Construct clinical reasoning skills to evaluate, plan, and implement care in 3 scenarios

In a previous learning activity, and throughout your nurse practitioner education you learned about the importance of evidence-based practice clinical practice guidelines

For this journal, you will construct clinical reasoning skills to evaluate, plan, and implement care in 3 scenarios.

· Acute injury or illness. Choose one.

· Ankle sprain

· Acute low back pain

· Pityriasis rosea

· Skin Abscess

· Wellness. Choose one:

· Adult wellness exam

· Annual Medicare wellness exam

· Prenatal visit

· Chronic condition management visit. Choose one.

· Acne

· Psoriasis

· Osteoarthritis

· Rheumatoid arthritis

Instructions

A. Choose one condition in each category for a total of 3 cases to present.

B. For each case, include an applicable clinical practice guideline to form the evaluation and management plan of care and briefly describe why each guideline is appropriate. Include the patient’s gender, age, and cultural aspects as related to your patient in each case, as well as the physical findings.

C. Next, complete a care management plan based on your knowledge of the condition and the guideline for each case. Include the following:

1. Guideline title

2. Medication/s- (with Dose and Sig details as in a script)

3. Non-medication treatments

4. Implementation of diagnostic testing if needed or your plan if no improvement

5. Culturally competent patient education considerations

6. Referrals if needed or if no improvement

7. Follow up

# 2 assignment,

Differentiate State Regulatory Restrictions on NP Practice

NPs have a scope of practice regulated by state laws, boards of nursing, boards of medicine, and reimbursement that may differ depending on your location. There are several sources of restrictions to NP practice, such as state laws and federal regulations which include who may prescribe controlled substances and which substances NPs can prescribe, as well as the various reimbursement payers which may have limits. It is essential that the NP be fully informed of what they are allowed to do by law (state and federal) or by other regulatory organizations.

These regulations vary widely from state to state and continue to rapidly change. They may also vary by facility policy. Consequences of practicing outside your scope of practice may include work-related discipline, fines, suspension or revocation of your license, a civil lawsuit, or even crimina l charges.

There are three major regulatory practice models for NPs: supervisory, collaborative, and independent. In this journal assignment:

· Define each model.

· Identify three states: one with each different model.

· Compare the three state models, using the following details:

1. collaborative agreement required

2. direct versus indirect supervision description

3. practice hours or wait period to full practice

4. review of documentation

5. prescribing restrictions, if any

6. NP payor reimbursement per each state/model

· Include other unique requirements noted.

Include at least one source. Word count should be 250 -300 words.

Assignment # 3

Developmental Surveillance

This case study assignment requires knowledge about age-based developmental surveillance, recognition of normal findings, red flags, follow-up, treatment plan, and when a referral is needed.

You are expected to use the most current and credible practice guidelines when answering the questions. It is highly recommended that you use updated CDC guidelines.

All of your recommendations require complete citations and references per APA.

You may use the table below to fill in your answers. This is not a formal APA paper.

Here are links to relevant growth charts. You are expected to “plot” this child’s growth measurements.

· 2 to 20 years: Boys Stature Weight-for-age percentiles

· 2 to 20 years: Boys Body mass index-for-age percentiles

· Weight-for-stature percentiles: Boys

Case Study

Timothy is a 12-year-2-month-old boy who presents to the primary care clinic with his mother, Nancy, for his 12-year-old well visit. Since birth, Timothy has been compliant with recommended well visits, screenings, and immunizations. He lives in a modern home with his biological mother and father. Both parents are employed full-time. Timothy is in the seventh grade and receives average grades, socializes with friends, and, per family and school personnel, has not demonstrated any cognitive or behavioral problems.

At this visit, Timothy’s mother reports that her son is doing well. Timothy’s sleep patterns are regular, he gets daily exercise, is obedient and is “well balanced.” Nancy adds that sometimes Timothy does not eat much but she knows every child is “different and believes this is a stage.” Overall, Nancy reports that there are no concerns and believes Timothy is progressing cognitively, physically, and socially as expected. Nancy denies any medical/surgical history and Timothy has no known allergies.

You are observing Timothy’s behavior, fine and gross motor skills, speech, and ability to achieve expected milestones. Timothy appears to be small for his age but interacts normally with his mother and healthcare provider without any speech concerns.

While conducting the annual physical exam on Timothy, you note that he weighs 54 pounds, and his height measures 52 inches. His Vital Signs are all within normal limits. During the physical examination, you notice bilateral breast enlargement and sexual maturity rating (SMR) Tanner stage 1. The rest of the exam appears within normal limits.

Assignment: Compared with exam findings one year ago, you note that height and weight were 53 inches and 50 lbs. Additionally, documentation from one year ago shows that Timothy’s sexual maturity rating was Tanner Stage one.

Download and use the template to complete this assignment.

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