MN569 Unit 1 Discussion latest 2018 January
Unit 1 Discussion
Topic 2: Primary Care
Discuss what is primary care and the ten most common diagnosis
seen in your clinic setting. Share with your peers what guidelines and tools
you will become familiar with when preparing for your clinical.
MN569 Unit 2 Discussion latest 2018 January
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 21st Century 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.
MN569 Unit 3 Discussion latest 2018 January
Unit 3 Discussion
Topic: 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!
MN569 Unit 4 Discussion latest 2018 January
Discussion Introduction/Overview
Topic:
Reflection
The
practicum experience helps to increase knowledge and skills learned in previous
courses. It creates an atmosphere to apply evidence-based concepts of disease
management to patient care plans. Sharing of practicum experiences with
classmates will increase knowledge of most common illnesses treated in
different practicum settings. Continue to ask questions of your preceptor and
examine rationales for prioritizing diagnoses and prescribing medications.
Please
share practicum experiences with classmates by addressing the following
information:
Type of
practicum setting
Average
number of patients seen by you and the preceptor on a daily basis
Most common
diagnosis treated
Available
resources (low cost meds, social services, community resources, etc.)
Most
interesting patient presentation
Comfort
level with history-taking, physical exam, medical diagnosing, Management plans
including prescribing medications and health education.
MN569 Unit 5 Discussion latest 2018 January
Topic: 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.
MN569 Unit 6 Discussion latest 2018 January
Topic: 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.
MN569 Unit 7 Discussion latest 2018 January
Topic:
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.
MN569 Unit 8 Discussion latest 2018 January
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.
MN569 Unit 9 Discussion latest 2018 January
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.
MN569 Unit 10 Discussion latest 2018 January
Topic: Performance and Evaluation in Primary Care
Share your
clinical experience and discuss your areas of strengths and areas in which you
would like to improve. How did you meet the course outcomes? Give examples
MN569 Unit 2 Assignment latest 2018 January
Health information technology (health IT) makes it possible for
health care providers to better manage patient care through secure use and
sharing of health information. Health IT includes the use of electronic health
records (EHRs) instead of paper medical records to maintain people’s health
information.
Share the EHR platform that your practice uses and discuss the
challenges and barriers to electronic charting. Why have we moved from paper
charting to EHR’s? What is meant by meaningful use regulations and why is this
important to know when documenting in the EHR?
Please support your work with at least three evidence based
practice resources that are less than 5 years old.
Written Paper (Microsoft Word doc): minimum 2000 words using 6th
edition APA formatting
MN569 Unit 3 Assignment latest 2018 January
Case Study #2
Date: November 12, 2016, 2:00 pm
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
ROS
General
Usual weight has been maintained
Fever for 5 days up to 101
Skin
Dry skin, uses emollient frequently
HEENT
Wears reading glasses
Dentition fair. Partial upper denture
Neck
No swelling or stiffness
Chest
Substernal pain on cough
Respiratory
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.
CV
No CP at rest or when not coughing
PV
Some swelling of feet and ankles at end of day, relieved by
elevating feet
GI
Decreased appetite for one week
No change in bowel habits
GU
No frequency, hesitancy, nocturia or change in bladder habits
Genitalia
No changes
MS
Stiffness in hands and legs on awakening. Relieved with activity
Psych
No depression, anxiety, or memory change
Neurologic
No numbness, weakness, headache, change in mentation, or paralysis
Hematologic
No past anemia
Endocrine
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
HEENT –
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:
- CAP
- Acute
bronchitis - Congestive
heart failure - Influenza
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.
MN569 Unit 6 Assignment latest 2018 January
Assignment Details
Patient care hinges in part on adequate and timely information
exchange between treating providers. Referral and reply letters are common
means by which doctors and nurse practitioners exchange information pertinent
to patient care. Ensuring that letters meet the needs of letter recipients
saves time for clinicians and patients, reduces unnecessary repetition of
diagnostic investigations, and helps to avoid patient dissatisfaction and loss
of confidence in medical practitioners.
As a Nurse Practitioner (NP) you will need to know the difference
between a consultation and a referral for treatment, when ordering and when
carrying out consultations or referrals.
Consultations
A consultation is a request for opinion or advice, so that the
requestor can manage the patient. A consultation is billed under one of the
consultation codes listed in Physicians’ Current Procedural Terminology (CPT)
(99241-99245 for outpatient of office consultations). If the NP is the
consultant, the NP should document the request for a consultation, the reason
for the consult, and the NP’s evaluation and recommendations.
When an NP requests a consultation from another provider, the N P
should request “consultation” on the referral form, rather than
“referring.”
Referrals:
A referral is made when the referring provider wants to turn the
management of the patient over to the referred-to provider, at least for the
current complaint.
When a NP refers a patient, the NP should state on the referral
form that the NP is “referring the patient for evaluation and
treatment.” The referred-to provider will bill an evaluation and
management code, rather than a consultation code.
Writing Assignment: Consult: Write up a consult
request and include all key elements.
Ms. Perez has been referred to Ms. Wilson FNP-C,APRN, MSN for
consultation regarding eczema unresponsive to treatment in the past six months.
Document the evaluation and recommendations for how Ms. Wilson
FNP-C,APRN,MSN should deal with the consultation request and bill a
consultation code.
Writing Assignment: Referral: Write up a referral
request and include all key elements.
As an NP and Ms. Perez primary care provider, you decide to refer
her to Dr. Owens a dermatologist for evaluation and treatment regarding eczema
unresponsive to treatment in the past six months.
1. Document your referral to Dr. Owens
2. Document the evaluation and recommendations for how Dr. Owens
should deal with the referral and bill a referral code.
MN569 Unit 10 Assignment latest 2018 January
Assignment Details
Final Clinical Evaluation — 300 points
This unit will contain the mandatory preceptor final evaluation in
Rxpreceptor. Your preceptors will receive an automatic email from the
Rxpreceptor system during week 8 and then weekly until week 9 to complete
evaluations. Once it is complete, you will review it and upload to the Unit 10
Dropbox for grading. Grading will follow the scale below and will be a
collaboration between your faculty and preceptor. Any area of assessment with a
score of 2.4 or below will receive an entire evaluation score of 0 points as
failure in any area of assessment constitutes a failing evaluation.Any element
of the evaluation that states the student is not safe or is unsafe will result
in a “0” for the final evaluation and failure of the course.
Final evaluation will be worth 300 points and will follow the grading rubric
below:
Score of 4 to 5 = all 300 points awarded
Score of 3 to 3.9 = 240/300 points awarded
Score of 2.5 to 2.9 = 210/300 points awarded
Score of 2.4 and below = 0
Students must also complete both the evaluation of their preceptor and site for
credit. The evaluations provide faculty an overview of your clinical
performance and experiences with your preceptor and clinical location. The
final clinical evaluation is required to pass the course.
