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A 6o-year-old white man presents with an accelerated decline in lung function. Last year he was diagnosed with metastatic ling cancer. Today he is dyspneic,
pale, and seems almost listless. He continues to smoke and his pack-year history is 40 years. He says “I am tired of this fight”.
CC: “I have to sleep in my recliner because I can’t lie in bed, and I have no energy to do anything—I don’t even have energy to eat, I just want to die.”
Physical exam: Blood pressure, 120/74; pulse rate, 120 beats/min; respiration rate, 36/min
Height, 5΄9΄΄; weight, 130 lbs.
AP to lateral diameter: 1:1
Cough with clear mucoid sputum
Diminished breath sounds
Dullness overright lower and middle lung fields on percussion and use of accessory muscles during respiration
Chest x-ray film: Mass noted RML and RLL, tracheal shift to left, no cardiomegaly
Arterial blood gases: pH 7.2, PaO2 55, pCO2 60, HCO3 26
Questions:
1.Subjective data: What subjective data should the APN obtain? How is the complaint investigated ie HPI?
This area should discuss history, ROS, and HPI format.
2. You will reassess to verify the presented information. For what additional objective data will you assess and why?
3. What co-morbid conditions should be investigated through the physical exam, how and why?
4. What National Guidelines are appropriate to this case? What do the guidelines state?
What level of evidence supports these guidelines?
5. What diagnostic tests will you order? Why do they apply to this case? What is the sensitivity and specificity? When it is positive or negative what does that mean?
6. What is your medical diagnosis? What are the differential diagnoses?
7. Treatment plan should clearly state what exact orders you are ordering. All medications must have a name, a dose, a route, and a frequency. The diet must be specific. The diagnostics must be specific. Do not say XRAY say type of Xray ie AP/Lat chest Xray
8. Are there any Healthy People 2030 goals that you should consider? How will you promote health with this case? How does it meet the 2030
9. What specific patient teaching is needed? Do not say “how to use an inhaler” state exactly what you will teach
10. What billing codes would you recommend? This must include the CPT code for outpatient office visits. ICD classify diagnoses ie HTN i10, CPT codes are 992–, Describe the difference between the first visit billing code and follow up billing code.
11. Follow up and evaluation. When will the next office visit occur? What will you assess? How will you revise the plan based upon this assessment? For instance, if you are assessing the HgbA1c and it is 9, what will you order? If it is 6.5 what will you do?
Criteria
10 Points
8 Points
6 Points
0 Points
Assessment
Develops and demonstrates a clear & precise assessment plan supported with professional literature and includes objective and subjective data.
Develops and demonstrates an assessment plan but not fully supported with professional literature may be missing one important piece of data
Develops and demonstrates a brief & vague assessment plan while missing important details of the assessment data; supported with minimal professional literature.
No paper submitted or content missing
/10
Guidelines/Evidence
Thoroughly describes all relevant practice guidelines. Clearly defines and delineates the levels of evidence that support the guidelines.
Describes relevant practice guidelines and/or describes levels of evidence to support guidelines but does not do both.
Describes a brief & vague treatment plan but lists no guidelines and does not level evidence.
No paper submitted or content missing
/10
Diagnostics
Clearly describes all appropriate diagnostics (including sensitivity and specificity). Clearly differentiates the difference between a positive and a negative finding and APN considerations
Describes all appropriate diagnostics but does not discuss the difference between a positive and negative finding or lacks a discussion of specificity and sensitivity for each diagnostic
Simply lists some diagnostics but does not discuss specificity, sensitivity, negative, or positive and APN considerations
No paper submitted or content missing
/10
Treatment Plan
Develops and provides a clearly written set of orders inclusive of all essential elements in a treatment plan.
Develops a clear set of written orders but omits an important order for the diagnosis
Develops and provides a brief set of orders for the treatment plan with more than one omission.
No paper submitted or content missing
/10
Evaluation
Develops and demonstrates a clear & precise evaluation plan for the next office visit inclusive of data that will indicate no change necessary in plan or changes necessary in the plan
Develops a evaluation plan for next office visit. Includes data but does not describe predictive changes
Develops a vague evaluation plan. There is no data identified or plan
No paper submitted or content missing
/10
Criteria
10 Points
9 Points
7 Points
0 Points
Healthy People 2020
Health Promotion
Develops and demonstrates a clear & precise description of the Healthy People 2020 goals and specifically relates one goal to current case.
Develops a Health Promotion plan and/or discusses Healthy People 2020 and the relation to the case
Describes Health Promotion but does not relate back to the case
No paper submitted or content missing
/10
Patient/Family Teaching
Develops and demonstrates a clear & precise educational plan for the patient and family.
Educational topics are described but no plan is developed for the patient and family
A general educational plan is shared but is not specific to the current case..
No paper submitted or content missing
/10
Billing
Discusses all levels of billing that apply to the case and most likely appropriate level for first visit and one follow up visit
Discusses only the billing level that the APN may utilize without rationalization and the differences in initial and follow up
Discusses billing levels however provides inaccurate levels or rationalization
No paper submitted or content missing
/10
Follow up
Develops a follow up plan that specifically identifies the data that will need to be reviewed during the follow up visit. (This may function as communication to the team…i.e. check BP, cholesterol, and EKG next visit)
Discusses a general plan for follow up but no specific data is listed. May not indicate when follow up should occur or why?
Describes a generalized follow up plan that applies to all patients not the specific case.
No paper submitted or content missing
/10
5 Points
4 Points
2 Point
0 Points
Grammar, spelling, and punctuation
There are no errors in grammar, spelling, and punctuation
There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning
There are major errors in grammar, spelling, and punctuation that do not reflect scholarly writing
No submission
/5
APA
The paper meets APA format guidelines
There are minor APA format errors
There are significant errors in format
No Submission
/5
Total Points Possible = 100

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