Patient care hinges in part on adequate and timely information exchange between treating providers. Referral and reply letters are common means by which doctors and nurse practitioners exchange information pertinent to patient care. Ensuring that letters meet the needs of letter recipients saves time for clinicians and patients, reduces unnecessary repetition of diagnostic investigations, and helps to avoid patient dissatisfaction and loss of confidence in medical practitioners.As a Nurse Practitioner (NP) you will need to know the difference between a consultation and a referral for treatment, when ordering and when carrying out consultations or referrals.ConsultationsA consultation is a request for opinion or advice, so that the requestor can manage the patient. A consultation is billed under one of the consultation codes listed in Physicians’ Current Procedural Terminology (CPT) (99241-99245 for outpatient of office consultations). If the NP is the consultant, the NP should document the request for a consultation, the reason for the consult, and the NP’s evaluation and recommendations.When an NP requests a consultation from another provider, the N P should request “consultation” on the referral form, rather than “referring.”Referrals:A referral is made when the referring provider wants to turn the management of the patient over to the referred-to provider, at least for the current complaint.When a NP refers a patient, the NP should state on the referral form that the NP is “referring the patient for evaluation and treatment.” The referred-to provider will bill an evaluation and management code, rather than a consultation code. Writing Assignment: Consult: Write up a consult request and include all key elements.Ms. Perez has been referred to Ms. Wilson FNP-C,APRN, MSN  for consultation regarding eczema unresponsive to treatment in the past six months. Document the evaluation and recommendations for how Ms. Wilson FNP-C,APRN,MSN should deal with the consultation request and bill a consultation code. Writing Assignment: Referral: Write up a referral request and include all key elements.As an NP and Ms. Perez primary care provider, you decide to refer her to Dr. Owens a dermatologist for evaluation and treatment regarding eczema unresponsive to treatment in the past six months.1. Document your referral to Dr. Owens2. Document the evaluation and recommendations for how Dr. Owens should deal with the referral and bill a referral code.
Written Paper (Microsoft Word doc): minimum 2000 words using 6th edition APA formatting  Please review the grading rubric under Course Resources in the Grading Rubric section.

In collaboration with your approved course mentor, you will identify a specific evidence-based practice proposal topic for the capstone project. Consider the clinical environment in which you are currently working or have recently worked. The capstone project topic can be a clinical practice problem, an organizational issue, a quality improvement suggestion, a leadership initiative, or an educational need appropriate to your area of interest as well as your practice immersion (practicum) setting. Examples of the integration of community health, leadership, and an EBP can be found on the “Educational and Community-Based Programs” page of the Healthy People 2020 website.

Write a 500-750 word description of your proposed capstone project topic. Make sure to include the following:

1. The problem, issue, suggestion, initiative, or educational need that will be the focus of the project
2. The setting or context in which the problem, issue, suggestion, initiative, or educational need can be observed.
3. A description providing a high level of detail regarding the problem, issue, suggestion, initiative, or educational need.
4. Impact of the problem, issue, suggestion, initiative, or educational need on the work environment, the quality of care provided by staff, and patient outcomes.
5. Significance of the problem, issue, suggestion, initiative, or educational need and its implications to nursing.
6. A proposed solution to the identified project topic

You are required to retrieve and assess a minimum of 8 peer-reviewed articles. Plan your time accordingly to complete this assignment

INSTRUCTIONS

The Case of Marisol

Marisol is a 40-year old single female from a tight knit Puerto Rican family. She is employed full time as a data analyst for a technology company. She has steadily progressed in her career by working for relatively small companies where her role allowed her to work relatively independently. Unfortunately, working for small organizations was less stable financially so she has been working for a larger company for the past four years. Interacting with a larger work group has challenged her comfort zone. She prefers to spend time with a network of close friends she has known most of her life whom she visits with one on one. Her family lives in the area, and she sees them frequently. Her parents and older brother have always provided a support system and practical help. She enjoys quiet evenings alone or at the home of her brother and his family. Her friends and family privately wonder why she’s never dated or wanted to travel.

For each case study, you will complete a descriptive diagnosis using tools you select from the list of assessment tools provided later in the assignment. Each case requires the following information to be addressed:

• Identify presenting concerns from the client’s perspective as described in the video and accompanying narrative. Include relevant cultural and systemic considerations that frame the client’s presentation.
• Describe what information is still needed to make a differential diagnosis and evaluate how at least one assessment tool, which is listed in the List of Assessment Tools resource, will aid in obtaining that information. The Differential Diagnosis Decision Tree may be helpful to guide this process.
• Present DSM-5 and ICD-10 codes, including relevant V and Z codes.
• Provide a descriptive rationale for the DSM diagnosis that best fits the information provided including relevant ICD codes. This should be written in a narrative form using complete sentences. Support your rationale with scholarly sources. Optional readings found in the course syllabus may be particularly relevant.
• Determine if a medication consultation is appropriate and provide a rationale with support from scholarly sources.

LIST OF ASSESSMENT TOOLS AND SUPPORTING RESOURCES

• Beck, A. T., Epstein, N., Brown, G., & Steer, R. (1988). Beck Anxiety Inventory. Psyctests, doi:10.1037/t02025-000
  • Bardhoshi, G., Duncan, K., & Erford, B. T. (2016). Psychometric meta‐analysis of the English version of the Beck Anxiety Inventory. Journal of Counseling & Development, 94(3), 356–373.
    • Review this source to review how to interpret the Beck Anxiety Inventory.
• Derogatis, L. R. (1977). Symptom checklist-90–revised. Psyctests, doi:10.1037/t01210-000
  • Grande, T. L., Newmeyer, M. D., Underwood, L. A., & Williams, C. R. (2014). Path analysis of the SCL-90-R: Exploring use in outpatient assessment. Measurement and Evaluation in Counseling and Development, 47(4), 271–290.
    • Review this source to review how to interpret the SCL-90-R.
• Prevatt, F., Dehili, V., Taylor, N., & Marshall, D. (2015). Anxiety Symptom Checklist. Psyctests, doi:10.1037/t39906-000
• Beck Depression Inventory–II
  • Erford, B. T., Johnson, E., & Bardoshi, G. (2016). Meta-analysis of the English version of the Beck Depression Inventory–Second edition. Measurement and Evaluation in Counseling and Development, 49(1), 3–33.
    • This resource will help you use the Beck Depression Inventory-II if you access that assessment tool.

SUBMISSION REQUIREMENTS

• Written communication: Written communication must be grammatically correct and free of errors that detract from the overall message. Writing should be consistent with graduate level scholarship.
• APA formatting: Title page, main body, and references should be formatted according to the current APA style and formatting.
• Number of resources: Minimum of six scholarly resources. Distinguished submissions typically exceed this minimum.
• Length of paper: 5–7 typed double-spaced pages. Abstract and Table of Content pages are not necessary.
• Font: Times New Roman, 12 point.

An RN working in the Intensive Care Unit (ICU) is caring for a patient with an acute gastrointestinal hemorrhage related to Hepatitis C liver damage that resulted from cocaine abuse. At the end of the shift, the outgoing RN states to the incoming RN, “I have been in that patient’s room all day, transfusing blood products. It’s such a waste of resources. Why should we even bother to treat him, since he will just be using cocaine again after discharge?”

Initial Discussion Post:

Address the following:
What is the most appropriate way for the incoming RN to approach this situation after hearing the outgoing nurse’s comments? Include ethical and legal considerations.
What is the role of an RN in addressing the value system of other health care workers that may have a negative impact on patient care? Include ethical and legal considerations.
Should an RN be able to refuse an assignment if a patient’s value system is in direct conflict with his/her own? Why or why not? Include ethical and legal considerations.

350 words

 APA format  no more than 5 years

and in text citation