NR601 Week 3 Discussion Part 1 and 2

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PART 1

Mr. M.J. is a 64-year-old patient of Hispanic descent who presents to the clinic today with concerns about epigastric and substernal pain that has gotten progressively worse over the past 3 months. He complains of mild “heartburn after eating a large meal for at least 2 years. He has tried over the counter products occasionally with adequate response. Three months ago, he was awakened with severe burning discomfort that extended from his mid-chest to his jaw that lasted 30 minutes before he was able to fall back to sleep. He is now experiencing these attacks about 3 times per week. He has tried avoiding large meals and is now sleeping on two pillows at night to relieve his pain which has improved his pain. The pain now occurs regularly after meals and randomly during the day. He takes antacids with each meal, but the pain still persists. Overall, he considers himself to be very healthy.

Past Medical History

Depression diagnosed 6 months ago

Family History

Unknown; was adopted from an orphanage when he was 3 months old; Wife died of breast cancer approximately 8 months ago. They were unable to have children.

Social History

Drinks beer occasionally when out with friends

No smoking history

Current Medications

Multivitamin daily

Discussion Questions Part One

Describe how you would work-up this patient’s abdominal pain based on current clinical guidelines.

Provide further ROS questions needed to develop differential diagnoses.

Provide the differential diagnoses (DD) with rationale.

Decide whether or not this patient should also be worked-up for depression. Why or why not?

Based on the data provided, what types of screening tools would be useful in this patient’s case?

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PART 2

S. (Subjective)

CC – Mild “heartburn” after eating a large meal for at least 2 years.

Background: Mr. M.J. is a 64-year-old patient of Hispanic descent who presents to the clinic today with concerns about epigastric and substernal pain that has gotten progressively worse over the past 3 months. He has tried over the counter products occasionally with adequate response. Three months ago, he was awakened with severe burning discomfort that extended from his mid-chest to his jaw that lasted 30 minutes before he was able to fall back to sleep. He is now experiencing these attacks about 3 times per week. He has tried avoiding large meals and is now sleeping on two pillows at night to relieve his pain which has improved his pain. The pain now occurs regularly after meals and randomly during the day. He takes antacids with each meal, but the pain still persists. Overall, he considers himself to be very healthy.

HPI:

Current Medications:

PMH:

Social Hx:

Family Hx

Focused ROS and Physical Exam:

ROS:

Objective:

Physical examination:

Primary Diagnosis:

Differential Diagnosis:

Plan:

NR 601 Primary Care of the Maturing and Aged Family – NR601 Week 3 Discussion Part 1 and 2

Week 6 Discussion

DQ1 Post Menopausal and Sexuality Issues in the Maturing and Older Adult

Students will not receive credit for any discussions posted after Sunday 11:59pm MT.

Ageism and gender bias can affect who and how we ask about sexual health, sexual activity, and concerning symptoms. Depending on your own level of comfort and cultural norms this can be a tough conversation for some providers. But this is an important topic and as our videos discussed, women are wanting us to ask about sexual concerns. This week we also reviewed sexually transmitted diseases and the effects of ageism on time to diagnosis so it is necessary to ask these questions and provide good education for all patients. You will not know any needs unless you ask.

Discussion Questions:

Review the required NAMS videos. What was the most surprising thing you learned about in the videos? Explain why it was surprising.

What is GSM? What body systems are involved? How does this affect a woman’s quality of life?

What treatment does Dr Shapiro recommend?

Review one aspect of treatment that Dr Shapiro recommends and include an EBP journal article or guideline recommendation in addition to referencing the video in your response.

Sexuality and the older adult

What is your level of comfort in taking a complete sexual history? Is this comfort level different for male or female patients? If so, why?

How will this information impact the way you will interact with your mature and elderly clients?

DQ2 Urologic Concerns in the Maturing and Older Adult

Men and women both can experience urologic concerns with aging. This week’s presentations and readings covered urologic concerns and common problems. Utilize the national guidelines and scholarly references to develop your responses.

Urinary Tract Infections

What risk factors contribute to the development of a UTI in men versus women?

In which sex is a UTI more concerning and why?

It is important to know when to treat a UTI and when not to treat. Is there a particular situation where you would not treat a UTI?

BPH

As a provider it is essential for you to know to interpret DRE findings and what your next step should be. The American Urology Association has specific recommendations based on age. Be sure you know these because the guidelines will guide your patient counseling and treatment plan.

What does the AUA state about drawing PSA levels?

If you do decide to draw a level what specific counseling should you include in your education today?

NR 601 Primary Care of the Maturing and Aged Family

Week 7 Discussion

Reflection

Reflect back over the past seven weeks and describe how the achievement of the course outcomes in this course have prepared you to meet the MSN program outcome #5, the MSN Essential VIII, and the Nurse Practitioner Core Competency # 8 Ethics Competencies.

Chamberlain College of Nursing Program Outcome #5

Advocates for positive health outcomes through compassionate, evidence-based, collaborative advanced nursing practice. (Extraordinary nursing)

Masters Essential VIII: Clinical Prevention and Population Health for Improving Health

Design patient-centered and culturally responsive strategies in the delivery of clinical prevention and health promote on interventions and/or services to individuals, families, communities, and aggregates/clinical populations.

Integrate clinical prevention and population health concepts in the development of culturally relevant and linguistically appropriate health education, communication strategies, and interventions.

NONPF: #8 Ethics Competencies

Integrates ethical principles in decision making.

Evaluates the ethical consequences of decisions.

Applies ethically sound solutions to complex issues related to individuals, populations and systems of care

NR601 Week 3 Discussion Part 1 and 2