NU668 2022 November Complete Course Latest (Full)
NU668 Roles and Issues in Advance Practice Nursing
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Week 1 Discussion
Meet Your Classmates Forum
Use this area to create a 2- to 3-minute video showing your face and using your voice to introduce yourself to the group. In the video, please make sure to complete the following items:
Your specialty track (Pediatric, Family, Psych/Mental Health, Women’s Health, Adult Geriatric-Primary, or Adult Geriatric-Acute) and why you chose this track.
Describe how you envision your “dream job” for entry into advanced practice.
Share a question that you hope this class will answer for you.
Add any personal information you would like to share with the class.
Follow the instructions on Creating Unlisted YouTube Videos for Upload to Your Course Assignments to create and link the video. You can use Zoom or your personal preference to create your video.
After your recording is complete, you will need to submit the YouTube video URL for this discussion. Please share this URL in the discussion board initial post so that classmates and faculty may get to know you!
In order for this discussion to be considered complete, you will need to post a video showing your face and using your voice that addresses all the prompts by Day 3 AND complete at least 2 responses to your peers’ posts by Day 7.
NU668 Roles and Issues in Advance Practice Nursing
Week 2 Discussion
Core Competencies
In your initial post, using the NONPF core competency you chose in Week 2 Choice: Core Competencies, discuss ways you as a student have or can begin to exemplify this competency. These exemplars can be from clinical experiences over the past year, course work or assignments completed in other classes, and internal (employment) and external (regional, state, national) professional activities.
In this initial post, you are asked to provide exemplars that are personal experiences. However, the rubric includes having three references. If you do not have three references that is ok; you will not be graded down on references for this discussion. However, your initial post will probably contain at least two references (one being the NONPF competency document itself and the other related to nursing practice, etc.).
Choices
Scientific Foundations
Leadership
Quality
Practice Inquiry
Technology and Information Literacy
Policy
Health Delivery Systems
Ethics
Independent Practice
Reply Posts
For the reply post, select a posting from one of your classmates that chose a different competency and discuss how your preceptor demonstrated proficiency with this competency during your clinical practice and what you have gained from that experience. If you have not worked with a preceptor yet, you may choose an example of an NP who you have worked with, or an NP who you have observed. If you are having difficulty identifying a personal story, please feel free to demonstrate your understanding of a second competency through an evidence-based essay that adds depth to a peer’s initial post.
In this discussion, you are asked to provide exemplars that are personal experiences. For the reply posts, the rubric includes having two references. If you do not have two references that is ok; you will not be graded down.
NU668 Roles and Issues in Advance Practice Nursing
Week 3 Discussion
Role-Specific Nurse Practitioner Competencies
Initial Post
In your initial post, you should locate your role-specific nurse practitioner (NP) competency in the Required Resources. You should review this before completing your initial post. Please note this is an introduction to the role-specific competencies and, at the end of your program, you will have an opportunity to share how you have met all these role-specific NP competencies before graduation.
In this initial post, please address the following prompts related to your role-specific NP competency:
Which role-specific NP competency did you review?
Address two of the following competency areas in respect to your role-specific NP competency by explaining in your own words the competency and which areas in your curriculum you have worked on this competency:
Scientific Foundation
Leadership
Quality
Practice Inquiry
Technology and Information Literacy
Policy
Health Delivery Systems
Independent Practice
Please note that each person will have a different perspective on this discussion board, dependent on where you are in your course plan and your role specialization. The rubric states there should be three references, however your initial post will probably contain at least two references (one being the NONPF role-specific NP competency document itself and the other related to nursing practice, etc.).
Reply Posts
For the two reply posts, select a posting from one of your classmates who chose a different competency area for your first reply post and one of your classmates who addressed a different role-specific NP competency for your second reply. Discuss the similarities and differences and add any questions you may have related to their post.
NU668 Roles and Issues in Advance Practice Nursing
Week 6 Discussion
Prescriptive Authority: State Regulations
Initial Post
To get started, review the Nurse Practitioner Interactive Map.
In your initial post, please identify the prescriptive authority regulations in the state where you are going to practice. Are there any restrictions, supervision, or collaboration required from a physician? If so, please explain. If you will be practicing in multiple states, do the regulations in those states differ? If you are in a clinical placement, please ask your preceptors about the prescriptive regulations and if an agreement is needed. If so, ask to see a copy of the agreement so that you can review what will be required when you begin to practice. Share with one another on the discussion board what you have found. If you are precepting at more than one facility, discuss whether these agreements differ at all, what your thoughts are about any differences, and which agreements you like best.
Reply Posts
Reply to at least one of your classmates. In your reply post, compare and contrast the state regulatory requirements of the state in your initial post with a different state. Discuss with your colleague rationales behind these differences and how the difference affects healthcare access, quality and cost.
Please refer to the Grading Rubric for details on how this activity will be graded and incorporate these guidelines in your discussion.
NU668 Roles and Issues in Advance Practice Nursing
Week 7 Discussion
Opioid Epidemic
Initial Post
In your initial post, please identify the current trends of opioid addiction in your state and region. Provide demographic data for incidence and occurrence and list what community resources are available to you.
Reply Posts
Reply to one of your classmates, identifying strategies that they, as an NP, can begin to help clients with an opioid addiction and providing strategies that can help to educate communities.
Please refer to the Grading Rubric for details on how this activity will be graded and incorporate these guidelines in your discussion. The grading for the number of reply posts is based on individual Discussion Board instructions. If the rubric indicates a different number for reply posts, you will not be graded down as long as you have followed the reply post instructions.
In order for this assignment to be considered complete, you will need to address all the prompts including current trends of opioid addiction in your state by Day 3 and reply to at least one classmate with strategies on how they can help patients with an opioid addiction by Day 7.
NU668 Roles and Issues in Advance Practice Nursing
Week 9 Discussion
APRNs and Malpractice
Initial Post
Review Tables 29.1 and 29.2 in the Joel textbook (2022) and compare APRN adverse events and malpractice claims to MDs in your state of practice. Identify the differences, explain why you think there is a difference, and discuss how malpractice suits affect patient access.
Reply Posts
Reply to at least two of your classmates—from different states if possible—after reviewing the information provided in the initial post and comparing your state stats. Address some of the problems, if any, with the current malpractice legal system related to malpractice.
Please refer to the Grading Rubric for details on how this activity will be graded and incorporate these guidelines in your discussion. The grading for the number of reply posts is based on individual Discussion Board instructions. If the rubric indicates a different number for reply posts, you will not be graded down as long as you have followed the reply post instructions.
For this assignment to be considered complete, you must address all the prompts—including how malpractice suits affect patient access to care, comparing APRN to MD adverse events in your state, noting what differences there are, and discussing why there may be differences—by Day 3 and reply to two classmates, addressing some of the problems with the current malpractice legal system by Day 7.
NU668 Roles and Issues in Advance Practice Nursing
Week 11 Discussion
Next Steps: Job Search, Interview, and Negotiation
Initial Post
After completing this week’s reading and learning materials, identify four concerns or questions you have regarding the following:
Job search process
Interviewing
Negotiation
Identify one concern/ question for each of the three categories; the fourth concern can be a second item from any category.
Reply Posts
Reply to two of your classmates with strategies, suggestions, or answers to the questions/ concerns they posted in the initial post, utilizing material from the course as well as experience.
The grading for the number of reply posts is based on individual Discussion Board instructions. If the rubric indicates a different number for reply posts, you will not be graded down, as long as you have followed the reply post instructions.
For this assignment to be considered complete, you must identify at least one concern or question regarding each of the following: the job search process, interviewing, and negotiation. You must post at least four questions/ concerns by Day 3. You must reply to at least two classmates and answer at least one of their questions no later than Day 7.
NU668 Roles and Issues in Advance Practice Nursing
Week 13 Discussion
APRN Political Action State Initiatives
Initial Post
Using the NP Association links in the Nurse Practitioner Interactive Map, identify your state NP association and the current political action initiatives they are currently working on. State professional organizations will have an advocacy team working on the state initiatives determined by the organization, so look for an advocacy tab, political action coalition (PAC) tab, or policy issues tab on the home website.
How do these issues restrict your practice and how will your practice change if these issues are resolved?
Identify your role in addressing these political movements.
If your state NP association does not have any political action initiatives, look at either a national professional organization’s political initiatives, such as AANP, or a state health initiative, such as immunization rate, obesity rate, texting laws or the like and complete the same instructions.
Reply Posts
Reply to two of your classmates, either classmates from different states or classmates who identify a different political issue from what you identified.
The grading for the number of reply posts is based on individual Discussion Board instructions. If the rubric indicates a different number for reply posts, you will not be graded down, as long as you have followed the reply post instructions. For this assignment to be considered complete, you must post your initial response and address all prompts related to the APRN Political Action State Initiatives by Day 3. In addition, you must reply to two classmates from different states or classmates who focused on an issue different than your own by Day 7.
NU668 Roles and Issues in Advance Practice Nursing
Week 14 Discussion
Practical/Clinical Issue
Initial Post
After reviewing the 2012 QSEN Graduate Competencies (PDF), identify a quality/safety issue that you have seen in your practice or clinical setting.
Explain to your classmates the issue you have identified and the reasons why it is an issue. Include the potential negative outcomes that can arise if the issue is not resolved.
For example, you notice that the provider is not following the American Cancer Society’s recommendation for cervical cancer screening. This issue in quality competency can lead to under-testing, over-testing, increased cost, and increased potential for surgical procedures. These factors can have negative consequences, such as higher risk for preterm labor or infertility.
As you create your post, review the knowledge, skills, and attitudes of the relevant competency regarding the quality/safety issue you have identified.
Remember: The material and feedback from this assignment will be used in Week 15 Assignment 1: SWOT Analysis.
Reply Posts
Using the SWOT Analysis Resource, review two classmates’ posts.
Identify two items from each of the four components (S, W, O, T) that are relevant to the problem your classmate identified. Explain your reasoning for each.
To reply to the example in the initial post, you could select advantages of the proposition and financial reserves from the Strengths quadrant. Elaborate on the advantages of following the recommendations—for example, following professional standards of equal care, decreasing cost by not ordering unnecessary diagnostic tests, and increasing revenue from shorter visit times.
Items you might identify from the Weakness quadrant could include processes and systems, and morale commitment and leadership. These items are weaknesses because of the need to train providers on national recommendations and to create a system within the EMR to track PAP smears.
You should then choose two items from both the Opportunities quadrant and the Threats quadrant and include them in your reply post.
The grading for the number of reply posts is based on individual Discussion Board instructions. If the rubric indicates a different number for reply posts, you will not be graded down, as long as you have followed the reply post instructions.
For the assignment to be considered complete, make sure that you address all prompts in your initial post by Day 3 and reply to at least two classmates by Day 7.
NU668 Roles and Issues in Advance Practice Nursing
Week 1 Assignment
Elevator Speech on the Role of the NP
Instructions
The purpose of this assignment is to prepare you as future APRNs to communicate your professional role and clarify the difference between APRNs and other advanced practice healthcare providers. Once you have presented this, you will work on making this more concise and compelling since you will be asked these questions in your new role.
Using Screencast-O-Matic, Zoom, or YouTube, create a video that is 3 to 5 minutes in length and shows your face and uses your voice. Answer the following questions:
What is a Nurse Practitioner?
How does a Nurse Practitioner differ from a Physician Assistant?
How does a Nurse Practitioner differ from a Physician?
Why don’t you just become a physician?
If you have never recorded a presentation, Screencast-O-Matic is a free, easy-to-use tool recommended for this purpose. Instructional videos on how to use Screencast-O-Matic are available at Screencast-O-Matic Help Videos.
NU668 Roles and Issues in Advance Practice Nursing
Week 4 Assignment
Instructions
The purpose of this assignment is to practice evaluating patient encounter notes to identify appropriate Current Procedural Terminology (CPT) codes to submit for billing. This is an important skill to master as an NP.
In this assignment, you are provided with three patient SOAP notes from an encounter with an NP. Using the Required Readings and Required Resources, identify the appropriate code (i.e., 99211, 99212, 99213, etc.) that should have been billed for the visit. In addition, provide detailed rationale on how you came to this decision. Please use the Patient Billing Template (Word).
Patient 1 SOAP note (Word)
Patient 2 SOAP note (Word)
Patient 3 SOAP note (Word)
Submit the completed Patient Billing Template to this assignment.
In order for this assignment to be considered complete, you will need to complete the coding for each of the three patients and cite rationales for your decision using the most current APA format by Day 7. Remember that this assignment is complete at 100 points, so make sure you review all requirements and complete the assignment in its entirety. If the assignment is not complete, it is considered incomplete and will result in a 0.
SOAP Note 1
Maria Rodriguez
Age: 25 y.o.
Ethnicity: Hispanic
Past Medical history: None
Past Surgical History: Tonsillectomy age 7
Medications: none
Family history: Mother Diabetes, Father Hyperlipidemia
Employment: works as a phlebotomist full time
S: Maria is an established patient who presents to office today for birth control. Pt is in a monogamous relationship with her current boyfriend of 4 months and is using condoms 100% of the time. Pt would like to start a more reliable form of birth control. Menarche 12 y.o menses: every 28 days and lasts for 5 days, patient denies cramps or irregular menses history. Patient is a non-smoker and does not use any substances. Last pap was 6 months ago negative for cytology. Gonorrhea and Chlamydia culture 6 months ago was neg/neg. HPV vaccine completed.
O: 5 feet 6 inches 140 pounds 98.4-80-16-122/76
General: Healthy appearing Hispanic woman in no apparent distress
Skin: No skin lesions identified
Head: Normocephalic, good hair distribution, no alopecia no nits
Eyes: Symmetrical with no erythema or discharge. Vision grossly normal
Ears: Symmetrical with gross hearing intact
Nose: midline, no septal defect, no discharge
Mouth: good dentition, moist mucous membranes
Cardiac: HR 80 normal sinuses rhythm, no S3 or S4, no arrhythmias noted
Lungs: Clear to auscultation bilaterally A & P, no use of accessory muscles
Abdomen: flat, soft, non-distended. Bowel sounds active in all 4 quadrants, tympanic throughout, no hepatosplenomegaly, no rebound or guarding.
A: Contraception Counseling
P: Diagnostics up to date
Education: During the 20-minute face-to-face visit, I discussed with patient the various forms of contraception including barrier, hormonal, non-hormonal, abstinence and natural family planning. Discussed efficacy, cost, risks and benefits of each method, using the Birth control option handout. Discussed timing to start method and how to use method to ensure efficacy. Patient decided to start oral contraceptives. Discussed Sunday start, daily dosing, missed pills, common side effect and major side effects, such as ACHES and when to call.
Continue Condom use for STD prevention
Pharm: Ortho-Tricyclen 28 day, 1 pill every day to start on Sunday after first day of menses. 3 refills
Referrals: none
Follow- up: 3 months
SOAP Note 2
Patient name: Rebecca Jones
S:
This new patient is a 26-year-old woman who presents to the primary care office complaining of “a sore throat and cold that has gotten worse.” Patent states that her cough has been productive with thick yellow-green sputum. The patient explains that she has a sore throat, stuffy nose, and a fever. Patient estimates that she has had the “cold” for the past three weeks and it has not gotten any better.
Aggravating factors: ambulation (short distances) and smoke.
Relieving factors: cold beverages, cough syrup, cough drops, rescue inhaler one to two times a week, and allergy medicine with minimal effect.
She denies any known sick contacts. She explains that she does not normally get colds that last this long but usually gets them once or twice a year. The patient reports smoking a pack of cigarettes a day and denies alcohol or drug use. The patient has no known diagnosed allergies. No additional concerns at this time.
ROS- Patient denies: chills, travel, headache, chest pain, chest tightness, palpations, wheezing, nausea, vomiting, loose stools, blurry vision, floaters, nausea, vomiting, or loose stools. No foreign body visualized, new bites, flushing, pruritus, anxiety, faintness, blunt force trauma, new foods/ medications/ hygiene products, or sense of impending doom.
Medical history per chart review and patient: asthma, upper respiratory infection on 1/9/17 treated with Z-Pack. The patient denies any cardiovascular issues.
Surgical history: laparoscopic appendectomy 3/23/14, admitted for two days. Familial history, hypertension. The patient is currently employed as a receptionist.
Social History: The patient is single and lives alone in an apartment. The patient is a one pack a day smoker.
Health Promotion: due for pneumonia vaccination (PPSV23).
Medications: Paragard IUD. Albuterol 180mcg oral inhalation two puffs with spacer every six hours as needed for shortness of breath.
O:
General Survey—Alert, friendly, well-kempt woman, good historian.
Vital signs: temperature 98.4, heart rate 114, respirations 25, blood pressure 112/62, SPO2 92% room air.
Head: normocephalic, no lumps or lesions.
Face: symmetrical, no drooping.
Eyes: clear sclera, clear conjunctiva, PERRLA.
Cardiovascular: regular—elevated rate, no rubs, gallops, or murmurs, no jugular vein distention, capillary refill time less than 3 seconds.
Integumentary: skin warm, dry, intact, good turgor. Lap sites scars.
Mouth: lips intact, no caries, moist erythemic mucosa, enlarged tonsils grade 2, no lesions noted.
Nose: no polyps, erythema in both nares, no blisters, petechial, ulcerations.
Throat: erythema, thick yellow-green sputum, no lesions, no difficulty swallowing.
Neck: trachea midline, no nodules, no bruits, no stridor; swollen and tender submental, submandibular, superficial cervical and posterior cervical lymph nodes.
Lungs: tachypnea, coarse inspiratory crackles in right lower lobe, diminished lung sounds in the bases, dullness sound with percussion over right lower lobe; positive tactile fremitus, bronchophony muffled, and egophony abnormal. No nasal flaring, perioral or nail bed cyanosis, sternal, subcoastal, intercostal, or supraclavicular retractions.
A:
Community Acquired Bacteria Pneumonia, RLL
Differential Diagnosis:
1. Nasopharyngitis
2. Postnasal drip syndrome
3. Acute Bronchitis
Possible organisms: need sputum and nasal cultures to determine organism
Haemophilus influenza
Group A beta-hemolytic streptococcus
Group C and G streptococci
Chlamydia pneumoniae
Diphtheria
Mycoplasma pneumonia
Legionella pneumophilia
Neisseria gonorrhoeae or chlamydia trachomatis
Influenza A, B
Epstein-Barr
Coccidioidomycosis
Histoplasmosis
Blastomycosis
P:
Diagnostic tests: rapid strep test, Influenza type A and B swabs, COVID-19 swab. Consider a 2-view chest X-ray (if swabs are negative), and complete blood count with differential.
Pharmacologic interventions: azithromycin 500 mg on day 1 followed by four days of 250 mg a day, acetaminophen 650 mg by mouth as needed for fever of pain or ibuprofen 400 mg by mouth every six hours as needed for fever or pain.
Non-pharmacologic interventions: gargle with warm saltwater (1 tsp salt to 1 cup water), avoid smoking and other respiratory irritants (smoke, automotive exhaust, pollen, dust, dander, strong scents such as perfume), increase nonalcoholic fluid intake, rest, increase room humidity.
Referrals: None at this time. Pulmonology if condition does not improve with oral antibiotics.
Education: side effects of azithromycin, antibiotic teaching about finishing treatment, cough hygiene, fluids, soft foods, when to go to the emergency room, when to call the office.
Follow-up: call the office or go to the nearest emergency room if you have a fever greater than 101, shaking, chills, confusion, blue fingernaisl or lips, have increased cough, difficulty breathing at rest, or increased shortness of breath. Please follow up in the clinic in one week.
SOAP Note 3
Source: MT (self) and facility staff
Reliability: good
MT is an 88-year old white male established patient, who has been in the assisted living facility for the past 2 years. He was living with his oldest son and his family for about 15 years. He said his son kept all his pension and social security money and only gave him $50 every month. He said he finally asked his doctor to help him get a referral for social services when he was hospitalized for a fall incident with no complications or sequela.
He is being seen today for his monthly follow-up visit. He said he feels fine except that he started to have on and off loose stools in the past two weeks. The facility staff put him on diapers to prevent him from soiling his pants.
Subjective: Chief Complaint: Diarrhea
Onset of diarrhea 2 weeks ago. Loose watery brown stools about 2-3 times a day but not every day. Denies blood or mucus in his stool. Denies abdominal pain or cramping. MT said he gets an “accident” sometimes and soils his pants. He said he cannot get to the bathroom on time to have a bowel movement. He said he cannot walk fast enough. Denies urinary incontinence. Denies having eaten any exotic or rotten food. He had not been out to eat in the restaurant. Denies having any antibiotics in the past 2 weeks. Facility staff denies having any gastroenteritis cases in the past two weeks. Denies fever, nausea or vomiting. Denies contact with anyone with same symptoms and denies recent travel. He said he did not take any OTC treatment.
ROS: Denies fever, fatigue or chills; Respiratory: Denies cough; Cardiovascular: Denies palpitations; GI: Denies nausea or vomiting, abdominal pain; Reported diarrhea on and off for the past 2 weeks. GU: Denies urinary frequency, urgency or dysuria
Allergies: No Known Allergies
Current medications: Donepezil 5 mg at HS (started 4 weeks ago with previous follow up visit). Vitamin D3 once daily, Vitamin B Complex once daily, Alendronate 70 mg once weekly
Medical History: Alzheimer’s Dementia; Osteoporosis
Surgical History: Inguinal hernia repair, Cataract surgery with lens implant
Social History: Lives at the assisted living facility. He was married once. His wife died about 17 years ago. He has five children.
Smoking: Never smoked; Alcohol: Denies alcohol use; Coffee: 4 cups a day
Family History: Mother died at age 93 from old age; Father died at age 48 from Malaria complications.
Vital signs: BP 108/72 mmHg Temp: 98.4 F HR: 78 bpm RR: 18 bpm
Height: 70 inches
Weight: 150 pounds
Objective:
Physical Examination: Alert awake and oriented to person, place and situation; well nourished; Pharynx: Buccal mucosa is moist, no erythema or edema; Respiratory: Lungs clear to auscultation with no adventitious lung sounds; Cardiovascular: Heart rate regular, with no murmurs; Abdomen soft, non-distended, with normal bowel sounds on all four quadrants; no tenderness, no rigidity, no rebound tenderness, no guarding; No CVA; Skin: warm, dry and intact with good turgor. Walks with a cane.
MT is appropriately dressed and well groomed. He has good eye contact and is cooperative. Mood is euthymic with full range affect. He knows the month and the year but does not remember the exact date and day of the week. Speech, language and responses are normal. Immediate recall is 3/3 and delayed memory recall is 1/3. Serial 7’s counting backwards from 100 is accurate. Spelling WORLD backwards is correct. Judgment and insight is good. Perceptual disturbances such as hallucinations and delusions are not observed. MMSE = 26/30
Clock Drawing: Correctly drew an analogue clock with minute and hour hands at 2:45
Assessment: Mild Neurocognitive Disorder due to Alzheimer’s Dementia
Drug-Induced Diarrhea
The most common side effects of donepezil are nausea, and diarrhea. The prevalence increases with higher doses. The side effects are usually transient and for most patients, the side effects resolve in 2-3 weeks (Rosenblatt, Gao, Mackell, & Richardson, 2010).
Differential Diagnosis
1. Infectious diarrhea is caused by enteric pathogens such as bacteria, viruses and parasites. Common pathogens are Vibrio cholerae, Clostridium difficile, Shigella, and Escherichia coli. Examples of parasites are Giardia lamblia and Entamoeba histolytica (Hodges & Gill, 2010). Although the history and pattern of diarrhea appears to be drug-induced diarrhea, infectious diarrhea still needs to be ruled out (Hodges & Gill, 2010).
2. Gastroenteritis is a viral infection of the intestines that usually causes watery diarrhea, abdominal cramps, nausea or vomiting. Sometimes it is accompanied by fever. Many different viruses cause viral gastroenteritis such as rotavirus and norovirus. Most viral gastroenteritis is self-limiting and does not usually last for over 2 weeks (““Stomach Flu”,” n.d.).
3. Functional Diarrhea is chronic diarrhea without a known cause. It is also classified as a functional gastrointestinal disorder (FGD). The Rome III diagnostic criteria for FGD is a change in stool consistency occurring in at least the last 3 months with onset at least 6 months prior to diagnosis. Functional diarrhea is different than Irritable Bowel Syndrome – diarrhea type (IBS-D) due to a lack of abdominal pain that is present in IBS-D (Bolen, 2017). MT has diarrhea on and off for the past 2 weeks.
Plan: Discontinue Donepezil
Labs: Stool C & S; O & P; CBC
Facility staff to report worsening diarrhea
Patient Education: Rehydration therapy
Follow up in 1-2 weeks or sooner as needed. Follow up when lab results are back.
Referral: None as of this time
NU668 Roles and Issues in Advance Practice Nursing
Week 5 Assignment
Individual Professional Practice Document: Scope of Practice
Instructions
During this course, you
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