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MN561 Advance Practice Nurse Clinical
 Unit 1 Discussion
DQ1  Check-In
Please confirm that you have accessed and read the syllabus and unit overview, and received the course expectation document emailed to you prior to start of this course. All practicum hours and field encounters should be entered in Rx Preceptor. Practicum hours must be confirmed by the preceptor to receive credit. Inform the instructor if you are aware of required and recommended textbook and clinical pocket companions as noted in the syllabus. The preceptor contact form should be submitted to Unit 1 drop box. You will complete 185 practicum hours during this term. Please inform the instructor if you have any questions regarding course expectations.
Please feel free to share a little about your professional background and what you expect to learn during this practicum rotation.
DQ2 Oral Presentation
The goal of any oral presentation is to pass along the “right amount” of patient information to your preceptor in an efficient fashion. When done well, this enables you and your preceptor to quickly understand the patient’s issues and generate an appropriate plan of action.
As a general rule, oral presentations are shorter than written presentations as they should focus on the most active issues of the day (Chief Complaint).
Subjective- how patient feels and reports to you.
Objective- vital signs and pertinent physical exam findings; what you hear, feel, smell, and see.
Assessment- should include working diagnosis from presenting problem and prior diagnoses that are being actively addressed during the present appointment.
Plan – this is the area that should be very specific as if you are entering the orders.
Some of the most common stumbling blocks for students (other than nerves) include going into too much detail in the subjective and objective sections!
Discussion: Share with your peers your approach to oral presentations in the clinic setting and ways in which you have perfected your approach to communicating information about your patient to your preceptor. Share your PEARLS of Wisdom!
MN561 Advance Practice Nurse Clinical
 Unit 2 Discussion
Topic: Be Prepared
Being prepared as a Nurse Practitioner when entering the clinic setting is a win-win for the student, the preceptor and most of all the patient. Safe, effective delivery of patient care requires that the nurse practitioner student understand the complexity of healthcare systems, the limits of human factors, safety design principles, characteristics of high reliability organizations, and patient safety resources. These components are critical to the preparation of safe clinicians and essential for 21stCentury healthcare delivery.
Discuss how you met the Unit Two Objectives as well as barriers to safe practice that can occur if you come to the clinic setting unprepared. Support your discussion with evidence based practice and recommendations for improvement of safe patient care in the primary care setting.
MN561 Advance Practice Nurse Clinical
 Unit 3 Discussion
Topic: Medical Record Documentation
Medical record documentation is required to record pertinent facts, findings, and observations about an individual’s health history, including past and present illnesses, tests, treatments, and outcomes. The medical record chronologically documents the care of the patient and is an important element contributing to high-quality safe care.
Discuss your State Board of Nursing nurse practitioner documentation guidelines and how this can impact your level of reimbursement in the clinical setting.
MN561 Advance Practice Nurse Clinical
 Unit 4 Discussion
DQ1 Topic 1: Social Services
Share what social services are available in your community and give examples of when it is important to involve social services in the management of your patients in the primary care setting? Please give examples of what you have done in your clinic setting involving social services. Support your discussion with evidence based practice and recommendations.
DQ2 Topic 2: Interprofessional Team
A multiprofessional team practice is necessary as you cannot be expected to know everything there is to know and have all the skills to address the complete range of episodic and chronic health problems commonly seen in the primary care setting.
Discuss what you believe is the ideal provider mix for an interprofessional team in primary care. Design an interprofessional team to meet the primary care needs in your community and share with your peers in the discussion forum.
Support your discussion with evidence based practice and recommendations.
MN561 Advance Practice Nurse Clinical
 Unit 5 Discussion
UTIs are responsible for > 7 million physician visits annually and approximately 15% of all community-prescribed antibiotics in the US are dispensed for UTI’s.   In the US, UTIs account for > 100,000 hospital admissions annually, most often for pyelonephritis (European Association of Urology, 2015). Describe the current clinical practice guidelines for diagnosis, management, and prevention of UTI’s.
MN561 Advance Practice Nurse Clinical
 Unit 6 Discussion
Topic: Preventative vs Diagnostic
Discuss the difference between preventative and diagnostic laboratory tests and why this is important to distinguish between in the primary care site. Include in the discussion the ten most commonly ordered laboratory and diagnostic tests ordered in your practicum site and the criteria for ordering.
MN561 Advance Practice Nurse Clinical
 Unit 7 Discussion
DQ1 Topic: Contraceptive counseling
Contraceptive counseling provides education, dispels misinformation, facilitates selection of a method that will be successful for the individual, and encourages patient involvement in healthcare decisions and life goals. Discussing contraception brings the nurse practitioner and patient together to create a tailored plan that meets the individual’s reproductive needs over a lifetime.
Discuss any clinical encounters that you may have had relating to contraception. How did you counsel patients on their choices and possible risks? Describe how you would explain the differences to your patients in the long acting reversal contraceptive devices.
DQ2 Topic 2: Sexuality
Sexuality affects individuals and society across a broad spectrum of activities through health, but also through factors at multiple levels, such as gender relations, reproduction, and economics. Physiologic, behavioral, and affective measurement of sexuality and sexual behavior is complicated by cultural values and norms but is essential to individual health (including happiness) as well as public health. Cultural or structural norms that stigmatize aspects of sexuality, such as sexual orientation, have adverse effects on individuals across their lifespan, with homophobia being a prominent example of such.
Discuss how one’s age, race, lifestyle, and demographics have an impact on your choice to complete a sexual history when working in the primary care setting with women across a lifespan.
MN561 Advance Practice Nurse Clinical
 Unit 8 Discussion
Topic: Depression
Depression is one of the leading causes of disability in adults. It affects men and women of all ages, races, and social and economic groups. Depression has a major impact on a person’s quality of life and can increase the risk of suicide. It can make it more difficult for people to care for other health conditions they may have. Depression also can affect family members, especially children.
Discuss what The U.S. Preventive Services Task Force (Task Force) has recommended concerning screening for depression in the primary care setting. What are the recommended screening tools age specific.
Share what you have used in your practicum site to screen for depression and how it was addressed.
MN561 Advance Practice Nurse Clinical
 Unit 9 Discussion
Click [Start a New Thread] to post to the Discussion, then click [Post] once complete.  Be sure to post a response to all Discussion topics. Please review the Discussion Board Participation grading rubric under Course Resources. This is important information that will ensure that you earn maximum points. Your postings should be qualitative and provide substantive depth that advances the discussion. Please see the Writing Center for assistance with writing, APA, and online communication.
After completing the Reading, reflect on the concepts covered in this unit.
Describe evidenced-based treatment plans for specific sexually transmitted diseases.
Reflect on how you have met each of the course objectives over these past 9 weeks.
Explain how you will integrate the outcomes of the course into your role as a nurse practitioner working in primary care caring for adult patients presenting with acute, episodic, and chronic illness and conditions.
Provide one example of how you have met each of the six course outcomes these past 9 weeks.
MN561 Advance Practice Nurse Clinical
 Unit 10 Discussion
Click [Start a New Thread] to post to the Discussion, then click [Post] once complete.  Be sure to post a response to all Discussion topics. Please review the Discussion Board Participation grading rubric under Course Resources. This is important information that will ensure that you earn maximum points. Your postings should be qualitative and provide substantive depth that advances the discussion. Please see the Writing Center for assistance with writing, APA, and online communication.
Topic: Testicular pain
It is crucial for providers to investigate and differentiate complaints of testicular pain. Testicular torsion is an emergency which requires immediate diagnosis and management. Describe and depict the history and physical exam findings in testicular torsion. What would be the treatment or management for patients with testicular torsion?
MN561 Advance Practice Nurse Clinical
 Unit 3 Assignment
Location: XYZ Family Practice
You are an NP student in this practice. Your next patient is the following:
“I had to come in today because I have been coughing for a long time”
Amanda Smith (69 year old, black female) is a retired postal worker. During the visit, she is coughing continually. She states the cough started 5 days ago intermittently but 2 days ago it became constant. Her chart indicates that she has been a patient of the practice for 5 years, gets care regularly and her HTN has been controlled for 4 years.
Social History
Married – 2 adult children A & W
Non-Smoker now. Smoke 1 pack a day for 15 years. Quit x5 years ago
No alcohol or drug use
Baptist, attends church regularly and is a member of the choir
Family History
Mother – Deceased at age 27 from traumatic accident
Father – Deceased age 78 related to renal failure secondary to diabetes type II
Siblings – one brother age 61 A & W
Medical/Surgical/Health Maintenance Hx
Measles, mumps and chicken pox as a child.
Tetanus/Diptheria/Pertussis – Last dose 2 years ago
Influenza – Last dose 9 months ago
Pneumococcal vaccine at age 65
Zostivax at age 60
Chronic diagnoses – HTN x 5 years
Takes HCTZ 25 mg daily
Usual weight has been maintained
Fever for 5 days up to 101
Dry skin, uses emollient frequently
Wears reading glasses
Dentition fair. Partial upper denture
No swelling or stiffness
Substernal pain on cough
Began coughing 4 days ago. Started mild, intermittent and non-productive. Two days ago became constant and productive of frothy sputum. Keeps her awake at night. No relief with OTC cough syrup. She states she is short of breath today.
No CP at rest or when not coughing
Some swelling of feet and ankles at end of day, relieved by elevating feet
Decreased appetite for one week
No change in bowel habits
No frequency, hesitancy, nocturia or change in bladder habits
No changes
Stiffness in hands and legs on awakening. Relieved with activity
No depression, anxiety, or memory change
No numbness, weakness, headache, change in mentation, or paralysis
No past anemia
No change in weight, thirst, heat/cold intolerance.
Your physical exam reveals:
Temp 101.4, Resp 30 labored, no retractions, BP 135/92, HR 110, Pulse Ox 90 Wt 130 lbs
General appearance – Alert in all spheres, in mild respiratory distress, able to answer questions with short sentences, tripod breathing
Eyes ,ear, nose, head wnl
Mouth -mucosa dry
Pharynx – tonsils present not enlarged, normal pink color
Lymph – no enlargement
Skin – Dry and scaly legs and arms. Tenting of skin noted
Heart- regular rhythm at 110 bpm, no murmurs or extra sounds
Lungs – normal breath sound without crackles, bronchophony or egophony
Abdomen – no mass, tenderness, rigidity
Extremities – Hands – no swelling, Feet/legs – +1 edema feet to ankle level
Pedal pulses – wnl
Differential diagnoses:
Acute bronchitis
Congestive heart failure
Plan – transfer to acute care setting for further work-up
Assignment Details:
The “Elevator Consult”
In this activity, you will practice giving a synopsis of your patient to your preceptor. In practice, you may often give this type of report if you are sending a patient for a consultation and your phone the specialist to discuss the patient. This report should be concise and clear. The receiver should, within one minute (slightly less for simple cases, slightly more for complex cases) have a picture of the patient in his/her head. You will report on ONLY items pertaining to the acute problem in this case. Do not include extraneous material or material not directly impacting the decision-making regarding this problem. Remember, this is a FOCUSED visit and assessment to evaluate a focused concern. The history and physical exam applies techniques relevant to the specific complaint for the patient at that visit. Your report should be similarly focused, providing only information that relates specifically to the presenting problem.
Please review the grading rubric under Course Resources in the Grading Rubric section.
How to Submit:
Submit your Assignment to the unit Dropbox before midnight on the last day of the unit.
When you are ready to submit your Assignment, select the unit Dropbox then attach your file. Make sure to save a copy of the Assignment you submit.
MN561 Advance Practice Nurse Clinical
 Unit 5 Assignment  
Midterm Clinical Evaluation
For the Midterm Clinical Evaluation in Week 5 you will be required to schedule a preceptor call with your instructor and preceptor utilizing the faculty directions in the course Announcements. Failure to schedule or complete this preceptor call could result in failure of the course.
Grading will follow the rubric and will be a collaboration between your faculty and preceptor. Any area of clinical concern will require faculty and student conference as well as implementation of an individual learning plan.
You can find the rubric located in Course Resources.
MN561 Advance Practice Nurse Clinical
 Unit 7 Assignment
For this Assignment, you will select one of the following case studies below. Then, using the case information and best evidence, complete the chart below. Make sure to address all columns in the chart.
Select a case study of interest to you from the listed scenarios below.
Case #1: Jane
Jane is a 42-year-old G4P2103. Jane is divorced and works long, hard hours as a real estate agent. Jane was having irregular and heavy menses for 6 months, and then they abruptly stopped 3 months ago. Jane has been having nausea and vomiting for 6 weeks but attributed it to having the flu recently. She also admits to gaining about 10 pounds in the last few months and experiencing breast tenderness. Jane comes to the clinic today to discuss menopause symptoms and treatment. During the visit, a urine pregnancy test came back positive. During the exam, you palpate a 16-week-size uterus and get fetal heart tones of 165. Jane is in disbelief.
Case #2: Natalie
Natalie is a 27-year-old G4P0120. Natalie is married; she and her husband both work two part-time jobs to cover the bills. Natalie presents to your office at about 20 weeks gestation for her initial OB visit. Natalie states she has not been evaluated prior to today for the pregnancy because of lack of funds and ability to get off of work. Natalie also complains of multiple yeast infections during this pregnancy. During your interview with Natalie, you find she has no known medical diagnoses, she is not taking medications, she is a smoker, and she has a negative surgical history. Natalie’s OB history includes two spontaneous losses at 8 and 12 weeks gestation and a loss of a 32 weeks infant following premature rupture of membranes. The 32 week infant was 7 pounds; lived 24 hours; and experienced hypoglycemia, respiratory distress, and sepsis infections. Natalie tells you she waited to seek prenatal care until this point because she did not have enough money to pay for the visit. She and her husband are still paying off medical expenses from the death of their 32 week infant. She tells you that she probably would have waited longer, but she keeps getting these terrible yeast infections. On exam you note a fundal height of 26 weeks and urine dip reveals 1+ leukocytes, 1+ protein, trace blood and 3+ glucose.
Case #3: Katie
Katie is a 17-year-old G1P0. She presents to your office with four missed periods in a row. Katie is a high school student; she is in the 10th grade. She lives with her mother and four siblings. You ask Katie about the father of the baby and she tells you he states “that baby is not mine.” They are not speaking to each other right now. Katie tells you she has been “vomiting a lot and her stomach hurts when she pees.” A urine pregnancy test comes back positive. Katie is so confused because she has been using douching after intercourse as her method of birth control. You ask Katie about the father of the baby, and she tells you he states “that baby is not mine.” They are not speaking to each other right now. 
Katie’s past medical history is positive for chlamydia twice in the last year. She was treated at the Health Department but never went back for a follow up. Katie has had no surgeries and is on no medication. When asked, Katie states her last known weight was about 120. Katie’s V/S are BP 110/70, temp 102.5, weight 107. You note enlarged cervical lymph nodes, FHTs are 160, fundal height is 18. Katie’s urine reveals 2+ ketones, 2+ nitrates, and 3+ leukocytes.
Case #4: Sara
Sara is a 32-year-old G1P1001. She presents to your office for a 6-week postpartum check following a normal vaginal delivery of a healthy baby girl. Sara had an 18-hour labor with Pitocin augmentation and delivered a 7 pound 2 oz. girl with a second degree laceration repaired with sutures. Sara spent 2 days in the hospital and was discharged home with her infant and husband. Over the last few weeks, Sara has called the office multiple times with questions about breastfeeding and her sutures healing. Upon walking into the exam room to see Sara, you see her baby in the stroller crying and Sara sitting on the exam table crying into her hands.
Complete the following chart:
Pregnancy Case Review Chart- 
Description of the case chosen:

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