Sources needed on some questions and week 4 assignment
Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Head, neck, and face disorders. In Advanced practice nursing in the care of older adults (2nd ed., pp. 127–151). F. A. Davis.
Goldberg, C. (2018b). The eye exam. In C. Goldberg, Practical guide to clinical medicine. Regents of the University of California. https://meded.ucsd.edu/clinicalmed/eyes.htm
Required Media (click to expand/reduce)
Doctors in Training [doctorsintraining]. (2016, October 18). PANCE and PANRE review course sample video—eye disorders part 1 [Video]. YouTube. https://youtu.be/lALqptCrPrs
Recommended Media (click to expand/reduce)
Engage-IL (Producer). (2017p). Nutrition for the older adult [Video]. https://engageil.com/modules/nutrition-for-the-older-adult/
Note: View the Nutrition for the Older Adult video module available in this free course.
Engage-IL (Producer). (2017q). The older adult with visual, hearing, and cognitive impairment [Video]. https://engageil.com/modules/the-older-adult-with-visual-hearing-and-cognitive-impairment/
Note: View The Older Adult with Visual, Hearing, and Cognitive Impairment video module available in this free course.
Engage-IL (Producer). (2017s). Oral health and the older adult [Video]. https://engageil.com/modules/oral-health-and-the-older-adult/
Note: View the Oral Health and the Older Adult video module available in this free course.
Assignment: Assessing, Diagnosing, and Treating Head, Neck, and Face Disorders
Photo Credit: Getty Images/Blend Images
Head, neck, and face disorders are common, and thus you will likely care for elderly patients with these disorders. In your role as an advanced practice nurse, you must be able not only to correctly assess and diagnose patients but also help patients manage the disorder by planning necessary treatments, assessments, and follow-up care.
To prepare:
• Review the case study provided by your Instructor.
• Reflect on the patient’s symptoms and aspects of disorders that may be present.
• Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.
• Access the Focused SOAP Note Template in this week’s Resources.
Instructions :
The Assignment:
Complete the Focused SOAP Note Template provided for the patient in the case study. Be sure to address the following:
• Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding their history of present illness and personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list to the American Geriatrics Society Beers Criteria®, and consider alternative drugs if appropriate. Provide a review of systems.
• Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results?
• Assessment: Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
• Plan: Provide a detailed treatment plan for the patient that addresses each diagnosis, as applicable. Include documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, caregiver support, and any planned follow-up visits. Provide a discussion of health promotion and disease prevention for the patient, taking into consideration patient factors, past medical history (PMH), and other risk factors. Finally, include a reflection statement on the case that describes insights or lessons learned.
• Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines, which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. Follow APA 7th edition formatting.
NOTE!!!!!!!
6540 NRNP Week 4 Begins Dec. 20 – Head, Neck, and Face Disorders
IMPORTANT FEEDBACK:
Please complete the required readings and media, use these in your references as appropriate.
Please review the Rubric provided in BB.
Submit in the Originality report section.
Just a reminder that you are responsible to read all the required readings for the week in BB, all the information & rubrics, as well as all of the feedback that I give you. The information that I provided included that soap notes are virtual: meaning that as the student you fill in any missing or pertinent information that you feel is important to the case (YES, you are ‘filling in the blanks” Use your experience with past patients to do this).
This would include VS (if not given) – you can choose a weight, and you will need to calculate the BMI – which is easy to do on your phone, ROS, PE, FH, SH, etc. You also need to provide a paragraph for diagnostics and lab results ( as an NP these are put at the end of the PE, not interspersed in the ROS or PE). This is a major difference between a nursing note and a medical note. I will take points off if there are lab results in the ROS or PE.
CHOICE CASE STUDY:
PLEASE CHOOSE ONE OF THE CASES BELOW FOR YOUR SOAP NOTE:
Week 4 Case 1
A 76-year-old woman presents today with complaints of nasal drainage, clearing of throat, and occasional nasal congestion, especially on waking in the morning. She has recently moved into an independent living center after living in her home for 40 years. She states that, although she has had these symptoms before, generally the symptoms appeared in the spring, and she associated the nasal drainage with pollination. Because it is winter, she could not identify the trigger of her symptoms.
Chief complaint: Persistent “runny nose” for 3-week duration, associated clearing of throat, and nasal congestion on awakening in the morning.
Objective data: Blood pressure (BP) 130/84, temperature 98.6, pulse 78, respiratory rate 20. WT:___ BMI:____
What further ROS questions will you want to ask her? List at least three.
What physical exam (PE) will you perform on this patient? List at least three.
What are the differential diagnoses that you are considering? Describe at least four.
What laboratory tests will help you rule out some of the differential diagnoses?
You have determined, by choosing your ROS, PE, and differential diagnosis, that this patient has allergic rhinitis (AR). Describe the treatment options for your diagnosis, and what specific information about the prescription will you give to this patient? List at least two treatment options: medications with dose, side effects and/or cautions in the older adult.
When will you have the patient follow up? Be specific.
Write a focused SOAP note for this case. Choose the ROS, PE, and medications you will use in your SOAP note.
Week 4 Case 2
CC: My wife seems to be having trouble hearing me when I talk. She is turning the TV up loud.
HPI: Mary is an 88-year-old African American (AA) female married for 50 years to Albert. Albert complains that Mary cannot hear or hears but does not understand (especially in a group); turns up radio or television louder to hear (also noted by family, friends, and neighbors); Mary complains of tinnitus; and she feels like people are “mumbling.”
PMH: Mary takes ramipril for hypertension (HTN), a baby aspirin for cardio protection, and a statin for hypercholesterolemia.
Vital signs are 120/88 P: 88 P02: 96% WT: 156 HT: 5’6” BMI:
_____
ROS: Ask if Mary has had any exposure to ototoxic drugs or other otic damage in the past. Describe at least three.
PE: What examinations will you perform on the ear? Describe the areas of the ear you will evaluate and what you will expect to find.
Diagnostic Testing: Please describe at least three (3) methods to test for hearing.
You determine that Mary has a hearing deficit and tinnitus. What differential diagnoses do you want to consider? Describe at least three.
What will your treatment plan for this patient be?
What other recommendations will you make (i.e., screening)?
What referrals will you make?
Education: Name at least two things you will educate your patient about regarding their hearing.
Choose the ROS, PE, and DD and final diagnosis for this patient, and then write up your focused SOAP note.
—
The week 4 assignment requires sources.
Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). (2019). Kopf-Neck-Face Disorders 127–151 in Advanced practice nursing for older persons. DAVIS, F.
Goldberg (2018b). EYE EXAM , C. Goldberg, Clinical medicine: UC Regents https://meded.ucsd.edu/clinicalmed/eyes.htm
Media (click to enlarge/reduce)
Doctors in Training (2016, October 18). The first section of the PANCE and PANRE review course [Video]. YouTube. https://youtu.be/lALqptCrPrs
Media Suggestions (click to enlarge)
Engage-IL (Producer). (2017p). Senior nutrition [Video]. https://engageil.com/modules/nutrition-for-the-older-adult/
View the free course’s Nutrition for Older Adults video module.
Engage-IL (Producer). (2017q). Blind, deaf and cognitively impaired older adults [Video]. https://engageil.com/modules/the-older-adult-with-visual-hearing-and-cognitive-impairment/
View the free course’s video module on The Older Adult with Visual, Hearing, and Cognitive Impairment.
Engage-IL (Producer). (2017s). [Video] Oral health in the elderly https://engageil.com/modules/oral-health-and-the-older-adult/
View the Oral Health and Aging video lesson in this free course.
Anatomy of the Head-Neck-Face
Getty Images/Blend Images
You will likely care for older individuals with head, neck, and face issues. To be an advanced practice nurse, you must be able to accurately assess and diagnose patients while also planning treatments, assessments, and follow-up care.
• Review your instructor’s case study.
• Consider the patient’s symptoms and any underlying disorders.
• Consider how you may assess, diagnose, and treat patients with the symptoms in this situation.
Obtain this week’s Focused SOAP Note Template.
Directions:
The Assignment:
The case study patient’s Focused SOAP Note Template is provided. Address the following:
In what way did the patient feel? What information did the patient disclose about their current disease, personal and medical history? Include a list of current prescription and OTC medications. Compare this list to the AGS Beers Criteria® and investigate alternatives. Review systems.
• Objective: What did the physical assessment reveal? Was the lab, imaging, or functional testing resulted?
• Assessment: Provide three differential diagnoses. Prioritize them from highest to lowest. Compare the diagnostic criteria for each differential and explain why. Describe your critical thinking process that led to your primary diagnosis. Include the patient’s specific positives and negatives.
• Plan: Create a treatment plan for the patient that addresses all diagnoses. Be sure to capture the results of any diagnostic tests, referrals to other health care professionals and any planned follow-up appointments. Discuss with the patient health promotion and illness prevention, taking into account patient variables, past medical history, and other risk factors. Finally, include a case reflection statement describing key takeaways.
• Support your diagnostic and differential diagnosis with at least three peer-reviewed journal publications or evidence-based guidelines. Ensure they are up-to-date (less than 5 years old) and complement the treatment strategy. Format in APA 7th edition.
NOTE!!!!!!!
The NRNP Week 4 topic is Head, Neck, and Face Disorders.
NOTICE:
Please complete the prescribed readings and media and cite them appropriately.
Examine the rubric in BB.
Send it to the originality section.
Just a reminder that you must read all required readings for the week in BB, all information & rubrics, and all feedback from me. As a student, you fill in any missing or significant information that you feel is important to the case (YES, ‘fill in the blanks’ using past patient experience).
Then there’s VS (if not supplied) — you can choose a weight and compute your BMI on your phone. Include a paragraph for diagnosis and lab results ( as an NP these are put at the end of the PE, not interspersed in the ROS or PE). This distinguishes a nursing note from a medical note. I will deduct points if the ROS or PE has lab results.
SELECT A CASE FOR YOUR SOAP NOTE:
W4C1 Case 1
A 76-year-old lady complains of nasal drainage, throat clearing, and nasal tightness, especially in the morning. After 40 years in her house, she recently moved into an independent living complex. Her symptoms always arose in the spring, and she related the nasal drainage with pollination. Because it was winter, she couldn’t pinpoint her symptoms.
Complaint: 3-week-long “runny nose,” throat clearing, and morning nasal congestion.
Observations: BP 130/84, temp 98.6, pulse 78, respiration rate 20.
What more ROS questions do you have for her? List three.
What physical exam (PE) will you give him? List three.
What are your differential diagnoses? Describe four.
That is, what lab tests will Help you rule out some of the diagnoses?
You choose allergic rhinitis as the patient’s ROS, PE, and differential diagnosis (AR). Describe the therapy possibilities for this patient’s diagnosis. Mention two therapy alternatives, including dosage, adverse effects, and/or warnings for the elderly.
When will the patient be contacted? Specify.
Create a case-specific SOAP note. Pick your ROS, PE, and meds for your SOAP note.
Week 4 Case 2 CC: My wife has problems hearing me. She’s cranked up the TV.
Mary, 88, is an African American woman married to Albert for 50 years. (Noted by family, friends, and neighbors) Albert says that Mary can’t hear or hears but doesn’t comprehend (particularly in a group); Mary complains of tinnitus; and she thinks others are “mumbling.”
Mary takes ramipril for HTN, aspirin for cardiovascular prevention, and a statin for hypercholesterolemia.
WT: 156 HT: 5’6” BMI:
Ask if Mary has ever been exposed to ototoxic medications or other otic harm. Describe three.
PE: What ear exams will you do? Describe the ear locations you will examine and what you will find.
Describe three (3) procedures to test for hearing.
Mary suffers a hearing loss and tinnitus. You want to consider differential diagnoses. Describe three.
What is your patient’s treatment plan?
What other suggestions (screening) do you have?
What will you recommend?
Education: Name two things you’ll teach your patient about hearing.
Write down the patient’s ROS, PE, DD, and ultimate diagnosis in your focused SOAP note.
