Week 10: Assessment and Care of Patients with Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery
Jill Joyce experienced years of back pain that prevented her from completing even the most basic tasks. Bulging discs and degenerative changes in her spine were affecting nerve function, which caused pain that could be alleviated only with surgery (Healthy Life, 2008). Like Jill’s back pain, many conditions related to neurology, orthopedics, and plastic/reconstructive surgery may affect patients’ function and mobility. In your role as advanced practice nurse, you must not only diagnose and treat these patients but also help them manage changes in their function and mobility. Assessment and Care of Patients with Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery Essay Assignment Papers
Learning Objectives
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By the end of this week, students will:
Evaluate medical and surgical patients with conditions related to neurology, orthopedics, and plastic/reconstructive surgery
Develop differential diagnoses for medical and surgical patients with conditions related to neurology, orthopedics, and plastic/reconstructive surgery
Develop treatment plans for medical and surgical patients with conditions related to neurology, orthopedics, and plastic/reconstructive surgery
Learning Resources
Required Readings
Colyar, M. R. (2015). Advanced practice nursing procedures (1st ed.). Philadelphia, PA: F. A. Davis Company.
Chapter 28, “Bone Marrow Aspiration and Biopsy”
Chapter 29, “ Lumbar Puncture”
Chapter 31, “Arthrocentesis”
Chapter 32, “Assessment for Compartment Syndrome and Pressure Testing”
Chapter 35, “Dislocation Reduction”
Chapter 36, “Ganglion Cyst Aspiration and Injection”
Doherty, G. M. (2015). Current diagnosis and treatment: Surgery (14th ed.). New York, NY: McGraw Hill.
Chapter 36, “Neurosurgery”
Chapter 40, “Orthopedic Surgery”
Chapter 41, “Plastic & Reconstructive Surgery”
Chapter 42, “Hand Surgery”
Weber, E. C., Vilensky, J. A., & Fog, A. M. (2013). Practical radiology: A symptom-based approach. Philadelphia, PA: F. A. Davis Company.
Chapter 2, “Shoulder, Pelvis, and Limbs”
Chapter 3, “Spine and Spinal Cord”
Chapter 4, “Brain”
Chapter 11, “Imaging of Bone Disease and Endocrine Disorders”
Kuntz, A. F., Lai, W.-S., Norton, P. T., Yao, L. L., & Gay, S. B. (2013). Skeletal trauma radiology. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/index.html
Shonka, D. C., Gay, S. B., Marx, W. F., Frederick, J. A., Vu, Q. D. M., Higginbotham, J., … Rehm, P. K. (2013). Introduction to head CT. Retrieved from http://www.med-ed.virginia.edu/courses/rad/headct/index.html
Required Media
i-Human Patient Cases. (2014). Retrieved from https://ih2.i-human.com/users/sign_in
AshtonMoh. (2011). Lumbar puncture 2 [Video file]. Retrieved from https://www.youtube.com/watch?v=QoUGM4wqUU0
Doe, J. (2012). Knee aspiration [Video file]. Retrieved from https://www.youtube.com/watch?v=Jx8HmJJOGas
Optional Resources
American Academy of Orthopaedic Surgeons. (2015). Broken bones & injuries. Retrieved from http://orthoinfo.aaos.org/menus/injury.cfm
American Society of Plastic Surgeons. (2015). Evidence-based practice guidelines and practice parameters. Retrieved from http://www.plasticsurgery.org/for-medical-professionals/legislation-and-advocacy/health-policy-resources/evidence-based-guidelinespractice-parameters.html
Boyd, A. S., Benjamin, H. J., & Asplund, C. (2009). Splints and casts: Indications and methods. American Family Physician, 80(5), 491–499. Retrieved from http://www.aafp.org/afp/2009/0901/p491.html
Discussion Part I: Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery
This week, you study neurologic and orthopedic conditions with plastic surgery considerations. Both neurologic and orthopedic conditions are seen in the trauma areas of the hospital. These conditions encompass cardiovascular, pulmonary, and metabolic aspects of care in the ICU. For this Discussion, focus on adolescent patients, and consider potential diagnoses, treatment, and/or referral options for the patients in the following 3 case studies.
Case Study 1
A 17-year-old male was celebrating his birthday with friends and alcohol. At one point he jumped into the hotel pool three stories below, hitting the side of the pool with his chest. EMS arrived and packaged him with spinal support. He arrives in the ER with breathing difficulty, chest pain, GCS 10, and O2 sat of 94%. You do initial assessment in the first 10 minutes and find that his chest is asymmetric for breathing and contusions are noted all over his chest. His CXR shows multiple rib fractures on both sides and pulmonary contusions. His cervical spine is stable in a collar. His thoracic and lumbar films are negative for fractures. In the next hours, what are your priorities, and what plan would you have for this patient as he moves to the ICU? At what stage of development is he, and how does that affect his care? Assessment and Care of Patients with Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery Essay Assignment Papers
Case Study 2
A 13-year-old female restrained passenger of a vehicle was involved in an MVA at 60 mph on the highway. The vehicle experienced a frontal impact. The patient arrived in the ER with closed fractures of the left tibia and fibula with angulation, dislocation of the right ankle, multiple pelvic fractures, and femur fracture on the left side. Her BP is 92/54 with pulse of 130. What is your plan for this patient, and what are the considerations to prevent further morbidity? At what stage of development is she, and how does that impact her care?
Case Study 3
A 19-year-old male private in the U.S. Air Force was driving with friends when they dared him to “surf the car.” He fell off the roof of the car while it was moving at a speed of approximately 40 mph. He landed face first. He is now in the ICU with a closed head injury. His intracranial pressure is elevated, and his pupillary response is slowing. At this time, what medications do you recommend, and what other medical treatments do you recommend? In addition, after the acute situation is controlled and the patient awakens, what medication do you use for his agitation?
To prepare:
Review and select 1 of the 3 provided case studies. Analyze the patient information.
Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or nonpharmacologic treatments.
Consider strategies for educating patients and families on the treatment and management of the trauma care.
By Day 3
Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of neurologic and orthopedic conditions.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on 2 different days in both of the ways listed below. Respond to colleagues who selected different case studies from yours.
Describe how culture might affect the diagnosis, management, and follow-up care of patients with the neurological, orthopedic, or plastics disorders your colleagues discussed.
Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives. Assessment and Care of Patients with Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery Essay Assignment Papers
Discussion Part II: Pharmacology
To prepare:
Read the following articles to enhance your knowledge of commonly prescribed medications:
Family Practice Notebook. (2015). Nonsteroidal anti-inflammatory. Retrieved from http://www.fpnotebook.com/Pharm/Analgesic/NnstrdlAntInflmtry.htm
Press, C. D. (2013, September 10). Infiltrative administration of local anesthetic agents. Retrieved from http://emedicine.medscape.com/article/149178-overview
All of the following groups of medications are commonly prescribed in the acute care setting. Choose one of the topics below to discuss. If it is a medication group, select a specific drug within that group. (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.
Glycopeptides
Oxazolidinones (Bs)
Monobactams
Ansamycins
Metronidazole
Lincosamides (Bs)
Tinidazole
Lidocaine
Marcaine
NSAIDs
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.
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. Assessment and Care of Patients with Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery Essay Assignment Papers
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. Describe a patient you would prescribe this medication to. Assessment and Care of Patients with Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery Essay Assignment Papers
Note: To be considered as one of your required responses, your pharmacology rationale must include a supporting reference.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 10 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 10 Discussion
Assignment: Assessing, Diagnosing, and Treating Pre- and Post-Operative Care Patients – Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery
Neurologic and orthopedic conditions and plastic/reconstructive surgery often affect patients’ function and mobility. Changes in function and mobility sometimes are subtle and might not be identified immediately, requiring you to monitor patients closely for signs and symptoms. For this Assignment, as you examine this week’s i-Human patient case study, consider how you might evaluate and treat pre- and post-operative patients who present with neurologic and orthopedic conditions and plastic/reconstructive surgery.
To prepare:
Review this week’s Learning Resources. With neurology, orthopedics, and plastic/reconstructive surgery in mind, consider how to assess, diagnose, and treat patients in pre- and post-operative care.
Review this week’s i-Human case study. Based on the patient information provided, think about the health history you would need to collect from the patient. Assessment and Care of Patients with Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery Essay Assignment Papers
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.
Develop a treatment plan for the patient that includes health promotion and patient education strategies for medical and surgical patients with conditions related to neurology, orthopedics, and plastic/reconstructive surgery. Assessment and Care of Patients with Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery Essay Assignment Papers
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 2 Learning Resources.
By Day 7
This Assignment is due.
Grading Information
Week 10 i-Human Rubric
Practicum Reminder: Week 10 Time Log
Time Logs
You are required to keep a log of the time you spend related to your practicum experience and enter every patient you see each day. You can access your time log from the Welcome Page in your Meditrek account. You will track time individually for each patient you work with. Please make sure to continuously input your hours throughout the term. Assessment and Care of Patients with Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery Essay Assignment Papers
Assessment and Care of Patients with Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery Essay Assignment Papers
Application_Rubric
Novice Emerging 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 question
11 (11%) – 13 (13%)
Correctly answered 70-89% of the clinical question
14 (14%) – 15 (15%)
Correctly answered 90-100% of the clinical questions
Assessment and Care of Patients with Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery Essay Assignment Papers
Discussion_Rubric
Grid View
List View
Outstanding Performance Excellent Performance Competent Performance Room for Improvement Poor Performance
Content-Main Posting
30 (30%) – 30 (30%)
-Main posting addresses all criteria with 75% of post exceptional depth and breadth supported by credible references
27 (27%) – 29 (29%)
-Main posting addresses all criteria with 75% of post exceptional depth and breadth supported by credible references
24 (24%) – 26 (26%)
Main posting meets expectations. All criteria are addressed with 50% containing good breadth and depth.
21 (21%) – 23 (23%)
Main posting addresses most of the criteria. One to two criterion are not addressed or superficially addressed.
0 (0%) – 20 (20%)
Main posting does not address all of criteria, superficially addresses criteria. Two or more criteria are not addressed.
Course Requirements and Attendance
20 (20%) – 20 (20%)
-Responds to two colleagues’ with posts that are reflective, are justified with credible sources, and ask questions that extend the discussion.
18 (18%) – 19 (19%)
-Responds to two colleagues’ with posts that are reflective, are justified with credible sources, and ask questions that extend the discussion.
16 (16%) – 17 (17%)
Responds to a minimum of two colleagues’ posts, are reflective, and ask questions that extend the discussion. One post is justified by a credible source.
14 (14%) – 15 (15%)
Responds to less than two colleagues’ posts. Posts are on topic, may have some depth, or questions. May extend the discussion. No credible sources are cited
0 (0%) – 13 (13%)
Responds to less than two colleagues’ posts. Posts may not be on topic, lack depth, do not pose questions that extend the discussion
Scholarly Writing Quality
30 (30%) – 30 (30%)
-The main posting clearly addresses the discussion criteria and is written concisely. The main posting is cited with more than two credible references that adhere to the correct format per the APA Manual 6th Edition. No spelling or grammatical errors. ***The use of scholarly sources or real life experiences needs to be included to deepen the discussion and earn points in reply to fellow students.
27 (27%) – 29 (29%)
-The main posting clearly addresses the discussion criteria and is written concisely. The main posting is cited with more than two credible references that adhere to the correct format per the APA Manual 6th Edition. No spelling or grammatical errors.
24 (24%) – 26 (26%)
-The main posting clearly addresses the discussion criteria and is written concisely. The main posting is cited with a minimum of two current credible references that adhere to the correct format per the APA Manual 6th Edition. Contains one to two spelling or grammatical errors. Assessment and Care of Patients with Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery Essay Assignment Papers
21 (21%) – 23 (23%)
-The main posting is not clearly addressing the discussion criteria and is not written concisely. The main posting is cited with less than two credible references that may lack credibility and/or do not adhere to the correct format per the APA Manual 6th Edition. Contains more than two spelling or grammatical errors.
0 (0%) – 20 (20%)
-The main posting is disorganized and has one reference that may lack credibility and does not adhere to the correct format per the APA Manual 6th Edition or has zero credible references. Contains more than two spelling or grammatical errors.
Professional
Communication
Effectiveness
20 (20%) – 20 (20%)
-Communication is professional and respectful to colleagues and response to faculty questions are answered if posed. Provides clear, concise opinions and ideas effectively written in Standard Edited English -Responses posted in the discussion demonstrate effective professional communication through deep reflective discussion which leads to an exchange of ideas and focus on the weekly discussion topic.
18 (18%) – 19 (19%)
-Communication is professional and respectful to colleagues. -Provides clear, concise opinions and ideas effectively written in Standard Edited English -Responses posted in the discussion demonstrate effective professional communication through deep reflective discussion which leads to an exchange of ideas and focus on the weekly discussion topic . -Responses are cited with at least one credible reference per post and a probing question that extends the discussion. Adheres to the correct format per the APA Manual 6th Edition. No spelling or grammatical errors.
16 (16%) – 17 (17%)
-Communication is professional and respectful to colleagues. Provides clear, concise opinions and ideas effectively written in Standard Edited English. -Responses posted in the discussion demonstrate effective professional communication through deep reflective discussion which leads to an exchange of ideas and focus on the weekly discussion topic. -Responses are cited with at least one credible and/or contain probing questions that extends the discussion. Adheres to the correct format per the APA Manual 6th Edition. May have one to two spelling or grammatical errors.
14 (14%) – 15 (15%)
-Communication is professional and respectful to colleagues. Provides opinions that may not be concise or ideas not effectively written in Standard Edited English. -Responses posted in the discussion may lack effective professional communication that does not extend the discussion, leads to an exchange of ideas and/or not focused on the weekly discussion topic. -Responses are not cited and/or do not contain a probing question. May not adhere to the correct format per the APA Manual 6th Edition. May have more than two spelling or grammatical errors.
0 (0%) – 13 (13%)
-Communication may lack professional tone or be disrespectful to colleagues. Provides opinions that may not be concise or ideas not effectively written in Standard Edited English -Responses posted in the discussion lack effective professional communication through discussion that does not extend the discussion, do not lead to an exchange of ideas and/or not focused on the weekly discussion topic. -Responses are not cited and do not contain a probing question. May not adhere to the correct format per the APA Manual 6th Edition. May have multiple spelling or grammatical errors.
Timely Submission
0 (0%) – 0 (0%)
All criteria met: Initial post submitted on time. Response to two peer initial posts. Response on 3 separate days.
-5 (-5%) – 0 (0%)
5 points deducted for responding to less than two peers or 5 points deducted for responding less than three days
-10 (-10%) – -5 (-5%)
5 points deducted for responding to less than two peers and 5 points deducted for responding less than three days
-10 (-10%) – -10 (-10%)
10 points deducted for Initial post submitted late
-20 (-20%) – -15 (-15%)
Initial post submitted late and 5 points deducted for responding to less than two peers and/ or 5 points deducted for responding less than three days
Assessment and Care of Patients with Neurologic and Orthopedic Conditions and Plastic/Reconstructive Surgery Essay Assignment Papers
