NR507 All Discussions May 2023 Latest

NR507

Week 2 Case Study

Discussion

Purpose The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced nursing practice. Scholarly information obtained from credible sources as well as professional communication are required. Application of information to professional experiences promotes the analysis and use of principles, knowledge, and information learned and related to real-life professional situations. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared. Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

1.Explain the pathophysiology of heart failure by analyzing a patient's symptoms. (CO1) 2.Differentiate between systolic and diastolic heart failure. (CO1) 3.Explain the significance of physical exam and diagnostic findings in the diagnosis of heart failure. (CO4) Due Date Initial post is due on Wednesday by 11:59 p.m. MT. All posts are due by Sunday, 11:59 p.m. MT A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59pm MT. Total Points Possible: 100 Preparing the Assignment

Requirements

1.Read the case study below. 2.In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT. 3.Provides a minimum of two responses weekly on separate days; e.g., replies to a post from a peer; AND faculty member's question; OR two peers if no faculty question using appropriate resources, before Sun., 11:59 pm MT. Case Scenario A 72-year-old male presents to the primary care office with shortness of breath, leg swelling, and fatigue. He reports that he stopped engaging in his daily walk with friends three weeks ago because of shortness of breath that became worse with activity. He decided to come to the office today because he is now propping up on at least 3 pillows at night to sleep. He tells the NP that he sometimes sleeps better in his recliner chair. PMH includes hypertension, hyperlipidemia and Type 2 diabetes.

Physical Exam:

BP 106/74 mmHg, Heart rate 110 beats per minute (bpm) HEENT: Unremarkable Lungs: Fine inspiratory crackles bilateral bases Cardiac: S1 and S2 regular, rate and rhythm; presence of 3rd heart sound; jugular venous distention. Bilateral pretibial and ankle 2+pitting edema noted ECG: Sinus rhythm at 110 bpm Echocardiogram: decreased wall motion of the anterior wall of the heart and an ejection fraction of 25% Diagnosis: Heart failure, secondary to silent MI

Discussion Questions

•Differentiate between systolic and diastolic heart failure. •State whether the patient is in systolic or diastolic heart failure. •Explain the pathophysiology associated with each of the following symptoms: dyspnea on exertion, pitting edema, jugular vein distention, and orthopnea. •Explain the significance of the presence of a 3rd heart sound and ejection fraction of 25%

NR507

Week 5 Case Study

Discussion

Purpose The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced nursing practice. Scholarly information obtained from credible sources as well as professional communication are required. Application of information to professional experiences promotes the analysis and use of principles, knowledge, and information learned and related to real-life professional situations. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared. Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

1.Compare and contrast the pathophysiology of diverticular disease (diverticulosis) and acute diverticulitis. (CO1) 2.Identify risk factors for acute diverticulitis and the clinical signs and symptoms associated with the disease. (CO3) 3.Explain the significance of physical exam and diagnostic findings in the diagnosis of diverticular disease. (CO4) Due Date Initial post is due on Wednesday by 11:59 p.m. MT. All posts are due by Sunday, 11:59 p.m. MT A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59pm MT. Total Points Possible: 100 Preparing the Assignment

Requirements:

Read the case study below. In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT. Provides a minimum of two responses weekly on separate days; e.g., replies to a post from a peer; AND faculty member’s question; OR two peers if no faculty question using appropriate resources, before Sun., 11:59 pm MT.

Case Scenario:

An 84-?year-old?-female who has a history of diverticular disease presents to the clinic with left lower quadrant (LLQ) pain of the abdomen that?is accompanied?by with constipation, nausea, vomiting and a?low-grade?fever (100.20?F) for 1 day. On physical exam the patient appears unwell. She has signs of dehydration (pale mucosa, poor skin turgor with mild hypotension [90/60 mm Hg] and tachycardia [101 bpm]). The remainder of her exam is normal except for her abdomen where the NP notes a distended, round contour. Bowel sounds a faint and very hypoactive. She is tender to light palpation of the LLQ but without rebound tenderness. There is hyper-resonance of her abdomen to percussion.?? •The following diagnostics reveal:?? •Stool for occult blood is positive. •Flat plate abdominal x-ray demonstrates a bowel-gas pattern consistent with an ileus.? •Abdominal CT scan with contrast shows no evidence of a mass or abscess. Small bowel in distended.? Based on the clinical presentation, physical exam and diagnostic findings, the patient is diagnosed with acute diverticulitis and she is admitted to the hospital. She is prescribed intravenous antibiotics and fluids (IVF). Her symptoms improved and she could tolerate a regular diet before she was discharged to home. ??

Discussion Questions:

1.Compare and contrast the pathophysiology between diverticular disease (diverticulosis) and diverticulitis. 2.Identify the clinical findings from the case that supports a diagnosis of acute diverticulitis. ? 3.List 3 risk factors for acute diverticulitis. 4.Discuss why antibiotics and IV fluids are indicated in this case.

NR507

Week 7 Case Study

Discussion

Purpose The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced nursing practice. Scholarly information obtained from credible sources as well as professional communication are required. Application of information to professional experiences promotes the analysis and use of principles, knowledge, and information learned and related to real-life professional situations. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared. Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

1.Compares and contrasts the pathophysiology between Alzheimer's disease and frontotemporal dementia. (CO1) 2.Identifies the clinical findings from the case that supports a diagnosis of Alzheimer's disease. (CO3) 3.Explain one hypothesis that explains the development of Alzheimer's disease (CO3)

4.Discuss the patient's likely stage of Alzheimer's disease (CO4)

Due Date Initial post is due on Wednesday by 11:59 p.m. MT. All posts are due by Sunday, 11:59 p.m. MT A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59pm MT. Total Points Possible: 100 Preparing the Assignment

Requirements

1.Read the case study below. 2.In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT. 3.Provides a minimum of two responses weekly on separate days; e.g., replies to a post from a peer; AND faculty member’s question; OR two peers if no faculty question using appropriate resources, before Sun., 11:59 pm MT. Case Scenario A 76-year -old man is brought to the primary care office by his wife with concerns about his worsening memory. He is a retired lawyer who has recently been getting lost in the neighborhood where he has lived for 35 years. He was recently found wandering and has often been brought home by neighbors. When asked about this, he becomes angry and defensive and states that he was just trying to go to the store and get some bread. His wife expressed concerns about his ability to make decisions as she came home two days ago to find that he allowed an unknown individual into the home to convince him to buy a home security system which they already have. He has also had trouble dressing himself and balancing his checkbook. At this point, she is considering hiring a day-time caregiver help him with dressing, meals and general supervision why she is at work. Past Medical History: Gastroesophageal reflux (treated with diet); is negative for hypertension, hyperlipidemia, stroke or head injury or depression Allergies: No known allergies Medications: None Family History •Father deceased at age 78 of decline related to Alzheimer's disease •Mother deceased at age 80 of natural causes? •No siblings Social History •Denies smoking •Denies alcohol or recreational drug use? •Retired lawyer •Hobby: Golf at least twice a week Review of Systems •Constitutional: Denies fatigue or insomnia •HEENT: Denies nasal congestion, rhinorrhea or sore throat.?? •Chest: Denies dyspnea or coughing •Heart: Denies chest pain, chest pressure or palpitations. •Lymph: Denies lymph node swelling. •Musculoskeletal: denies falls or loss of balance; denies joint point or swelling General Physical Exam?? •Constitutional: Alert, angry but cooperative •Vital Signs: BP-128/72, T-98.6 F, P-76, RR-20 •Wt. 178?lbs., Ht.?6'0", BMI 24.1

HEENT

•Head normocephalic; Pupils equal and reactive to light bilaterally; EOM's intact Neck/Lymph Nodes •No abnormalities noted ? Lungs? •Bilateral breath sounds clear throughout lung fields. Heart? •S1 and S2 regular rate and rhythm, no rubs or murmurs.? Integumentary System? •Warm, dry and intact. Nail beds pink without clubbing. ? Neurological •Deep tendon reflexes (DTRs): 2/2; muscle tone and strength 5/5; no gait abnormalities; sensation intact bilaterally; no aphasia Diagnostics •Mini-Mental State Examination (MMSE): Baseline score 12 out of 30 (moderate dementia) •MRI: hippocampal atrophy •Based on the clinical presentation and diagnostic findings, the patient is diagnosed with Alzheimer's type dementia.

Discussion Questions

1.Compare and contrast the pathophysiology between Alzheimer's disease and frontotemporal dementia. 2.Identify the clinical findings from the case that supports a diagnosis of Alzheimer's disease. ?

3.Explain one hypothesis that explains the development of Alzheimer's disease

4.Discuss the patient's likely stage of Alzheimer's disease.