Assignment: Decision Tree for Neurological and Musculoskeletal Disorders

For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.

Photo Credit: Getty Images/Science Photo Library RF

To Prepare

• Review the interactive media piece assigned by your Instructor. 
• Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.
• Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.
• You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.

By Day 7 of Week 8

Write a 1- to 2-page summary paper that addresses the following:

• Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.
• Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.
• What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.
• Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

This week’s assignment is a written piece that will be not be due until Week 8!!!  

The assignment is based on decision tree interactive media under resources in Week 6.   

I have selected the Alzheimer’s Disease for our focus.   

To Prepare 

• Review the interactive media piece for Alzheimer’s Disease.   
• Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece. 
• Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned. 
• You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment. 

By Day 7 of Week 8 

• Write a 1- to 2-page summary paper that addresses the following: 
• Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. 
• Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources. 
• What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources. 
• Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples. 

three sources for this assignment

 

Reimbursement rates and medical coding can be almost as complicated as treating some mental illnesses. As a PMHNP, you will be faced with varying rates that may be different than other health care providers you may work with.

In this Practicum Journal Assignment, you will analyze reimbursement rates for mental health treatments you will likely use in your practice and compare those rates to other provider rates.

Learning Objectives

Students will:

• Analyze reimbursement rates for mental health treatments

To prepare for this Practicum Journal:

• Research reimbursement rates for various treatment modalities.
• Compare NP rates to other provider rates.

For this Practicum Journal:

Complete the Reimbursement Rate Template in your Learning Resources using the five types of services you are likely to use in your practice.

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mrs. J., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

Subjective Data

1. Is very anxious and asks whether she is going to die.
2. Denies pain but says she feels like she cannot get enough air.
3. Says her heart feels like it is “running away.”
4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

1. Height 175 cm; Weight 95.5kg.
2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

1. IV furosemide (Lasix)
2. Enalapril (Vasotec)
3. Metoprolol (Lopressor)
4. IV morphine sulphate (Morphine)
5. Inhaled short-acting bronchodilator (ProAir HFA)
6. Inhaled corticosteroid (Flovent HFA)
7. Oxygen delivered at 2L/ NC

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

1 Describe the clinical manifestations present in Mrs. J.

2 Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.

3 Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.

4 Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.

5 Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.

6 Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.

7 Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. 

 PLEASE FOLLOW INSTRUCTIONS AND COVER AREAS BELOW TO COMPLETE FOCUSED SOAP NOTE. 

• Review the Focused SOAP Note template, which you will use to  complete this Assignment. There is also a Focused SOAP Note Exemplar  provided as a guide for Assignment expectations.
• Review the video, Case Study: Dev Cordoba. You will use this  case as the basis of this Assignment. In this video, a faculty member is assessing a mock patient. The patient will be represented  onscreen as an avatar.
• Consider what history would be necessary to collect from this patient.
• Consider what interview questions you would need to ask this patient.

The Assignment

Develop a Focused SOAP Note, including your  differential diagnosis and critical-thinking process to formulate a  primary diagnosis. Incorporate the following into your responses in the  template:
 

• Subjective: What details did the patient provide regarding  their chief complaint and symptomology to derive your differential  diagnosis? What is the duration and severity of their symptoms? How are  their symptoms impacting their functioning in life?
• Objective: What observations did you make during the psychiatric assessment?  
• Assessment: Discuss the patient’s mental status examination  results. What were your differential diagnoses? Provide a minimum of  three possible diagnoses with supporting evidence, listed in order from  highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria  rules out the differential diagnosis to find an accurate diagnosis.  Explain the critical-thinking process that led you to the primary  diagnosis you selected. Include pertinent positives and pertinent  negatives for the specific patient case. 
• Plan: What is your plan for psychotherapy? What is your plan  for treatment and management, including alternative therapies? Include  pharmacologic and nonpharmacologic treatments, alternative therapies,  and follow-up parameters, as well as a rationale for this treatment and  management plan. Also incorporate one health promotion activity and one  patient education strategy.
• Reflection notes: What would you do differently with this  patient if you could conduct the session again? Discuss what your next  intervention would be if you could follow up with this patient. Also  include in your reflection a discussion related to legal/ethical  considerations (demonstrate critical thinking beyond confidentiality and  consent for treatment!), health promotion, and disease prevention,  taking into consideration patient factors (such as age, ethnic group,  etc.), PMH, and other risk factors (e.g., socioeconomic, cultural  background, etc.).
• Provide at least three evidence-based, peer-reviewed journal  articles or evidenced-based guidelines that relate to this case to  support your diagnostics and differential diagnoses. Be sure they are  current (no more than 5 years old).

** Three references required

** No plagiarism