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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.

0

 
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WEEK 15

Examine how might nurses and nursing organizations improve policies to encourage the judicious use of antibiotics in humans? Identify the correlation between global disease surveillance and domestic disease surveillance, and the significant role the family nurse practitioner plays. 

 
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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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  • What is utilization and case management?
  • How is this related to managed care and quality care and control issues?  
  • How does APNP  clinical expertise and patient management skills provide a foundation for utilization and case management?
  • Provide an example of how case management improves patient care outcomes. Use an EBP research article to support your case. Provide detailed examples.

Students are expected to:

  1. Post an initial substantive response of 200-250 words to each 
  2.  Please be sure to validate your opinions and ideas with citations and references in APA format.  
 
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Db10 Week 13

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DB10-WEEK 13

Trace the history of cannabis use in medicine for the treatment and management of illness via nursing scholarly journal articles. Examine your sources for the following information below and describe the following:

1. Who are the stakeholders both in support of and in opposition to medicinal cannabis use?

2. What does current medical/nursing research say regarding the increasing use of medicinal cannabis?

3. What are the policy, legal and future practice implications based on the current prescribed rate of cannabis?

Attached below is an additional resource that details current state medical marijuana laws:

National Conference of State Legislatures- State Medical Marijuana Laws: http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx

 
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Db10 Week 13 19295161

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DB10-WEEK 13

Trace the history of cannabis use in medicine for the treatment and management of illness via nursing scholarly journal articles. Examine your sources for the following information below and describe the following:

1. Who are the stakeholders both in support of and in opposition to medicinal cannabis use?

2. What does current medical/nursing research say regarding the increasing use of medicinal cannabis?

3. What are the policy, legal and future practice implications based on the current prescribed rate of cannabis?

Attached below is an additional resource that details current state medical marijuana laws:

National Conference of State Legislatures- State Medical Marijuana Laws: http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx

 
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Evaluating Patients

Instructions

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]

Case study:

Bana is a 24-year-old Muslim woman who was recently relocated to the United States as a refugee from Syria, along with her husband and three young children. She arrives at your office today for a physical with her children and a case manager. Her English is limited, and she relies on her case manager to explain the details of her situation, although the case manager does not speak Arabic and thus cannot interpret for her.

In interviewing Bana with the help of the case manager, you learn that her husband is currently looking for a job and that she works at night cleaning office buildings. Her last menstrual period was about 8 weeks ago, and she has been experiencing nausea and vomiting in the mornings recently. A pregnancy test proves positive, and you provide some prenatal education to the client.

During the physical, you notice recent bruises around her throat. She is embarrassed by them and indicates that she was assaulted in Syria before flying to the United States several weeks ago. On questioning further about the assault, Bana appears not to understand and looks at her case manager for help.

  1. What is the biggest barrier you face in providing care to Bana at this point?
  2. What is the priority action for you to take at this time?
  3. What action is most important for you to take to ensure the health and safety of the fetus?
  4. Given Bana’s financial situation, you are concerned about her and her family having adequate nutrition. Which intervention would best address this concern?

Online discussions are intended to be thoughtful exchanges among students that focus on the weekly readings and translating theory to practice. Initial postings are expected to be completed by Wednesday of each week. Response posts are due by Sunday of each week. Minimum expectations are to complete the initial posting and provide a substantive response to the initial posting of one other classmate who posted to a different question. Students earn points weekly for posts which meet (or exceed) minimum posting requirements. Points are deducted daily for late initial posts. Late response posts will not be accepted.

Estimated time to complete: 3 hours

 
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nit 1  – Advanced Nur 

Unit 1 Discussion – Advanced

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.).

Advanced Nursing Practice Situation

Scenario: Today is a busy day at the community health center since yesterday was a holiday. I am seeing walk-ins, and my three examination rooms are full. I hope I will be able to see more than 20 patients today—the expectation of ‘management’—and will be rewarded with a productivity bonus. My next patient is John, a 42-y.o. man I have known for several years. He is accompanied as usual by his wife Mary. Today, John is complaining of lower extremity swelling and pain in most of his joints. He is worried about losing his job as a truck driver, because he is having difficulty climbing in and out of his truck. He is afraid that he may have lupus, because all of his siblings and his mom have this disorder. He also requests a refill on his antidepressant, which doesn’t seem to be working as well as it did a month ago. While reviewing his chart, I notice that John has gained weight—he now weighs over 300 lbs. In reviewing his medications, I see that the antidepressant he is taking may be contributing to his weight gain. John’s physical examination is unremarkable. His heart rate is regular without murmur or irregularity, and his lung sounds are without wheezes or crackle. Since John is a large man, all of his joints areas are large, but they are all symmetrical, with good range of motion and only mild palpation tenderness in his wrists. His ankles are large but without erythema or other skin discoloration or disruption, and his pedal pulses are strong and equal bilaterally.

I ponder how to manage this visit. Do I take the time to investigate John’s depression more thoroughly, wondering about his 11 y.o. daughter, who at his last visit was on chemotherapy for a neuroblastoma? Should we discuss the pros and cons of different antidepressants? Should we discuss the possibility of a gastric bypass again, even though I know the thought of anesthesia terrifies him? Do we again discuss the importance of a healthy diet and increased exercise, giving consideration to his joint pain? I am torn between what I feel this patient deserves and the call of the clock. Would it be unreasonable to order the necessary lab tests to investigate the possibility of lupus, hypothyroidism, or some other disorder and postpone these time-consuming discussions until his next visit?If I am expedient with this visit, the other patients waiting also will be grateful. Maintaining a caring practice in an economically driven discipline requires skill and grounding in those values that are essential for quality patient care. In the context of the caring theory and analysis of the Advanced Practice Nursing Situation above, let’s discuss this situation using “multiple ways of knowing.”

Questions for this week’s Postings:

  • In your posting this week please provide a word metaphor that might express the meaning of this situation as described above?
  • Remember this is your opportunity to tap into the aesthetics of knowing that is seeing the beauty and uniqueness in this situation so think about it a bit before responding.
  • Make it your own word and not just what someone else said.
  • Please explain why you chose this word and if you have experienced this type of situation before and what did feel about that situation? 

 

Please be sure to validate your opinions and ideas with citations and references in APA format. 

Estimated time to complete: 1 hour

Search entries or author Filter replies by unreadUnread   Collapse replies Expand replies Subscribe ReplyReply to Unit 1 Discussion – Advanced Nursing Practice Situation

  •  sing Practice Situation

 
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Select ONE of the questions listed below and create a substantive initial post. Please post the question number you chose in the title of your post. (i.e. Question 2 Prenatal Testing)  

  1. Review the essential elements of a fetal assessment during the last trimester of pregnancy. What are the clinical indicators of fetal well being (normal findings) and what steps would you take if findings are not reassuring? 
  2. Access a nationally recognized professional practice resource such as AAP, AAFP, AWHONN, March of Dimes, CDC, etc. Review guidelines for prenatal testing, prenatal assessments, or maternal fetal outcomes related to prenatal care. What information did you find that influenced your awareness of prenatal testing and prenatal care? What information will you utilize when you provide care for a woman who is pregnant or planning a pregnancy? 

Estimated time to complete: 3 hours

 
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 Reply Amanda

Question #1

An ultrasound in third trimester could show many clinical indicators of fetal well-being.  First it shows us the fetal number-which most likely is already known.  It also shows us the baby’s presentation.   “If breech, describe the “type” of breech” Frank, Complete, Incomplete, Footling” (TOP, 2017).  This ultrasound will also tell us the fetal biometry and estimated fetal weight, Amniotic Fluid Volume, Placentation, Fetal movements, and Consider re-visualizing select fetal anatomic structures when a third trimester assessment is being performed (TOP, 2017). Its also important to check the babies heart tones and the mother’s vital signs, particularly the blood pressure.  Always ask if the mother is having any bleeding, leaking, constant contractions and is she feeling the baby move well.  It is also important to check the mother’s urine. 

Steps to take if findings are not reassuring during third trimester depend on the finding.  If the baby is breech.  External cephalic version is one way to turn a baby from breech position to head down position while it’s still in the uterus. It involves the doctor applying pressure to your stomach to turn the baby from the outside(Healthline, 2018).  For high blood pressure and signs of preeclampsia, “You may have to stay at the hospital for observation and to manage your blood pressure until the baby is old enough for delivery. If your baby is younger than 34 weeks, you will probably be given medication to speed up the baby’s lung development”(Healthline, 2018).  For most findings that are not reassuring the patient will be sent to the hospital for monitoring for mother and baby.

Healthline. (2018). What Might Go Wrong in the Third Trimester?. Retrieved on February 23, 2019 from https://www.healthline.com/health/pregnancy/third-trimester-complications#post–term

Toward Optimized Practice (TOP). (2017). THIRD TRIMESTER FETAL WELL-BEING STUDIES: CRITERIA AND MANAGING RESULTS.  Retrieved on February 23, 2019 from http://www.topalbertadoctors.org/download/2129/Third%20Trimester%20Fetal%20Well-Being%20Studies.pdf?_20180914050143

 Reply Hollie

Question 1—Third Trimester

Fetal growth is an important part of fetal assessment in the third trimester. Studies show that poor fetal growth in the second and third trimesters are associated with increased risks of preterm birth, low birthweight, and long-term adverse health outcomes (Gaillard, Steegers, de Jongste, Hofman, & Jaddoe, 2014). Fundal height is often used to assess fetal growth. If fundal height differs by 3 cm or more from gestational age, a follow-up ultrasound is advised to assess further (McCowan, Figueras, & Anderson, 2018).

Fetal heart rate and fetal activity should also be routinely assessed. The mother should be asked about fetal activity. Counting the kicks should be highly encouraged starting at week 28 (Bryant & Thistle, 2019). A kick count of less than 10 in 2 hours may be cause for concern (Bryant & Thistle, 2019). Fetal heart rate should also be assessed at every prenatal visit in the third trimester (ACOG, 2018). A typical fetal heart rate is between 120 and 160 beats per minute. Changes in fetal activity or fetal heart rate indicate a need for further testing. A non-stress test and/or a biophysical profile (BPP) may be ordered when results are nonreassuring (ACOG, 2018). A biophysical profile is an ultrasound that assesses: fetal breathing movement, fetal movement of the body or limbs, fetal tone and amniotic fluid volume (Bryant & Thistle, 2019).

Maternal blood pressure, urinalysis, and degree of edema are also important measurements that can affect the health of the fetus (Zolotor & Carlough, 2014). Blood pressure measurements can help identify chronic hypertension or hypertensive disorders that develop during pregnancy, such as preeclampsia or gestational hypertension (Zolotor & Carlough, 2014). Edema may be a normal finding but can also be a sign of preeclampsia (Zolotor & Carlough, 2014). Protein in the urine may also indicate preeclampsia risk (Zolotor & Carlough, 2014). These findings may also suggest the need for blood tests, fetal ultrasounds, nonstress tests, or a BPP (Zolotor & Carlough, 2014).

Lastly, fetal presentation is encouraged to be assessed beginning at 36 weeks gestation (Zolotor & Carlough, 2014). This is most often done using the Leopold maneuvers (Zolotor & Carlough, 2014). External cephalic version may be used to turn a fetus from a breech or transverse position into a vertex position before birth (Zolotor & Carlough, 2014).

References

ACOG. (2018). Special tests for monitoring fetal health. Retrieved from https://www.acog.org/Patients/FAQs/Special-Tests-for-Monitoring-Fetal-Health?IsMobileSet=false#exam

Bryant, J. & Thistle, J. (2019). Fetal movement. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470566/

Gaillard, R., Steegers, E. A., de Jongste, J. C., Hofman, A., & Jaddoe, V. W. (2014). Tracking of fetal growth characteristics during different trimesters and the risks of adverse birth outcomes. International Journal of Epidemiology, 43(4), 1140-1153. https://dx.doi.org/10.1093%2Fije%2Fdyu036

McCown, L., Figueras, F., & Anderson, N. (2018). Evidence-based national guidelines for the management of suspected fetal growth restriction: Comparison, consensus, and controversy. American Journal of Obstetrics & Gynecology, 218(2),855–868. doi: 10.1016/j.ajog.2017.12.004.

Zolotor, A., & Carlough, M. (2014). Update on prenatal care. American Family Physician, 89(3), 199-208. Retrieved from https://www.aafp.org/afp/2014/0201/p199.html

Edited by Hollie Finders on Feb 24 at 2:57pm Reply 

 
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