Please read the instructions and answer the questions. Be aware that it is master level, APA format 6 edit, more than 3 updated references. 

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?

Unit 7 Class Participation: Polit and Beck (2018), Chapter 14 pp. 227 – 233, 238, or 242 – 259
 

Due Sunday, 2/17 at 11:59 PM.

1. The highest potential points for in-class participation are 5-points. Please use these guidelines for online  participation.

1. To earn points for weekly class participation, you must submit a one paragraph (100-125 words) summary of one of the required Polit and Beck (2018) readings from each unit.
2. APA format is not required, but the material must be paraphrased, cited, and referenced. The citation and reference will always be Polit and Beck (2018). Include the page number(s) you found the material on in your citation.
3. Polit, D. E & Beck, C. T. (2018). Essentials of nursing research: Appraising evidence for nursing practice(9th. ed.). Philadelphia, PA: Wolters Kluwer   
4. Put your name, date, and unit number at the top of the paper, immediately followed by the summary and then the reference.
5. All of the above should be submitted on one page. 

Florence Nightingale was the first modern nurse. She worked during the Crimean War 1854-1856 initially dealing with unsanitary conditions that existed in field hospitals during the war.  Florence Nightingales created the Coxcomb Diagram.  This was a monthly analysis categorizing death from wounds, death from preventable diseases, and death from all other causes. 

Simple changes to sanitary conditions resulted in dramatic decrease in mortality rates in a 6-month period.

Nightingale founded training schools for nurses in 1860. 

Lillian Ward founded visiting nurse services of New York.  She cared for poor immigrants on the lower east side of Manhattan a practice which continues to this day. 

Ward is credited with the organization of public school nursing designed to decreases absenteeism in NYC schools.

In the 20 th Century improvement to pharmacology made it easier to treat diseases.  There was also a shift from public health to individual well-being.

At first, nurses were trained by hospitals, eventually institutes of higher learning; i.e. colleges and universities. 

One of the greatest changes in the nursing profession are the various education touchstones.  The three most common are diploma, associates and baccalaureate.

Today we treat the whole person and utilize a holistic approach as is seen in the metaparadigm of nursing concepts; nursing, person, environment and health.

Cathy Giomblanco 

Tuesday 

Feb 5 at 7:45pm

Manage Discussion Entry 

U5 DB Initial Post

Presenting and Associated Symptoms

            Chest pain from acute myocardial infarction is usually sudden onset in the substernal area, which may or may not radiate. Associated symptoms are weakness, dyspnea, diaphoresis, nausea, vomiting, palpitations, and anxiety. The pain usually lasts thirty minutes or more. Morphine and nitroglycerin do not completely relieve the pain (Uphold, & Graham, 2013).

Specific diagnostic tests used in the work up

            Vital signs including heart rate, temperature, and blood pressure, and oxygen saturation should be done at regular intervals. Diagnostic tests include a 12 lead ECG, the cardiac biomarkers of CPK with isoenzymes, troponin T or I, high sensitivity C-reactive protein, CBC, erythrocyte sedimentation rate, serum electrolytes, BUN and serum creatinine. Perform a complete heart and lung exam. Assess peripheral pulses, and assess extremities for edema, cyanosis, and clubbing. Echocardiography should be ordered. This is the gold standard in diagnosing wall motion abnormalities, ventricular function, valvular or septal defects, and ejection fractions (Mcconaghy, & Oza, 2013).

1st line therapeutic interventions, patient education and follow up expectations

            The first line therapeutic interventions are: aspirin 162-325 mg chewed, give nitroglycerin every 5 minutes times three doses or until chest pain is perceived as a 0 out of 10 on the pain score. Monitor the patient for hypotension. The patient should be transferred to a hospital emergency department with access to a cardiac catheterization lab. This will allow immediate reperfusion therapy with angioplasty within 2 hours if available (Dunphy, Winland-Brown, Porter, & Thomas, 2015).

Support whether or not you would refer the patient to another health care provider for treatment. Include the name of the specialty and your rationale for the referral.

            Patients who present with chest pain, with or without radiation, SOB, weakness, diaphoresis, nausea, lightheadedness and a suspected MI, should be transported to the ER (Uphold & Graham, 2013). Patients with a negative ECG but their clinical presentation is suspicious should be referred to the ER. Non-urgent cases can be referred to cardiology for further investigation (Biesemans, Cleef, Willemsen, Beatriis, Reniere, Buntinx…Dinant, 2018).

Patient Education

            Patient education should include teaching about medications usage, adverse effects, and how to take nitroglycerin prophylactically. Patients should also be taught proper care of the nitroglycerin tablets. Patients with a higher BMI should be placed on a low-fat reduced calorie diet. Patients should be encouraged to enter a cardiac rehabilitation program of safe exercise and risk factor modification including smoking cessation (Dunphy, Winland-Brown, Porter, & Thomas, 2015).

References

Biesemans, L., Cleef, L. E., Willemsen, R. T. A., Beatrijs, B. N. H., Renier, W. S.,

Buntinx, F., . . . Dinant, G. (2018). Managing chest pain patients in general practice: An interview-based study. BMC Family Practice, 19doi:http://dx.doi.org/10.1186/s12875-018-0771-0

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. A. (2015). Primary care. The art and science of advanced practice nursing. (4th Ed.). Philadelphia, PA. F. A. Davis Company.

Mcconaghy, J. R., & Oza, R. S. (2013). Outpatient diagnosis of acute chest pain in adults.

American family physician. 87(3)177-82. Retrieved from www.aafp.org/afp

 (Links to an external site.)

Links to an external site.

Uphold, C. R., & Graham, M. V. (2013). Clinical guidelines in family practice.

Gainsville, FL. Barmarrae Books, Inc.

 CASE STUDY 3 – Reflecting on week 4’s lessons in the syllabus,select a patient population (pediatric, young adult, adult or geriatric), and briefly analyze a chronic cardiovascular disease (HTN, Heart failure, Dyslipidemia, Heart murmur etc.…), that may affect this population. 

-Tell how it impacts the patient’s quality of life.

– analyze the current research evidence on this topic and gold standard of care for your chosen population (CDC guidelines) . (You may use an example from your clinical rotation (past or present) that you have encountered). 

-Describe how you as Family Nurse Practitioner, can/or have made a difference in the care of patients with this specific disease and tell of one specific patient care teaching that he/she may do to help minimize disease symptoms. Use apa format and References scholarch article no older than 5 years.  (Due 02/12/19.