Chamberlain NR601 Week 5 Assignment Clinical Patient
Chamberlain NR601 Week 5 Assignment Clinical Patient
Addendum to Directions:
NR601 Primary Care Mature & Aging Adults
Week 5 Assignment: Clinical Patient
This patient is your clinical patient for week 5. You are the Student NP Provider making decisions about your patient. This is not a group assignment. This is an individual assignment. Chamberlain NR601 Week 5 Assignment Clinical Patient
1). You must cite current Clinical Practice Guidelines for primary & secondary diagnoses. If there are 2021 versions you must cite 2021. No Exceptions
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- You must cite 2 Scholarly Provider (NP, PA, MD, DO) Journal articles & at least 1 scholarly evidence-based journal article published in the last 5 years to support your work.
Textbooks, other books, .orgs, .edu’s, CDC, Stat Pearls & other websites cannot be cited. No Exceptions
- Medications: you must cite Online Prescribers Digital Reference (PDR) or CPG or Journal No Exceptions
Medication costs: You must cite Pharmacy Checker: https://www.pharmacychecker.com/drug- price-comparisons/#!. No Exceptions
Pharmacy Checker: Type in the medication, next page scroll to the bottom of the page, add quantity & your zip code to review the options for the lowest cost options. No Exceptions
4). This is your patient in a primary care clinical environment. You make the decisions in the role of NP provider using the Clinical Practice Guidelines & current evidence to provide Best Practice care. This is an individual assignment.
- 2 submission limit to Turnitin – Review policy No Exceptions 6). All submissions & TII reports are reviewed by your Professor
Clinic Patient
Week 5 Assignment: Clinical Patient Annika Chase Carter
Chart 0002100
75-year-old Female with complaints of a sore near her R ankle. She said it has been there since she worked in her rose garden about a week ago. She washed it with soap and water the day it happened.
Have you tried any OTC topical antibacterial ointments? No, nothing but soap and water once and a band aid.
It looks like a scrape. Let’s have the MA cleanse the area. We will apply some Neosporin today and give you some samples to take home with a couple of band aids. If it is not better in 3 days, come back to the office.
Did we review your recent lab values last time you were her for an appointment?
No, I don’t remember talking about the labs. Is anything wrong?
Let’s start with the normal values and go from there and discuss next steps. General overview of patient: complete in outline document
Current medications: Vitamin D, OTC Capsaicin topical for L knee pain, 1st dose Pfizer COVID vaccine 2021.
PMH: Lap chole about 10 years ago, fractured ulna age 10 bike accident, 2 live births, NSVD.
FH: married 45 years, 1 daughter, no health issues, siblings: 1 sister endometrial cancer-survivor, Mother deceased breast cancer, Father deceased 68 years old unknown cause.
SH: Retired Xray Tech, no illicit drug use, drinks 1-2 glasses of wine weekends. No tobacco or illicit drug use.
Allergies: Penicillin/hives
Vital signs: BP 138/80; pulse 80, regular; respiration 18, regular Height 5’0, weight 180 pounds
HEENT: head normocephalic. Eyes clear without exudate. Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender. Nares patent without exudate. Neck supple. Anterior cervical lymph nontender to palpation. No lymphadenopathy. Thyroid midline, small and firm without palpable masses.
CV: S1 and S2 RRR no murmurs.
Lungs: Bilaterally clear to auscultation, respirations unlabored.
Abdomen: soft, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits. No CVAT.
Derm: R ankle 2cm circular scrape with scab.
+pedal pulses bilaterally
Laboratory Tests
| UA | pH 5.2 RBC (-)
Leukocyte Esterase (-) Nitrates (-) Glucose (-) Protein Trace Ketone (-) |
| Complete Blood Count | RBC 4.92 million HGB 12.4gm/dl HCT 40%
MCV 84 fl MCHC 32 g/dl RDW 13.6% WBC 4200/mm3 |
| CMP | NA+ 138
K+ 4.2 Chloride 98 Glucose 99 BUN 12 Creatinine 1.00 GFR non-AA 94 mL/min GFR est AA 99 mL/min CA 9.5 Total Protein 7.7 Bilirubin total 0.6 Alk phos 74 AST 34 ALT 36 Bun/Creatinine 10 |
| Thyroid | Free T4 0.6 |
| TSH 2.05 | |
| HbA1c | 7.9% |
| Lipid Panel (fasting) | LDL-C 194 mg/dL
HDL-C 50 mg/dL Total-C 236 mg/dL Triglycerides 132 mg/dL |
Diagnostics –
EKG: normal sinus rhythm
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Remove all red instructions before submission to gradebook
Introduction
(General Patient Overview in your own words. You are the NP provider)
Diagnosing Your Clinical Patient
Based on data collected discuss 3 Differential Diagnoses for your patient: (in your own words)
Basis for your decision for Primary Diagnosis: (explain in your own words, paraphrase, cite scholarly provider article)
Based on your findings, (physical exam, lab values, diagnostics) what is the primary diagnosis for your patient today? Cite 2021 ADA Clinical Practice Guideline: What information in the CPG let you to this primary diagnosis? (paraphrase & cite in your own words content from the 2021 ADA guideline.)
Interpret Labs: (include lab values in your descriptions) Number each lab #1, #2, etc. (Cite Current Scholarly Provider Reference)
Primary Diagnosis ICD10 Code:
Pathophysiology (cellular level) for primary diagnosis: (Cite current scholarly provider article/evidence)
Based on your findings (physical exam, lab values, diagnostics) what is the Secondary diagnosis for your patient? Cite current Clinical Practice Guideline: (paraphrase & cite in your own words content from the CPG you chose led you to this diagnosis?)
Interpret Labs: (include lab values in your descriptions) Number each lab #1, #2, etc. (Cite current scholarly reference)
Secondary Diagnosis ICD10 Code:
Pathophysiology (cellular level) for secondary diagnosis: (cite current scholarly references, paraphrase in your own words)
Will you (NP Provider) Order Lab Tests?
Based on the CPG information what lab tests do you need to order and why. Provide an explanation in your own words for each lab test you order for your patient. Number each test. (1, 2, 3, etc). Cite CPG and/or scholarly provider journal articles. Chamberlain NR601 Week 5 Assignment Clinical Patient
Lab Orders:
Will you (NP Provider) order medications?
Based on the data collected & lab orders you wrote will you order medications? Write out each medication in RX format and number each medication #1, #2, #3, #4 etc. Provide an explanation as to why the patient needs each medication. Cite current CPG or current scholarly provider journal article.
Medication Orders: (Cite current scholarly reference for each medication)
#1
Foundation for orders (link to diagnosis):
#2
Foundations for your orders (link to diagnosis):
Personalized Patient Education: Explain these areas & fully describe to your patient in your own words, laymen’s terms as an NP provider. Paraphrase & cite a current scholarly CPG or current scholarly provider reference for each area of education. Link the diagnoses you chose to the education.
Fully Describe Education: All Diagnoses:
Fully Describe Education for Medications: Dosage, Frequency, MOA, Contraindications, Side Effects, Special Instructions:
.
Fully Describe Education for Fluids, Calories, Meal, Diet, & Snack Planning:
Fully Describe Education for Physical Activity, Exercise, Cardiovascular Strength, Muscle Strength. Assist your patient with understanding the importance of health:
Additional Medical Care: Does your patient needs any referrals or consults? Include the Best Practice information for referring the patient. Number each referral. Cite Current CPG for each referral.
#1
#2
#3
#4
Return to Office: Explain why & when. Include exact time frame. What is the foundation for this office visit? (Cite current CPG)
Concern For Your Patient: Physiological & Psychological Disorders Co-Existing with Primary Diagnosis (Cite current CPG)
Calculate your patients Medication Costs in the WellRX online website (No Exceptions) using your zip code (write paragraph format, review grading rubric for this section to include all components.
Conclusion
(Summarize & fully describe your NP provider experience with your patient in your own words)
References (APA 7th Edition)
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