KAPLAN MN569 Full Course Latest 2018 May

MN569 Clinical-Life Span Health Focus
Unit 1 Discussion

Topic 1: Introduction

Throughout this course you will have many opportunities to respond to the opinions and comments of your classmates. Take this opportunity to introduce yourself and to learn about each other. Be sure to include your name, location, and something about you that you would like your classmates to know.

Topic 2: Primary Care

Discuss what is primary care and the ten most common diagnosis seen in your clinic setting. Share with your peers what guidelines and tools you will become familiar with when preparing for your clinical.

MN569 Clinical-Life Span Health Focus

Unit 2 Discussion

Be Prepared

Being prepared as a Nurse Practitioner when entering the clinic setting is a win-win for the student, the preceptor and most of all the patient. Safe, effective delivery of patient care requires that the nurse practitioner student understand the complexity of healthcare systems, the limits of human factors, safety design principles, characteristics of high reliability organizations, and patient safety resources. These components are critical to the preparation of safe clinicians and essential for 21st Century healthcare delivery.

Discuss how you met the Unit Two Objectives as well as barriers to safe practice that can occur if you come to the clinic setting unprepared. Support your discussion with evidence based practice and recommendations for improvement of safe patient care in the primary care setting.

MN569 Clinical-Life Span Health Focus

Unit 3 Discussion

Oral Presentation

The goal of any oral presentation is to pass along the “right amount” of patient information to your preceptor in an efficient fashion. When done well, this enables you and your preceptor to quickly understand the patient’s issues and generate an appropriate plan of action.

As a general rule, oral presentations are shorter than written presentations as they should focus on the most active issues of the day (Chief Complaint).

Subjective- how patient feels and reports to you.

Objective- vital signs and pertinent physical exam findings; what you hear, feel, smell, and see.

Assessment- should include working diagnosis from presenting problem and prior diagnoses that are being actively addressed during the present appointment.

Plan – this is the area that should be very specific as if you are entering the orders.

Some of the most common stumbling blocks for students (other than nerves) include going into too much detail in the subjective and objective sections!

Discussion: Share with your peers your approach to oral presentations in the clinic setting and ways in which you have perfected your approach to communicating information about your patient to your preceptor. Share your PEARLS of Wisdom!

MN569 Clinical-Life Span Health Focus

Unit 4 Discussion

Reflection

The practicum experience helps to increase knowledge and skills learned in previous courses. It creates an atmosphere to apply evidence-based concepts of disease management to patient care plans. Sharing of practicum experiences with classmates will increase knowledge of most common illnesses treated in different practicum settings. Continue to ask questions of your preceptor and examine rationales for prioritizing diagnoses and prescribing medications.

Please share practicum experiences with classmates by addressing the following information:

Type of practicum setting

Average number of patients seen by you and the preceptor on a daily basis

Most common diagnosis treated

Available resources (low cost meds, social services, community resources, etc.)

Most interesting patient presentation

Comfort level with history-taking, physical exam, medical diagnosing, Management plans including prescribing medications and health education.

MN569 Clinical-Life Span Health Focus

Unit 5 Discussion

Social Services

Share what social services are available in your community and give examples of when it is important to involve social services in the management of your patients in the primary care setting? Please give examples of what you have done in your clinic setting involving social services. Support your discussion with evidence based practice and recommendations.

MN569 Clinical-Life Span Health Focus

Unit 6 Discussion

Interprofessional Team

A multiprofessional team practice is necessary as you cannot be expected to know everything there is to know and have all the skills to address the complete range of episodic and chronic health problems commonly seen in the primary care setting.

Discuss what you believe is the ideal provider mix for an interprofessional team in primary care. Design an interprofessional team to meet the primary care needs in your community and share with your peers in the discussion forum.

Support your discussion with evidence based practice and recommendations.

MN569 Clinical-Life Span Health Focus

Unit 7 Discussion

Medical record documentation is required to record pertinent facts, findings, and observations about an individual’s health history, including past and present illnesses, tests, treatments, and outcomes. The medical record chronologically documents the care of the patient and is an important element contributing to high-quality safe care.

Discuss your State Board of Nursing nurse practitioner documentation guidelines and how this can impact your level of reimbursement in the clinical setting.

MN569 Clinical-Life Span Health Focus

Unit 8 Discussion

Preventative vs Diagnostic

Discuss the difference between preventative and diagnostic laboratory tests and why this is important to distinguish between in the primary care site. Include in the discussion the ten most commonly ordered laboratory and diagnostic tests ordered in your practicum site and the criteria for ordering.

MN569 Clinical-Life Span Health Focus

Unit 9 Discussion

Depression

Depression is one of the leading causes of disability in adults. It affects men and women of all ages, races, and social and economic groups. Depression has a major impact on a person’s quality of life and can increase the risk of suicide. It can make it more difficult for people to care for other health conditions they may have. Depression also can affect family members, especially children.

Discuss what The U.S. Preventive Services Task Force (Task Force) has recommended concerning screening for depression in the primary care setting. What are the recommended screening tools age specific.

Share what you have used in your practicum site to screen for depression and how it was addressed.

MN569 Clinical-Life Span Health Focus

Unit 10 Discussion

Performance and Evaluation in Primary Care

Share your clinical experience and discuss your areas of strengths and areas in which you would like to improve. How did you meet the course outcomes? Give examples.

MN569 Clinical-Life Span Health Focus

Unit 2 Assignment

Health information technology (health IT) makes it possible for health care providers to better manage patient care through secure use and sharing of health information. Health IT includes the use of electronic health records (EHRs) instead of paper medical records to maintain people’s health information.

Share the EHR platform that your practice uses and discuss the challenges and barriers to electronic charting. Why have we moved from paper charting to EHR’s? What is meant by meaningful use regulations and why is this important to know when documenting in the EHR?

Please support your work with at least three evidence based practice resources that are less than 5 years old.

Written Paper (Microsoft Word doc): minimum 2000 words using 6th edition APA formatting

Please review the grading rubric under Course Resources in the Grading Rubric section.

MN569 Clinical-Life Span Health Focus

Unit 3 Assignment

Case Study #2

Date: November 12, 2016, 2:00 pm

Location: XYZ Family Practice

You are an NP student in this practice. Your next patient is the following:

“I had to come in today because I have been coughing for a long time”

Amanda Smith (69 year old, black female) is a retired postal worker. During the visit, she is coughing continually. She states the cough started 5 days ago intermittently but 2 days ago it became constant. Her chart indicates that she has been a patient of the practice for 5 years, gets care regularly and her HTN has been controlled for 4 years.

Social History

Married – 2 adult children A & W

Non-Smoker now. Smoke 1 pack a day for 15 years. Quit x5 years ago

No alcohol or drug use

Baptist, attends church regularly and is a member of the choir

Family History

Mother – Deceased at age 27 from traumatic accident

Father – Deceased age 78 related to renal failure secondary to diabetes type II

Siblings – one brother age 61 A & W

Medical/Surgical/Health Maintenance Hx

Measles, mumps and chicken pox as a child.

Tetanus/Diptheria/Pertussis – Last dose 2 years ago

Influenza – Last dose 9 months ago

Pneumococcal vaccine at age 65

Zostivax at age 60

Chronic diagnoses – HTN x 5 years

Takes HCTZ 25 mg daily

ROS

General

Usual weight has been maintained

Fever for 5 days up to 101

Skin

Dry skin, uses emollient frequently

HEENT

Wears reading glasses

Dentition fair. Partial upper denture

Neck

No swelling or stiffness

Chest

Substernal pain on cough

Respiratory

Began coughing 4 days ago. Started mild, intermittent and non-productive. Two days ago became constant and productive of frothy sputum. Keeps her awake at night. No relief with OTC cough syrup. She states she is short of breath today.

CV

No CP at rest or when not coughing

PV

Some swelling of feet and ankles at end of day, relieved by elevating feet

GI

Decreased appetite for one week

No change in bowel habits

GU

No frequency, hesitancy, nocturia or change in bladder habits

Genitalia

No changes

MS

Stiffness in hands and legs on awakening. Relieved with activity

Psych

No depression, anxiety, or memory change

Neurologic

No numbness, weakness, headache, change in mentation, or paralysis

Hematologic

No past anemia

Endocrine

No change in weight, thirst, heat/cold intolerance.

Your physical exam reveals:

Temp 101.4, Resp 30 labored, no retractions, BP 135/92, HR 110, Pulse Ox 90 Wt 130 lbs

General appearance – Alert in all spheres, in mild respiratory distress, able to answer questions with short sentences, tripod breathing

HEENT –

Eyes ,ear, nose, head wnl

Mouth -mucosa dry

Pharynx – tonsils present not enlarged, normal pink color

Lymph – no enlargement

Skin – Dry and scaly legs and arms. Tenting of skin noted

Heart- regular rhythm at 110 bpm, no murmurs or extra sounds

Lungs – normal breath sound without crackles, bronchophony or egophony

Abdomen – no mass, tenderness, rigidity

Extremities – Hands – no swelling, Feet/legs – +1 edema feet to ankle level

Pedal pulses – wnl

Differential diagnoses:

CAP

Acute bronchitis

Congestive heart failure

Influenza

Plan – transfer to acute care setting for further work-up

Assignment Details:

The “Elevator Consult”

In this activity, you will practice giving a synopsis of your patient to your preceptor. In practice, you may often give this type of report if you are sending a patient for a consultation and your phone the specialist to discuss the patient. This report should be concise and clear. The receiver should, within one minute (slightly less for simple cases, slightly more for complex cases) have a picture of the patient in his/her head. You will report on ONLY items pertaining to the acute problem in this case. Do not include extraneous material or material not directly impacting the decision-making regarding this problem. Remember, this is a FOCUSED visit and assessment to evaluate a focused concern. The history and physical exam applies techniques relevant to the specific complaint for the patient at that visit. Your report should be similarly focused, providing only information that relates specifically to the presenting problem.

Please review the grading rubric under Course Resources in the Grading Rubric section.

MN569 Clinical-Life Span Health Focus

Unit 6 Assignment

Patient care hinges in part on adequate and timely information exchange between treating providers. Referral and reply letters are common means by which doctors and nurse practitioners exchange information pertinent to patient care. Ensuring that letters meet the needs of letter recipients saves time for clinicians and patients, reduces unnecessary repetition of diagnostic investigations, and helps to avoid patient dissatisfaction and loss of confidence in medical practitioners.

As a Nurse Practitioner (NP) you will need to know the difference between a consultation and a referral for treatment, when ordering and when carrying out consultations or referrals.

Consultations

A consultation is a request for opinion or advice, so that the requestor can manage the patient. A consultation is billed under one of the consultation codes listed in Physicians’ Current Procedural Terminology (CPT) (99241-99245 for outpatient of office consultations). If the NP is the consultant, the NP should document the request for a consultation, the reason for the consult, and the NP’s evaluation and recommendations.

When an NP requests a consultation from another provider, the N P should request “consultation” on the referral form, rather than “referring.”

Referrals:

A referral is made when the referring provider wants to turn the management of the patient over to the referred-to provider, at least for the current complaint.

When a NP refers a patient, the NP should state on the referral form that the NP is “referring the patient for evaluation and treatment.” The referred-to provider will bill an evaluation and management code, rather than a consultation code.

Writing Assignment: Consult: Write up a consult request and include all key elements.

Ms. Perez has been referred to Ms. Wilson FNP-C,APRN, MSN for consultation regarding eczema unresponsive to treatment in the past six months.

Document the evaluation and recommendations for how Ms. Wilson FNP-C,APRN,MSN should deal with the consultation request and bill a consultation code.

Writing Assignment: Referral: Write up a referral request and include all key elements.

As an NP and Ms. Perez primary care provider, you decide to refer her to Dr. Owens a dermatologist for evaluation and treatment regarding eczema unresponsive to treatment in the past six months.

1. Document your referral to Dr. Owens

2. Document the evaluation and recommendations for how Dr. Owens should deal with the referral and bill a referral code.

Written Paper (Microsoft Word doc): minimum 2000 words using 6th edition APA formatting

Please review the grading rubric under Course Resources in the Grading Rubric section.

MN569 Clinical-Life Span Health Focus

Unit 10 Assignment

Final Clinical Evaluation — 300 points

This unit will contain the mandatory preceptor final evaluation in Rxpreceptor. Your preceptors will receive an automatic email from the Rxpreceptor system during week 8 and then weekly until week 9 to complete evaluations. Once it is complete, you will review it and upload to the Unit 10 Dropbox for grading. Grading will follow the scale below and will be a collaboration between your faculty and preceptor. Any area of assessment with a score of 2.4 or below will receive an entire evaluation score of 0 points as failure in any area of assessment constitutes a failing evaluation. Any element of the evaluation that states the student is not safe or is unsafe will result in a “0” for the final evaluation and failure of the course.

Final evaluation will be worth 300 points and will follow the grading rubric below:

Score of 4 to 5 = all 300 points awarded

Score of 3 to 3.9 = 240/300 points awarded

Score of 2.5 to 2.9 = 210/300 points awarded

Score of 2.4 and below = 0

Students must also complete both the evaluation of their preceptor and site for credit. The evaluations provide faculty an overview of your clinical performance and experiences with your preceptor and clinical location. The final clinical evaluation is required to pass the course.

Failure to complete all clinical hours or all associated Rxpreceptor documentation (clinical time log, patient encounter log, preceptor evaluation of student, and student evaluation of preceptor) will result in failure of the course.

[Unit 10 Assignment Dropbox]

Upload a copy of your evaluation of the preceptor and clinical site. The form can be found in Rxpreceptor.

MN569 Clinical-Life Span Health Focus

Unit 1 Seminar Quiz

Question 1

Clinic hours must be confirmed by your preceptor every:

Question options:

Two weeks

Every month

At the end of term

Every week

Question 2

You must arrange three phone call meetings with the preceptor, faculty and self during the 10 week period you are in clinic.

Question options:

True

False

Question 3

You can wear scrubs to your clinical practicum.

Question options:

True

False

Question 4

It is OK to complete your clinical hours in the hospital setting.

Question options:

True

False

Question 5

The student must complete all 160 required clinical hours no later than the Monday of Week Ten.

Question options:

True

False

MN569 Clinical-Life Span Health Focus

Unit 4 Seminar Quiz

Question 1

There are 12 steps to writing a prescription.

Question options:

True

False

Question 2

You must include your DEA Number on all prescriptions

Question options:

True

False

Question 3

Superscription (RX) indicates that the patient may refill their own medication:

Question options:

True

False

Question 4

Schedule II controlled substances can have as many as five refills.

Question options:

True

False

Question 5

Your signature and degree finalize the legal document. A signature stamp can be used for controlled substances

Question options:

True

False

MN569 Clinical-Life Span Health Focus

Unit 7 Seminar Quiz

Question 1

The focus of this Unit 7 Seminar was to discuss medical documentation and coding: ICD-10, CPT codes only. Level of care was not discussed.

Question options:

True

False

Question 2

Principles of Coding include all except:

Question options:

Only provide the level of care that is medically necessary per clinical judgment.

Always code a lower level of service then you think needed.

Always provide and document services in accordance with the established best practices.

Always code and document exactly what care was provided.

Question 3

ICD-10 codes describe what it was done for the patient.

Question options:

True

False

Question 4

CPT codes describe WHAT was done for the patient.

Question options:

True

False

Question 5

When coding for Preventive Care Services it is mandatory to include the minimum of five components.

Question options:

True

False