Essay NU636-7B Unit 1 Discussion – Alternative Modalities Herzing

Essay NU636-7B Unit 1 Discussion – Alternative Modalities Herzing

NU636-7B Unit 1 Discussion – Alternative Modalities Herzing

Discussion Prompts

• From your review of the NCCIH website you know that about 30% of adults engage with health care modalities not typically considered part of the conventional medical care model.
• The likelihood exists that either you or someone you know has utilized complementary, alternative or integrative health care modalities.
• Reflect on one of those non-conventional modalities that you have experience with.
• Construct a discussion of that experience utilizing the PDSA model schemata.
• Support elements of the ‘Plan’ aspect with appropriate information from scholarly resources.
• Compare the ‘Study’ aspect with findings from scholarly resources.

Please be sure to validate your opinions and ideas with citations and references in APA format.

NU636-7B Unit 2 Discussion 1 – Treating Hypertensive Urgencies Herzing

Discussion Prompt

• Utilize the information provided in the scenario to create your discussion post.
• Construct your response as an abbreviated SOAP note (Subjective Objective Assessment Plan).
• Structure your ‘P’ in the following format:  [NOTE:  if any of the 3 categories is not applicable to your plan please use the ‘heading’ and after the ‘:’ input N/A]

Therapeutics: pharmacologic interventions, if any – new or revisions to existing; include considerations for OTC agents (pharmacologic and non-pharmacologic/alternative); [optional – any other therapies in lieu of pharmacologic intervention]

Educational: health information clients need in order to address their presenting problem(s); health information in support of any of the ‘therapeutics’ identified above; information about follow-up care where appropriate; provision of anticipatory guidance and counseling during the context of the office visit

Consultation/Collaboration: if appropriate – collaborative ‘Advanced Care Planning’ with the patient/patient’s care giver; if appropriate -placing the patient in a Transitional Care Model for appropriate pharmacologic and non-pharmacologic care; if appropriate – consult with or referral to another provider while the patient is still in the office; Identification of any future referral you would consider making

• Support the interventions outlined in your ‘P’ with scholarly resources.

Please be sure to validate your opinions and ideas with citations and references in APA format.

The post and responses are valued at 40 points. Please review post and response expectations. Please review the rubric to ensure that your response meets criteria.

Estimated time to complete: 2 hours

Instructions:

• Read the SOAP notes constructed by your course colleagues.
• Review the ‘P’s posted by your peers from your advanced practice nursing role perspective – educator, leader or practitioner.  From your advanced practice mindset reflect on a discussion you would like to have with two of your course colleagues about their ‘P’.
• Post a response individually to each of them that expresses your advanced practice nursing role perspective of their ‘P’.
• Use scholarly resources relevant to your advanced practice nursing role to support the key elements of the peer discussions you construct. [For example – if you are a nurse educator (clinical or academic) what are your thoughts about the patient education provided in the ‘P’, or do you want to comment on the fact that a peer put N/A for educational, etc.?’; if you a nurse leader what are your thoughts about the risk profile or cost effectiveness of the ‘P’, or adherence to the Patient Bill of Rights, etc.?; if you are a nurse practitioner did your peer develop a ‘P’ that aligns with Evidence Based Practice (EPB)/Clinical Practice Guidelines (CPG) and/or the basic sciences, etc.?

NU636-7B Unit 2 Discussion 2 – Treatment of Hyperlipidemia Herzing

Discussion Prompt

Utilize the information provided in the scenario to create your discussion post.

Construct your response as an abbreviated SOAP note (Subjective Objective Assessment Plan).

Structure your ‘P’ in the following format:  [NOTE:  if any of the 3 categories is not applicable to your plan please use the ‘heading’ and after the ‘:’ input N/A]

Therapeutics: pharmacologic interventions, if any – new or revisions to existing; include considerations for OTC agents (pharmacologic and non-pharmacologic/alternative); [optional – any other therapies in lieu of pharmacologic intervention]

Educational: health information clients need in order to address their presenting problem(s); health information in support of any of the ‘therapeutics’ identified above; information about follow-up care where appropriate; provision of anticipatory guidance and counseling during the context of the office visit

Consultation/Collaboration: if appropriate – collaborative ‘Advanced Care Planning’ with the patient/patient’s care giver; if appropriate -placing the patient in a Transitional Care Model for appropriate pharmacologic and non-pharmacologic care; if appropriate – consult with or referral to another provider while the patient is still in the office; Identification of any future referral you would consider making

Support the interventions outlined in your ‘P’ with scholarly resources.

Please be sure to validate your opinions and ideas with citations and references in APA format.

The post and responses are valued at 40 points. Please review post and response expectations. Please review the rubric to ensure that your response meets criteria.

Estimated time to complete: 2 hours

Instructions:

• Read the SOAP notes constructed by your course colleagues.
• Review the ‘P’s posted by your peers from your advanced practice nursing role perspective – educator, leader or practitioner.  From your advanced practice mindset reflect on a discussion you would like to have with two of your course colleagues about their ‘P’.
• Post a response individually to each of them that expresses your advanced practice nursing role perspective of their ‘P’.
• Use scholarly resources relevant to your advanced practice nursing role to support the key elements of the peer discussions you construct. [For example – if you are a nurse educator (clinical or academic) what are your thoughts about the patient education provided in the ‘P’, or do you want to comment on the fact that a peer put N/A for educational, etc.?’; if you a nurse leader what are your thoughts about the risk profile or cost effectiveness of the ‘P’, or adherence to the Patient Bill of Rights, etc.?; if you are a nurse practitioner did your peer develop a ‘P’ that aligns with Evidence Based Practice (EPB)/Clinical Practice Guidelines (CPG) and/or the basic sciences, etc.?

NU636-7B Unit 3 Discussion 1 – Treatment of COPD Herzing

Discussion Prompt

Scenario: You are seeing an 89-year-old male who has a history of smoking 2 packs of cigarettes a day for 69 years.

• He quit smoking cold turkey when he was 78 years old.
• He is in your office for a general health evaluation.  He reports ongoing challenges with ‘belching’ but other than that he conveys that he is feeling pretty good.
• He is on no routine medications.
• During your interview with the patient you note that he utilizes pursed lip breathing.  At times you note a faint ‘whistling’ sound associated with his respiratory effort.
•  In conducting your review of systems he reports a cough, particularly in the mornings, productive for thick clear to white sputum.
• When queried about shortness of breath he does indicate that he gets SOB more easily than he used to.
• His breath sounds are course and diminished in the lower lobes bilaterally.

Please develop a discussion that responds to each of the following prompts.  Where appropriate your discussion needs to be supported by scholarly resources.  Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

Initial post

Utilize the information provided in the scenario to create your discussion post.

Construct your response as an abbreviated SOAP note (Subjective Objective Assessment Plan).

Structure your ‘P’ in the following format:  [NOTE:  if any of the 3 categories is not applicable to your plan please use the ‘heading’ and after the ‘:’ input N/A]

Therapeutics: pharmacologic interventions, if any – new or revisions to existing; include considerations for OTC agents (pharmacologic and non-pharmacologic/alternative); [optional – any other therapies in lieu of pharmacologic intervention]

Educational: health information clients need in order to address their presenting problem(s); health information in support of any of the ‘therapeutics’ identified above; information about follow-up care where appropriate; provision of anticipatory guidance and counseling during the context of the office visit

Consultation/Collaboration: if appropriate – collaborative ‘Advanced Care Planning’ with the patient/patient’s care giver; if appropriate -placing the patient in a Transitional Care Model for appropriate pharmacologic and non-pharmacologic care; if appropriate – consult with or referral to another provider while the patient is still in the office; Identification of any future referral you would consider making

Support the interventions outlined in your ‘P’ with scholarly resources.

Please be sure to validate your opinions and ideas with citations and references in APA format.

The post and responses are valued at 40 points. Please review post and response expectations. Please review the rubric to ensure that your response meets criteria.

Estimated time to complete: 2 hours

Peer Response: Unit 3

Treatment of COPD

Instructions:

• Read the SOAP notes constructed by your course colleagues.
• Review the ‘P’s posted by your peers from your advanced practice nursing role perspective – educator, leader or practitioner.  From your advanced practice mindset reflect on a discussion you would like to have with two of your course colleagues about their ‘P’.
• Post a response individually to each of them that expresses your advanced practice nursing role perspective of their ‘P’.

Use scholarly resources relevant to your advanced practice nursing role to support the key elements of the peer discussions you construct. [For example – if you are a nurse educator (clinical or academic) what are your thoughts about the patient education provided in the ‘P’, or do you want to comment on the fact that a peer put N/A for educational, etc.?’; if you a nurse leader what are your thoughts about the risk profile or cost effectiveness of the ‘P’, or adherence to the Patient Bill of Rights, etc.?; if you are a nurse practitioner did your peer develop a ‘P’ that aligns with EBP/CPG guidelines and/or the foundational basic sciences, etc.?

Please be sure to validate your opinions and ideas with citations and references in APA format.

NU636-7B Unit 3 Discussion 2 – Treatment of URI Herzing Herzing

Discussion Prompt

Scenario: You are seeing a 34-year-old multi-race female who is a school counselor.

• She reports a 3-day history of a sore throat, rhinorrhea, nasal stuffiness and postnasal drip.
• She states she thinks she may be running a low-grade fever but reports she has not actually taken her temperature.
• She reports feeling tired.
• She has a history of migraine headaches for which she utilizes ibuprofen as needed.  She has a script for Maxalt if needed however reports she hasn’t used that in several years.
• She is on hormonal contraceptive management.  BP 112/66, P 68, Resp 18, Temp 98.7, SpO2 99% on RA
• On your exam you note clear nasal discharge, tympanic membranes are pearly gray, posterior pharynx is erythematous, no tonsillar enlargement noted.
• Breath sounds are clear bilateral.

Please develop a discussion that responds to each of the following prompts.  Where appropriate your discussion needs to be supported by scholarly resources.  Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

NU636-7B Unit 4 Discussion 1- Diabetes Management Herzing

Discussion Prompt

Scenario:

You are seeing a 64-year-old Hispanic male for his diabetes management.  He reports that his morning capillary blood sugar readings are ranging in the 150 to 190 range.

• Last month his Hgb A1C was 7.4
• He is on Metformin 1000mg twice a day and Glipizide 5mg daily.
• He walks a couple miles three to five times a week.
• A dietary review reveals that his daily total carbohydrate intake is in the range of 75 to 100 grams.
• Last eye exam did not reveal any problems.  He wears reading glasses when needed.
• He does report some intermittent burning sensation in his feet.
• Ht 6’2”, Wt 200 lbs, BP 118/72, P 72, R 17
• Heart regular rhythm, without murmur or gallop
• Lungs clear
• Monifilament testing does not reveal any decreased sensation in the feet

Please develop a discussion that responds to each of the following prompts.  Where appropriate your discussion needs to be supported by scholarly resources.  Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

NU636-7B Unit 4 Discussion 2 – Treatment of Hypothyroidism Herzing

Discussion Prompt

Scenario: You are evaluating a 53-year-old white female who wants to talk to you about lab work that she had done recently at “Any Lab Test Now”.

• She wanted to have lab work done because she was feeling tired and unmotivated.  Additionally, she had put on about 15 pounds even though she has been teaching yoga 2-3 times a week for the last few years.
• The lab results reveal a TSH of 93.
• She reports her last menstrual period was about 3 years ago.  She experienced some menopausal symptoms of hot flashes and night sweats.  However, she states they weren’t too much of a problem and those resolved a couple years ago.
• She denies any difficulty swallowing or neck pain/tenderness.
• Constitutional exam: 5’5” tall, 154 pounds, BP 145/88, P 60, R 16, Temp 97.2
• Neck – nontender, mild goiter with right side of thyroid larger than the left side
• Heart – regular rhythm without murmur or gallop
• Lungs – clear
• Skin – dry on extremities with some flaking noted
• A slowness of the relaxation phase of the Achilles tendon reflex is noted

Please develop a discussion that responds to each of the following prompts.  Where appropriate your discussion needs to be supported by scholarly resources.  Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

NU636-7B Unit 5 Discussion 1 – PUD and Anemia Herzing

Discussion Prompt

Scenario: The family of a 62-year-old white female call your office and ask if you can see their family member.  The person being requested to be seen is known to you for the last twenty years.

• She is your former supervisor and a fellow FNP.
• The family reports your colleague is demonstrating signs of dementia.
• They note that she has not been eating much for the past few weeks reporting she has a gnawing pain in her stomach.  If she does eat she reports getting ‘full’ very quickly.  She reports feeling mildly nauseous for the last few weeks.
• Your friend sustained a fall injury about 9 months ago from a ladder.  She shattered some teeth and developed an infection.  She is under the care of an oral surgeon.
• You have seen a few of her patients in your practice over the last couple weeks because ‘she is never in her office or available’ over the last few weeks.
• You reflect on your last few conversations with your colleague and think to yourself that you also thought she seemed ‘off her game’.
• You recommend her family take her to Urgent Care and you convince your colleague this is in her best interest.
• Labs drawn at Urgent Care reveal a Hgb of 8 and HCT of 24.

Please develop a discussion that responds to each of the following prompts.  Where appropriate your discussion needs to be supported by scholarly resources.  Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

NU636-7B Unit 5 Discussion 2 – Anti-coagulant Therapy Herzing

Discussion Prompt

Scenario: A 77-year-old white male comes into your office complaining of feeling dizzy, short of breath, easily fatigued and having a sensation of his heart ‘skipping beats’.

• He reports he has had these same symptoms numerous times over the last year or so, but they only lasted for about a day.
• He thought since he has been experiencing them now for about 3 days he should come in and get checked out.
• He was diagnosed with type 2 diabetes twenty years ago and hypertension fifteen years ago.
• Current medications include Lisinopril 20 mg daily and Metformin 1000 mg daily.
• BP 172/100, P 123 irregularly irregular, R 20
• Skin is warm, pale with a slight gray cast; lungs are clear to auscultation; heart irregular rhythm

Please develop a discussion that responds to each of the following prompts.  Where appropriate your discussion needs to be supported by scholarly resources.  Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

NU636-7B Unit 7 Discussion 1 – Anxiety Herzing

Discussion Prompt

Scenario:

• A 32-year-old white female is in the office today with a chief complaint “I have to force myself to go to work and other than that I don’t want to leave my house.”
• She reports that last week she tried to go to a Pampered Chef party one of her coworkers was having and she only got about three blocks from her house and had to turn around and go back home.
• She admits that being anxious is not new for her but feels as though lately those feelings are negatively impacting her life.
• Her medical history is inclusive for a diagnosis of psoriasis.
• She is married and has a 4-year-old son.
• She is presently on no routine medications.  She takes an over-the-counter B-50 vitamin to help her manage stress associated with marital strife and childcare challenges secondary to her work schedule.
• Her last menstrual period was two weeks ago.
• BP 100/58, P 66, R 18
• Large raised silvery-white scaly patch noted posterior occipital region of scalp; no thyroid enlargement or tenderness with palpation; heart -regular rate and rhythm; lungs are clear to auscultation

Please develop a discussion that responds to each of the following prompts.  Where appropriate your discussion needs to be supported by scholarly resources.

NU636-7B Unit 7 Discussion 2 – Migraine Herzing

Discussion Prompt

Scenario:

• A 46-year-old white male comes in for evaluation of his migraine headache management.
• His medical history is inclusive for hypertension and a myocardial infarction at the age of 39. He was diagnosed with migraine headaches three years ago.
• Current medications include Losartan 50 mg a day, verapamil SR 100 mg at bedtime, Carvedilol 25 mg a day, Lipitor 40 mg a day, Topamax 50mg a day
• He has been admitted to the hospital for migraine management 3 times over the last 6 months.  Inpatient admissions have ranged anywhere from 3 to 6 days.  Management strategies utilized during the hospitalization include IV corticosteroids, IV Dilaudid and IV magnesium sulfate.
• BP 132/84, P 82, R 15
• Skin: pink, warm, dry
• Neuro: alert and oriented, CNs II – XII intact
• Cardio: radial and pedal pulses 2+, heart regular rate and rhythm without murmur or gallop
• Lungs: clear to auscultation
• Abdomen: large, non-distended, active bowel sounds all quadrants, non-tender to palpation

Please develop a discussion that responds to each of the following prompts.  Where appropriate your discussion needs to be supported by scholarly resources.  Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

NU636-7B Unit 8 Discussion – Reflection Herzing

Instructions:

For each of the learning objectives, provide an analysis of how the course supported each objective.

1. Discriminate among the mechanisms of action for the major classes of drugs/medications
2. Critique evidence that supports proposed pharmacotherapeutic protocols for appropriateness of application across the lifespan
3. Integrate the teaching-learning needs of clients across the lifespan when proposing pharmacotherapies
4. Propose prescriptive therapies for selected clients evaluating safety factors while utilizing knowledge of how current health status, age, gender, culture, genetic factors, ethical concerns and prescriptive authority impact decision making

Explain how the material learned in this course, based upon the objectives, will be applicable to professional application.

Provide evidence (citations and references) to support your statements and opinions.

All references and citations should in APA format.

NU636-7B Unit 1 Assignment – Case Study: Polypharmacy Herzing

Instructions

Estimated time to complete: 2 hours

Case Study

Mrs. A is a 71 year old widow with CHF and osteoarthritis who has recently been exhibiting quite unusual behavior. Her daughter is concerned about her mother’s ability to remain independent and wishes to pursue nursing home admission arrangements. She fears the development of a dementing illness. Over the last two to three months Mrs. A has become confused, easily fatigued and very irritable. She has developed disturbing obsessive/compulsive behavior constantly complaining that her lace curtains were dirty and required frequent washing. Detailed questioning revealed that she thought they were yellow-green and possibly moldy. Her prescribed medications are:

• Furosemide 40 mg daily in the morning
• Digoxin 250 micrograms daily
• Paracetamol 500 mg, 1-2 tablets 4-hourly PRN
• Piroxicam 20 mg at night
• Mylanta suspension, 20 ml PRN
• Coloxyl 120 mg, 1-2 tablets at night

Assignment Questions

1. Critically discuss this case study in terms of the problematic nature of this patient’s pharmacological management.
2. Outline some pharmacokinetic changes in the geriatric population that may affect drug disposition.
3. Outline how changes in renal and hepatic function may affect treatment strategies.
4. In the drug regimen presented above – discuss potential side effects and potential interactions, if any?
5. Your response should include a discussion of the problems of polypharmacy as it is related to this case study and the assessment/management and educational strategies which could have been implemented to improve the outcome of Mrs. A.

Instructions

• Prepare and submit a 3-4 page paper [total] in length (not including APA format).
• Answer all the questions above.
• Support your position with examples.
• Please review the rubric to ensure that your assignment meets criteria.
• Submit the following documents to the Submit Assignments/Assessments area:
  • Case Study: Polypharmacy

NU636-7B Unit 2 Assignment – CAM Paper Herzing

Instructions

1.  Health Interview Survey (NHIS) were findings that 38% of adults use CAM [complementary and alternative medical] health care modalities.
2. Construct a professional paper that outlines how the use of the following CAM health care modalities impacts the cardiovascular system.
   • Ginseng
   • Hawthorn
   • L-Arginine
   • St. John’s Wort
3. For each of the modalities the discussion must include:
   • effect on the cardiovascular system
   • anticipated benefits
   • any identified risks or adverse effects
   • relative patient education
   • supporting reference from scholarly literature.

• Instructions
  • Prepare and submit a minimum of a 6 page paper pages [excluding title and reference pages].
  • Format consistent with APA style without an abstract page.
  • Answer all the questions above.
  • Please review the rubric to ensure that your assignment meets criteria.
  • Submit the following documents to this assignment area:
    • Assignment: Cardiac Impact

NU636-7B Unit 5 Assignment – Case Study: Inflammatory Bowel Disease Herzing

Case Study

Mrs. Z is a 34-year-old female who come in with a complaint of diarrhea accompanied by abdominal pain.  Onset of the symptom was about 4 days ago.  She reports thinking she is running a fever but has not taken her temperature.  She concerned that she is starting to feel weak.

When asked how about the characteristics and the number of bowel movements a day, she reports increased number of BMs over the last few months.  In the last few days she reports averaging about 10 small volume watery stools with varying amounts of blood daily.

She denies recent travel and reportedly has not been on any antibiotics in the past few weeks.

In reviewing her record, you notice that her health history is positive for history of ulcerative colitis.  She has not been on any medications for this over the last few years as she had not been symptomatic.

Mrs. Z is on an oral contraceptive.  She takes slippery elm capsules and has for the last several years.  She reports that she has been taking 2 to 3 doses of Benefiber prebiotic fiber for the last couple days.

Objective data:

BP 116/70 sitting, 100/66 standing; P 92; Temp 100.1

Abdomen – active bowel sounds all 4 quadrants, mild tenderness with palpation

Otherwise her exam is unremarkable for pertinent positives or negatives.

Labs – WBC 14,000; Hgb 11.9; Hct 35.7; Sodium 133; Potassium 3.3

• What pharmacologic therapy would you prescribe for Mrs. Z?
• How will you evaluate the effectiveness of this therapy?
• What patient education would you provide for Mrs. Z relative to the pharmacologic agent you prescribed?
• Are there any pharmacogenetic considerations related to what you prescribed for the patient?
• Are there any alternative therapies or over-the-counter agents that might be of value to Mrs. Z?
• What, if any, lifestyle changes would you recommend?

Instructions: Please prepare and submit a paper 3-4 pages [total] in length (not including APA format) answering the questions below.  Please support your position with examples.