Much of the ongoing debate over scope-of-practice (SoP) laws that govern the practice of nurse practitioners (NPs) across the country focuses on the cost of and access to health care and on whether these laws legitimately promote patient safety or are simply anticompetitive restrictions on NPs’ ability to compete with physicians. After completing the following CE activity at Medscape https://www.medscape.org/viewarticle/506277_1 ( sign for the free account), please answer the following questions:

Should an NP who is educationally prepared as an acute care NP work in an adult primary care setting? 

Is it within the scope for an FNP to diagnose and treat uncomplicated mental health conditions like depression, anxiety, and ADHD?

Are there any restrictions for the FNP to treat patients with mood disorders and to prescribe them antipsychotics or SSRIs ?

Discussion Grading Criteria:Agreeing and disagreeing do not mean just voicing one’s opinion. The focus of the discussions should remain on the ideas posed in the readings. Agreeing and disagreeing mean making scholarly arguments from the literature that may support your own ideas. Faculty expects you to support your ideas from the readings or similar scholarly writing about the topic in nursing literature. Always cite your source(s).

CASE STUDY 1: Headaches

A 20-year-old male complains of experiencing intermittent headaches. The headaches diffuse all over the head, but the greatest intensity and pressure occurs above the eyes and spreads through the nose, cheekbones, and jaw.

To Prepare

• By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
• Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.

With regard to the case study you were assigned:

• Review this week’s Learning Resources, and consider the insights they provide about the case study.
• Consider what history would be necessary to collect from the patient in the case study you were assigned.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
• Identify at least three possible conditions that may be considered in a differential diagnosis for the patient.

The Case Study Assignment

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each. 

please note the underlined info below.

Case Study: Contraception 

Scenario 3

Elaine Goodwin is a 38-year-old G5 P5 LC 6 presenting to your clinic today to discuss contraceptive options. She states that she is not interested in having more children but her new partner has never fathered a child. Her medical history is remarkable for exercise-induced asthma, migraines, and IBS. Her surgical history is remarkable only for tonsils as a child. Her social history is negative for alcohol and tobacco; she reports daily marijuana use. She has no known drug allergies and takes only vitamin C. Hospitalizations were only for childbirth. Family history reveals that her maternal grandmother is alive with dementia, while her maternal grandfather is alive COPD. Her paternal grandparents are both deceased due to an automobile accident. Her mother is alive with osteopenia and fibromyalgia, and her dad had a history of skin cancer (basal cell). Elaine has one older sister with endometriosis who was told not to have more children because she had blood clots when she was pregnant with her second child. She also has one younger brother with no reported medical problems.  

• Height 5’ 7” Weight 148 (BMI 23.1)   BP 118/72 P 68  
• HEENT:  wnl  
• Neck: supple without adenopathy  
• Lungs/CV: wnl  
• Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge  
• Abd: soft, +BS, no tenderness  
• VVBSU: wnl,   
• Cervix: firm, smooth, parous, without CMT  
• Uterus: mid, mobile, non-tender, approximately 8 cm,  
• Adnexa: without masses or tenderness  

QUESTION:

What other information do you need?  

Elaine relates to you that she has used birth control pills before but “would keep messing them up.”  After that she switched to the patch, which she found worked well but discontinued use for reasons she does not remember. After that she used natural family planning but still conceived her last two children unexpectedly.  She has had three partners in last 12 months and has been with her current partner for the previous two months. She believes that he is “the one.”    

Elaine relates that her cycles come every 28-32 days, for a duration of 5-8 days, and on her heaviest day she must use a super tampon every hour and get up to change her pad 2-3 times at night. Her last gyn exam was one year ago and she shows you a copy of the results on her patient portal. The results for the pap were NILM, HPV negative, and her cultures for GC/CT were negative.  

In further questioning, you ask her about her sister’s blood clots and her father’s PE.  She shares that her father was 48 years old and “just died one day.” Her sister was on “shots” for her blood clots and then took a pill. She had some blood test done and they said she had something called heterozygous MTHFR and Factor V Leiden.  

She has heard about a pill where she will only get her period four times a year and feels now that she’s older she can remember to take the pill daily and plans on putting a reminder in her phone.  

QUESTIONS: 

1. What are your next steps/considerations?  
2. What teaching should you do?  
3. What other information do you need? 

Here are the instructions

Case Study Discussion: Gynecologic Health

Case studies provide the opportunity to simulate realistic scenarios involving patients presenting with various health problems or symptoms. Such case studies enable nurse learners to apply concepts, lessons, and critical thinking to interviewing, screening, diagnostic approaches, as well as the development of treatment plans.

Photo Credit: Teodor Lazarev / Adobe Stock

For this Case Study Discussion, you will review a case study scenario to obtain information related to a comprehensive well-woman exam and determine differential diagnoses, diagnostics, and develop treatment and management plans.

To prepare:

• By Day 1 of this week, you will be assigned to a specific case study scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your case study assignment from your Instructor.
• Review the Learning Resources for this week and pay close attention to the media program related to the basic microscope skills. Also, consider re-reviewing the media programs found in Week 1 Learning Resources.
• Carefully review the clinical guideline resources specific to your assigned case study.
• Use the Focused SOAP Note Template found in the Learning Resources to support Discussion.

By Day 3

Based on the case study scenario provided, complete a comprehensive well-woman exam and critically analyze to focus attention on the diagnostic tests then,

Post your differential diagnosis. Include the additional questions you would ask the patient. Be sure to include an explanation of the tests you might recommend, ruling out any other issues or concerns and include your rationale. Be specific and provide examples. Use your Learning Resources and/or evidence from the literature to support your explanations.

Read a selection of your colleagues’ responses.

After reading the Kaiser Family Foundation summary on the Patient Protection and Affordable Care Act, state why or why not you believe the act should remain in law, or which pieces should be reversed. Then describe two pieces of the act that you were unaware was part of the act and how that may affect you as a citizen.

A walk through the Business section of any bookstore or a quick Internet search on the topic will reveal a seemingly endless supply of writings on leadership. Formal research literature is also teeming with volumes on the subject.

However, your own observation and experiences may suggest these theories are not always so easily found in practice. Not that the potential isn’t there; current evidence suggests that leadership factors such as emotional intelligence and transformational leadership behaviors, for example, can be highly effective for leading nurses and organizations.

Yet, how well are these theories put to practice? In this Discussion, you will examine formal leadership theories. You will compare these theories to behaviors you have observed firsthand and discuss their effectiveness in impacting your organization.

To Prepare:

• Review the Resources and examine the leadership theories and behaviors introduced.
• Identify two to three scholarly resources, in addition to this Module’s readings, that evaluate the impact of leadership behaviors in creating healthy work environments.
• Reflect on the leadership behaviors presented in the three resources that you selected for review.

Post two key insights you had from the scholarly resources you selected. Describe a leader whom you have seen use such behaviors and skills, or a situation where you have seen these behaviors and skills used in practice. Be specific and provide examples. Then, explain to what extent these skills were effective and how their practice impacted the workplace. 3 to 4 references