nurs6550 all week discussions latest 2017

Week 1 discussion

Discussion Part I: Medicolegal Considerations

Note: In this course, all Discussions will have two parts:

Part I will consist of a specific topic related to the Week’s content.

Part II will consist of a pharmacology review of approximately 250 words. Please submit each posting separately but within the same Discussion thread.

You will be assessed on your posting and responses to both parts.

As an advanced practice nurse (APN), it is essential to understand your medicolegal responsibilities as they relate to coding the services you provide to patients. Improper coding, undercoding, or overcoding can have serious implications for patients, providers, and the provider’s care setting. For this Discussion, you examine potential coding issues in case studies and consider the medicolegal responsibilities of the advanced practice nurse.

Case Study 1:

Sally Jones, an acute care advanced practice nurse, is making hospital rounds on the same patients her colleague nurse practitioner saw yesterday. Sally had five history and physicals to complete on admissions that came in overnight. At the beginning of her shift, she had to complete two emergency admissions and was then called to intensive care, where she spent most of the afternoon. She had to leave work early because of her husband’s retirement party. Because she knew most of the patients on her rounding list, she decided to visit each patient’s room quickly for about 10 minutes. She coded all of the visits the same way she had done the day before, with codes 99231 and 99232.

Case Study 2:

Lisa Smith, an acute care advanced practice nurse, is making hospital rounds on the same patients her colleague nurse practitioner saw yesterday. It took her 50 minutes to see 10 of her patients and 30 minutes to see each of the remaining patients on her list. She used the same code for all visits—99233.

To prepare:

Select one of the provided case studies.

Review the patient documentation given for the case. Think about medicolegal considerations and the responsibilities of the advanced practice nurse.

Consider the medical codes selected by the advanced practice nurse. Reflect on how the selections might impact clinical practice and billing. Think about how the impact might differ from primary to acute care settings.

Post on or before Day 3 a brief description of the patient documentation given for the case study you selected. Explain any medicolegal considerations, including the role and responsibilities of the advanced practice nurse. Then, explain how medical coding might impact clinical practice and billing, as well as how implications might differ from primary to acute care settings.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days who selected a different case study than you. Share additional insights or alternative perspectives.

Discussion Part II: Pharmacology

Read the following articles to enhance your knowledge on commonly prescribed medications:

River-Bou, W. & Brown, D. (2014). Thrombolytic Therapy. Retrieved from http://emedicine.medscape.com/article/811234-overview

Thrombolytics are used for AMI, DVT, acute peripheral arterial occlusion, occlusion of indwelling catheters, pulmonary embolism, and stroke.

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

Activase

Retavase

Urokinase

Streptokinase

TNKase

Anistreplase.

Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

For this Discussion, address 1 of the following options. Post by day 3:

Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient to whom you would prescribe this medication.

Note: To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

Week 2 discussion

Discussion Part I: Assessment of Psychosocial Health Conditions

In acute care settings, patients with psychosocial health conditions may present with a variety of complex symptoms that require comprehensive assessment. The results from this assessment are crucial to developing a diagnosis and creating an individualized treatment plan for a patient. For this Discussion, you focus on the assessment as you consider case studies of patients with psychosocial health conditions. You determine what history should be collected from the patients as well as what physical exams and diagnostic tests should be conducted, and you formulate a differential diagnosis with several possible conditions.

To prepare:

Review this week’s media in Assessment of Psychosocial Health Conditions and select one of the three case studies.

With the case study you selected in mind, reflect on the patient information provided.

Think about the health history you would need to collect from the patient.

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

Identify at least five possible conditions to consider in a differential diagnosis for the patient.

Post on or before Day 3 a description of the health history you would need to collect from the patient in the case study you selected. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five possible conditions for the patient’s differential diagnosis and justify why you selected each.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days who selected different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition and justify your reasoning.

Discussion Part II: Pharmacology

To Prepare:

Read the following articles to enhance your knowledge of commonly prescribed medications:

Sutphen, S. (2006). New drugs; New overdoses: Highlights from the American College of Emergency Physicians meeting (ACEP). Retrieved from http://www.medscape.com/viewarticle/548191_3

All of the following medications are commonly prescribed in the acute care setting. Choose one of the drugs below to discuss. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

Benztropine,

Clomipramine

Physostigmine

Diphenhydramine,

Scopolamine

Droperidol

Valproate

Haloperidol

Ketamine

Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

For this Discussion, address 1 of the following options. Post by day 3:

Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Discuss a patient to whom you would prescribe this medication.

Note: To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

Week 3 discussion

Discussion Part I: Limitations and Challenges

The nursing field requires professionals to be committed to life-long learning and growth. Because a large part of this learning and growth is achieved through clinical experiences, it is invaluable for advanced practice nurses to be able to apply knowledge recently gained from clinical experiences to new situations. By collaborating with colleagues and sharing these experiences and knowledge, advanced practice nurses can further enhance their professional competency.

This week in order to demonstrate collaborative learning; discuss a situation in your acute hospital experience of a collaboration that occurred. Reflect on the experience and the impact it had on your care of this patient. How will this experience possibly impact you in your future practice with these type of patients? What are some limitations and challenges you encountered during this clinical experience?

To prepare:

Reflect on this week’s clinical experiences.

Consider one limitation or challenge you encountered.

Think about how you overcame this limitation or challenge and how this might impact your future practice in acute care settings.

Post on or before Day 3 a description of at least one limitation or challenge you encountered during your clinical experience this week. Explain how you overcame this limitation or challenge and how this might impact your future practice.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to two colleagues by sharing additional insights or alternative perspectives.

Discussion Part II: Pharmacology

To Prepare:

Read the following article to enhance your knowledge on commonly prescribed medications:

Overgaard, C. B., & Dzavik, V. (2008). Review of Physiology and Clinical Use in Cardiovascular Disease. Circulation, 118: 1047-1056. Copyright 2008 by Llippincott Williams & Wilkins – Journals. Reprinted by permission of Llippincott Williams & Wilkins – Journals via the Copyright Clearance Center.

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

Antiemetic:

Zofran

Kytril

Phenergan;

Positive Inotropes:

Digoxin

Catecholamines:

Dobutamine

Dopamine

Epinephrine

Norepinephrine

Vasopressin

Nitroglycerine;

Amrinone

Midodrine

Milrinone

Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

For this Discussion, address 1 of the following options. Post by day 3:

Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Discuss a patient to whom you would prescribe this medication.

Note: To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

Week 5 discussion

Discussion Part I: Benefits of Clinical Experiences

Clinical experiences in acute care settings may differ considerably from those in primary care settings. You likely have encountered new situations during your acute care clinical experiences, such as using unfamiliar assessment tools, interacting with patients who have unique needs, and communicating with colleagues from multiple disciplines. For this Discussion, consider how these experiences might benefit your future practice as an advanced practice nurse in the acute care setting.

To prepare:

Reflect on this week’s clinical experiences (i.e., using a new assessment tool, obtaining health information from a patient, evaluating a patient who presents with symptoms that are new to you, etc.).

Consider how and why this experience might benefit your future practice.

Post on or before Day 3 a description of at least one clinical experience from this past week that might benefit you in your future practice. Explain how and why this experience would benefit you as an advanced practice nurse.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to two colleagues by sharing additional insights or alternative perspectives.

Discussion Part II: Pharmacology

To Prepare:

Read the following articles to enhance your knowledge on commonly prescribed medications:

Panchmatia, S. (2009). Nitrates: uses, actions and prescribing rationale. Nurse Prescribing, 7(9), 404- 409.

Roush, G. C., Kaur, R., & Ernst, M. E. (2014). Diuretics: a review and update. Journal Of Cardiovascular Pharmacology And Therapeutics, 19(1), 5-13. doi:10.1177/1074248413497257

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

Atropine,

Ipratropium

Bromide,

Prostigmin,

Bumex,

Furosemide,

Nitroprusside,

Nitro,

Esomeprazole,

Pantoprazole,

Lanzoprazole,

Metoclopramide

Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

For this Discussion, address 1 of the following options. Post by day 3:

Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient to whom you would prescribe this medication.

Note: To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

Week 7 discussion

Discussion Part I: Assessment and Treatment of the Genitourinary, Gynecologic, and Renal Systems and Acid/Base Disorders

Common emergency department complaints are vaginal bleeding, and STIs. An understanding of the differential diagnoses that might occur with pregnant and non-pregnant women is important to grasp. Advanced clinical skills that the Acute Care Nurse Practitioner must be familiar with include the auscultation of fetal heart tones, basic fetal heart monitoring, pelvic exams, and delivery of fetal demise or precipitous deliveries of viable fetuses. Pregnancy can alter the diagnostic possibilities of a patient with acute abdominal pain and change the clinical findings. Advanced pregnancy can make it even more difficult.

The Centers for Disease Control and Prevention estimates that there are 19 million new cases of sexually transmitted infections every year in the United States. STIs may present serious health implications for infected patients—especially for those who are unaware of their health condition. Studies show that women are not only at greater risk of contracting these infections, but they also tend to have more severe health problems resulting from infections than men. As an advanced practice nurse, you must educate female patients and emphasize the importance of prevention and STI testing for all women regardless of marital status, race, ethnicity, or socioeconomic status.

Case Study 1: A 19-year-old Asian American female comes into the urgent care clinic. She is complaining of severe abdominal pain, that radiates to her back. She is having a moderate amount of vaginal bleeding. She has a past medical history of PID and has used an IUD in the past. Her vitals are T 37.7, P 116, RR 18, BP 88/50.

Case Study 2: A 31-year-old African American female is brought into the ER with vaginal hemorrhage. She is unsure of her last menstrual period. States she is sexually active and does not use protection. On exam there are large clots noted in the vaginal vault, with possible tissue. Vital signs are T 37, P 134, RR 26, BP 180/110.

Case Study 3: A 21-year-old nulligravida comes to the ER, concerned about vague lower abdominal pain for two days associated with a yellowish, nonodorous, vaginal discharge. Past history reveals regular menstrual periods and no previous surgeries or significant medical problems. Her last menstrual period was normal and ended two days ago. She had a similar episode about eight months ago for which she did not seek care because of lack of health insurance. She is currently sexually active with one partner and has had two partners in the past year. She is not using any type of contraception. On physical exam you note a temperature of 38º C, a regular pulse of 100, and a BP of 110/65. Her abdomen is diffusely tender in both lower quadrants. Pelvic exam reveals a yellowish cervical discharge with cervical motion tenderness and a tender fullness in both adnexa.

To prepare:

Review and select one of the three provided case studies. Reflect on the patient information.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.

Consider strategies for educating patients on the treatment and management of the gynecological condition you identified as your primary diagnosis.

Post on or before Day 3 an explanation of the differential diagnosis for the patient in the case study you selected. Provide a minimum of three possible diagnoses, and list them from highest priority to lowest priority. Explain which is the most likely diagnosis for the patient and why. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patient.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to at least two of your colleagues on two different days in both of the ways listed below. Respond to colleagues who selected different case studies than you did.

Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or contrasting perspectives.

Discussion Part II: Pharmacology

Read the following article to enhance your knowledge of commonly prescribed medications:

Harder, S., & Graff, J. (2013). Novel oral anticoagulants: clinical pharmacology, indications and practical considerations. European Journal Of Clinical Pharmacology, 69(9), 1617-1633. doi:10.1007/s00228-013-1510-z

Stöllberger, C., & Finsterer, J. (2013). Concerns About the Use of New Oral Anticoagulants for Stroke Prevention in Elderly Patients with Atrial Fibrillation. Drugs & Aging, 30(12), 949-958. doi:10.1007/s40266-013-0119-3

Wright, P., & Antoniou, S. (2013). Acute coronary syndrome: potent oral antiplatelets. Nurse Prescribing, 11(8), 397-400.

Lira, A., & Pinsky, M. R. (2014). Choices in fluid type and volume during resuscitation: impact on patient outcomes. Annals Of Intensive Care, 438. doi:10.1186/s13613-014-0038-4 Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4298675/

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

Anticoagulants: rivaroxaban, apixaban, dabigatran,

Antiplatelets: ASA, Clopidogrel, Dipyridamole,

IV insulin,

IV fluids: volume expanders colloids vs saline-

Isotonic,

Hypotonic,

Hypertonic,

Potassium,

Topical anesthetics

sq anesthetics

Note: When sharing your initial post, select a drug that has not yet been discussed. If all drugs have been discussed, then you may select that drug again.

For this Discussion, address 1 of the following options. Post by day 3:

Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Describe a patient to whom you would prescribe this medication.

Note: To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

Week 9 discussion

Discussion Part I: Nurse Practitioner Roles in Multidisciplinary Teams

Patient care requires collaboration and communication among members of the multidisciplinary care team. As an advanced practice nurse, you are an important member of this team of medical professionals. By facilitating collaboration among members of the care team, you can ensure that patients’ needs and concerns are met, care plans are individualized, and appropriate treatment and support are available. For this Discussion, you will consider the role you filled in multidisciplinary care in your clinical setting and how this experience might impact your future practice in acute care.

To prepare:

Reflect on your clinical experiences from this week that included multidisciplinary care.

Consider your role as the advanced practice nurse in these experiences. Think about how you contributed to and supported the multidisciplinary teams. Include why your role is important to the holistic care of patients.

Reflect on how these experiences will inform your future clinical practice in acute care settings.

Post on or before Day 3 a description of this week’s clinical experiences that included multidisciplinary care. Explain your role as the advanced practice nurse in these experiences. Include why your role is important to the holistic care of patients. Then, explain how these experiences will inform your future clinical practice in acute care settings.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to two colleagues by sharing additional insights or alternative perspectives.

Discussion Part II: Pharmacology

To prepare:

Read the following articles to enhance your knowledge of commonly prescribed medications:

Scheinfeld, N. & Chanddrasekar, P. (2015). Intravenous-to-Oral Switch Therapy. Retrieved from: http://emedicine.medscape.com/article/237521-overview

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

epinephrine

hydroxyzine

dopamine

Cephalosporin generation 1

Cephalosporin generation 2

Cephalosporin generation 3

Sulfonamides (Bs)

Tetracyclines

Nitrofurans

Penicillin combinations

Mupirocin

Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

For this Discussion, address 1 of the following options. Post by day 3:

Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Discuss a patient to whom you would prescribe this medication.

Note: To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.

Week 11 Discussion

Discussion Part I: “Aha” Moments

Clinical experiences are essential to your development as an advanced practice nurse, because new learning and discoveries may offer “aha” moments. These moments of insight, inspiration, or realization contribute to your professional growth and strengthen your value in an acute care setting. For this Discussion, consider an “aha” moment that you had during your clinical experience and how this moment might impact your future practice.

To prepare:

Reflect on your clinical experiences.

Consider “aha” moments (e.g., moments of insight, inspiration, or realization) that might impact your future clinical practice.

Post on or before Day 3 a description of three “aha” moments you experienced over the course of your clinical experiences. Explain how these moments might impact your future clinical practice.

Read a selection of your colleagues’ responses.

Respond on or before Day 6 to two colleagues by sharing additional insights or alternative perspectives.

Discussion Part II: Pharmacology

To prepare:

Read the following articles to enhance your knowledge of commonly prescribed medications:

Siân Williams, A. (2014). Pharmacology of steroids in the musculoskeletal system. Nurse Prescribing, 12(5), 237-242.

Trinka, E., Höfler, J., Zerbs, A., & Brigo, F. (2014). Efficacy and safety of intravenous valproate for status epilepticus: a systematic review. CNS Drugs, 28(7), 623-639. doi:10.1007/s40263-014-0167-1

All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

Solumedrol

Dexamethazone

Teriparatide vs biophosphonates

Non-depolarizing blockers vs Depolarizing blockers for neuromusclular agents

Succinylcholine, decamethonium,

Pancuronium, vecuronium, rocuronium

Anticonvulsant Barbiturates and benzodiazepines

Valproates and Fosphenytoin and topiramate

GABA analogs and Triazines

Migraine medications

Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group.

For this Discussion, address 1 of the following options. Post by day 3:

Option 1: Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

Option 2: Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

Option 3: Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Discuss a patient to whom you would prescribe this medication.

Note: To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message

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