week 8

Directions:

1. Select one of the following prompts. 2. Complete the corresponding “Differentials Table” (this week focuses on chronic conditions

commonly referred to as palliative care) – include 5 differentials (excluding the example provided).

3. Upload your Differentials Table and answers to your chosen prompt to the Discussion Board.

Week 8 Prompts

1. Self-care is important to personal health, professional growth, and the ability to care for others. Discuss the importance of self-care for the APRN. Provide examples with your rationale.

2. Compassion fatigue is flourishing in our society today, due in part to the increasing demands of managed care, and it can impair your ability to function effectively. Discuss strategies to avoid compassion fatigue. Provide examples with your rational.

Differentials Table

Common Diagnoses Necessitating Palliative Care Referral by Nurse Practitioner

Signs/ Symptoms

Gold Standard Diagnostics Gold Standard Treatment

Ex: COPD

Chronic cough, chronic sputum production, shortness of breath worse with physical exertion, progressive symptoms, barrel chest, weight loss; hyperresona nce upon percussion, tactile fremitus and egophony is decreased; CXR may show hyperinflatio n; bullae sometimes present; coarse crackles.

Refer to GOLD Report – Global Initiative for Chronic Obstructive Lung Disease. 
 A diagnosis of COPD should be considered in any patient who has dyspnea, chronic cough or sputum production, a history of recurrent lower respiratory tract infections and/ or a history of exposure to risk factors for the disease, but forced spirometry showing the presence of a postbronchodil ator FEV1/ FVC < 0.7 is mandatory to establish the diagnosis of COPD.

Prevention and Maintenance Therapy: Smoking cessation, Vaccination (pneumonia, influenza, COVID-19, Tdap). 
 Acute exacerbation: SABA (albuterol, levalbuterol). SAMA (Ipratropium bromide) often used in combination with SABA. While continuation of ongoing therapy with long-acting beta agonists (LABAs) or LAMAs has not been specifically studied, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy advises their continuation. Oral Glucocorticoid therapy: 40mg per day for 5-14 days 
 Antibiotic Therapy: the GOLD strategy recommends empiric antibiotics for patients with COPD exacerbations who have increased sputum purulence and either increased sputum volume or increased dyspnea, or for patients who require ventilatory assistance.

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