid bruits, thyroid size 25 gm, no masses or tenderness. Cardiovascular: No JVD. No thrills, heaves, or lifts. PMI normal size and location.  Heart RRR Normal S1 and S2, no murmurs appreciated. No carotid bruits, abdominal aorta normal size no bruits, pedal pulses present and symmetrical, no evidence of peripheral edema or varicosities. Respiratory: Normal chest shape, normal respiratory movement, no tenderness, and percussion normal. Auscultation found normal breath sounds throughout without wheezing, rales or ronchi. Abdomen/GI: Flat contour. Scars consistent with prior surgical history. Normal bowel sounds present. Soft to palpation without tenderness all 4 quadrants.  Liver edge felt below the coastal margin, span normal to percussion. Spleen normal size. No masses or organomegaly. GU: Normal genitalia, no evidence of infection. Normal ovaries to manual palpation. Pap smear done. MSK: Normal ROM and muscle tone throughout. Muscle strength and flexibility throughout axial and appendicular skeleton normal. Motor 5/5 all extremities. Neurological: A & O x 4, good attention, memory, normal gait, CN 2-12 intact, reflexes 4/4 throughout. Normal cerebellar exam with finger to nose (FTN), rapid alternating movements (RAM), heal to shin (HTS) bilaterally. Allergic/Immunologic: No worrisome preauricular, posterior auricular, anterior cervical, posterior cervical, submandibular, supraclavicular lymph nodes. Lymphatic/Endocrine: Thyroid normal to palpation, 25 gm, no masses or tenderness. Hematologic: Normal capillary refill. No evidence of anemia NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

Assessment

Problem List:

Breast mass/lump, neoplastic

Invasive ductal carcinoma, left breast ER/PR negative, HER2 positive

Evidence of metastasis: 2 out of 2 left axillary lymph nodes positive for metastatic spread

 

Differential diagnoses:

Differential Diagnoses

How Was This Diagnosis Ruled Out?

Breast hamartoma

Fibroadenoma

Breast lipoma

Plan

Include the following:

Medications to be prescribed (drug-dose directions)

Instructions to continue, discontinue, or start medications, including changes to routine medications.

Diagnostic tests in the proper order and reason for the order (e.g., CT abdomen and pelvis with and without contrast, Dx, LLQ abdominal pain)

Labs, including appropriate serum panels (e.g., BMP, CBC with diff., TSH, T4, UA, C&S)

Patient education pertinent to health condition

Follow-up plan

Referrals

Plan

Rationale and/or results

Breast Cancer Susceptibility Genetic Test (BRCA1 and BRCA2).

No mutation detected.

Diagnostic mammogram.

Left breast BI-RADS 5, (3 cm irregular shaped mass in upper outer quadrant worrisome for malignancy). Right breast BI-RADS 1, normal.

Left breast biopsy with lymph node biopsy.

Invasive ductal carcinoma with nuclear pleomorphism. Mitotic counts: score 2. Estrogen receptor negative. Progesterone receptor negative. HER2 receptor positive.

Breast ultrasound.

Left breast solitary mass measuring 3 cm X 3.2 cm X 3.0 cm at 9 o’clock upper outer quadrant. Some skin thickening overlying the mass was also noted. In the left axilla 2.0 cm X 1.8 cm X 2.0 cm lymph node was identified. Suspicious for malignancy.

Surgical referral for modified radical left mastectomy and axillary dissection/removal of suspicious lymph nodes.

Radiation referral for therapy.

HER2 antagonist therapy (trastuzumab)

Oncology referral to discuss treatment options NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

Referral for education, counseling, supported decision making and support groups. Life long cancer surveillance.

Lab to check lipid panel and BMP.

 

NRP/563: Management Of Women’s Health Issues

Wk 3 – Signature Assignment: iHuman Patient Betty Burns Reflection

See attached SOAP note for Betty Burns.

Write a 500-word summary regarding your patient encounter with Betty Burns.

Include the following in your summary:

Explain how you arrived at your differential diagnoses.

Explain the steps you used to determine the final diagnosis.

Give examples of how you can integrate cultural preferences, values, health beliefs, and behaviors into the treatment plan using Watson’s theory.

Describe the appropriate management (e.g. health maintenance, diagnostics, medications/treatment) and support with evidence.)

Critique your overall case evaluation, highlighting takeaways to improve your clinical skills now that the diagnosis has been revealed.

Cite a minimum of 3 peer-reviewed journal references within the last 5 years supporting your responses according to 7
th
edition APA guidelines.

Course Textbooks:

Schuiling, K. D., Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Jones & Bartlett Learning.

Dunphy, L. (2019). Primary care: The art and science of advanced practice nursing (5th ed.). F.A. Davis NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

Management Of Women’s Health Issues Week 3 – Signature Assignment: iHuman Patient Betty Burns Reflection

Student’s Name

Institution

Course Code, Course Name

Instructor’s Name

Date

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Explain How You Arrived At Your Differential Diagnoses

Diseases are characterized by patterns of symptoms reported by patients, the signs obtained during physical exam, and the results obtained from diagnostic tests. According to Dunphy (2019), determining the differential diagnoses is a process of distinguishing between diseases which present with the same symptoms. In Betty Burns’ iHuman case study, I arrived at   the differential diagnosis   using a systematic approach through the following steps; generating a list of Betty Burn’s medical issues through history taking, a physical exam, and evaluating  the  findings of the laboratory tests. Burns’ chief complaint was a lump on her left breast for about one month. The most common problems which present with this symptom among women aged 40 years or older are; fibroadenomas, breast lipoma, breast hamartoma, and breast adenocarcinoma. Using a local anatomic differential diagnosis framework and applying to it the pertinent positives and negatives resulted in the following differentials;

Fibroadenoma-presents as a painless, benign and firm lesion

Fibrocystic Breast Disease: it usually presents with changes in breast tissue such as lobular hyperplasia and cysts that are smooth and movable (Schuiling & Likis, 2017).

For Betty Burns, the physical exam was also consistent with mild fibrocystic disease.

Breast Cancer-Betty Burns’ breast biopsy findings was significant for an invasive ductal carcinoma with nuclear pleomorphism which is indicative of breast cancer NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

Steps Used To Determine the Final Diagnosis

To determine the final diagnosis, I identified the disease that accounted for all of Betty Burn’s problems from the initial list of differential diagnoses and was supported by the diagnostic test findings
.
The most appropriate diagnosis that met this criterion was breast mass/lump, neoplastic. Betty Burns was 48 years old and had a family history of breast cancer (mother). The risk of breast cancer increases in women aged 40 years and older (Schuiling & Likis, 2017). . She reported discoloration near the left breast nipple, an immobile lump on the left breast with thickening and indentations over the area with the lump. She also reported occasional bloody discharge in the cup of bra of the left breast. The physical exam findings were consistent with dimpling of the skin of the left breast, a fixed and firm mass (3cm) palpated at the 9 o’clock position, and bloody nipple discharge. The diagnostic breast biopsy was positive for an invasive ductal carcinoma, HER2 positive with evidence for metastasis (2 out of 2 left axillary lymph nodes positive for metastatic spread).

How To Integrate Cultural Preferences, Values, Health Beliefs, and Behaviors Into the Treatment Plan Using Watson’s Theory

Watson bases her theory of caring on seven major assumptions starting with the notion that caring can only happen at an interpersonal level between nurses and patients. Oher assumptions posit that caring   leads to growth of the patient and family, patient satisfaction, needs acceptance, is the core of nursing, and creates an environment where individuals make wide decisions (Pajnkihar, Štiglic & Vrbnjak, 2017). Basing on the aforementioned assumptions, she mentions  10 Carative factors  that nurses can implement in practice to; instill hope, develop trust, develop values, incorporate science to address  issues, support  a positive mental,  physical, social, and spiritual environment, continuous learning, and  help with physical needs (Pajnkihar, Štiglic & Vrbnjak, 2017). Applying this theory to the care of Betty Burns, I will develop a helping-trusting relationship and allow her to share both her positive and negative feelings, being authentic to, engage Betty Burn in genuine teaching-learning experience about her health status, and try to address her spiritual and physical needs by being open to discussions and matters spirituality NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

Appropriate Management (Health Maintenance, Diagnostics, Medications/Treatment)

Non-pharmacological treatment:
refer for modified radical left mastectomy and axillary dissection/removal of suspicious lymph nodes.

Pharmacological treatment:
refer for radiation or/and chemotherapy (HER2 antagonist therapy (trastuzumab) (Schuiling & Likis, 2017).

Patient Education: breast cancer and gynecological follow up in six months, lifelong cancer surveillance screening (clinical breast exam every 6-12 months), MRI/mammogram every 6-12 months.

Diagnostics:

Genetic Testing (BRCA)-No mutation detected.

Left breast biopsy with lymph node biopsy- Invasive ductal carcinoma with nuclear pleomorphism. Mitotic counts: score 2. Estrogen receptor negative. Progesterone receptor negative. HER2 receptor positive.

CT of abdomen and chest

Diagnostic mammogram- Left breast BI-RADS 5, (3 cm irregular shaped mass in upper outer quadrant worrisome for malignancy). Right breast BI-RADS 1, normal.

Breast ultrasound-Left breast solitary mass measuring 3 cm X 3.2 cm X 3.0 cm at 9 o’clock upper outer quadrant. Some skin thickening overlying the mass was also noted. In the left axilla 2.0 cm X 1.8 cm X 2.0 cm lymph node was identified, suspicious for malignancy.

BMP

Lipid Panel

Referral to an oncologist for further evaluation and management

Overall Case Evaluation and Takeaways

In my next assessments, I will be keener to conduct a more focused history taking and physical exam based on a patient’s presenting complaint. A focused history using focused questions and a focused physical exam will provide more comprehensive and direct clues of a patient’s most probable diagnosis. When compared to past assessments, I must admit that my history taking and physical exam techniques have tremendously improved. Besides, I can effortlessly incorporate pathophysiology knowledge that I have obtained in class in clinical and diagnostic reasoning to determine the appropriate tests to order and make appropriate diagnoses NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

References

Dunphy, L. (2019). Primary care: The art and science of advanced practice nursing (5th ed.). F.A. Davis.

Pajnkihar, M., Štiglic, G., & Vrbnjak, D. (2017). The concept of Watson’s carative factors in nursing and their (dis)harmony with patient satisfaction. 
PeerJ
, 
5
, e2940. https://doi.org/10.7717/peerj.2940

Schuiling, K. D., Likis, F. E. (2017). Women’s gynecologic health (3rd ed.). Jones & Bartlett Learning NRP/563: Management Of Women’s Health Issues – Betty Burns iHuman Reflection.

Evita Alonso GI ihuman assignment

Week 7: Evaluation and Management of Renal and Genitourinary Conditions

The renal and genitourinary system is critical to the function of the entire body. As an advanced practice nurse, obtaining a relevant, focused history is critical. Conditions involving the genitourinary system, such as prostate cancer, often create a feeling of powerlessness, frustration, anxiety, and embarrassment in patients. Having provider-patient conversations about symptoms, potential treatment options, and patient education can be overwhelming for patients under such stress. It is your role to sensitively facilitate the treatment and management process through these difficult conversations and ultimately promote their well-being and empowerment. An accurate assessment will help you recognize and address any impact on the renal and genitourinary system in order to manage and prevent damages to the kidneys or other components of the system. Your role in the clinical setting is unique, as it is not only your responsibility to evaluate, diagnose, manage, and educate patients on their conditions, but also to provide emotional and psychological support to patients and their families Evita Alonso GI ihuman assignment.

For this week, you will analyze an i-Human simulation case study about an adult patient with a gastrointestinal condition. Based on the patient’s information, you will formulate a differential diagnosis, evaluate treatment options, and then create an appropriate treatment plan for the patient.

Learning Objectives

Students will:

Formulate differential diagnoses for adult patients with renal and genitourinary conditions

Analyze pattern recognition in adult patient diagnoses

Analyze the role of patient information in differential diagnosis

Evaluate pharmacologic and non-pharmacologic treatment options for adult patients

Create an appropriate treatment plan that includes health education and follow-up care

Learning Resources

Required Readings
 (click to expand/reduce)

Required Media
(click to expand/reduce)

Assignment: i-Human Case Study: Evaluating and Managing Genitourinary or Gastrointestinal Conditions

Urinary frequency is an example of a genitourinary condition that presents problems for adults across the lifespan. It can be the result of various systemic conditions such as diabetes, urinary tract infections, enlarged prostates, kidney infections, or prostate cancer. Many of these conditions have very serious implications requiring thorough patient evaluations. When evaluating patients, it is essential to carefully assess the patient’s personal, medical, and family history prior to recommending certain physical exams and diagnostic testing, as sometimes the benefits of these exams do not outweigh the risks Evita Alonso GI ihuman assignment.

Photo Credit: Crystal light / Adobe Stock

For this Case Study Assignment, you will analyze an i-Human simulation case study about an adult patient with a gastrointestinal condition. Based on the patient’s information, you will formulate a differential diagnosis, evaluate treatment options, and then create an appropriate treatment plan for the patient.

To prepare:

Review this week’s Learning Resources. Consider how to assess, diagnose, and treat patients with GI or GU conditions.

Access i-Human from this week’s Learning Resources and review this week’s i-Human case study. Based on the provided patient information, think about the health history you would need to collect from the patient.

Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.

Identify three to five possible conditions that may be considered in a differential diagnosis for the patient.

Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.

Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with GI or GU conditions Evita Alonso GI ihuman assignment.

Assignment

As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the 
i-Human Graduate Programs Help 
link within the i-Human platform.

By Day 7

Complete your Assignment in i-Human.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK7Assgn+last name+first initial.(extension)” as the name.

Click the 
Week 7 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 7 Assignment 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK7Assgn+last name+first initial.(extension)” and click 
Open
.

If applicable: From the Plagiarism Tools area, click the checkbox for 
I agree to submit my paper(s) to the Global Reference Database
.

Click on the 
Submit
 button to complete your submission.

Grading Criteria

To access your rubric:

Week 7 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 7 Assignment draft and review the originality report.

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Submit Your Assignment by Day 7

To participate in this Assignment:

Week 7 Assignment Evita Alonso GI ihuman assignment

What’s Coming Up in Week 8?

Week 8 Knowledge Check

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Week 8, you will complete the next Knowledge Check, which covers the Module 3 topics from Weeks 6, 7, and 8. Refer to the Week 8 Knowledge Check Assignment for further details related to the topics covered. Plan your time accordingly.

To go to the next week:

NRNP_6531_Week7_Assignment_Rubric

Novice

Competent

Proficient

HPI statement

0 
(0%)
 – 5 
(5%)

Poorly written HPI statement. Incomplete ideas and sentences. Lacks basic history taking skills

6 
(6%)
 – 10 
(10%)

Well written HPI statement but may be missing 1-2 key components from the history

11 
(11%)
 – 15 
(15%)

Clearly written HPI statement with comprehensive information gathering from case questions.

History

0 
(0%)
 – 6 
(6%)

Incomplete history missing 3 or more aspects of the OLDCARDS critical to patient’s diagnosis.

7 
(7%)
 – 8 
(8%)

Fairly complete history covering most of the requirements but may be missing 1-2 aspects of OLDCARDS critical to patient’s diagnosis.

9 
(9%)
 – 10 
(10%)

Complete history covering all critical components of a focus exam. Includes all aspects of OLDCARDS

Physical Exam

0 
(0%)
 – 6 
(6%)

Incomplete physical examination. May be missing 3 or more key exam findings that are critical to patient’s diagnosis.

7 
(7%)
 – 8 
(8%)

Fairly complete physical examination but may be missing 1-2 key exam findings critical to patient’s diagnosis.

9 
(9%)
 – 10 
(10%)

Complete physical examination covering all critical components of a focus exam.

Testing

0 
(0%)
 – 6 
(6%)

Includes 3 or more inappropriate exams or tests. May include contraindicated testing.

7 
(7%)
 – 8 
(8%)

Tests ordered are generally apprropriate. May include 1-2 unnecessary exams or tests.

9 
(9%)
 – 10 
(10%)

Tests that are ordered are appropriate for patient and cost effective.

Differential Diagnosis Summary

0 
(0%)
 – 9 
(9%)

Primary diagnosis may be wrong.Differential diagnosis list too brief and inconclusive. May be missing 3 or more critical components.

10 
(10%)
 – 14 
(14%)

Correct primary diagnosis identified. Well written differential diagnoses. May be missing 1-2 critical components. Priority list may be out of order

15 
(15%)
 – 20 
(20%)

Primary diagnosis identified. Clearly written differential diagnoses.

Plan for patient

0 
(0%)
 – 15 
(15%)

Poorly written plan. May be missing 3 or more key issues that are critical to patient’s diagnosis.

16 
(16%)
 – 25 
(25%)

Well written plan but may be missing 1-2 key issues critical to patient’s diagnosis.

26 
(26%)
 – 30 
(30%)

Clearly written plan covering all critical components for patient’s final diagnosis.

Exercises

0 
(0%)
 – 2 
(2%)

Correctly answered 0-69% of the clinical questions.

3 
(3%)
 – 4 
(4%)

Correctly answered 70-89% of the clinical questions.

0 
(0%)
 – 5 
(5%)

Correctly answered 90-100% of the clinical questions.

Total Points: 100

Name: NRNP_6531_Week7_Assignment_Rubric Evita Alonso GI ihuman assignment

Darius Davis ihuman case study

NRNP_6531_Week4_Assignment_Rubric

Novice

Competent

Proficient

HPI statement

0 
(0%)
 – 5 
(5%)

Poorly written HPI statement. Incomplete ideas and sentences. Lacks basic history taking skills

6 
(6%)
 – 10 
(10%)

Well written HPI statement but may be missing 1-2 key components from the history

11 
(11%)
 – 15 
(15%)

Clearly written HPI statement with comprehensive information gathering from case questions.

History

0 
(0%)
 – 6 
(6%)

Incomplete history missing 3 or more aspects of the OLDCARDS critical to patient’s diagnosis.

7 
(7%)
 – 8 
(8%)

Fairly complete history covering most of the requirements but may be missing 1-2 aspects of OLDCARDS critical to patient’s diagnosis Darius Davis ihuman case study.

9 
(9%)
 – 10 
(10%)

Complete history covering all critical components of a focus exam. Includes all aspects of OLDCARDS

Physical Exam

0 
(0%)
 – 6 
(6%)

Incomplete physical examination. May be missing 3 or more key exam findings that are critical to patient’s diagnosis.

7 
(7%)
 – 8 
(8%)

Fairly complete physical examination but may be missing 1-2 key exam findings critical to patient’s diagnosis.

9 
(9%)
 – 10 
(10%)

Complete physical examination covering all critical components of a focus exam.

Testing

0 
(0%)
 – 6 
(6%)

Includes 3 or more inappropriate exams or tests. May include contraindicated testing.

7 
(7%)
 – 8 
(8%)

Tests ordered are generally apprropriate. May include 1-2 unnecessary exams or tests.

9 
(9%)
 – 10 
(10%)

Tests that are ordered are appropriate for patient and cost effective.

Differential Diagnosis Summary

0 
(0%)
 – 9 
(9%)

Primary diagnosis may be wrong.Differential diagnosis list too brief and inconclusive. May be missing 3 or more critical components.

10 
(10%)
 – 14 
(14%)

Correct primary diagnosis identified. Well written differential diagnoses. May be missing 1-2 critical components. Priority list may be out of order

15 
(15%)
 – 20 
(20%)

Primary diagnosis identified. Clearly written differential diagnoses.

Plan for patient

0 
(0%)
 – 15 
(15%)

Poorly written plan. May be missing 3 or more key issues that are critical to patient’s diagnosis.

16 
(16%)
 – 25 
(25%)

Well written plan but may be missing 1-2 key issues critical to patient’s diagnosis.

26 
(26%)
 – 30 
(30%)

Clearly written plan covering all critical components for patient’s final diagnosis.

Exercises

0 
(0%)
 – 2 
(2%)

Correctly answered 0-69% of the clinical questions.

3 
(3%)
 – 4 
(4%)

Correctly answered 70-89% of the clinical questions Darius Davis ihuman case study.

0 
(0%)
 – 5 
(5%)

Correctly answered 90-100% of the clinical questions.

Total Points: 100

Name: NRNP_6531_Week4_Assignment_RubricAssignment: i-Human Case Study: Evaluating and Managing Cardiovascular Conditions

Because cardiovascular conditions are preventable and manageable, it is important that the advanced practice nurse use both their understanding of the cardiovascular system and the impact of patient factors and behaviors that might increase patient risk of such conditions. This critical information can guide you in immediately identifying signs and symptoms that can inform differential diagnoses and lead to identification of appropriate treatment options and a treatment plan Darius Davis ihuman case study.

Photo Credit: yodiyim / Adobe Stock

For this Case Study Assignment, you will analyze an i-Human simulation case study about an adult patient with a cardiovascular condition. Based on the patient’s information, you will formulate a differential diagnosis, evaluate treatment options, and create an appropriate treatment plan for the patient.

To prepare:

Review this week’s Learning Resources. Consider how to assess, diagnose, and treat patients with cardiovascular conditions.

Access i-Human from this week’s Learning Resources and review this week’s i-Human case study. Based on the provided patient information, think about the health history you would need to collect from the patient.

Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.

Identify three to five possible conditions that may be considered in a differential diagnosis for the patient.

Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.

Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with cardiovascular conditions.

Assignment

As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the 
i-Human Graduate Programs Help 
link within the i-Human platform Darius Davis ihuman case study.

  ORDER A PLAGIARISM FREE PAPER NOW

By Day 7

Complete
 and 
submit
 your Assignment in i-Human.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.

Click the 
Week 4 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 4 Assignment 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click 
Open
.

If applicable: From the Plagiarism Tools area, click the checkbox for 
I agree to submit my paper(s) to the Global Reference Database
.

Click on the 
Submit
button to complete your submission Darius Davis ihuman case study.

NRNP – 6531 Week 2: Kaylee Hales Derm ihuman case study

The following information is to be included in your i-Human cases:

HPI: You will type this in the EMR section of the case (NOT the problem statement)

This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. This is for subjective findings. Use LOCATES or OLDCARTS Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. Include any pertinent history information that might impact the differential diagnosis formulation. If the CC was “headache,” the LOCATES for the HPI would include the following information:NRNP – 6531 Week 2: Kaylee Hales Derm ihuman case study

Location: head

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

Severity: 7/10 pain scale

 

Plan: Type the information regarding each of the following sections into the i-Human Plan section of your case. You must address each of the 6 topics. For example, if you will not be consulting anyone then you must write “no consults indicated”. Each section of the plan is worth 5 points to total 30 points.

Additional labs or diagnostic tests: Additional laboratory and diagnostic tests may be necessary to establish or evaluate a condition. Some tests, such as MRI, may require prior authorization from the patient’s insurance carrier.

Consults: referrals to specialists, therapists (physical, occupational), counselors, or other professionals. If you are sending to hospital, what orders would you write for a direct admit?

Therapeutic modalities: pharmacological and nonpharmacological management. Give specific medications, dosing and duration. Include anticipated therapeutic modalities/symptomatic treatment for patients if they are sent to ED or directly admitted.

Health Promotion: Address risk factors as appropriate. Consider age-appropriate preventive health screening. What immunizations do they need?

Patient education: Explanations and advice given to patient and family members about diagnosis and treatment plan.

Disposition/follow-up instructions: include when to follow up in clinic, follow up sooner, or go to ER. When should they be seen by a specialist or therapist. When the patient is to return sooner, and when to go to another facility such as the emergency department, urgent care center, specialist or therapist NRNP – 6531 Week 2: Kaylee Hales Derm ihuman case study.

Finally, be sure to include a minimum of 3 timely, scholarly references, that proves this plan and follows current standards of care. The course text may NOT be used as a reference. The references must be professional and not general patient education websites.

Assignment:
i-Human Case Study
: Evaluating and Managing Integumentary Conditions

This course will require you to complete a series of case studies using the i-Human software application. The i-Human Patients (IHP) Case Player enables you to interact with virtual patients for the purpose of learning patient-assessment and diagnostic-reasoning skills. With IHP, you will be able to independently interview, examine, diagnose, and treat virtual patients and receive expert feedback on your performance.

Photo Credit: RFBSIP / Adobe Stock

The integumentary system is susceptible to a variety of diseases, conditions, and injuries, ranging from the bothersome but relatively innocuous bacterial or fungal infections that are categorized as disorders to skin cancer and severe burns, which can be life-threatening.

For this Case Study Assignment, you will examine your first case study and work with a patient with an integumentary condition. You will formulate a differential diagnosis, evaluate treatment options, and then create an appropriate treatment plan for the patient.

To prepare:

Review this week’s Learning Resources. Consider how to assess, diagnose, and treat patients with integumentary conditions.

Access i-Human from this week’s Learning Resources and review this week’s i-Human case study. Based on the provided patient information, think about the health history you would need to collect from the patient.

Consider what physical exams and diagnostic tests would be most appropriate to gather more information about the patient’s condition.

Reflect on how the results would be used to make a diagnosis.

Identify three to five possible conditions that may be considered in a differential diagnosis for the patient.

Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.

Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with integumentary conditions NRNP – 6531 Week 2: Kaylee Hales Derm ihuman case study.

Assignment

As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Graduate Programs Help link within the i-Human platform.

 

NRNP_6531_Week2_Assignment_Rubric

Grid View

List View

Novice

Competent

Proficient

HPI statement

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0 (0%) – 5 (5%)

Poorly written HPI statement. Incomplete ideas and sentences. Lacks basic history taking skills

6 (6%) – 10 (10%)

Well written HPI statement but may be missing 1-2 key components from the history

11 (11%) – 15 (15%)

Clearly written HPI statement with comprehensive information gathering from case questions.

History

0 (0%) – 6 (6%)

Incomplete history missing 3 or more aspects of the OLDCARDS critical to patient’s diagnosis.

7 (7%) – 8 (8%)

Fairly complete history covering most of the requirements but may be missing 1-2 aspects of OLDCARDS critical to patient’s diagnosis.

9 (9%) – 10 (10%)

Complete history covering all critical components of a focus exam. Includes all aspects of OLDCARDS

Physical Exam

0 (0%) – 6 (6%)

Incomplete physical examination. May be missing 3 or more key exam findings that are critical to patient’s diagnosis.

7 (7%) – 8 (8%)

Fairly complete physical examination but may be missing 1-2 key exam findings critical to patient’s diagnosis.

9 (9%) – 10 (10%)

Complete physical examination covering all critical components of a focus exam.

Testing

0 (0%) – 6 (6%)

Includes 3 or more inappropriate exams or tests. May include contraindicated testing.

7 (7%) – 8 (8%)

Tests ordered are generally apprropriate. May include 1-2 unnecessary exams or tests.

9 (9%) – 10 (10%)

Tests that are ordered are appropriate for patient and cost effective.

Differential Diagnosis Summary NRNP – 6531 Week 2: Kaylee Hales Derm ihuman case study

0 (0%) – 9 (9%)

Primary diagnosis may be wrong.Differential diagnosis list too brief and inconclusive. May be missing 3 or more critical components.

10 (10%) – 14 (14%)

Correct primary diagnosis identified. Well written differential diagnoses. May be missing 1-2 critical components. Priority list may be out of order

15 (15%) – 20 (20%)

Primary diagnosis identified. Clearly written differential diagnoses.

Plan for patient

0 (0%) – 15 (15%)

Poorly written plan. May be missing 3 or more key issues that are critical to patient’s diagnosis.

16 (16%) – 25 (25%)

Well written plan but may be missing 1-2 key issues critical to patient’s diagnosis.

26 (26%) – 30 (30%)

Clearly written plan covering all critical components for patient’s final diagnosis.

Exercises

0 (0%) – 2 (2%)

Correctly answered 0-69% of the clinical questions.

3 (3%) – 4 (4%)

Correctly answered 70-89% of the clinical questions.

0 (0%) – 5 (5%)

Correctly answered 90-100% of the clinical questions.

Total Points: 100

Name: NRNP_6531_Week2_Assignment_Rubric NRNP – 6531 Week 2: Kaylee Hales Derm ihuman case study

NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies
Career Goals: Strengths and Challenges Related to Nursing Practice Competencies

As I start on the course on “Primary Care Adults Across the Lifespan,” I anticipate gaining some understanding on some of the complex nature in the diagnosing and management of healthcare needs for adult patients. The course, based on my present understanding, provides the learners with learning experience, particularly in the focus on art and science of clinical decision-making, which is a skill critical for my future role as an Adult-Gerontology Primary Nurse Practitioner (AGPCNP). Throughout the course, I remain expectant to increase my knowledge in both the physical and behavioral elements of the disease process. More so, I aim at refining my skills in developing the best treatment programs for my patients. The opportunity to be a part of assignments that reflect the actual life situation will further help prepare me and align my expectations to the state of illnesses within the primary healthcare setting.

One of my expectations for the course lies in strengthening my diagnostic skills. My background in skilled nursing and sub-acute care will help me to have a solid foundation in the assessment of patients and planning for their care as well. I acknowledge that transitioning to a nurse practitioner role mandates an understanding of the processes of diagnosis. The course will help me to build on my existing knowledge and sharpen my skills in diagnosing conditions impeccably, which is a critical competency when working with adult patients across the lifespan.

Another major expectation is deepening my understanding of therapeutic treatment planning. My experience in long-term care has given me insight to the essence of individualized care plans, but the course will take that understanding to a higher level. I look forward to learning more about the latest evidence-based practices in planning for treatment and how to evaluate and adjust the treatment programs based on outcomes for a patient. Such a skill is critical as I aim at providing the highest quality care to patients while ensuring that the treatment plans are effective and tailored to the unique needs of a patient.

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In reflecting on my strengths and challenges as they relate to the competencies, I believe that the experience in the development of care plans and my dedication to patient education are some of my major strengths. Over the years, I have sharpened my ability to work with physicians, nurse personnel, and different health providers in the creation of individualized care plans addressing each of the unique needs of a patient. The experience has reinforced the essence of patient and family education, which I regard to be effective in healthcare. Besides, I still acknowledge that the expanded practice scope as an AGPCNP presents certain challenges, especially in areas of advanced diagnostic reasoning and pharmacologic management. Despite my foundational knowledge in the areas, I remain eager to deepen my expertise and acquire confidence in making complex clinical decisions independently.

The course is usually directly linked with my career goals of becoming a skilled AGPCNP who can make significant impact in the lives of the adult patients, especially those in the long-term situation. Reducing fragmentation of care is one of my goals, especially between acute care and long-term care, and making sure that patients continue receiving exceptional care when they are moved to the next level of care (Mann et al., 2021). The following knowledge and skills are expected to be acquired from this course and will help in the achievement of this goal. Also, I have the desire to be not only a professional in my sphere but also a specialist who will introduce new standards in the healthcare system and work towards enhancing the overall quality of patients’ treatment. NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies

A review of the literature has recommended enhanced clinical decision-making competencies to enhance patient outcomes, especially in scenarios where NPs work in primary healthcare facilities. A study conducted by Evans et al. (2021) identified that Advanced Practice Nurse practitioners with an understanding of acute conditions requiring a first point of contact were more effective in delivering the best care by quickly identifying these conditions and satisfying patient needs. Additionally, the capacity to write effective patient care plans is also significant, considering the various problems that adults have, as indicated by Htay and Whitehead (2021). These understandings highlight the significance of the competencies that I will acquire within this course and the potential for their application towards the improvement of my practice in the future.

Therefore, I anticipate starting this course as it will help me to develop the competencies that are necessary to become an AGPCNP. Thus, I am confident that the acquired knowledge and practical experience will help me achieve high results in my future position, where I will have a chance to enrich the lives of my patients and their families.

References

Evans, C., Poku, B., Pearce, R., Eldridge, J., Hendrick, P., Knaggs, R., Blake, H., Yogeswaran, G., McLuskey, J., Tomczak, P., Thow, R., Harris, P., Conway, J., & Collier, R. (2021). Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: A scoping review. 
BMJ Open
, 
11
(8), e048171. 
https://doi.org/10.1136/bmjopen-2020-048171

Htay, M., & Whitehead, D. (2021). The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic review. 
International Journal of Nursing Studies Advances
, 
3
, 100034. 
https://doi.org/10.1016/j.ijnsa.2021.100034

Mann, C., Timmons, S., Evans, C., Pearce, R., Research, C. O., Hinsliff-Smith, K., & Conway, J. (2021). Exploring the role of advanced clinical practitioners (ACPs) and their contribution to health services in England. 
Nurse Education in Practice
. 
https://doi.org/10.21203/rs.3.rs-602519/v1
  NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies

 

 

NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies

Wk1 Competencies Initial Discussion Post

The expectations that I have, as an Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP) student in NRNP 6531, are to become affluent in the examinations, procedures, and documentation skills that are expected in this advanced practice clinical course.  I have been apprehensive about starting this initial clinical because I may not immediately remember everything that I have been taught in this program, up to this point, when assessing patients with my preceptor.  I do realize that this is a learning experience, and the skills will become easier to implement with practice NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies.

Strengths and challenges are evident while self-appraising one’s ability in any professional setting.  The strengths that I bring to this clinical course, and subsequent career as an autonomous nurse practitioner, are that I display critical thinking and reasoning in my patient assessments and health management, develop trusting relationships with my patients and their families, displays empathy for others, and provides education to patients and their caregivers throughout their treatment and care.  These strengths relate to the AGPCNP competencies provided by the American Association of Colleges of Nursing.  Nurse practitioner core competencies require that the provider critically evaluates information and evidence for improving advanced nursing practice and incorporates this knowledge from the humanities and sciences within the context of nursing science.  The ACPCNP competencies require that reputable sources of national data on aging be analyzed and included in patient care.  Such sources include the Centers for Disease Control and Prevention (CDC), Healthy Aging Data Portfolio, and National Health and Aging Trends Study.  Competencies also include creating a climate of mutual trust while providing comfort and emotional support to patients and their families.  Educating the patients and caregivers is required by educating management strategies among normal development, aging, and mental and physical disorders (
The American Association,
2016).  The challenges that I have are that I tend to think and work in the moment, with not much thought on the patient’s future.  Advanced practice nurses are more expected to modify their care to patient responses, to contemplate beyond the immediate situation, and to relate past patient experiences with conceivable paths.  AGPCNP’s must recognize clinical trends and anticipate variations from the standard findings (Flanders et al., 2017) NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies.

My career goals are to become a AGPCNP in a palliative care setting.  I want to provide primary and palliative care to adult-gerontology oncology patients in need.  This course will assist me in accomplishing my goals by preparing me for advanced clinical assessments in a primary care setting.  Performing clinicals in a primary care setting will have a significant impact on the application of knowledge by immersing one’s self in skills required to care for palliative care patients (Gentry & Dahlin, 2020).

References

The American Association of Colleges of Nursing (AACN …
 American Association of Colleges of Nursing. (2016). Retrieved December 1, 2021, from 
https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Adult-Gero-NP-Comp-2016.pdf
.

Flanders, S. A., Gunn, S., Wheeler, M., Newsome, E., & Altman Klein, H. (2017) Accelerating the Development of Higher-Level Clinical Thinking in Novice Nurses. 
Journal for Nurses in Professional Development, 33
(5), 240-246.

Gentry, Jennifer, DNP, ANP-BC, GNP, ACHP, Dahlin, Constance, MSN, ANP-BC & ACHPN, FPCN. (2020). The Evaluation of a Palliative Care Advanced Practice Nursing Externship. 
Journal of Hospice & Palliative Nursing
, 
22
, 172-179. 
https://doi.org/10.1097/NJH.0000000000000637
.

response

Great post!  I can relate to your challenge and have not previously been mindful of planning the patient’s future on my own.  I worked with a nurse for several years in the emergency department that went back to pursue her FNP.  As I have been in this program, I have spoken with her about the journey.  I have discussed multiple challenges that I have faced throughout the program so far.  She told me once that as my role changes from RN to APRN, my perspective will change.  How I look at my responsibilities to the patient will help develop my skills as a practitioner.  She said you just look at things differently.  As I have progressed in the program, I have begun to understand what she was talking about.  I feel like as we grow and learn, we will start to put it all together and be able to make a plan for our patient’s future NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies.

According to Barnes et al (2018), advanced practice nurses play a vital role in expanding patients’ access to healthcare and the delivery of healthcare.  As we pursue an advanced degree, we are positively contributing to the patient’s healthcare.  The more we learn about our new role, the more we will be able to see the big picture, which involves positively contributing to our patient’s future healthcare.  Popejoy et al (2017) report that advanced practice nurses that have support to develop their skills can make positive changes.  Through our studies of evidenced-based practices, we will learn the best ways to treat and take care of our patients, therefore, positively improving patient outcomes (Moore et al, 2019).

References

Barnes, H., Richards, M. R., McHugh, M. D., & Martsolf, G. (2018). Rural And nonrural primary care physician practices increasingly rely on nurse practitioners. 
Health Affairs (Project Hope)
, 
37
(6), 908–914. doi: 10.1377/hlthaff.2017.1158

Moore, E. R., Watters, R., & Wallston, K. A. (2019). Effect of evidence‐based practice (EBP) courses on MSN and DNP students’ use of EBP. 
Worldviews on Evidence-Based Nursing
, 
16
(4), 319–326. https://doi.org/10.1111/wvn.12369

Popejoy, L., Vogelsmeier, A., Galambos, C., Flesner, M., Alexander, G., Lueckenotte, A., Lyons, V., & Rantz, M. (2017). The APRN Role in Changing Nursing Home Quality: The Missouri Quality Improvement Initiative. 
Journal of Nursing Care Quality
, 
32
(3), 196–201. doi: 10.1097/NCQ.0000000000000264 NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies

Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies

An advanced practice nurse collaborates and communicates with patients, families, doctors, nurses, and specialists to ensure patients receive the care they need. As they diagnose, treat, manage, and educate patients, they are responsible for ensuring patient safety and maintaining ethical behavior. Competencies have been developed to help the advanced practice nurse to understand the practice knowledge, skills, and attitudes they need to be successful.

Photo Credit: michaeljung / Adobe Stock

For this Discussion, you will examine advanced nursing practice competencies and reflect on your strengths and challenges related to the competencies. In light of your reflection, you will consider how this course may help you attain your career goals or objectives NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies.

To prepare:

Review the Learning Resources for this week, specifically the advanced nursing practice competencies. As you review the competencies, reflect on your own strengths and challenges when working with adults across the lifespan.

By Day 3

Post
 a summary of your expectations of this course. Also, include a brief explanation of your strengths and challenges as they relate to nursing practice competencies when working with adults. Describe any career goals or objectives this course may help you accomplish in the Family Nurse Practitioner (FNP) or 
Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP) 
role and explain why. Use your research to support your explanations by providing credible and scholarly sources.

Read
 a selection of your colleagues’ responses.

By Day 6

Respond
 to 
at least two
 of your colleagues on 
two different days
 by offering a suggestion or resources to help your colleagues in addressing their personal strengths or challenges, or their career goals. Use your research to support your suggestions. Provide at least 3 credible and current scholarly sources.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the 
Post to Discussion Question
 link and then select 
Create Thread
 to complete your initial post. Remember, once you click 
Submit
, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit! NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies

 

NRNP_6531_Week1_Discussion_Rubric

Grid View

List View

Excellent

Point range: 90–100

Good

Point range: 80–89

Fair

Point range: 70–79

Poor

Point range: 0–69

Main Posting:

Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

40 
(40%)
 – 44 
(44%)

Thoroughly responds to the discussion question(s).

Is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

No less than 75% of post has exceptional depth and breadth.

Supported by at least 3 current credible sources.

35 
(35%)
 – 39 
(39%)

Responds to most of the discussion question(s).

Is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of the post has exceptional depth and breadth.

Supported by at least 3 current credible references.

31 
(31%)
 – 34 
(34%)

Responds to some of the discussion question(s).

One to two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with fewer than 2 credible references.

0 
(0%)
 – 30 
(30%)

Does not respond to the discussion question(s).

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only 1 or no credible references.

Main Posting:

Writing

6 
(6%)
 – 6 
(6%)

Written clearly and concisely.

Contains no grammatical or spelling errors.

Further adheres to current APA manual writing rules and style.

5 
(5%)
 – 5 
(5%)

Written concisely.

May contain one to two grammatical or spelling errors.

Adheres to current APA manual writing rules and style.

4 
(4%)
 – 4 
(4%)

Written somewhat concisely.

May contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

0 
(0%)
 – 3 
(3%)

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Posting:

Timely and full participation

9 
(9%)
 – 10 
(10%)

Meets requirements for timely, full, and active participation.

Posts main discussion by due date.

8 
(8%)
 – 8 
(8%)

Posts main discussion by due date.

Meets requirements for full participation.

7 
(7%)
 – 7 
(7%)

Posts main discussion by due date.

0 
(0%)
 – 6 
(6%)

Does not meet requirements for full participation.

Does not post main discussion by due date.

First Response:

Post to colleague’s main post that is reflective and justified with credible sources.

9 
(9%)
 – 9 
(9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 
(8%)
 – 8 
(8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

7 
(7%)
 – 7 
(7%)

Response is on topic, may have some depth.

0 
(0%)
 – 6 
(6%)

Response may not be on topic, lacks depth.

First Response:

Writing

6 
(6%)
 – 6 
(6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in Standard, Edited English.

5 
(5%)
 – 5 
(5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in Standard, Edited English.

4 
(4%)
 – 4 
(4%)

Response posed in the discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

0 
(0%)
 – 3 
(3%)

Responses posted in the discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

First Response:

Timely and full participation

5 
(5%)
 – 5 
(5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

4 
(4%)
 – 4 
(4%)

Meets requirements for full participation.

Posts by due date.

3 
(3%)
 – 3 
(3%)

Posts by due date.

0 
(0%)
 – 2 
(2%)

Does not meet requirements for full participation.

Does not post by due date.

Second Response:

Post to colleague’s main post that is reflective and justified with credible sources.

9 
(9%)
 – 9 
(9%)

Response exhibits critical thinking and application to practice settings.

Responds to questions posed by faculty.

The use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives.

8 
(8%)
 – 8 
(8%)

Response has some depth and may exhibit critical thinking or application to practice setting.

7 
(7%)
 – 7 
(7%)

Response is on topic, may have some depth.

0 
(0%)
 – 6 
(6%)

Response may not be on topic, lacks depth.

Second Response:

Writing

6 
(6%)
 – 6 
(6%)

Communication is professional and respectful to colleagues.

Response to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies.

5 
(5%)
 – 5 
(5%)

Communication is mostly professional and respectful to colleagues.

Response to faculty questions are mostly answered, if posed.

Provides opinions and ideas that are supported by few credible sources.

Response is written in standard, edited English.

4 
(4%)
 – 4 
(4%)

Response posed in the discussion may lack effective professional communication.

Response to faculty questions are somewhat answered, if posed.

Few or no credible sources are cited.

0 
(0%)
 – 3 
(3%)

Responses posted in the discussion lack effective communication.

Response to faculty questions are missing.

No credible sources are cited.

Second Response:

Timely and full participation

5 
(5%)
 – 5 
(5%)

Meets requirements for timely, full, and active participation.

Posts by due date.

4 
(4%)
 – 4 
(4%)

Meets requirements for full participation.

Posts by due date.

3 
(3%)
 – 3 
(3%)

Posts by due date.

0 
(0%)
 – 2 
(2%)

Does not meet requirements for full participation.

Does not post by due date.

Total Points: 100

Name: NRNP_6531_Week1_Discussion_Rubric

Career goals: Strengths and challenges related to nursing practice competencies

Advanced nurse practitioners have core competencies that need to be accomplished in order for nurse practitioners to practice independently and successfully.  As nurse practitioner students, we must use current competencies for our practice.  This course is designed to introduce and guide us through the practicum experience by allowing us to learn our own strengths and weaknesses as nurses.  The purpose of this discussion is to explain my expectations of this course, my strengths and challenges when working with adults, and the career goals that this course may help me accomplish.

  ORDER A PLAGIARISM FREE PAPER NOW

Summary of expectations of this course

I am anticipating this course to be the place where everything comes together as we start our practicum experience.  I expect this course to be eye-opening and satisfying as we put everything we have learned in theory together in the clinical world.  I also expect to learn even more from my preceptor, instructors, and colleagues in both the NRNP and practicum courses.  I hope to gain more confidence as I learn from my preceptor during practicum NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies.

Brief explanation of your strengths and challenges as they relate to nursing practice competencies when working with adults

My strengths related to nursing practice competencies are advocating for patients and their best interests by communicating and collaborating with the interdisciplinary team to improve patient outcomes and quality of care (The National Organization of Nurse Practitioner Faculties, 2017).  My experience as a registered nurse at a rehabilitation hospital has improved my communication techniques between the patients, family, physicians, and colleagues.  Education is very important for both the patient and family for them to fully take advantage of their health, so I try to educate my patients whenever possible (Chan et al., 2019).  I contribute to the design of clinical information systems in my unit because I am efficient with technology and dealing with computers on my unit.

The challenges that I am afraid of as an advanced nurse practitioner are facing ethical and legal issues with misdiagnosing and treating patients with the wrong treatments (The National Organization of Nurse Practitioner Faculties, 2017).  I am afraid of missing important details or critical tests and making mistakes all because I lack the confidence and experience in that role.

Describe any career goals or objectives this course may help you accomplish in the FNP role and why

As I explore all the opportunities that an FNP can do, I feel like I would like to start with family practice in a clinic to gain experience and confidence in the field.  I would like that time to learn and grow as a novice nurse practitioner treating patients of all age groups.  The surrounding towns I live in are all rural areas and I would like that opportunity to serve the community to promote education and provide more resources for healthy living.  I would also consider public health or community health by working closely with the outreach program at the local hospital in town.  This course can help me accomplish this FNP role by guiding me to analyze my professional growth and development related to advanced nursing practice (Walden University, 2020).  By the end of this course, I will be able to analyze conditions of body systems and formulate diagnoses and treatment plans for adult patients (Walden University, 2020) NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies.

Summary

I am looking forward to learning and growing into the advanced practice nurse role in this next term.  I am excited to incorporate all that I have learned into the real world to find my strengths and weaknesses in this practice so I can work on strengthening those weaknesses.  I am prepared to face challenges so I can find ways to improve and be the best advocate for my patients.

References

Chan, T. E., Lockhart, J. S., Thomas, A., Kronk, R., & Schreiber, J. B.  (2019).  An integrative review of nurse practitioner practice and its relationship to the core competencies.  
Journal of Professional Nursing, 36
(4), 189-199.  
https://doi.org/10.1016/j.profnurs.2019.11.003
.

The National Organization of Nurse Practitioner Faculties.  (2017).  
Nurse practitioner core competencies contents.  
https://nursing.lsuhsc.edu/Docs/Quality/Nurse%20Practitioner%20Core%20Competencies%20(2017).pdf
.

Walden University.  (2020).  
Outcomes/Alignment Chart, NRNP 6531: Primary care of adults across the lifespan.
  
https://content.waldenu.edu/e96ba5fcda8f577a44864e45d4902cd2.pdf
.

REPLY QUOTE 
EMAIL AUTHOR

 
9 days ago

Rowena Manzano 

RE: Rowena Manzano-Discussion Response 1 to Esai Seechan

COLLAPSE

Discussion Response 1 to Esai Seechan

Hi Esai,

Good post. I agree that educating the patient, a collaborative attitude, and good communication are vital for patient care. Collaboration with other healthcare professionals will open the channels of best practice possibilities (Haddad & Geiger, 2021). In addition, cooperation in clinical practice improved the quality of patient care as professionals shared expertise ( Buttaro et al., 2021). As we start with our practicum, there are always challenges met, but preparation is vital to gain more confidence and overcome the fear. Stimulation courses can provide interactive and real learning experiences, enhance knowledge and skills in a caring patient with a different health problem (Torkshavand et al., 2020). Therefore, it is vital to practice with our stimulation courses in I Human continually NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies.

Ethical and legal issues are also a challenge for me being a novice in this field. Haddad & Geiger (2021) stated that nurses must be familiar with legal and ethical issues. The authors further noted that nurses must have high-level support for all individuals and allow dignity concerning care and communication. In addition, nurses must be familiar with professional guidelines in practice and always consider the patient first. It is also an obligation to gain competence by committing to continued learning. It is vital to continue to grow with improvements to care, adopt changes or trends through research and evidence-based practice, and have the ability to practice in various healthcare settings with continued acts of advocacy (Haddad & Geiger, 2021). Getting to know the preceptor and establishing a trusting relationship are also crucial for students’ learning ‌(Nyhagen & Strøm, 2016).

 

                                       References

Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2021).

Primary care: Interprofessional collaborative practice (6th ed.).

Elsevier.

Haddad, L. M., & Geiger, R. A. (2021, August 30). 
Nursing Ethical 

      Considerations
. Nih.gov; StatPearls Publishing.

https://www.ncbi.nlm.nih.gov/books/NBK526054/

‌Nyhagen, R., & Strøm, A. (2016). Postgraduate students’ perceptions of

high-quality precepting in critical care nursing. 
Nurse Education in 

       Practice
, 
21
, 16–22. https://doi.org/10.1016/j.nepr.2016.09.002

‌Torkshavand, G., Khatiban, M., & Soltanian, A. R. (2020). Simulation-

based learning to enhance students’ knowledge and skills in

educating older patients. 
Nurse Education in Practice
, 
42
, 102678 NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies.

https://doi.org/10.1016/j.nepr.2019.102678

response

You brought up a great point when you mentioned you are afraid of missing important details that could impact the patient’s healthcare.  I think that would probably be a fear of everyone in this course at this moment.  Smith and Rushton (2018) report student nurses are often lacking experience and confidence.  We are only beginning the training that will prepare us for such a responsibility.  As we work with experienced healthcare providers, we will gain knowledge that will help prepare us.  Torrens et al (2020) report that developing interprofessional relationships helps advanced practice nurses to be successful.  Drayton-Brooks et al (2017) report that advanced practice nursing students will further develop skills by having practicum experiences with multiple providers that see different types of patients.  As we continue through this program and have these experiences, our skills will improve, therefore, improving our confidence.

References

Drayton-Brooks, S. M., Gray, P. A., Turner, N. P., & Newland, J. A. (2017). Building clinical education training capacity in nurse practitioner programs. 
Journal of Professional Nursing
, 
33
(6), 422–428. https://doi.org/10.1016/j.profnurs.2017.02.002

Smith, J., & Rushton, M. (2018). Improving student nurses’ confidence in managing the acutely ill patient. 
British Journal of Nursing
, 
27
(3), 124–129. doi: 10.12968/bjon.2018.27.3.124

Torrens, C., Campbell, P., Hoskins, G., Strachan, H., Wells, M., Cunningham, M., Bottone, H., Polson, R., & Maxwell, M. (2020). Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: A scoping review. 
International Journal of Nursing Studies
, 
104
. doi: 10.1016/j.ijnurstu.2019.103443 NRNP- 6531 Week 1 Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies

NRNP – 6531 Adv Practice Care of Adults Across the Lifespan full course

Week 1: Competencies of Advanced Nursing Practice

Advanced nursing practice competencies focus on the unique practice knowledge, skills, and attitudes a nurse practitioner must demonstrate as they work with adults across the lifespan in clinical settings. They are developed by experts in the field and provide clarity about what is needed to be successful in your career. Competencies need to be practiced so they can be used to effectively address a wide range of situations. In addition to real-world settings, there are virtual opportunities that can facilitate the development of competencies. For example, throughout this course, you will complete case study simulation assignments with virtual i-Human patients presenting a variety of medical conditions. These types of virtual simulations provide you with the formative practice needed to help guide and prepare you for the real-world clinical experience.

For this week, you will examine advanced nursing practice competencies and reflect on your strengths and challenges related to the competencies. In light of your reflection, you will consider how this course may help you attain your career goals or objectives.

Learning Objectives

Students will:

Analyze strengths and challenges related to nursing practice competencies

Describe professional career goals or objectives NRNP – 6531 Adv Practice Care of Adults Across the Lifespan full course

Learning Resources

Required Readings
 (click to expand/reduce)

Required Media
 (click to expand/reduce)

Class Café: Introductions

Photo Credit: nakophotography / Adobe Stock

This Class Café is a place for discussions that do not necessarily relate to the formal content of this course and will not be assessed. However, we encourage you to get to know your colleagues and familiarize yourselves with everyone’s background and personal history. 
Note
: If your posting is of a personal nature or involves issues that are of concern only to you and require an individual response from the Instructor, please email the Instructor directly.

By Day 2

Post
 and introduce yourself to your colleagues and ask any questions you might have about the course or questions in general.

Respond
 to your colleagues and answer any questions or ask any questions that you might have.

Note
: This Class Café is not required and will not be assessed; however, you are encouraged to get to know your colleagues.

Submission and Grading Information

Post by Day 2

To Participate in this Discussion:

Class Café: Introductions NRNP – 6531 Adv Practice Care of Adults Across the Lifespan full course

Discussion: Career Goals: Strengths and Challenges Related to Nursing Practice Competencies

An advanced practice nurse collaborates and communicates with patients, families, doctors, nurses, and specialists to ensure patients receive the care they need. As they diagnose, treat, manage, and educate patients, they are responsible for ensuring patient safety and maintaining ethical behavior. Competencies have been developed to help the advanced practice nurse to understand the practice knowledge, skills, and attitudes they need to be successful.

Photo Credit: michaeljung / Adobe Stock

For this Discussion, you will examine advanced nursing practice competencies and reflect on your strengths and challenges related to the competencies. In light of your reflection, you will consider how this course may help you attain your career goals or objectives.

To prepare:

Review the Learning Resources for this week, specifically the advanced nursing practice competencies. As you review the competencies, reflect on your own strengths and challenges when working with adults across the lifespan.

By Day 3

Post
 a summary of your expectations of this course. Also, include a brief explanation of your strengths and challenges as they relate to nursing practice competencies when working with adults. Describe any career goals or objectives this course may help you accomplish in the Family Nurse Practitioner (FNP) or 
Adult-Gerontology Primary Care Nurse Practitioner (AGPCNP) 
role and explain why. Use your research to support your explanations by providing credible and scholarly sources NRNP – 6531 Adv Practice Care of Adults Across the Lifespan full course.

Read
 a selection of your colleagues’ responses.

By Day 6

Respond
 to 
at least two
 of your colleagues on 
two different days
 by offering a suggestion or resources to help your colleagues in addressing their personal strengths or challenges, or their career goals. Use your research to support your suggestions. Provide at least 3 credible and current scholarly sources.

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the 
Post to Discussion Question
 link and then select 
Create Thread
 to complete your initial post. Remember, once you click 
Submit
, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6

To Participate in this Discussion:

Week 1 Discussion

Assignment

Practicum Manual Acknowledgment

The Practicum Manual describes the structure and timing of the classroom-based and practicum experiences and the policies students must follow to be successful in the nurse practitioner (NP) specialties.

Field Experience: MSN Nurse Practitioner Practicum Manual

Click here and follow the instructions to confirm you have downloaded and read the entire MSN Nurse Practitioner Practicum Manual and will abide by the requirements described in order to successfully complete this program NRNP – 6531 Adv Practice Care of Adults Across the Lifespan full course.

What’s Coming Up in Week 2?

Practicum – Upcoming Deadline

In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms, 
you will need to submit your application via 
Meditrek
 .

For information on the practicum application process and deadlines, please visit the 
Field Experience: College of Nursing: Application Process – Graduate
 web page.

Please take the time to review the 
Appropriate Preceptors and Field Sites
 for your courses.

Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the 
Field Experience: College of Nursing: Student Resources and Manuals
 web page.

Field Experience: College of Nursing Quick Answers

Field Experience: MSN Nurse Practitioner Practicum Manual

Student Practicum Resources: NP Student Orientation

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will analyze an i-Human simulation case study about an adult patient with an integumentary condition and formulate a differential diagnosis, based on the patient’s information. Using the findings of your analysis, you will evaluate treatment options and then create an appropriate treatment plan for the patient NRNP – 6531 Adv Practice Care of Adults Across the Lifespan full course.

Looking Ahead:

In this course and beginning in Week 2, you will be required to complete case study assignments using the web-based software i-Human. You should have received an email with your i-Human Patients login and password information. If you have not received this information, please contact the Course Instructor.

Ensure that you are able to log in to the software and review the 
i-Human Patients Case Player Student Manual
 as needed to familiarize yourself about how to navigate i-Human.

Week 3: Evaluation and Management of HEENT Conditions

Last week, observing external characteristics of a patient was introduced as an important initial component of a physical examination. In addition to those observations, additional patient information can be learned by examining the head, eyes, ears, nose and throat, referred to as the HEENT system. Abnormal or disease manifestations may cause changes to one or more parts of the HEENT system, and understanding those manifestations is a critical skill for the advanced practice nurse.

For this week, you will not have a simulation case study however, it will be important for you to recognize that your continued observations and additional patient information are critical to your advanced nursing skills. This Week 3 concludes Module 1, and you will complete a Knowledge Check assessment covering the Module 1 topics examined in Weeks 1–3.

Learning Objectives

Students will:

Identify key terms, concepts, and principles related to the primary care of adults across the lifespan NRNP – 6531 Adv Practice Care of Adults Across the Lifespan full course

Learning Resources

Required Readings
 (click to expand/reduce)

Required Media
(click to expand/reduce)

Knowledge Check: Module 1: Advanced Nursing Practice Competencies, Integumentary, and HEENT Conditions

In this exercise, you will complete a 10- question Knowledge Check to gauge your understanding of this module’s content.  Please note that this is a formative practice to help you better prepare for your Midterm and Final Exam as well as your Nurse Practitioner (NP) certification exam. The questions in this Knowledge Check are related to the topics from Weeks 1, 2, and 3 Topics include:

Nursing competencies

Billing and coding

Integumentary conditions

HEENT conditions

It is in your best interest to take your time, do your best, and answer each question to the best of your ability.

Photo Credit: [DirtyDog_Creative]/[Vetta]/Getty Images

By Day 7

Complete 
and 
submit 
your Knowledge Check.

Submission Information

Submit Your Knowledge Check by Day 7

To submit your Knowledge Check:

Week 3 Knowledge Check

What’s Coming Up in Module 2?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Module 2, you will examine the evaluation and management of cardiovascular conditions in Week 4 and respiratory conditions in Week 5. You will consider how to assess, diagnose, and treat two i-Human patients—one presenting a cardiovascular condition and one presenting a respiratory condition.

Week 5 Knowledge Check

In Week 5, you will experience your next Knowledge Check which covers the Module 2 topics from Weeks 4 and 5. Refer to the Week 5 Knowledge Check Assignment for further details related to the topics covered. Plan your time accordingly NRNP – 6531 Adv Practice Care of Adults Across the Lifespan full course.

Week 4: Evaluation and Management of Cardiovascular Conditions

Many of the factors that contribute to cardiovascular conditions are preventable or manageable. Addressing the modifiable risk factors and adopting healthier lifestyle habits early in life can dramatically reduce the risk of developing cardiovascular conditions. The advanced practice nurse plays an important role in educating and advising their patients about ways to reduce modifiable risk factors, as well as encouraging and supporting their efforts.

However, if cardiovascular conditions are left unmanaged, patients may suffer from serious complications. When evaluating patients, it is important to consider individual patient factors and behaviors that might increase patient risk of conditions, such as hypertension. There are also other conditions that require advanced practice nurses to use appropriate and critical thinking to correctly diagnose cardiovascular or other vascular-related conditions. For this reason, as the advanced practice nurse caring for patients, it is critical that you immediately identify signs and symptoms of blood clots and other cardiovascular conditions.

For this week, you will analyze an i-Human simulation case study about an adult patient with a cardiovascular condition. Based on the patient’s information, you will formulate a differential diagnosis, evaluate treatment options, and create an appropriate treatment plan for the patient NRNP – 6531 Adv Practice Care of Adults Across the Lifespan full course.

Learning Objectives

Students will:

Formulate differential diagnoses for adult patients with cardiovascular conditions

Analyze pattern recognition in adult patient diagnoses

Analyze the role of patient information in differential diagnosis

Evaluate pharmacologic and non-pharmacologic treatment options for adult patients

Create an appropriate treatment plan that includes health education and follow-up care

Learning Resources

Required Readings
 (click to expand/reduce)

Required Media
(click to expand/reduce)

Assignment: i-Human Case Study: Evaluating and Managing Cardiovascular Conditions

Because cardiovascular conditions are preventable and manageable, it is important that the advanced practice nurse use both their understanding of the cardiovascular system and the impact of patient factors and behaviors that might increase patient risk of such conditions. This critical information can guide you in immediately identifying signs and symptoms that can inform differential diagnoses and lead to identification of appropriate treatment options and a treatment plan.

Photo Credit: yodiyim / Adobe Stock

For this Case Study Assignment, you will analyze an i-Human simulation case study about an adult patient with a cardiovascular condition. Based on the patient’s information, you will formulate a differential diagnosis, evaluate treatment options, and create an appropriate treatment plan for the patient NRNP – 6531 Adv Practice Care of Adults Across the Lifespan full course.

To prepare:

Review this week’s Learning Resources. Consider how to assess, diagnose, and treat patients with cardiovascular conditions.

Access i-Human from this week’s Learning Resources and review this week’s i-Human case study. Based on the provided patient information, think about the health history you would need to collect from the patient.

Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.

Identify three to five possible conditions that may be considered in a differential diagnosis for the patient.

Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.

Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with cardiovascular conditions.

Assignment

As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the 
i-Human Graduate Programs Help 
link within the i-Human platform.

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By Day 7

Complete
 and 
submit
 your Assignment in i-Human.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK4Assgn+last name+first initial.(extension)” as the name.

Click the 
Week 4 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 4 Assignment 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK4Assgn+last name+first initial.(extension)” and click 
Open
.

If applicable: From the Plagiarism Tools area, click the checkbox for 
I agree to submit my paper(s) to the Global Reference Database
.

Click on the 
Submit
 button to complete your submission.

Grading Criteria

To access your rubric:

Week 4 Assignment Rubric

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Week 4 Assignment draft and review the originality report NRNP – 6531 Adv Practice Care of Adults Across the Lifespan full course.

Submit Your Assignment by Day 7

To participate in this Assignment:

Week 4 Assignment

What’s Coming Up in Week 5?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will complete the next Knowledge Check which covers the topics from Weeks 4 and 5 of Module 2. Refer to the Week 5 Knowledge Check Assignment for further details related to the topics covered. Plan your time accordingly.

Week 5: Evaluation and Management of Respiratory Conditions

Respiratory conditions can often be well managed when properly diagnosed and treated. Despite the existence of effective pharmacological treatments, lack of patient adherence to those treatments can negatively affect patient outcomes. As an advanced practice nurse, you play a critical role in the management of respiratory conditions, including providing education to patients about treatment options and their potential side effects and helping them weigh the benefits and risks. You must know when to treat, when to order diagnostics, and when to refer for specialized care. Failure to implement the appropriate actions can negatively impact the diagnosis and treatment of a patient, including the possible loss of their life.

For this week, you will complete a Knowledge Check assessment covering the Module 2 topics examined in Weeks 4 and 5.

Learning Objective

Students will:

Identify key terms, concepts, and principles related to the primary care of adults across the lifespan (KC)

Learning Resources

Required Readings
 (click to expand/reduce)

Required Media
(click to expand/reduce)

Knowledge Check: Module 2: Cardiovascular and Respiratory Conditions

In this exercise, you will complete a 10-question Knowledge Check to gauge your understanding of this module’s content. Please note that this is a formative practice to help you better prepare for your Midterm and Final Exam as well as your NP certification exam. The questions in this Knowledge Check are related to the topics from Weeks 4 and 5. Topics include:

acute bronchitis

asthma

chronic obstructive pulmonary disease (COPD)

other respiratory conditions

myocardial infarction (MI)

hypertension (HTN)

thrombotic events

Photo Credit: [ismagilov]/[iStock / Getty Images Plus]/Getty Images

It is in your best interest to take your time, do your best, and answer each question to the best of your ability.

By Day 7

Complete
 and 
submit
 your Knowledge Check.

Submission Information

Submit Your Knowledge Check by Day 7

To submit your Knowledge Check:

Week 5 Knowledge Check NRNP – 6531 Adv Practice Care of Adults Across the Lifespan full course

What’s Coming Up in Module 3?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Module 3, you will examine the evaluation and management of gastrointestinal conditions in Week 6, genitourinary and endocrine conditions in Week 7, and hematologic conditions in Week 8. In Weeks 7 and 8, you will also analyze an i-Human simulation case study about an adult patient presenting a condition and consider how to assess, diagnose, and treat the patient.

Week 6 Midterm Exam

In Week 6, you will not participate in a Discussion or complete an Assignment; however, you will take a Midterm Exam. Please, take this time to review the topics and resources covered in Weeks 1–6 to prepare for your exam. Plan your time accordingly.

Photo Credit: [triloks]/[E+]/Getty Images

Week 8 Knowledge Check

Photo Credit: ARTQU / iStock / Getty Images Plus / Getty Images

In Week 8, you will complete the next Knowledge Check, which covers the topics from Weeks 6, 7, and 8 of Module 3. Refer to the Week 8 Knowledge Check Assignment for further details related to the topics covered. Plan your time accordingly NRNP – 6531 Adv Practice Care of Adults Across the Lifespan full course.Week 6: Evaluation and Management of Gastrointestinal Conditions

Diagnosis of gastrointestinal conditions often begins with assessing the gastrointestinal tract. If it appears normal, but is not working correctly, the condition can often be a manifestation of an issue with the patient’s exercise regimen, diet, and/or medications. Other times, the gastrointestinal tract appears abnormal, does not work correctly, and may necessitate surgery to remove or repair the source of the manifestation. Patients with gastrointestinal conditions face many daily challenges as they adhere to treatment and management plans. For example, for some, it impacts their social life due to the potential complications related to the medications or diet restrictions that may be part of the treatment plan. They may feel that they are unable to tell others about the adverse effects, such as intense pain, nausea, bowel obstructions, dehydration, fatigue, and depression. As the advanced practice nurse, you must not only evaluate and treat patients experiencing these challenges but also help them to develop management plans that will minimize daily challenges related to their conditions.

For this week, you will not participate in a Discussion or complete an Assignment; however, you will examine the evaluation and management of gastrointestinal conditions through the variety of Learning Resources available to you. Additionally, you will complete and submit the Midterm Exam. Take this time to review the topics and resources covered in Weeks 1–6 and prepare for your exam. Plan your time accordingly NRNP – 6531 Adv Practice Care of Adults Across the Lifespan full course.

Learning Objective

Students will:

Synthesize key terms, concepts, and principles related to the primary care of adults across the lifespan

Learning Resources

Required Readings
 (click to expand/reduce)

Required Media
(click to expand/reduce)

Midterm Exam

This 100-question exam is a test of your knowledge in preparation for your certification exam. 
No outside resources,
 including books, notes, websites, or any other type of resource, are to be used to complete this exam. You are expected to 
comply with Walden University’s Code of Conduct
.

This exam will be on topics covered in Weeks 1, 2, 3, 4, 5, and 6. Prior to starting the exam, you should review all of your materials. This exam is timed with a limit of 150 minutes for completion.

Photo Credit: [triloks]/[E+]/Getty Images

By Day 7

Submit
 your Midterm Exam.

Submission Information

Submit Your Exam by Day 7

To submit your Exam:

Week 6 Midterm Exam

What’s Coming Up in Week 7?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will analyze an i-Human simulation case study about an adult patient with a gastrointestinal condition. Based on the patient’s information, you will formulate a differential diagnosis, evaluate treatment options, and create an appropriate treatment plan for the patient.

To go to the next week:

Week 7 NRNP – 6531 Adv Practice Care of Adults Across the Lifespan full course

NRS-434VN: Developmental Assessment and the School-Aged Child

Children who are between the ages of 5 and 12 years are in the developmental stage and are school going. According to Cherry (2018), physical examination is carried out on these children for various reasons such as being taken to a well-baby clinic, or they are sick and are about to be admitted. The underlaying issue is that it is essential to be conscious of the needs of a child based on their age and developmental stage (Sevo, 2017). The assessment will inform the care panning for the child upon receiving the right subjective and objective information NRS-434VN: Developmental Assessment and the School-Aged Child.

Physical Assessment

Physical assessment among the children between the ages of 5 and 15 years is quite different from that of the toddlers and preschoolers. This is because the school going children have started appreciating and understanding the reality as opposed to fantasy. They are capable of thinking logically and can easily understand the resultant effect of an action. Their thoughts processes at this stage of development are known as ‘concrete operations’. At this stage their reasoning is advanced and can interact with other people in the outside world. It is also essential to note that at this stage, the child becomes very eager to learn, accomplish tasks and be appreciated. Developmental theorist Erik Erikson points out that between 5-12 years the child is in the stage of industry which explains their industrious nature (Cherry, 2018).

Between the ages of 5-12 years, a child is able to give an accurate account of their illness. This is one of the reasons why they should be interviewed together with parents or guardians. The techniques can be modified to suite the age and development stage of the child (Kaufman, 2018). Children at this stage are asked questions they can answer, especially regarding school, how they perform and their friends. They are examined thoroughly just like an adult because they can cooperate when carrying out the procedure (Kaufman, 2018) NRS-434VN: Developmental Assessment and the School-Aged Child.

The needs of between the ages of 5 and 12 years also vary. The data obtained at each age is therefore different at each age. The mode of assessment should be dynamic. For example, a 5-year-old obtains more information from the parent or caregiver while a 12-year old can easily express themselves well. One of the techniques that can be used during the assessment is observation. In this case, the caregiver will interact with the child and come up with conclusions based on how the child conducts themselves (Kaufman, 2018). Caregiver rating, portfolios and standardized test are some of the methods that can be used. The methods are applicable to different ages, and in each case, techniques are modified accordingly. For instance, questions can be read out on a standardized test to a 5-year-old while a 12-year old will be left to read for themselves. After an examination, the assessor will be able to identify specific needs that help in establishing the intervention required to support a child. The assessor will also come up with an individualized strategy for a child or a group of children within a given age to provide the best care (Cherry, 2018).

The specific developmental milestones attained by children need to be appreciated by the assessors. It will help them understand the various needs and problems of the children based on their ages. Assessment is essential in determining the welfare of a child. The caregivers will also have an opportunity to understand the special needs required by a child. It is also a perfect opportunity for both the caregiver and the parent to cooperate and support the child. However, the needs of a child keep on changing with time, therefore the mechanism used should also vary NRS-434VN: Developmental Assessment and the School-Aged Child.

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References

 
Cherry, K. (2018). Erik Erikson’s Stages of Psychosocial Development. 
Retrieved Juny
, 
5
, 2018.

Kaufman, A. S. (2018). 
Contemporary intellectual assessment: Theories, tests, and issues
.     Guilford Publications.

Sevo, M. D. . (2017).
Pediatric Nursing: Content Review PLUS Practice           Questions.

 
Pennsylvania:  F.A. Davis

 

Course Code

Class Code

Assignment Title

Total Points

NRS-434VN

NRS-434VN-O502

Developmental Assessment and the School-Aged Child

110.0

Criteria

Percentage

1: Unsatisfactory (0.00%)

2: Less Than Satisfactory (75.00%)

3: Satisfactory (79.00%)

4: Good (89.00%)

5: Excellent (100.00%)

Content

80.0%

Comparison of Physical Assessment Among School-Aged Children

25.0%

A comparison of physical assessments among different school-aged children is omitted.

An incomplete comparison of physical assessments among different school-aged children is summarized. How assessment techniques would be modified depending on the age and developmental stage of the child is omitted or contains significant inaccuracies.

A general comparison of physical assessments among different school-aged children is summarized. How assessment techniques would be modified depending on the age and developmental stage of the child is generally described. More information or support is needed for clarity or accuracy.

A comparison of physical assessments among different school-aged children is presented. How assessment techniques would be modified depending on the age and developmental stage of the child is described. Some information is needed for clarity.

A detailed comparison of physical assessments among different school-aged children is presented. How assessment techniques would be modified depending on the age and developmental stage of the child is thoroughly described. Insight is demonstrated into the physical assessment of school age children.

Typical Assessment for a Child of a Specific Age

25.0%

The typical developmental stage of a child between the ages 5 and 12 is not described.

The typical developmental stage of a child between the ages 5 and 12 is summarized. The summary contains significant inaccuracies for the age of the child.

The typical developmental stage of a child between the ages 5 and 12 is generally described. The description contains some inaccuracies for the age of the child.

The typical developmental stage of a child between the ages 5 and 12 is described. The overall description is accurate. Some information is needed for clarity.

The typical developmental stage of a child between the ages 5 and 12 is accurately and thoroughly described.

Developmental Assessment of a Child Using a Developmental Theory (Erickson, Piaget, Kohlberg)

30.0%

A child assessment based on a developmental theory is omitted.

A child assessment based on a developmental theory is partially summarized. Partial strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are omitted or are incorrect. There are significant inaccuracies.

A child assessment based on a developmental theory is generally described. General strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are summarized. There are minor inaccuracies.

A child assessment based on a developmental theory is described. Appropriate strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are described. Some information is needed for clarity.

A child assessment based on a developmental theory is thoroughly described. Well-developed strategies to gain cooperation and for how explanations would be offered during the assessment are presented. The potential findings expected from the assessment are all accurate and described in detail.

Organization and Effectiveness

15.0%

Thesis Development and Purpose

5.0%

Paper lacks any discernible overall purpose or organizing claim.

Thesis is insufficiently developed or vague. Purpose is not clear.

Thesis is apparent and appropriate to purpose.

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Argument Logic and Construction

5.0%

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

5.0%

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English.

Format

5.0%

Paper Format (use of appropriate style for the major and assignment)

2.0%

Template is not used appropriately, or documentation format is rarely followed correctly.

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

Template is used, and formatting is correct, although some minor errors may be present.

Template is fully used; There are virtually no errors in formatting style.

All format elements are correct.

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

3.0%

Sources are not documented.

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Total Weightage

100%

 

The needs of the pediatric patient differ depending on age, as do the stages of development and the expected assessment findings for each stage. In a 500-750-word paper, examine the needs of a school-aged child between the ages of 5 and 12 years old and discuss the following:

Compare the physical assessments among school-aged children. Describe how you would modify assessment techniques to match the age and developmental stage of the child NRS-434VN: Developmental Assessment and the School-Aged Child.

Choose a child between the ages of 5 and 12 years old. Identify the age of the child and describe the typical developmental stages of children that age.

Applying developmental theory based on Erickson, Piaget, or Kohlberg, explain how you would developmentally assess the child. Include how you would offer explanations during the assessment, strategies you would use to gain cooperation, and potential findings from the assessment.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
for assistance NRS-434VN: Developmental Assessment and the School-Aged Child.