It is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format (6th Ed.).

Classroom Participation

Students are expected to initially address the discussion question by Wednesday of each week. Participation in the discussion forums is expected with a minimum total of three (3) substantive postings (this includes your initial posting and posting to two peers) on three (3) different days per week. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.

All discussion boards will be evaluated utilizing rubric criterion inclusive of content, analysis, collaboration, writing and APA. If you fail to post an initial discussion you will not receive these points, you may however post to your peers for partial credit following the guidelines above. Due to the nature of this type of assignment and the need for timely responses for initial posts and posting to peers, the Make-Up Coursework Policy (effective July 2017) does not apply to Discussion Board Participation.

Discussion Prompt [Due Wednesday]

A 36-year-old woman is seen with complaints of abdominal bloating and gas. She says she has been really tired and has noticed sores in her mouth and tingling in her legs. She states her bloating and gas seem to get better when she is fasting.

Critical Thinking Questions

1. What additional questions should you ask the patient and why?
2. What should be included in the physical examination at this visit?
3. What are the possible differential diagnoses at this time?
4. What test should you order and why?
5. How would you manage this patient based on your diagnosis?

 

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Shelly is a 4-year-old preschooler who lives with her parents and younger brother. She and her brother attend a local daycare center during the week while their parents are at work. In the evenings she and her brother take a bath and then their parents read to them before bedtime at 8 PM. Shelly’s daycare class includes many children her age and she enjoys playing outside with them. Although snack times are planned, Shelly would rather play and does not always finish her beverages. 

Shelly’s mother calls the clinic and tells the nurse practitioner that Shelly has been “running a fever of 101 F for the past 2 days” and although her temperature decreases to 37.2 C (99 F) with Tylenol, it returns to 38.4 C (101 F) within 4 hours of each dose. Further, her mother says that Shelly complains that “it hurts when I pee-pee”. Shelly’s mother also has noticed that her daughter seems to be in the bathroom “every hour”. She makes an appointment to see the nurse practitioner this afternoon.

The potential diagnosis is UTI.

1. What other assessment data would be helpful for the nurse practitioner to have?

2. What are the organisms most likely to cause an UTI?

3. What is the pharmacological treatment for Shelly? Keep in mind safe dosing.

4. What are the teaching priorities for Shelly and her mother prior to her discharge from the clinic?

Please keep it concise. 1 initial post and 2 replies using peer-reviewed references published within 5 years.

 

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Based on last week’s reading, you now have an idea of the role of the APRN, and legal/professional issues in prescribing. As a future nurse practitioner, you have the authority, based on your state nurse practice act, to prescribe medications for the patients for whom you will provide care, and the responsibility of prescriptive authority is more than just simply writing a prescription correctly.

Important Links:

https://www.flsenate.gov/Committees/BillSummaries/2016/html/1424

http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-19-2014/No2-May-2014/Barriers-to-NP-Practice.html

https://floridasnursing.gov/new-legislation-impacting-your-profession/

https://www.aanp.org/advocacy/advocacy-resource/position-statements/nurse-practitioner-prescriptive-privilege

Discuss the role of advanced practice nursing in safe prescribing and 3  prescribing barriers for APRNs.

1. You need 1 initial post, and 2 replies to 2 different students.

2. A minimum of 2 paragraphs is required for all posts (initials and replies).

3. Support all posts with at least 2 cited peer review references within 5 years of publication (references cannot be older than 5 years).

4. All posts are to be written in APA 6th edition format as required by the university.

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Gastro instestinal  Case Study

Chief complaint: “I have recurrent H. Pylori infection”. 

HPI: M.C. a 46-year-old Hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has PMH of dyspepsia, and GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms. 

PMH: 

H. Pylori infection gastritis

Diabetes Mellitus, type 2

Surgeries: None

Allergies: NKDA

Vaccination History: Up-to-date

Social history:

High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.

Family history:

Both parents are alive. Father has history of DM type 2, Tinea Pedis. Mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis. 

ROS:

Constitutional: Negative for fever. Negative for chills. 

Respiratory: No Shortness of breath. No Orthopnea. 

Cardiovascular: No edema. No palpitations. 

Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal

Assessment:

Primary Diagnosis: Recurrent H. Pylori infection gastritis

Secondary Diagnoses: Dyspepsia

Differential Diagnosis: Peptic Ulcer Disease

Previous medication plan: two months ago and failed.

1. Clarithromycin      500 mg po BID for 2 weeks
2. Omeprazole      40 mg po BID for 2 weeks and then po daily.
3. Cipro      500 mg po BID for 2 weeks

Plan: Tests

Pt had EGD done 2 weeks ago that showed H. Pylori positive gastritis in biopsy results. 

Urea breath test 8 weeks after treatment with H. Pylori medications. Pt needs to stop PPI’s 2 weeks prior to Urea Breath test. 

Labs: No new labs are needed.  

Referrals: may refer based on effect of medication therapy given for 2 weeks.

Follow up: return to office in 8 weeks to reevaluate symptoms.

As a future nurse practitioner, it is important that you determine the medications used for recurrent H. Pylori infection. 

Please discuss new therapy guidelines for H. Pylori treatment, and provide patient education.

Below is the website for the American Academy of Gastroenterology Clinical Guidelines (ACG) for the updated H. Pylori therapy. Feel free to consult other peer-reviewed articles within 5 years of publication.

http://gi.org/wp-content/uploads/2017/02/ACGManagementofHpyloriGuideline2017.pdf

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• Legal issues, ethical considerations and risk management (insurance) – In your opinion, what is the relationship among these topics as they relate to NP’s?
• Define/describe what each of these are.
• Describe how each of these are interrelated.
• Provide an example of how ethics is interrelated into the legal issues of malpractice.
• Provide a journal summary to support your ideas.
• Please use ANA Code of Ethical Standards to guide the ethics discussion.
•  Post an initial substantive response of 200-250 words to each question 

 

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