Week 10 Discussion: Examining Endocrine, Metabolic and Hematologic Disorders Paper

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In the United States, 25.6 million adults age 20 years or older have diabetes (American Diabetes Association, 2011). If not properly treated and managed, these millions of diabetic patients are at risk for several alterations including heart disease, stroke, kidney failure, neuropathy, and blindness. Proper treatment and management is the key for diabetic patients, and as the advanced practice nurse providing care for these patients, it is your responsibility to facilitate this process. Patient education is critical, as is working with patients to establish a regular pattern for daily activities such as eating and taking medications. When developing care plans for patients, you must keep the projected outcomes of treatment in mind, as well as patient preferences and other factors that might impact adherence to treatment and management plans. In this Discussion, you draw from your Practicum Experience and consider factors that impact the education and treatment of patients with diabetes.

For this Discussion, consider the following three case studies of patients presenting with endocrine, metabolic, and hematological disorders. Week 10 Discussion: Examining Endocrine, Metabolic and Hematologic Disorders Paper.

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Case Study 1: Week 10 Discussion: Examining Endocrine, Metabolic and Hematologic Disorders Paper.

An 82-year-old female presents to the office complaining of fatigue, dizziness, weakness, and increasing dyspnea on exertion. She has a past medical history of atrial fibrillation, hypertension, and hyperlipidemia. Medications include warfarin 2 milligrams po daily, lisinopril 10 milligrams po daily, and simvastatin 10 milligrams po daily. There are no known drug allergies. The physical exam reveals a 5’2” older female. Her weight is 128 pounds, blood pressure is 144/80, heart rate is 98, temperature is 98 degrees Fahrenheit, and O2 saturation is 98%. Further examination reveals the following:

Eyes: + pallor conjunctiva

Cardiac: irregular rhythm. No S3 S4 or M. NO JVD

Lungs: CTA w/o rales, wheezes, or rhonchi

Abdomen: soft, BS +, + epigastric tenderness. No organomegaly, rebound, or guarding

Rectal: no stool in rectal vault. Week 10 Discussion: Examining Endocrine, Metabolic and Hematologic Disorders Paper.

Case Study 2

A 78-year-old female presents to the emergency room after a fall 3 days ago. She recently had a right above-the-knee amputation and was leaning over to pick something up when she fell. She did not want to come to the hospital, but she is having difficulty managing at home because of the pain in her left leg where she fell. Her patient medical history reveals RAKA, peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney disease. Current medications include quinapril 20 milligrams PO daily, Lantus 30 units at bedtime, and Humalog to scale before meals. There are no known drug allergies. The physical exam is negative and x-rays reveal no acute injuries. Laboratory studies reveal a normal white blood cell count: Hgb of 8 and HCT 24. The MCV is normal. Week 10 Discussion: Examining Endocrine, Metabolic and Hematologic Disorders Paper.

Case Study 3

V.G. is a 47 year old African American male with type 2 diabetes diagnosed two years ago. He is for a follow up and complaining of increased tingling to the lower extremities. PMH: obesity, dyslipidemia, HTN. He quit smoking smoking two years ago. Denies any alcohol use. SH: lives with alone in a subsidized housing. He is a veteran and relies on food stamps and welfare. Works occasionally. MEDS: he lost his medications and hasn’t taken any in about a week. His chart indicates his is on Lisinopril 20mg, Januvia 50mg QD, Lipitor 40mg QD, PE: 5’9, BP: 160/100 RBG: 415. Week 10 Discussion: Examining Endocrine, Metabolic and Hematologic Disorders Paper.

Week 1 Assignment – Practicum Experience – Journal Entry

As a future advanced practice nurse, it is important that you are able to connect your classroom experience to your Practicum Experience. By applying the concepts that you study in the classroom to clinical settings, you enhance your professional competency. Each week, you will reflect on your Practicum Experiences and relate them to the material presented in the classroom. This week, you begin your Practicum Experiences and will write your first Practicum Journal.

To prepare for this course’s Practicum Experience, address the following in your first Practicum Journal:

Select and describe a nursing theory to guide your practice.

Develop goals and objectives for your Practicum Experience in this course. When developing your goals and objectives, be sure to keep the seven domains of practice in mind.

Create a timeline of practicum activities based on your practicum requirements.

In a one-page journal entry (250-300 words), you should do the following:

Describe your practicum goals and objectives using the seven domains of practice

Discuss a nursing theory that would be used to guide your practice.

Include APA-style citations and references

Week 3 Assignment: Practicum Experience – Episodic SOAP Note #1

In addition to Journal Entries, SOAP Note submissions are a way to reflect on your Practicum Experiences and connect these experiences to your classroom experience. SOAP Notes, such as the ones required in this course, are often used in clinical settings to document patient care. Please refer to the Seidel, et. al. book excerpt and the Gagan article located in this week’s Learning Resources for guidance on writing SOAP Notes.

All SOAP notes must be signed and each page must be initialed by your preceptor. When you submit your SOAP Notes, you should include the complete SOAP Note as a Word document and pdf/images of each page that is initialed and signed by your preceptor. You must submit your SOAP Notes using SAFE ASSIGN.

Please Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.

To Prepare:

Review the Episodic SOAP Note Exemplar provided in this week’s Resources in preparation for this Assignment.

Use the Episodic SOAP Note Template to complete this Assignment.

After completing this week’s Practicum Experience, select a patient that you examined during the last 3 weeks. With this patient in mind, address the following in a SOAP Note:

Subjective: What details did the patient provide regarding his or her personal and medical history?

Objective: What observations did you make during the physical assessment?

Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?

Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management including alternative therapies?

Reflection notes: What would you do differently in a similar patient evaluation?

Please Note: Your Episodic SOAP Note Assignment must be signed by Day 7 of Week 3.

By Day 7 of Week 3

This Assignment is due. You will submit two files for the Week 3 Episodic SOAP Note, including a Word document and pdf/images of each page that is initialed and signed by your preceptor by Day 7 of Week 3.

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Week 6 Assignment: Practicum Experience – Episodic SOAP Note #2

After completing this week’s Practicum Experience, reflect on a patient who presented with abdominal pain. Describe the patient’s personal and medical history, drug therapy and treatments, and follow-up care.

Please Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.

By Day 7 of Week 6

This Assignment is due. You will submit two files for the Week 6 Episodic SOAP Note #2, including a Word document and pdf/images of each page that is initialed and signed by your preceptor by Day 7 of Week 6.

Week 8 Assignment: Practicum Experience – Comprehensive SOAP Note #3

After completing this week’s Practicum Experience, review the Comprehensive SOAP Note Exemplar and Template in this week’s Resources, and reflect on a patient who presented with musculoskeletal disorders or pain. Describe the patient’s personal and medical history, drug therapy and treatments, and follow-up care.

Please Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.

By Day 7 of Week 8

This Comprehensive SOAP Note #3 is due. You will submit two files for the Week 8 Comprehensive SOAP Note #3, including a Word document and pdf/images of each page that is initialed and signed by your preceptor by Day 7 of Week 6.

Week 10 Assignment: Practicum Experience – Journal Entry

To follow up on this course’s Practicum Experience, address the following in your Practicum Reflective Journal:

Select and describe a nursing theory that was used to guide your practice.

What goals and objectives were used for your Practicum Experience in this course? When developing your goals and objectives, were the seven domains of practice in mind?

Were you able to meet the timeline of practicum activities that you set at the beginning of the course in your initial journal based on your practicum requirements? If not, why and how do you plan to meet them in your next practicum experience?

By Day 7

Submit your Reflective Journal.by day 7 of week 10.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the following naming convention: “WK11Assgn1+lastname+first initial”.

Click the Week 11 Assignment 1 link.

Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK11Assgn1+last name+firstinitial.(extension)” and click Open. If you are submitting multiple files, repeat until all files are attached.

Click on the Submit button to complete your submission.

Week 10 Discussion: Examining Endocrine, Metabolic and Hematologic Disorders Paper