Advanced Practice Care of Adults

Advanced Practice Care of Adults

Psychosocial health conditions present many challenges in acute care settings. Consider a hospitalized patient who has depression and suffers from panic disorders. Such a patient not only may have comorbid health conditions but, like many patients diagnosed with psychosocial health conditions, also is more likely to be non-compliant with treatment regimens. Patients with psychosocial health conditions also have an increased risk of being readmitted to the hospital (American Hospital Association, 2012).

As an advanced practice nurse, you will often be the first point of contact for patients seeking treatment for psychosocial health conditions. Therefore, it is essential that you be able to stabilize and manage patients with multiple conditions, help them develop strong support systems, and ensure adherence to treatment plans.

This week, as you explore presentations of psychosocial health conditions in acute care settings, you will examine strategies for assessing, diagnosing, and treating patients with psychosocial health conditions.

Learning Objectives

By the end of this week, students will:

• Evaluate patients with psychosocial health conditions
• Develop differential diagnoses for patients with psychosocial health conditions
• Develop treatment plans for patients with psychosocial health conditions

Photo Credit: Plume Creative/DigitalVision/Getty Images

Learning Resources

Required Readings

Note: Because the information in this course is so vital, numerous resources are provided in various formats to facilitate your competence in caring for patients in acute care settings. When multiple resources are available on the same topic, select those that best meet your personal learning needs.

Papadakis, M. A., McPhee, S. J., & Rabow, M. W. (2018). Current medical diagnosis & treatment (57th ed.). New York, NY: McGraw Hill.

• Chapter 25, “Psychiatric Disorders” (pp. 1059-1116)

American Psychiatric Association. (n.d.). American Psychiatric Association practice guidelines. Retrieved October 27, 2014, from http://psychiatryonline.org/guidelines.aspx

Sutphen, S. (2006). New drugs; New overdoses: Highlights from the American College of Emergency Physicians meeting (ACEP). Retrieved from http://www.medscape.com/viewarticle/548191_3

Required Media

Laureate Education (Producer). (2014). Assessment of psychosocial health conditions. Baltimore, MD: Author.

You will use the case studies presented in the media, Assessment of Psychosocial Health Conditions, to complete this week’s Discussion. NURS 6550 – Psychosocial Health Conditions Essay Assignment papers – Advanced Practice Care of Adults in Acute Care Settings I

Zipped Folder: “Assessment of psychosocial health conditions”

i-Human Patient Cases. (2014). Retrieved from https://ih2.i-human.com/users/sign_in

 

Note: You should have received an e-mail with your i-Human Patients login and password information. If you have not received this information, please contact the course Instructor.

Optional Resources

Godara, H., Hirbe, A., Nassif, M., Otepka, H., & Rosenstock, A. (2014). The Washington manual of medical therapeutics (34th ed.). Baltimore, MD: Lippincott Williams & Wilkins.

Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F.A. Davis.

Discussion Part I: Assessment of Psychosocial Health Conditions

In acute care settings, patients with psychosocial health conditions may present with a variety of complex symptoms that require comprehensive assessment. The results from this assessment are crucial to developing a diagnosis and creating an individualized treatment plan for a patient. For this Discussion, you focus on the assessment as you consider case studies of patients with psychosocial health conditions. You determine what history should be collected from the patients as well as what physical exams and diagnostic tests should be conducted, and you formulate a differential diagnosis with several possible conditions. NURS 6550 – Psychosocial Health Conditions Essay Assignment papers – Advanced Practice Care of Adults in Acute Care Settings I

To prepare:

• Review this week’s media in Assessment of Psychosocial Health Conditions and select one of the three case studies.
• With the case study you selected in mind, reflect on the patient information provided.
• Think about the health history you would need to collect from the patient.
• Consider what physical exams and diagnostic tests would be appropriate to help you gather more information about the patient’s condition. Reflect on how results might be used to make a diagnosis.
• Identify at least five possible conditions to consider in a differential diagnosis for the patient.

By Day 3

Post a description of the health history you would need to collect from the patient in the case study you selected. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five possible conditions for the patient’s differential diagnosis and justify why you selected each.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition and justify your reasoning.

Discussion Part II: Pharmacology

To prepare:

Read the following articles to enhance your knowledge of commonly prescribed medications:

Sutphen, S. (2006). New drugs; New overdoses: Highlights from the American College of Emergency Physicians meeting (ACEP). Retrieved from http://www.medscape.com/viewarticle/548191_3

All of the following medications are commonly prescribed in the acute care setting. Choose one of the drugs below to discuss. (This is a good way for you to prepare for clinical practice, because you will get to know the drugs you will prescribe for patients.). Focus your discussion on the hospital or ICU setting and IV usage.

1. Benztropine,
2. Clomipramine
3. Physostigmine
4. Diphenhydramine,
5. Scopolamine
6. Droperidol
7. Valproate
8. Haloperidol
9. Ketamine

Note: When sharing your initial post, select a topic that has not yet been discussed. If all topics have been discussed, then you may select that topic again, but select a different drug within the medication group. NURS 6550 – Psychosocial Health Conditions Essay Assignment papers – Advanced Practice Care of Adults in Acute Care Settings I

By Day 3

For this Discussion, address 1 of the following options:

Option 1

Post a description of a patient you have taken care of (inpatient as an RN, or as an NP student) who has been prescribed the medication you selected. Include the scenario, indication, dosing, complications, and outcome. Then explain whether or not you would have ordered the same drug and same dose.

Option 2

Conduct an evidence-based drug search on the drug you selected and post an explanation of any possible issues. Are there any drug interactions? Any black box warnings? To what type of patient would you prescribe this medication?

Option 3

Post an explanation of the properties of the drug you selected, including usages and dosing in the hospital or ICU. Discuss a patient to whom you would prescribe this medication.

Note: To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.

Submission and Grading Information

Grading Criteria

Week 2 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 2 Discussion

Assignment: Assessing, Diagnosing, and Treating Psychosocial Health Conditions

When patients in acute care settings present with psychosocial health conditions, advanced practice nurses are responsible for stabilizing them, making diagnoses, establishing treatment regimens, and transitioning patients to outpatient and community-based services. Advanced practice nurses must also maintain the safety, dignity, and confidentiality of all patients while coordinating care with the multidisciplinary care team. For this Assignment, as you examine this week’s i-Human patient case study, consider how you might evaluate and treat patients presenting with psychosocial health conditions.

To prepare:

• Review this week’s i-Human case study. Based on the provided patient information, think about the health history you would need to collect from the patient.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
• Identify three to five possible conditions to consider in a differential diagnosis for the patient.
• Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
• Reflect on a treatment plan for the patient that includes health promotion and patient education strategies.

To complete:

As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Patients Case Player Student Manual in the Week 1 Learning Resources.

NURS 6550 – Psychosocial Health Conditions Essay Assignment papers – Advanced Practice Care of Adults in Acute Care Settings I

	Novice	Competent	Proficient
HPI statement	0 (0%) – 5 (5%) Poorly written HPI statement. Incomplete ideas and sentences. Lacks basic history taking skills	6 (6%) – 10 (10%) Well written HPI statement but may be missing 1-2 key components from the history	11 (11%) – 15 (15%) Clearly written HPI statement with comprehensive information gathering from case questions.
Objective testing and physical exam	0 (0%) – 5 (5%) Poorly written physical examination. May be missing 3 or more key exam findings that are critical to patient’s diagnosis. Includes 3 or more inappropriate exams or tests.	6 (6%) – 10 (10%) Well written physical examination but may be missing 1-2 key exam findings critical to patient’s diagnosis. May include 1-2 unnecessary exams or tests.	11 (11%) – 15 (15%) Clearly written physical examination covering all critical components of a focus exam. Tests that are ordered are appropriate for patient and cost effective.
Assessment	0 (0%) – 10 (10%) Differential diagnosis list too brief and inconclusive. May be missing 3 or more critical components. Priority list may be out of order. Primary diagnosis may be wrong.	11 (11%) – 19 (19%) Well written differential diagnoses. May be missing 1-2 critical components. Correct primary diagnosis identified.	20 (20%) – 25 (25%) Clearly written differential diagnoses. Primary diagnosis identified.
Plan for patient	0 (0%) – 15 (15%) Poorly written plan. May be missing 3 or more key issues that are critical to patient’s diagnosis.	16 (16%) – 25 (25%) Well written plan but may be missing 1-2 key issues critical to patient’s diagnosis.	26 (26%) – 30 (30%) Clearly written plan covering all critical components for patient’s final diagnosis.
Clinical Questions	0 (0%) – 10 (10%) Correctly answered 0-69% of the clinical questions.	11 (11%) – 13 (13%) Correctly answered 70-89% of the clinical questions.	14 (14%) – 15 (15%) Correctly answered 90-100% of the clinical questions.

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