Soap Note 1 Acute Conditions
SCHOOL OF GRADUATE STUDIES MSN Program
MSN5600L Diagnosis, Symptom and illness Management
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Modifications to the Course Syllabus The course syllabus may be modified at any time. Students will be informed of changes made to the syllabus. If a conflict exists between the course syllabus and the University Catalog, the University Catalog governs. Student Assessments Students will be given assessments from time to time at the instructor's discretion. As part of the course requirements, students must take both announced and unannounced assessments that may count toward their grade.
Course Description This course offers a variety of content to prepare the Family Nurse practitioner to deliver primary and/or acute care to adults, including the geriatric population, experiencing and managing health problems in one or more body systems. Nurse practitioner students will focus on health care for different type of population with particular emphasis on culture and the underserved populations. This course will also place emphasis on health promotion and disease prevention, screening of adult and older populations, and providing culturally competent care. Professional, ethical, and legal issues are addressed along with preparing the family nurse practitioner on how to appropriately diagnose and manage common health issues in the pediatric, adult and geriatric population Student Learning Outcomes After completing this course, the student should be able to:
1. Formulate differential diagnoses to promote health, prevent disease, and manage acute and chronic illness in the pediatric, adult and geriatric population
2. Employs screening and diagnostic strategies in the development of diagnoses
Course Number: MSN5600L Course Title: Diagnosis, Symptom and illness Management Credit Hours: 1 semester credit, 30 Lab Hours Prerequisites Required: MSN5150, MSN5200, MSN5250, MSN5300, MSN5350, MSN5400, MSN5550 Location: Miami Regional University/Remote Online Learning/ Via Slype Course Days and Times: Moodle Room Instructor: Grivel J. Hera Gomez, MSN, APRN FNP-C Contact Information: ghera@faculty.mru.edu
Office Hours:
By Appointment only - Monday Through Friday from 9:00 am to 6:00 pm via Skype /Microsoft Team/ phone. Please request appointments at least 24-48 hours in advance
SCHOOL OF GRADUATE STUDIES MSN Program
MSN5600L Diagnosis, Symptom and illness Management
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3. Critically analyze data and evidence for improving health outcomes 4. Formulate differential diagnoses to promote health, prevent disease and manage
acute and chronic illness in the pediatric, adult, and geriatric population, 5. Employ screening and diagnostic strategies in the development of diagnoses. 6. Critically analyze data and evidence for improving health outcomes.
Topical Course Outline
• Mechanism of Diagnosis and Treatment • Developmental and congenital childhood diseases and disorders • Diseases and Disorders of the Neurological System • Diseases and Disorders of the Cardiovascular System • Diseases and Disorders of the Respiratory System • Diseases and Disorders of the GI System • Diseases and Disorders of the Endocrine System • Diseases and Disorders of the Renal/GU System • Diseases and Disorders of the Reproductive System • Diseases and Disorders of the Integumentary System • Diseases and Disorders of the Musculoskeletal System
Methods of Delivery Lecture, Discussion, Audio-Visuals, Out-of-Class Assignments, Case Studies, Online Assignments, Demonstration and Practice, Group, and Individual Projects/Presentations.
Methods of Evaluation
Method %
Introduction & Syllabus Acknowledgment 5
Case Studies 20
Soap Notes 20
Typhon Assignments 15
Clinical Requirements (Complio American Data Bank) 20
PowerPoint Presentation 20
Total 100%
SCHOOL OF GRADUATE STUDIES MSN Program
MSN5600L Diagnosis, Symptom and illness Management
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Late Assignment Policy
Assignments turned in late will have 1 (one) point deduction per day submitted late. After 7 (seven) days, any assignment will get a grade of 0 (zero). No exceptions
Final Presentation will not be accepted late.
Grading Scale
Letter Grade Scale Numeric Grade A 4.0 90 - 100
B 3.0 80 - 89 F 0 < 80
Required Instructional Resources and Materials Terry Mahan Buttaro: Primary Care: A Collaborative Practice 5th Edition.(2016) Publisher: Mosby Ball, J., Dains, J., Flynn, J., Solomon, B., & Stewart, R. (2017). Seidel's Guide to Physical Examination (9thed.). St. Louis, MO: Elsevier Health Sciences. Domino, F., Baldor, R., Golding, J., Stephens, M. (2020). The 5-Minute Clinical Consult 2017 (28th ed.). Print (The 5-Minute Consult Series) Pagana, K., &Pagana, T. (2018). Mosby's Diagnostic and Laboratory Test Reference (14th ed.). St. Louis, MO: Elsevier Health Sciences. Out of Class Activities and Assignments: Students must complete all the clinical requirements needed to start their clinical rotations next semester. Students with "flagged" background and/or drug screen tests must be cleared by MRU Clinical Requirement Department and/or MRU Compliance department to continue their course of studies. Requirements for Successful Course Completion Students must attain a letter grade of B or higher for the course to count toward
SCHOOL OF GRADUATE STUDIES MSN Program
MSN5600L Diagnosis, Symptom and illness Management
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completion of the MSN. Academic Misconduct Statement Miami Regional University is a community dedicated to generating and imparting knowledge through excellent teaching and research, the rigorous and respectful exchange of ideas and community service. All students should respect the right of others to have an equitable opportunity to learn and honestly to demonstrate the quality of their learning. Therefore, all students are expected to adhere to the standard of academic conduct, which demonstrates respect for themselves, their fellow students, and the educational mission of the University. All students are deemed by the University to understand that if they are found responsible for academic misconduct, they will be subject to the Academic Misconduct procedures and sanctions, as outlined in the Student Handbook. Academic Misconduct includes: Cheating – The unauthorized use of books, notes, aids, electronic sources; or assistance from another person with respect to examinations, course assignments, service reports, class recitations; or the unauthorized possession of examination papers or course materials, whether originally authorized or not. Plagiarism – The use and appropriation of another's work without any indication of the source and the representation of such work as the student's own. Any student who fails to give credit for ideas, expressions or materials taken from another source, including internet sources, is responsible for plagiarism. Consequently, any student/s involved in such academic misconduct (such as cheating and PLAGIARISM) will receive 0 (zero) grade in such assignment/s and may be sent to the corresponding Academic Misconduct Committee. Syllabus Acknowledgment MUST be made by Moodle Room and required within the first week of class. No course work will be accepted or graded until the syllabus is acknowledged. Class Schedule
Week Topic and Lecture Objectives OCW and Assignments Total OCW = 96 Hours
1
• Course Orientation
• Syllabus Review
• Mechanism of disease diagnosis
and treatment
Read (Outcome 2, 3) Pagana, K., &Pagana, T. (2018). Mosby's manual of diagnostic and laboratory tests (14th ed.). St. Louis, MO: Elsevier Health Sciences. • Chapter 1 pages 1-10
SCHOOL OF GRADUATE STUDIES MSN Program
MSN5600L Diagnosis, Symptom and illness Management
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1. Introduction on Moodle Room 2. Acknowledge the syllabus in Moodle Room on the first week of class. Due by 05/08/2021 @11:59 pm
OCW: 1 hour
2 • Immunologic Diseases and
Disorders
• Guillain-Barré Syndrome
• HIV/AIDS
• Hodgkin Lymphoma
• Leukemia
• Lupus
• Multiple Myeloma
• Multiple Sclerosis
• Scleroderma
• Sjögren Syndrome
1. Read: (Outcome 1,3): 2 hours Domino, F., Baldor, R., Golding, J., Stephens, M. (2020). The 5- Minute Clinical Consult 2017
(28th ed.). Print (The 5-Minute Consult Series).
2. Read(Outcome 2, 3): 5.6 hours
Pagana, K., &Pagana, T. (2018). Mosby's manual of diagnostic and laboratory tests (14th ed.). St. Louis, MO: Elsevier Health Sciences.
• Appendix B: Immunologic Studies
OCW 7.6 Hours
3
Diseases and Disorders of the
Integumentary System
• Acne
• Burns
• Dermatitis
• Impetigo
• Lyme Disease
• Melanoma
• Methicillin-Resistant
Staphylococcus Aureus (MRSA)
• Pediculosis (Lice)
• Psoriasis
• Tinea (Capitis, Corporis, Cruris,
Pedis)
• Scabies
Read (Outcome 1,2): 3 hours 1. Terry Mahan Buttaro: Primary
Care: A Collaborative Practice (PART 5 SKIN DISORDERS
2. Read (Outcome 1,2): 3 hours
Domino, F., Baldor, R., Golding, J., Stephens, M. (2020). The 5- Minute Clinical Consult 2017
(28th ed.). Print (The 5-Minute Consult Series).
3. Read (Outcome 2, 3): 4.6 Hours
Pagana, K., &Pagana, T. (2018). Mosby's manual of diagnostic and laboratory tests (14th ed.). St. Louis, MO: Elsevier Health
SCHOOL OF GRADUATE STUDIES MSN Program
MSN5600L Diagnosis, Symptom and illness Management
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• Stevens-Johnson S.
Sciences. • Appendix B: Miscellaneous
Studies
• Appendix B: Melanoma Genetic Testing
4. Case Studies 1 & 2 due by 05/22/2021 @ 11:59 pm
OCW: 10.6 hours
4 Disease disorders of the Circulatory System:
• Acute Coronary Syndrome
• Anemia
• Aneurysm of the Abdominal Aorta
(Triple A)
• Atrial Fibrillation & Flutter
• Carotid Stenosis
• Deep Vein Thrombosis
• Endocarditis
• Heart Failure
• Hemophilia
• Heparin-Induced
Thrombocytopenia
• Hypercholesterolemia
• Hypertension
• Mitral Valve Prolapse,
Regurgitation, Stenosis
• Peripheral Arterial Disease
• Raynaud Phenomenon
• Rhabdomyolysis
• Rocky Mountain Spotted Fever
1. Read (Outcome 1,2, 3) 5 hours
Terry Mahan Buttaro: Primary
Care: A Collaborative Practice
PART 11 CARDIOVASCULAR
DISORDERS
2. Read (Outcome 1,2): 4 hours Domino, F., Baldor, R., Golding, J., Stephens, M. (2020). The 5- Minute Clinical Consult 2017
(28th ed.). Print (The 5-Minute Consult Series).
3. Read (Outcome 2, 3): 5 hours
Pagana, K., &Pagana, T. (2018). Mosby's manual of diagnostic and laboratory tests (14th ed.). St. Louis, MO: Elsevier Health Sciences.
• Appendix B: Cardiovascular Studies
OCW: 14 hours
5 Diseases and Disorders of the Respiratory System
• Asthma
1. Read (Outcome 1,2, 3) 5 hours Terry Mahan Buttaro: Primary Care: A Collaborative Practice
SCHOOL OF GRADUATE STUDIES MSN Program
MSN5600L Diagnosis, Symptom and illness Management
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• Atelectasis
• Basal/Squamous Cell Carcinoma
• Bronchitis
• Chronic Obstructive Pulmonary
Disease and Emphysema
• Cystic Fibrosis
• Influenza
• Legionnaires' Disease
• Sleep Apnea, Obstructive
• Pleural Effusion
• Pneumonia
• Pulmonary Emboli
• Sarcoidosis
• Tuberculosis (TB)
•
PART 10 RESP DISORDERS 2. Read (Outcome 1, 2): 3 hours
Domino, F., Baldor, R., Golding, J., Stephens, M. (2020). The 5- Minute Clinical Consult 2017
(28th ed.). Print (The 5-Minute Consult Series).
3. Read(Outcome 2, 3): 3.9 hours
Pagana, K., &Pagana, T. (2018). Mosby's manual of diagnostic and laboratory tests (14th ed.). St. Louis, MO: Elsevier Health Sciences.
• Appendix: Pulmonary Studies
4. Soap Note #1 (Any Adult Acute Condition from weeks 1 through 5) due by 06/05/2021 @11:59 pm
OCW: 11.9 hours
6 Diseases and Disorders of the Gastrointestinal System
• Ascites
• Appendicitis
• Celiac Disease
• Cholelithiasis
• Cirrhosis
• Clostridium Difficile (C. Diff)
• Colitis
• Crohn's Disease
• Constipation
• Diarrhea
• Diverticulitis
• Esophageal Varices
1. Read (Outcome 1,2, 3) 4hours Terry Mahan Buttaro: Primary Care: A Collaborative Practice PART 12 GI DISORDERS
2. Read(Outcome1,2): 3 hours
Domino, F., Baldor, R., Golding, J., Stephens, M. (2020). The 5- Minute Clinical Consult 2017
(28th ed.). Print (The 5-Minute Consult Series).
3. Read(Outcome 2, 3): 2.8 hours Pagana, K., &Pagana, T. (2018). Mosby's manual of diagnostic and laboratory tests (14th
SCHOOL OF GRADUATE STUDIES MSN Program
MSN5600L Diagnosis, Symptom and illness Management
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ed.). St. Louis, MO: Elsevier Health Sciences. • Appendix B: Gastrointestinal
Studies OCW: 9.8 hours
7
• Diseases and Disorders of the
Gastrointestinal System
• Gastritis
• Gastroesophageal Reflux Disease
• Hemorrhoids
• Hepatic Encephalopathy
• Hepatitis
• Irritable Bowel Syndrome (IBS)
• Pancreatic Cancer
• Pancreatitis
• Peptic Ulcer Disease (Zollinger-
Ellison Syndrome)
• Salmonella Infection
•
1. Read (Outcome 1,2, 3): 4 hours
Terry Mahan Buttaro: Primary
Care: A Collaborative Practice
PART 12 GI DISORDERS
2. Read(Outcome 1,2): 3 hours Domino, F., Baldor, R., Golding, J., Stephens, M. (2020). The 5- Minute Clinical Consult 2017
(28th ed.). Print (The 5-Minute Consult Series).
3. Read(Outcome 2, 3): 2.8 hours Pagana, K., &Pagana, T. (2018). Mosby's manual of diagnostic and laboratory tests (14th ed.). St. Louis, MO: Elsevier Health Sciences.
• Appendix B: Gastrointestinal Studies
• Case study 3 & 4 due 06/19/2021 @11:59 pm
OCW: 9.8 hours
8 • Mid Term Lecture Course • Preparation for Mid Term exam (Lecture Course)
9
Diseases and Disorders of the Renal/GU System
• Acute Kidney Injury (AKI)
• Bladder Cancer
1. Read(Outcome 1,2): 3 hours Domino, F., Baldor, R., Golding, J., Stephens, M. (2020). The 5- Minute Clinical Consult 2017
SCHOOL OF GRADUATE STUDIES MSN Program
MSN5600L Diagnosis, Symptom and illness Management
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• Glomerulonephritis
• Hematuria
• Hydronephrosis
• Interstitial Cystitis
• Priapism
• Prostate Cancer
• Prostatic Hyperplasia, Benign
(BPH)
• Prostatitis
• Pyelonephritis
• Testicular Torsion
• Urinary Tract Infection (UTI)
•
(28th ed.). Print (The 5-Minute Consult Series).
2. Read(Outcome 2, 3): 6.1 Hours
Pagana, K., &Pagana, T. (2018). Mosby's manual of diagnostic and laboratory tests (14th ed.). St. Louis, MO: Elsevier Health Sciences.
• Appendix B: Urologic Studies
3. Soap Note # 2 (Chronic Condition) due by 07/03/2021 at 11:59 pm Please pick any Adult Chronic Disease from Weeks 6-10
OCW: 9.1 hours
10 Diseases and Disorders of the Endocrine
System • Addison Disease
• Cushing Syndrome
• Diabetes
• Graves' Disease
• Hyper-, Hypoparathyroidism • Hyper-, Hypothyroidism
• Myasthenia Gravis
• Syndrome of Inappropriate Antidiuretic Hormone Secretion
1. Read (Outcome 1,2, 3) 5 hours
Terry Mahan Buttaro: Primary
Care: A Collaborative Practice.
2. Read(Outcome 1,2): 2 hours
Domino, F., Baldor, R., Golding, J., Stephens, M. (2020). The 5- Minute Clinical Consult 2017
(28th ed.). Print (The 5-Minute Consult Series).
3. Read(Outcome 2, 3): 7.7 hours Pagana, K., &Pagana, T. (2018). Mosby's manual of diagnostic and laboratory tests (14th ed.). St. Louis, MO: Elsevier Health Sciences. • Appendix B: Endocrine
Studies
OWC: 14.7 hours
SCHOOL OF GRADUATE STUDIES MSN Program
MSN5600L Diagnosis, Symptom and illness Management
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11
Mental Health Disorders
• Alcohol Abuse, Dependence, and
Withdrawal
• Alzheimer's
• Anorexia Nervosa
• Anxiety
• Bipolar
• Depression
• Obsessive-Compulsive Disorder
(OCD)
• Psychosis
• Schizophrenia
• Substance Use Disorders
1. Read (Outcome 1,2, 3) 4 hours Terry Mahan Buttaro: Primary Care: A Collaborative Practice
2. Read(Outcome 1,2): 2 hours
3. Domino, F., Baldor, R., Golding,
J., Stephens, M. (2020). The 5- Minute Clinical Consult 2017
(28th ed.). Print (The 5-Minute Consult Series).
4. Read(Outcome 2, 3): 1.5 hours Pagana, K., &Pagana, T. (2018). Mosby's manual of diagnostic and laboratory tests (14th ed.). St. Louis, MO: Elsevier Health Sciences.
• Appendix B: Nervous System Studies
Complio American Data bank: Due by Saturday 07/17/21 by 11:59 pm – Submit proof from Complio of completion as follows (such as a screenshot of from your Complio account including background and drug screen green checks )
All your clinical requirements documentation (such as vaccinations, tb, liability insurance, etc.) should have been already submitted. They all should be approved by this date)
OCW: 7.5 hours
SCHOOL OF GRADUATE STUDIES MSN Program
MSN5600L Diagnosis, Symptom and illness Management
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12 Diseases and Disorders of the Neurological System
• Bell Palsy
• Herpes Zoster (Shingles)
• Hydrocephalus
• Meningitis
• Parkinson Disease
• Posttraumatic Stress Disorder
(PTSD)
• Seizure
• Stroke
• Transient Ischemic Attack (TIA)
• Vertigo
Diseases and Disorders of the Eye and Ear
• Cataract
• Conjunctivitis
• Epistaxis
• Glaucoma
• Labyrinthitis
• Lacrimal Disorders
• Macular Degeneration
• Meniere Disease
• Otitis Media/Externa
• Tinnitus
• Retinal Detachment
OCW: # Hours
1. Read (Outcome 1,2, 3) 4 hours
Terry Mahan Buttaro: Primary
Care: A Collaborative Practice
2. Read(Outcome 1, 2): 4 hours Domino, F., Baldor, R., Golding, J., Stephens, M. (2020). The 5- Minute Clinical Consult 2017
(28th ed.). Print (The 5-Minute Consult Series).
3. Read(Outcome 2, 3): 1.6 hours
Pagana, K., &Pagana, T. (2018). Mosby's manual of diagnostic and laboratory tests (14th ed.). St. Louis, MO: Elsevier Health Sciences.
• Appendix B: Nervous System Studies
Typhon Assignment 1: Due by 07/24/2021
11:59 pm
Log into Typhon and Watch the Student Entry Tutorial Video (70 minutes) in all entirely.
Then write a 1 paragraph summary about what you learned about Typhon and upload a word document in external documents in Typhon.
Also, upload it into Moodle under Typhon Assignment 1. (5 points)
SCHOOL OF GRADUATE STUDIES MSN Program
MSN5600L Diagnosis, Symptom and illness Management
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OCW: 9.6 hours
13 Diseases and Disorders of the Musculoskeletal System
• Arthritis
• Carpal tunnel
• Fractures
• Gout
• Muscular Dystrophy
• Osteomyelitis
• Osteoporosis
• Plantar Fasciitis
• Popliteal (Baker) Cyst
1. Read (Outcome 1,2, 3) 4 hours Terry Mahan Buttaro: Primary Care: A Collaborative Practice
2. Read (Outcome 1,2,3): 2 hours Domino, F., Baldor, R., Golding, J., Stephens, M. (2020). The 5- Minute Clinical Consult 2017
(28th ed.). Print (The 5-Minute Consult Series).
3. Read (Outcome 2, 3): 1.6 hours Pagana, K., &Pagana, T. (2018). Mosby's manual of diagnostic and laboratory tests (14th ed.). St. Louis, MO: Elsevier Health Sciences.
• Appendix B: Skeletal System Studies
Start working on your clinical Case Study Presentation (PowerPoint) with VoiceOver. Pick any Disease from Week 11-15 Typhon Assignment 2: (5 points) due by Saturday 07/31/2021 at 11:59 pm
• Upload Soap Note 1 to External
Documents in Typhon (5 points)
Make a case log that goes with your patient in your soap note 1 (fill out all the information required in Typhon) Post time worked on both Soap and Case Log under time log (The purpose of this last assignment is to train /practice using Typhon in
SCHOOL OF GRADUATE STUDIES MSN Program
MSN5600L Diagnosis, Symptom and illness Management
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preparation for next semester for your clinical rotation)
OCW: 7.6 hours
14 Diseases and Disorders of the Reproductive System
• Amenorrhea
• Cervical Malignancy
• Chlamydia
• Ductal Carcinoma in Situ
• Ectopic Pregnancy
• Endometriosis
• Gonococcal Infections
• Gynecomastia
• Herpes, Genital
• Hydrocele
• Menopause
• Menorrhagia
• Ovarian Cancer, Cyst, Tumor
• Pelvic Inflammatory Disease
• Syphilis
• Trichomoniasis
• Uterine and Pelvic Organ Prolapse
OCW: # Hours
1. Read (Outcome 1,2, 3) 4 hours Terry Mahan Buttaro: Primary Care: A Collaborative Practice
2. Read(Outcome 1,2): 4 hours
Domino, F., Baldor, R., Golding, J., Stephens, M. (2020). The 5- Minute Clinical Consult 2017
(28th ed.). Print (The 5-Minute Consult Series).
3. Read(Outcome 2, 3): 6.3 hours
Pagana, K., &Pagana, T. (2018). Mosby's manual of diagnostic and laboratory tests (14th ed.). St. Louis, MO: Elsevier Health Sciences.
• Appendix B: Reproductive System Studies
4. Keep working on Clinical Case PowerPoint Presentation
5. Typhon Assignment 3: (5 points) Due by Saturday 08/07/2021 at 11:59 pm (5 points)
Upload Soap Note 2 to External Documents in Typhon
Make a case log that goes with your
patient in SOAP #2 (Fill out all demographics and required
SCHOOL OF GRADUATE STUDIES MSN Program
MSN5600L Diagnosis, Symptom and illness Management
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information, medications classes, and
a small note about your experience with Typhon)
Post time worked on both Soap note
and Case log under time log
(The purpose of this last assignment is
to train /practice using Typhon in
preparation for next semester for your
clinical rotation)
OCW: 14.3 hours
15 Developmental and congenital childhood diseases and disorders
• Atrial Septal Defect
• Attention Deficit/Hyperactivity Disorder
• Autism Spectrum Disorder
• Chicken Pox
• Cerebral Palsy
• CorPulmonale
• Croup
• Cryptorchidism
• Down Syndrome
• Hand-Foot-and-Mouth Disease
• Kawasaki disease
• Reye Syndrome
1. Read (Outcome 1,2, 3) 4 hours Terry Mahan Buttaro: Primary Care: A Collaborative Practice
2. Read(Outcome 1,2): 3 hours
Domino, F., Baldor, R., Golding, J., Stephens, M. (2020). The 5- Minute Clinical Consult 2017
(28th ed.). Print (The 5-Minute Consult Series).
3. Read (Outcome 2, 3): 2 hours
Pagana, K., &Pagana, T. (2018). Mosby's manual of diagnostic and laboratory tests (14th ed.). St. Louis, MO: Elsevier Health Sciences.
• Appendix B
Group Clinical Case Study Presentation
Due by Saturday 08/14/2021 at 11:59 pm)
Upload to Moodle Room.
*** No late Assignment will be accepted ***
SCHOOL OF GRADUATE STUDIES MSN Program
MSN5600L Diagnosis, Symptom and illness Management
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Prepare for the final exam in the lecture class
OCW: 9 hours
16 • Final Lecture Course
• Date TBD
Good Luck with your Final Exams! Last week of Class!