Skills and Competencies in Clinical Practice

Question 1

Review the course objectives and consider how you can develop the specified skills and competencies while applying clinical practise guidelines as an AGACNP providing patient care and creating appropriate patient-centred care plans. List three to five clinical objectives and write a 250-word summary of your plan to incorporate the course objectives and clinical practice guidelines for your clinical experience. Include a discussion of what you hope to achieve. You will refer back to this information during Topic 16 when you are asked to reflect on your clinical objectives. Skills and Competencies in Clinical Practice

Question 2

Acute care geriatric patients often present with muted or vague signs and symptoms of the infection process. They are at risk for a delay in diagnosis and treatment of acute infections, sepsis, and severe sepsis.

Discuss the etiology of their less than dramatic presentations, including pathophysiologic changes of aging and the “masking” of normal compensatory indicators by pharmaceuticals (e.g., beta-blockers, NSAIDs, prednisone, scheduled Tylenol-containing medications). Skills and Competencies in Clinical Practice

Provide an example of how you would provide family or significant others with education on the seriousness of sepsis in the elderly. Discuss how you would react to a family member’s request for an “alternative therapy.” Include discussion of how you would incorporate a Christian worldview into your practice as you approach a critically or terminally ill geriatric patient.

Question 3

Identify and discuss sepsis SIRS severe sepsis, and septic shock by listing the diagnostic criteria for each.

Discuss sepsis protocols employed at your current clinical or work site. Protocols are consistent for the most part, but individual sites may utilize empiric antibiotics/antifungals, steroids, ICU placement, empiric antibiotics, hemodynamic monitoring, and other interventions. Skills and Competencies in Clinical Practice

Review current literature and briefly summarize one novel or new approach to sepsis management.

Question 4

Due to the advances in imaging and diagnostic procedures, differential diagnoses for fever of unknown origin can usually be narrowed down. However, when a patient does present with fever and no clear origin, it is truly a challenge to locate the inflammation or infection in a timely manner so that focused treatment can be employed.

You are the AGACNP hospitalist provider tasked with admitting the following patient to the hospital:

  1. She is a 40-year-old, Hispanic, developmentally delayed, female from a local long-term care center with early dementia, DM-2 (insulin-dependent), neurogenic bladder, hypertension, and systolic dysfunction (EF 30%) due to ischemic cardiomyopathy.
  2. She is brought by emergency medical transport to the emergency department with altered mental status and the following vital signs: oral temp is 101.5, HR 72, RR=28, and oxygen saturation on room air is 88%.
  3. She is currently on prednisone 20 mg daily for temporal arteritis, and Coreg 12.5 mg BID, Namenda 10 mg daily, Lasix 40 mg daily, Levemir 20 units SQ BID, metformin 500 mg BID, and sliding scale insulin.

Explain the presentation, etiology, common differential diagnosis, typical diagnostic work-up, treatment plan, preventative measures (if any), and additional information that would be important to the geriatric population with regard to a fever of unknown origin.

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