• Katia Gedeon

Module 5 Discussion Weekly Clinical Experience

•            KJ is a 68-year-old female that visits the clinic complaining of intermittent, burning, epigastric pain for the past two weeks. The discomfort occurs once a day, about two to three hours after eating. Hunger and heavy, fatty foods aggravate the discomfort, while milk, antacids, and other foods relieve it. When it is at its extreme, the pain is at 7/10, and when it is at its diminished, the pain is at 0/10 in severity. Sometimes, the pain is accompanied by nausea. There are no signs of constipation or diarrhea, and the patient’s stool color, appetite, or weight, or have not changed. She has, however, vomited once, with a sour, yellowish, and non-bloody fluid.

Challenges and Success

           Throughout the week, both problems and successes were encountered. Under many circumstances, I was able to care for a variety of patients and make various diagnoses. The difficulties were related to complex circumstances that I had never encountered before in my work. Patients had to wait for the preceptor and other nurse practitioners because of these circumstances. Patients received poor quality care and services were delayed as a result of this. However, there were several triumphs, one of which was collaborating with my preceptor. The preceptor was able to assist me in improving my knowledge and skills in inpatient care for a variety of patients with various ailments. I was able to care for a variety of patients and make various diagnoses. Thus, I grew in my practice as I can now provide care to most patients on my own.

Patient Assessment, Plan of Care, Differential Diagnosis, and Health Promotion Intervention
Patient assessment of the symptoms is essential to determine the diagnosis and the care plan. The patient’s signs and symptoms include epigastric pain that increases when the patient takes fatty and heavy foods and when hungry, vomiting, and nausea showing that she has biliary colic or cholecystitis (K80.66) (Thomas, 2019). This is also proven by the physical examination that showed epigastric tenderness and positive murphy signs. The plan of care includes both pharmaceutical and non-pharmaceutical methods. The patient has been prescribed pain relievers such as ibuprofen and nonsteroidal anti-inflammatory drugs (NSAIDs). However, with this form of treatment the stones may fail to disappear or appear after some years (Thomas, 2019). Laparoscopic surgery or cholecystectomy is the most effective form of treatment where the gall bladder is removed (Thomas, 2019). Open surgery may also be used in more complex conditions. Other forms of treatment include dietary or nutritional changes where the foods that increase the pain are avoided with increased consumption of more fluids.

           Differential diagnoses include gastritis (K29. 70) due to signs and symptoms including nausea, epigastric pain, vomiting, and taking NSAIDs for a long time (Johnson, 2017). The pain in gastritis is, however, mild than what the patient is feeling. Peptic ulcer disease (K27. 9) is another likely diagnosis due to epigastric pain that is exacerbated by heavy and fatty foods and relieved by antacids (Johnson, 2017). The other differential diagnosis is Functional dyspepsia (K30) due to stomach pain, pain relieved by mediations and some meals, and nausea after meals (Johnson, 2017). However, the condition is non-ulcer. Health promotion intervention includes patient education on avoiding smoking, alcohol, and fatty foods, and encouraging non-alcoholic and non-acidic fluids and fiber consumption.   

Lessons Learnt 

           There were some crucial lessons learned during the week. I was able to comprehend the significance of educating patients in the delivery of care. The majority of the clients I educated, particularly on compliance with medication and other forms of treatment, had better patient outcomes, which made me realize the value of education to the patients. Another lesson learned was the value of effective communication and coordination in the delivery of care. The majority of the clients needed interprofessional collaboration between providers thrown in for good measure. It is critical for practitioners to communicate effectively in order to offer high-quality and safe care. Furthermore, for the care plan to operate and be followed, effective communication between both the care provider and the client is necessary.

References

Johnson, J. (2017). Ten causes of epigastric pain. Retrieved from https://www.medicalnewstoday.com/articles/study-finds-link-between-chronic-pain-and-  disrupted-eating#Chronic-pain-management (Links to an external site.)

Thomas, D. J. (2019). Gallbladder and pancreatic disorders. In L. Dunphy, J. Winland-Brown, B.Porter, & D. Thomas (Eds.), Primary care: The art and science of advanced practice nursing – an interprofessional approach (5th ed., pp. 603-612). Philadelphia, PA: F. A.      Davis

Patient, Family, or Population Health Problem Solution

Develop an intervention , as a solution to the patient, family, or population problem you’ve defined. Submit the proposed intervention to the faculty for review and approval. This solution needs to be implemented (shared) with your patient, family, or group. You are not to share your intervention with your patient, family, or group or move on to Assessment 5 before your faculty reviews/approves the solution you submit in Assessment 4. In a separate written deliverable, write a 5-7 page analysis of your intervention.

Please submit both your solution/intervention and the 5-7 page analysis to complete Assessment 4.

Introduction

In your first three assessments, you applied new knowledge and insight gleaned from the literature, from organizational data, and from direct consultation with the patient, family, or group (and perhaps with subject matter and industry experts) to your assessment of the problem. You’ve examined the problem from the perspectives of leadership, collaboration, communication, change management, policy, quality of care, patient safety, costs to the system and individual, technology, care coordination, and community resources. Now it’s time to turn your attention to proposing an intervention (your capstone project), as a solution to the problem.

Preparation

In this assessment, you’ll develop an intervention as a solution to the health problem you’ve defined. To prepare for the assessment, think about an appropriate intervention, based on your work in the preceding assessments, that will produce tangible, measurable results for the patient, family, or group. In addition, you might consider using a root cause analysis to explore the underlying reasons for a problem and as the basis for developing and implementing an action plan to address the problem. Some appropriate interventions include the following:

• Creating an educational brochure.
• Producing an educational voice-over PowerPoint presentation or      video focusing on your topic.
• Creating a teaching plan for your patient, family, or group.
• Recommending work process or workflow changes addressing your      topic.

Plan to spend at least 3 direct practicum hours working with the same patient, family, or group.

In addition, you may wish to complete the following:

• Review the assessment instructions and scoring guide to ensure that      you understand the work you will be asked to complete and how it will be      assessed.
• Conduct sufficient research of the scholarly and professional      literature to inform your work and meet scholarly expectations for supporting      evidence.

Instructions

Complete this assessment in two parts: (a) develop an intervention as a solution to the problem and (b) submit your proposed intervention, with a written analysis, to your faculty for review and approval.

Part 1

Develop an intervention, as a solution to the problem, based on your assessment and supported by data and scholarly, evidence-based sources.

Incorporate relevant aspects of the following considerations that shaped your understanding of the problem:

• Leadership.
• Collaboration.
• Communication.
• Change management.
• Policy.
• Quality of care.
• Patient safety.
• Costs to the system and individual.
• Technology.
• Care coordination.
• Community resources.

Part 2

Submit your proposed intervention to your faculty for review and approval.

In a separate written deliverable, write a 5-7 page analysis of your intervention.

• Summarize the patient, family, or population problem.
• Explain why you selected this problem as the focus of your project.
• Explain why the problem is relevant to your professional practice      and to the patient, family, or group.

In addition, address the requirements outlined below. These requirements correspond to the scoring guide criteria for this assessment, so be sure to address each main point. Read the performance-level descriptions for each criterion to see how your work will be assessed. In addition, note the additional requirements for document format and length and for supporting evidence.

• Define the role of leadership and change management in addressing      the problem.
  • Explain how leadership and change management strategies influenced       the development of your proposed intervention.
  • Explain how nursing ethics informed the development of your       proposed intervention.
  • Include a copy of the intervention/solution/professional product.
• Propose strategies for communicating and collaborating with the      patient, family, or group to improve outcomes associated with the problem.
  • Identify the patient, family, or group.
  • Discuss the benefits of gathering their input to improve care       associated with the problem.
  • Identify best-practice strategies from the literature for effective       communication and collaboration to improve outcomes.
• Explain how state board nursing practice standards and/or      organizational or governmental policies guided the development of your      proposed intervention.
  • Cite the standards and/or policies that guided your work.
  • Describe research that has tested the effectiveness of these       standards and/or policies in improving outcomes for this problem.
• Explain how your proposed intervention will improve the quality of      care, enhance patient safety, and reduce costs to the system and      individual.
  • Cite evidence from the literature that supports your conclusions.
  • Identify relevant and available sources of benchmark data on care       quality, patient safety, and costs to the system and individual.
• Explain how technology, care coordination, and the utilization of      community resources can be applied in addressing the problem.

Glossary of Terms & Chapter 1 Questions (150 points)

via D2L Assignments (week 2 folder)

The purpose of this assignment is to familiarize you with terms used throughout this textbook and class. In addition, you will become familiar with how to apply them in sport and PE. Finally, you will need to test your cognitive knowledge of the chapter by answering questions throughout. This assignment should be typed in a Word document to submit to D2L.

Part 1:

1. In your own words, but referencing where you found the information, define the following terms from chapter 1.

2. Provide an example of the term in relation to sport, PE, or PA.

3. Provide a reason why or how this activity aligns with the term

Example: 1) Motor skill: has an end goal, must use the body or limb movements to complete the goal, it is voluntary because I am controlling the movement, and it needs to be practiced and learned (Coker, 2018). 2) A ballet sequence of 4 steps. 3) The goal is to complete the sequence of steps using my entire body, it is voluntary because I am choosing to move the body, and I had to learn and practice it before performing the final outcome.

Chapter 1 terms (10 points each):

1. Process assessment

2. Product assessment

3. Motor skills

4. Fine motor skills

5. Gross motor skills

6. Discrete skill

7. Serial skill

8. Continuous skill

9. Closed skills

10. Open skills

Part 2:

Complete the following cerebral challenges and questions from chapter 1:

Cerebral Challenge 1.2 (10 points)

Determine whether each of the following skills would be classified as a fine (F) or gross (G) motor skill or has elements of both (B). Using a capital, bolded letter, label each skill next to the activity listed (i.e. G)

a. Signing a checke. Tackling

b. Dribbling a basketballf. Making a surgical incision

c. Throwing a discusg. Picking up a paper clip

d. Walking with crutchesh. Setting a volleyball

Cerebral Challenge 1.3 (10 points)

Categorize each of the following skills as discrete (D), serial (S), or continuous (C). Using a capital, bolded letter, label each skill next to the activity listed (i.e. D)

a. Triple jumpe. Gymnastics vault

b. Crochet shotf. Transfer from wheelchair to bed

c. Punting a football g. Walking with assisted walking device

d. Lungesh. Cross-country skiing

Cerebral Challenge 1.4 (15 points)

1. Determine where along the closed–open continuum the following skills fall, by labeling in bold, next to each statement. (i.e. open)

a. Walking with a cane through a crowded mall

b. BMX racing

c. Playing a video game

d. Guiding a patient through proprioceptive neuromuscular facilitation (PNF) exercises

e. Hitting a ball from a tee

f. Hitting a pitched ball

g. Mowing the lawn

h. Snowboarding

i. Balancing on a wobble board

2. Jose has been driving since he was 16. Now, in college, he wants to buy a certain car, but it has a manual transmission. He has never driven a manual stick shift before and has asked if you will teach him. You agree. Rank the following settings for Jose’s first lesson, with 1 being the best and 3 being the worst. Explain your rankings in complete sentences.

a.On a rural road

b.In an empty parking lot

c.In city traffic

Cerebral Challenge 1.5 (15 points)

Determine whether each of the items listed below would be considered as a regulatory (R) or non-regulatory (N) condition for dart throwing. Using a capital, bolded letter, label each skill next to the activity listed (i.e. R)

1.

a.Height of the dartboard

b.Crowd noise

c.Distance from the dartboard

d.Sharpness of the dart tip

e.Score

2. Identify at least one regulatory condition for each of the following.

a. Performing a bicep curl

b. Hiking along a forest trail

c. Diving from a springboard

d. Cross-country skiing

e. Stepping onto an escalator

f. Picking up your change from a counter

g. Dusting the furniture in your house

h. Retrieving your suitcase from a baggage carrousel

Personalized Pre-Chemotherapy Education Reduces Peri-Chemo Anxiety in Colorectal Cancer Patient, is a research article that studied the results of colorectal cancer patients who received chemotherapy and if anxiety was an issue with or without prechemo education. Strength- Numbers. 364 patients were involved in this study. 127 were given education before chemotherapy, while 237 did not receive any. Weakness- This study only looks at Colorectal cancer patients and study was done inpatient. This article will provide some supportive evidence to paper but can not be relied upon for sole support.

Chemotherapy Education: An interprofessional approach to standardizing processes and improving nurse and patient satisfaction, is a study of a interprofessional team with a standardized chemo teach and educating nurses to educate new chemo patients. Strength- Done in in a rural area and easier to follow through with patients. Weakness- The chemo teach was generalized and not specific to any one type of cancer. This article will support my rationale for a more standardized chemotherapy education, but can not support on its own.

Chemotherapy Discharge Education Class Improves Patient Safety, discusses having a discharge education class for chemo patients being discharged from the hospital. The article states HCAHPS scores were very low and after instituting the class the scores surpassed the original goal of increasing scores by 10%. Strength- This article shows the importance of education for those receiving chemo. Weakness- Patients were inpatient being discharged. My project stems from an outpatient clinic. This article will support my project by stating the importance of education, but can not maintain that support on its own.

Studies from Princess Margaret Cancer Centre Reveal New Findings on Gynecologic Cancer (Evaluating the Effect of a Group Pre-treatment Chemotherapy Psycho-education Session for Chemotherapy-naive Gynecologic Cancer Patients and Their Caregivers) This report is based on a study of educating gynecancer patients and their caregivers before they receives chemo. 83% reported overall less anxiety about treatment after taking the class. Strength- Article re-iterates the importance of prechemo education. Weakness-specific to one type of cancer. This article will support my paper, but not on its own.

The Effect of Peer Education on Management of Chemotherapy Side Effects in Patients with Cancer, is a study with focus on former chemotherapy patients talking about their experiences to new chemo patients. Strengths-new chemo patients are receptive to those who have had previous experience with chemo. Weakness-Each body is different and individuals respond to treatments differently. This article will benefit my paper by supporting education coming from different sources. This article can not solely support my subject.

Empowering patients and caregivers with knowledge: The development of a nurse-led gynecologic oncology chemotherapy education class , talks about a nurse led chemo education class for patients and their caregivers. Strengths- lessened anxiety in patients. Weakness- increased anxiety in caregivers. This article will support my project, not solely strong enough.

References:

Gallegos, R., Kogelman, A., Wagner, M., Cloud, A., Olson, M., Robideau, K., Patrick, L., Comfort, J., & Hirko, K. (2019). Chemotherapy Education: An interprofessional approach to standardizing processes and improving nurse and patient satisfaction. Clinical Journal of Oncology Nursing, 23(3), 309–314. https://doi-org.lopes.idm.oclc.org/10.1188/19.CJON.309-314

Goodman, A. (2017). Chemotherapy Discharge Education Class Improves Patient Safety. Oncology Nurse-APN/PA, 10(4), 26.

Jivraj, N., Gallagher, L. O., Papadakos, J., Abdelmutti, N., Trang, A., & Ferguson, S. E. (2018). Empowering patients and caregivers with knowledge: The development of a nurse-led gynecologic oncology chemotherapy education class. Canadian Oncology Nursing Journal, 28(1), 4–12. https://doi-org.lopes.idm.oclc.org/10.5737/2368807628147

Leyla Alilu, Leila Heydarzadeh, Hossein Habibzadeh, & Javad Rasouli. (2021). The effect of peer education on management of chemotherapy side effects in patients with cancer. Iranian Journal of Nursing and Midwifery Research, 26(1), 81–84. https://doi-org.lopes.idm.oclc.org/10.4103/ijnmr.IJNMR_227_19

Li, S., Li, L., Shi, X., Wang, M., Song, X., & Cui, F. (2021). Personalized Prechemotherapy Education Reduces Peri-Chemotherapy Anxiety in Colorectal Cancer Patients. Disease Markers, 1–5. https://doi-org.lopes.idm.oclc.org/10.1155/2021/6662938

Studies from Princess Margaret Cancer Centre Reveal New Findings on Gynecologic Cancer (Evaluating the Effect of a Group Pre-treatment Chemotherapy Psycho-education Session for Chemotherapy-naive Gynecologic Cancer Patients and Their Caregivers). (2021, February 25). Women’s Health Weekly, 511.

Week 7

Case Study 1:

R.B. 95-year-old, white male, currently living in a skilled nursing facility (SNF)

Chief complaint: “My urine is really red.”

HPI: On Wednesday (2 days ago) the patient was brought to your clinic by his son and complained that his urine appeared to be bright red in color. You ordered labs, urinalysis, culture, and sensitivity, and the results are below.

Allergies: Penicillin: Hives

Medications: Tamsulosin 0.4 mcg, 2 capsules daily, Aspirin 325 mg daily, Atorvastatin 10 mg 1 tablet daily, Donepezil 10 mg 1 tablet PO QHS, Metoprolol 25 mg 0.5 mg tablet every 12 hours, Acetaminophen 500 mg 1 tablet BID

Code status: DNR  Regular diet, pureed texture, honey-thickened liquids

Vitals: BP 122/70, HR 66, Temp 98.0 F, Resp 18, Pulse ox 98%

PMH: Cognitive communication deficit, pneumonitis due to inhalation of food and vomit, dysphagia, R-side hemiplegia and hemiparesis past ischemic CVA, moderate vascular dementia, malignant neoplasm of prostate, new-onset atrial fibrillation (12/2019), DVT on left lower extremity, gross hematuria

Labs:

RBC                         3.53 (L)

Hemoglobin           10.2 (L)

Microscopic Analysis, Urine, straight cath

Component:

WBC UA                                      42 (H)              (0-5/ HPF)

RBC, UA                                      >900 (H)  (0-5/HPF)

Epithelial cells, urine                2                    (0-4 /HPF)

Hyaline casts, UA                     0                    (0-2 /LPF)

Urinalysis

Color  Red

Appearance (Urine)       Clear

Ketones, UA                  Trace

Specific gravity             1.020                   (1.005-1.025)

Blood, UA                      Large

PH, Urine                       7.0        (5.0-8.0)

Leukocytes                    Small

Nitrites                          Positive

C&S results were not available yet.

Assignment: Assessing, Diagnosing, and Treating Abdominal, Urological, and Gynecological Disorders

Photo Credit: Teodor Lazarev / Adobe Stock

Accurate history taking of abdominal, urological, and gynecological complaints is essential for completing an assessment of the older adult. For this Assignment, as you examine this week’s patient case study, consider how you might evaluate and treat older adult patients who present with health concerns related to the abdominal, urological, or gynecological systems.

To prepare:

• Review the case study provided by your Instructor.
• Reflect on the patient’s symptoms and aspects of disorders that may be present.
• Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
• Access the Focused SOAP Note Template in this week’s Resources.

The Assignment:

Complete the Focused SOAP Note Template provided for the patient in the case study. Be sure to address the following:

• Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding their history of present illness and personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list to the American Geriatrics Society Beers Criteria®, and consider alternative drugs if appropriate. Provide a review of systems.
• Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results?
• Assessment: Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
• Plan: Provide a detailed treatment plan for the patient that addresses each diagnosis, as applicable. Include documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, caregiver support, and any planned follow-up visits. Provide a discussion of health promotion and disease prevention for the patient, taking into consideration patient factors, past medical history (PMH), and other risk factors. Finally, include a reflection statement on the case that describes insights or lessons learned.Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Abdominal disorders. In Advanced practice nursing in the care of older adults (2nd ed., pp. 225–279). F. A. Davis.

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Urological and gynecological disorders. In Advanced practice nursing in the care of older adults (2nd ed., pp. 280–304). F. A. Davis.

Demarest, L. (2019). Gotta go right now: What’s overactive bladder? Nursing Made Incredibly Easy!, 17(4), 11–14. https://doi.org/10.1097/01.NME.0000559586.35631.37

Jackson, P., & Vigiola, C. M. (2018). Intestinal obstruction: Evaluation and management. American Family Physician, 98(6), 362–367.

Shian, B., & Larson, S. T. (2018). Abdominal wall pain: Clinical evaluation, differential diagnosis, and treatment. American Family Physician, 98(7), 429–436.

Document: Focused SOAP Note Template (Word Document)

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