10 ExemplarsExemplar I NR503 Population Health, Epidemiology & .docx

10 Exemplars
Exemplar I: NR503 Population Health, Epidemiology &
Statistical Principles Week 3
The prevalence of underweight, overweight and obesity in
children and adolescents from Ukraine
The main objective of this study was to determine the
prevalence of obesity, overweight and underweight in Ukrainian
children. The study took the format of a cross-sectional design
where a representative sample of 13,739 was taken for the
children. Measures taken from the children included body
weight and height and the Body Mass Index (BMI) obtained
from these. Results were interpreted based on standards of the
US Center for Disease Control (CDC) International Obesity
Taskforce (IOTF) and the World Health Organization
(WHO).Results indicated that 12.1% of children are
underweight, 17.6% overweight and 12.6% obese among
children aged 12 to 18 years. More of the young
populations are obese than the old in the country. The
prevalence of overweight and obesity among Ukrainian children
is higher than the average for Europe that stands at
30%. However, compared to the US, 18.5% obesity in children,
Ukraine children are less obese. Included in the article are
measures that would help reduce the prevalence of overweight
at a national level (Dereń et al., 2018).
This article is relatively relevant to an average reader in the US.
While it does not indicate the impact of the high rate of
overweight and obesity, it shows that the US leads the world in
cases of obesity and overweight. It has the capacity to influence
group decision making more than individual based
decisions. The article left out the most relevant information
such as factors that have contributed to the high rate of
overweight and obesity among children in Ukraine. Another
important information that would have been included in the
article are measures to control the overweight epidemic at an

individual level (Dietz et al., 2015). Another important
information would be methods to determine one’s weight status
to determine if they are safe or not.
References
Dereń, K., Nyankovskyy, S., Nyankovska, O., Łuszczki,
E., Wyszyńska, J., Sobolewski, M., & Mazur, A. (2018). The
prevalence of underweight, overweight and obesity in children
and adolescents from Ukraine. Scientific reports, 8(1),
3625.https://www.nature.com/articles/s41598-018-21773-
4 (Links to an external site.)
Dietz, W. H., Baur, L. A., Hall, K., Puhl, R. M., Taveras, E.
M., Uauy, R., & Kopelman, P. (2015). Management of obesity:
improvement of health-care training and systems for prevention
and care. The Lancet, 385(9986), 2521-
2533.https://www.sciencedirect.com/science/article/pii/S014067
3614617487
Chamberlain Program Outcomes
· PO #1: Provide high quality, safe, patient-centered care
grounded in holistic health principles (Holistic Health &
Patient-Centered Care)
AACN MSN Essentials
· Essential I: Background for Practice from Sciences and
Humanities
NONPF Core Competencies
· Scientific Foundation Competencies
· Technology and Information Literacy Competencies
I have learned a lot of understanding and knowledge of
epidemiological and statistical concepts. It is stated in the
course overview, “epidemiology is an important tool in the
Advanced Practice Nurse (APN) arsenal for providing effective
and fiscally responsible healthcare to individuals and
populations.” With that being said, this course has given me the
necessary tools and knowledge to meet the MSN Essential II
and NP Core Competencies #2. Program Outcome #4 is
regarding quality improvement and safety, the integration of

scholarship into practice, and promoting the health of
populations through prevention (AACN, 2011). I was able to
achieve Program Outcome #4 through the case studies presented
each week. Each case required a list of possible differentials to
include pathophysiology, etiology, and treatment options. Each
case required critical thinking and the use of current research.
Quality improvement and safety were promoted with evidenced-
based research offering current evidenced-based treatment
options to incorporate into daily practice. Exemplar II: NR 505
Advance Research Methods Week 5
The research PICO question;
P = How effective is the incorporation of massage therapy
compared to the sole use of opioids in the management of
chronic pain among the elderly with chronic non-cancer pain
seeking help in a primary healthcare setting?
I = Intervention—Massage therapy and opioid prescription
C = Control or Comparison--- what is the effectiveness of
massage therapy versus Opioid use for chronic pain.
O = Outcome --- The acceptable pain level will less than 3.
T = Time Frame – 3 months
The quantitative research approach that provides a summary of
data gathered to support generalizations will be used. This
approach allows for a broader study by taking a big number of
subjects allowing generalization of results and also allowing for
a greater level of accuracy and objectivity (Choy, 2014). For the
study design to provide summaries of data that support
generalizations, a few variables are tested on many cases using
highly rigid prescribed procedures to ensure validity and
reliability. Finally, keeping a distance from the subjects and
ensuring they are unknown to him/her, the research can avoid
personal bias (Choy, 2014). The research aims at studying the
effectiveness of incorporation of massage therapy in pain
management and the exclusive use of opioids, in primary health
care. Consequently, we need measurable numerical descriptions
of effectiveness rather than narratives and verbatim information

given by a qualitative research approach (Choy, 2014). This will
help create a highly precise relational model between the
method of pain management used and the level of pain control
achieved.
The experimental design where the researcher manipulates the
independent variable in some independent groups will be used
in the study. The primary use of the experimental research
design is to understand the causal relationship (Salazar, Crosby
& DiClemente, 2015). Another hallmark of the experimental
research design is the random selection of participants to be
included in the groups available in the research making the
treatment distributed among the participants (Harriss &
Atkinson, 2015). Due to the repeatability of the experimental
research design, results can be checked and verified for validity.
The experimental design also allows for many variations that
allow the researcher to tailor their experiment while still
maintaining the design validity. The relative freedom of an
experimental method may lead to results that are not applicable
in real life situation if the researcher engages in too many
hypotheticals (Harriss & Atkinson, 2015). Also, ethical
considerations are very vital when the experimental
methodology is applied in human subjects hence is not highly
popular in health research (Bromley, Mikesell, Jones &
Khodyakov, 2015).
Data quality is defined by validity, reliability, objectivity,
integrity, relevance and completeness. To ensure the integrity of
data, there will be a random selection of participants to avoid
researcher bias. Careful provision of the treatments by first
treating the administers will ensure the validity of data. To
ensure generalizability, a relatively large number of participants
will be recruited. Consistency in recording results will ensure
the completeness of data.
References
Bromley, E., Mikesell, L., Jones, F., & Khodyakov, D. (2015).
From subject to participant: Ethics and the evolving role of

community in health research. American Journal of Public
Health, 105(5), 900-908.
https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.3
02403
Harriss, D. J., & Atkinson, G. (2015). Ethical standards in sport
and exercise science research: 2016 update. Int J Sports
Med, 36(14), 1121-1124.
http://researchonline.ljmu.ac.uk/2784/1/IJSM_HARRISS-14-
15%20final%20draft.pdf
Salazar, L. F., Crosby, R. A., & DiClemente, R. J.
(2015). Research methods in health promotion. John Wiley &
Sons.
https://www.tandfonline.com/doi/abs/10.1080/03630242.2014.9
32893
Choy, L. T. (2014). The strengths and weaknesses of research
methodology: Comparison and complimentary between
qualitative and quantitative approaches. IOSR Journal of
Humanities and Social Science, 19(4), 99-104.
https://s3.amazonaws.com/academia.edu.documents/37208325/N
0194399104.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53U
L3A&Expires=1533581350&Signature=sTabQTLpQs%2BaUY6
qNpYu77TDT40%3D&response-content-
disposition=inline%3B%20filename%3DThe_Strengths_and_We
aknesses_of_Research.pdf
· PO #5: Advocates for positive health outcomes through
compassionate, evidence-based, collaborative advanced nursing
practice (Extraordinary nursing)
AACN MSN Essentials
· Essential VI: Health Policy and Advocacy
· Scientific Foundation Competencies
· Policy CompetenciesExemplar III: NR 507 Advanced
Pathophysiology Week 3
Sickle cell anemia is a disorder that causes the oxygen-

carrying red blood cells to misshapen, distort, become rigid and
at times take a crescent shape. It is a genetic disease in which in
the sixth amino acid of the beta globin chain, valine is replaced
by glutamic acid. The valine replacing glutamic acid has the
ability to fit in the hydrophobic pocket of
the hemoglobinmolecule causing the hemoglobin in red blood
cell to polymerize and form hemoglobin tetramers recognized
by long stiff fibers (Rivera, Veneziani, Ware & Platt,
2016). The sickle cell disease occurs when a child inherits the
sickle cell gene from both parents.
The hemoglobin polymerization is either triggered by acidosis
or hypoxia that causes the increased rigidity of red blood cells
making them become crescent-shaped. Further, the deformed
cell may cause vaso-occlusion in small blood vessels when they
adhere to the endothelium that slow blood flow in larger
vessels (Steinberg et al., 2014). Further, the deformed cells are
susceptible to hemolysis cause anemia. The sickle cell state is
an inflammation resulting from the abnormal activation of
granulocytes and monocytes precipitated by cold, stress,
extreme exercise acidosis, dehydration, and infections among
other factors.
One of the hallmark symptoms in the patient is the episodic pain
where she complains of abdominal pain and severe chest
pain. The second sign is the high temperature that the patient
reports to have had during her exercise. Jaundice is also an
indicator of sickle cell (Steinberg et al., 2014). The low blood
pressure and the history of sickle cells confirm that she has the
disorder.
Pain is the major sign of sickle cell anemia and is referredto as
crises. It normally develops when the crescent shapes red blood
cells block small blood vessels in the chest, joint, andabdomen.
Lasting for weeks and varying in intensity is the major indicator
that the pain is caused by sickle cell. Sickle
cell anemia increases individual susceptibility to infections that
can cause fevers in the patient. Long lasting sickle cells
episodes can cause a deficiency in nitrous oxide as hemoglobin

and arginase are released from lysed blood cells
and scavenge on it (Steinberg et al., 2014). The deficiency
in nitrous oxide may cause thrombosis
or pulmonary vasoconstriction hence blood pressure problems.
One important teaching to give the patient is on the importance
of prevention of infections through hygiene and avoiding
exposure to germs. They should be advised to take plenty of
water as dehydration increases risk. They should avoid
temperature extremes, do regular but not extreme physical
exercise and avoid the uncontrolled use of over the counter
drugs as they may affect their kidneys (Steinberg, 2016).
References
Rivera, C. P., Veneziani, A., Ware, R. E., & Platt, M. O. (2016).
Sickle cell anemia and pediatric strokes: computational fluid
dynamics analysis in the middle cerebral artery. Experimental
Biology and Medicine, 241(7), 755-
765.http://journals.sagepub.com/doi/abs/10.1177/153537021663
6722 (Links to an external site.)
Steinberg, M. H. (2016). Overview of sickle cell anemia
pathophysiology. In Sickle Cell Anemia (pp. 49-73). Springer,
Cham.https://link.springer.com/chapter/10.1007/978-3-319-
06713-1_3
Steinberg, M. H., Chui, D. H., Dover, G. J., Sebastiani, P., &
Alsultan, A. (2014). Fetal hemoglobin in sickle cell anemia: a
glass half full?. Blood, 123(4), 481-
485.https://onlinelibrary.wiley.com/doi/full/10.1002/ajh.23811
· PO #2: Create a caring environment for achieving quality
health outcomes (Care-Focused)
· PO #4: Integrate professional values through scholarship and
service in health care (Professional identity)
AACN MSN Essentials
· Essential VIII: Clinical Prevention and Population Health for
Improving Health

· Independent Practice Competencies
· Policy Competencies
· The purpose of the MSN program is to equip students with
skills to integrate findings from different fields including
nursing, public health, genetics, nursing, biopsychological
fields to improve the quality of care delivered in diverse
settings. This course improves the ability of nursing
professionals to use available knowledge in these fields to
respond to the specific needs of patients under their care.
Throughout the course, I have learned and practised different
aspects that not only makes me able to respond to the needs of
the given patient but also create a holistic approach to dealing
with health challenges in the community.
· Among the most important aspects that we went through in
class are Evidence-Based Practice (EBP) and the utility of
research knowledge in patient care. EBP involves the explicit,
judicious and conscientious use of the most current research
findings to make decisions on patient care (Solomons, Spross &
Lamb, 2017). It involves the integration of patient values,
clinical expertise accumulated through experience and most
appropriate evidence from research to make decisions about
patient care. I have acquired the skills and knowledge necessary
to allow me to assess patients, ask clinical questions, acquire
evidence and appraise it before applying and evaluating it in the
clinical setting. While EBP gives an opportunity to reduce cost
and time used in care among other benefits, the most important
is the allowance for tailor making care to make it patient
centered.
· Through EBP, the specific needs of individual patients are
integrated with their values and desired outcomes. This is
patient-centred Care and leads to improved healthcare quality
and reduced hospital stay. Patient-centred healthcare involves
encouraging the active collaboration in making decisions among
the different stakeholders of patient care including family to
ensure customized care is provided (Elwyn et al., 2014).

Patient-centred goals are hence aligned with the vision, mission
and quality improvement goals of healthcare. Patient-centred
care focuses on both the emotional and physical comfort of
patients (Hack et al., 2017). Chief Benefit of this integration
includes improved healthcare outcomes and reduced stay in
hospitals.
· Nursing not only involves the integration of different fields in
EBD to provide both patient-centred care and enhance the
health of the society. In this course, different fields including
genetics, psychology, social science, biology and others were
used as the basis for understanding different conditions and
create solutions. This integration improves the quality of
healthcare delivered by the nurse to increase health quality in
the society.
·
· References
· Elwyn, G., Dehlendorf, C., Epstein, R. M., Marrin, K., White,
J., & Frosch, D. L. (2014). Shared decision making and
motivational interviewing: achieving patient-centered care
across the spectrum of health care problems. The Annals of
Family Medicine, 12(3), 270-275.
http://www.annfammed.org/content/12/3/270.short (Links to an
external site.)
· Hack, S. M., Muralidharan, A., Brown, C. H., Lucksted, A. A.,
& Patterson, J. (2017). Provider behaviors or consumer
participation: How should we measure person-centered
care?. International Journal of Person Centered Medicine, 7(1),
14-20.
http://ijpcm.org/index.php/IJPCM/article/view/602 (Links to an
external site.)
· Solomons, N. M., Spross, J. A., & Lamb, G. (2017). Influence
of Nurse Social Networks on Evidence-Based Practice (EBP):
Results of an Exploratory Study.
https://sigma.nursingrepository.org/handle/10755/622234
Exemplar IV: NR 508 Advanced Pharmacology Week 5
For Maria who is at risk of developing diabetes mellitus, there

are several treatment goals to help regulate and reduce the
chances of occurrence. Maria is at the pre-diabetes stage of the
disease and risks getting the disease with symptoms that may
impede her quality of life. The first goals are to lower the
fasting plasma glucose from 179mg/dl to the normal range of
less than 110 mg/dl to 90mg/dl. The second is to lower the
HgbA1C percentage from 7.4% to normal ranges of 4% to 5.6%.
The third goal is to reduce the TSH levels to 5.5 and below.
The final goal is to reduce Maria’s weight to lower the chances
of getting diabetes and the consequences that come with it.
Maria should get the first line of diabetes management drugs.
Metformin is the first line of diabetes medicine and is often
given to first time users. Metformin is an antihyperglycemic
agent that improves the patient’s tolerance to glucose through
several ways that lower basal and postprandial plasma glucose
(Chaudhury et al., 2017). First, metformin decreases intestinal
absorption of glucose hence making the amount reaching the
bloodstream from the intestines low (Lipska et al., 2015). It
also reduces hepatic glucose production hence lowers the
amount of glucose coming from the liver by glycogen
breakdown. Thirdly, metformin increases cell insulin
sensitivity by increasing peripheral uptake and utilization
(Chaudhury et al., 2017). It further does not cause
hypoglycaemia. The patient would also be given sulfonylureas
which act by increasing the production of insulin (Chaudhury et
al., 2017).
For patients using metformin, several points of teaching are
important to regulate blood sugar and ensure no negative
impacts. The first point is on the dosage of the drug where the
patient should adhere to the amount and frequency of the drug
prescribed by the doctor (Chaudhury et al., 2017). Secondly,
there is a need to teach the patients on when to take medicine in
relations to their food intake and exercise regime. The
thirdpoint, the patient should be taught on the possibility of side
effects including those related to the alimentary canal such as
indigestion, bloating, diarrhea and stomach pain. Other

symptoms that may develop are headache, chest pain, rash and
muscle pain(Chaudhury et al., 2017). Finally, there is a need to
teach what to do in case of overdose and the consequent
poisoning of the individuals.
If Maria was having an initial HbgA1C of 10.2mg/dl and fasting
glucose of 305 mg/dl, there would be a need to change the drug
to insulin. Insulin will break down the excess sugar in the blood
and lower it hence reduce the possibility of negative
consequences (Chaudhury et al., 2017).
References
Chaudhury, A., Duvoor, C., Dendi, R., Sena, V., Kraleti, S.,
Chada, A., ... & Kuriakose, K. (2017). Clinical review of
antidiabetic drugs: Implications for type 2 diabetes mellitus
management. Frontiers in endocrinology, 8,
6.https://www.frontiersin.org/articles/10.3389/fendo.2017.0000
6/full (Links to an external site.)
Lipska, K. J., Ross, J. S., Miao, Y., Shah, N. D., Lee, S. J., &
Steinman, M. A. (2015). Potential overtreatment of diabetes
mellitus in older adults with tight glycemiccontrol. JAMA
internal medicine, 175(3), 356-
362.https://jamanetwork.com/journals/jamainternalmedicine/full
article/2089233?utm_source=Silverchair%20Information%20S
practice (Extraordinary nursing).
AACN MSN Essentials
· Essential VII: Interprofessional Collaboration for Improving
Patient and
Population Health Outcomes.

Health Delivery Systems CompetenciesExemplar V: NR 509
Advanced Physical Assessments Week 4
The Cardiovascular System
Introduction
Also known as the circulatory system, the cardiovascular system
is responsible for the transportation of blood containing
nutrients and other substances including electrolytes, hormones,
carbon dioxide and blood cells throughout the body. The
circulatory system includes different components and is linked
to the lymph transporting lymphatic system (Feher, 2017). Due
to its importance as part of the body, the cardiovascular system
needs to be thoroughly taken care of through substantive
assessment not only during periods when people are unwell but
also when health to ensure normal functioning.
Structure and Function
In general, the cardiovascular system can be described as being
composed on the heart, blood vessels, and blood. The heart that
is located in the chest is the system that pumps blood through a
blood vessel to all the [parts of the body. The heart is made of
cardiac muscles that aid in the movement that result in the
pumping of blood throughout the body. The pumping of blood is
an involuntary action aided by the pacemaker (Feher, 2017).
Moreover, the heart is divided into four chambers, two atrium,
and two ventricles. While atrium receives blood from the body
parts, ventricles pump blood out.
Blood vessels carry blood from the heart to all the parts of the
body and back. Arteries are blood vessels that carry blood from
the heart to body parts while veins carry blood from all body
parts back into the heart. Due to the low pressure of blood in
veins compared to arteries, the former have valves that prevent
backflow of blood. Among the most important major blood
vessels include the pulmonary artery and vein that take oxygen
from the lungs, the hepatic artery and vein that take nutrients
from the alimentary canal and the coronary artery and vein that
circulate blood to heart muscles (Feher, 2017). Joining arteries
and veins are microscopic blood vessels called capillaries that

supply blood to tissues and cells.
Blood is the fluid that is pumped through blood vessels by the
heart and carries oxygen, nutrients, cells, electrolytes and waste
substances throughout the body. The major components of blood
are plasma and blood cells. Plasma is 92% water and is the fluid
within which ions, hormones, glucose, proteins, blood cells, and
carbon dioxide are found (Hillegass, 2016). On the other hand,
the blood cells are different and specialized for certain
functions. Red blood cells have hemoglobin to carry oxygen.
White blood cells fight disease-causing pathogens and platelets
aid in clotting.
Subjective data
Collections of subjective data on the circulatory system include
asking for common symptoms. These include the presence of
chest pain, its location, intensity, type, duration, radiation,
when it occurs and with and without exertion (Hillegass, 2016).
Also associated symptoms such as sweating, nausea, anxiety,
and shortness of breath should also be considered. Assessment
on the shortness of breath including whether it occurs when
bending, after waking up, while site, or when one cough (King,
2017). Other symptoms that should be considered include
irregular heartbeats, pain, numbness and tingling sensation on
extremities. Skin changes to pallor, hair loss, visible veins,
lower leg ulceration, and cold skin, should also be assessed.
Apart from symptoms, one should also ask for other risk factors
including personal history of heart disease, diet and weight
history, use of alcohol, illicit drugs, and smoking. Also the
history of type 2 diabetes and a family history of heart diseases
should be assessed. Information on usual daily activities such as
long standing or sitting duration, bleeding disorders should also
be gathered (King, 2017). History of other related diseases
including diabetes and hypertension should also be considered.
Objective Data
The collection of objective data on the cardiovascular system
involves the measurement of vital signs. The first is blood
pressure measurement where normal rates should be between

120/80mmhg and 140/90 mmHg (King, 2017). The second is the
pulse rate, and quality was normal for a person at rest should be
between 60 and 100 beats per minutes. The respiratory rate
should also be measured with an adult expected to have 12 to 20
breaths per minute. Secondly, the general appearance of the
patient should be checked. First, the mucous membrane should
be checked for pallor as normal should be pink to red.
Extremities should be checked for clubbing or cyanosis. The
patient should also be observed for pulsation, and retractions
while sited or lying down (King, 2017). Examination of blood
vessels in the neck to ensure that the corticoid artery has a local
and brisk pulsation. The internal jugular vein should also be
soft and with undulating pulses.
Special Examination Techniques
Auscultation is one technique used to examine the heart using a
stethoscope. The assessment should occur with the patient sited,
lying on the back with head lifted and lying on the left. The
examiner should listen to all the four sounds including the lab,
dib, ventricle gallop and the fourth (King, 2017). The examiner
should also listen to murmurs that occur when there is a
turbulent blood flow that can either be caused by defects in the
chambers of the valve and changes in blood viscosity.
Adapting the Examination
Infant/ Pediatric
The heart and blood vessels of children are not fully developed
and which makes the assessment different from that of adults.
First, due to the fact that the child’s body has a low surface for
the heart to pump blood, the pressure and rates are lower than
those of a normal adult (King, 2017). In conduction
auscultation, the examiner must consider the third heart sound
as normal since their cardiac output is high while it in adults is
vertical gallop.
Pregnant Women
Pregnancy increases the work of the heart as a woman has to
pump more blood to replenish the increased nutritional and
waste disposal needs of the body. Moreover, hormone changes

may result in increased blood pressure and other changes in the
cardiovascular system that may result in changes in the physical
examination (Hillegass, 2016). Moreover, to protect the mother
and her unborn child, frequent physical examinations are
recommended including measuring blood pressure and
conduction auscultation. For a pregnant woman, the breast may
be large. The breast must be displaced to the left when checking
for displacement.
Geriatric
There are age-related cardiac changes such as reduced arterial
compliance and the diastolic dysfunction of the left ventricle.
Also, one should check for nausea/vomiting, dyspnea and
diaphoresis in the elderly suspected with myocardial infarction.
Further, systolic blood pressure increase with age as the rigidity
of blood vessel walls increases. Other factors that may increase
with age include respiratory rate. Body temperature, on the
other hand, tends to reduce with age. These should be
considered during physical examination to ensure the quality of
data collected and escape misdiagnosis (Hillegass, 2016). Also,
knowing other medical conditions that may affect readings.
Heart Failure
Also known as congestive heart failure, this is a condition that
comes when the heart muscles do not pump blood sufficiently as
it should. The condition is caused by different factors including
the narrowing or blocking of blood vessels, high blood pressure
and accumulation of plague on blood vessels (Karlström et al.,
2016). These factors involve making the heart too weak and
stiff making it difficult to pump blood out. The disease can be
chronic or acute depending on the cause (Inamdar & Inamdar,
2016). The symptoms of heart failure include fatigue and
weakness, swelling especially on the legs, ankles, and feet,
shortness of breath, reduced the ability to work of exercise,
wheezing and persistent cough. Other signs of the disease
include the decrease in alertness and chest pain in case the heart
failure is caused by a heart attack (Hillegass, 2016). While heart
failure has no cure, those affected normally lead enjoyable lives

by management using drugs and lifestyle changes.
Objective data for Heart Failure
The first objective data collected for people with heart failure is
auscultation. The presence of the third heart sound, ventricular
gallop, indicate that the heart is struggling to pump blood and
hence positive for heart failure (Yancy et al., 2017). There is
also jugular venous distension among people with heart failure.
There is also displaced cardiac apex among people with
congestive heart failure. Others include pitting peripheral
edema due to volume overload, pulmonary rales, venous
distension and hepatojugular reflux (Inamdar & Inamdar, 2016).
Chest radiography is recommended when one suspects the
presence of heart failure. Intestinal edema and venous
congestion indicate positive for heart failure.
Summary
As one of the most important body systems responsible for
transportation, the circulatory system requires a constant
assessment to ensure its health. The system is made of the heart
that pumps blood, blood vessels which carry blood and blood
containing plasma and blood cells, which may be affected by
different conditions leading to ill health. In collecting
subjective data, both the history of previous disease and
symptoms are taken into account. Objective data mainly involve
auscultation to feel the functionality of the heart and blood
vessels. Due to the changes involved in old age and pregnancy,
physical assessment needs be changed to accommodate these
populations. One of the major disease affecting the
cardiovascular system is heart failure that involves the
ineffective working of the heart muscles hence inability to
effectively pump blood. Upon auscultation, patients with heart
failure have a ventricular gallop, show venous distension and at
times peripheral pitting edema.
References
Feher, J. J. (2017). Quantitative human physiology: an
introduction. Academic press.

Hillegass, E. (2016). Essentials of cardiopulmonary physical
therapy. Elsevier Health Sciences.
Inamdar, A., & Inamdar, A. (2016). Heart failure: diagnosis,
management, and utilization. Journal of clinical medicine, 5(7),
62.
Karlström, P., Johansson, P., Dahlström, U., Boman, K., &
Alehagen, U. (2016). Time since heart failure diagnosis
influences outcomes more than age when handling heart failure
patients: Results from the UPSTEP study.
King, D. (2017). U.S. Patent Application No. 15/228,494.
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E.,
Colvin, M. M., ... & Hollenberg, S. M. (2017). 2017
ACC/AHA/HFSA focused update of the 2013 ACCF/AHA
guideline for the management of heart failure: a report of the
American College of Cardiology/American Heart Association
Task Force on Clinical Practice Guidelines and the Heart
Failure Society of America. Journal of the American College of
Cardiology, 70(6), 776-803.
Patient-Centered Care).
AACN MSN Essentials
· Essential IX: Master’s-Level Nursing Practice
· Independent Practice CompetenciesExemplar VI: NR510:
Leadership and Role of the Advanced Practice Nurse Week 1
According to Hain and Fleck, (2014), Nursing Practice (NP) in
the US is affected by five major barriers. The first barrier is the
state licensure system that provides for varying regulation of
NPs across different states. The lack of adoption of full practice
laws by at least two-thirds f states in the US has significantly
reduced the ability of NPs to practice. The second barrier is the
belief by physicians that they are better equipped to handle
patients than nurses that diminishes the role of the NP. Thirdly,

there are restrictive payer policies that limit the ability of NPs
to practice independently. Again, while most states allow the
prescription of essential drugs by NPs, most do not provide for
follow up in acute care. Finally, there is the challenge of job
satisfaction which prompts the intent to terminate work by most
NPs (Hain & Fleck, 2014.
The barriers to APN practice are not new in any way to me as I
have experienced, heard and read about them many times. Most
common being the physician-related issues where most doctors
in the organization I worked belittled the role of nurses and any
attempt to help the patient in their absence was critically
discouraged. Melnyk et al., (2014) noted that most nurses are
either looking for new jobs or working and not satisfied.
Consequently, there are very few nurses who are seeking
advanced degrees in the US. While I have never been directly
involved in legislative level nursing, I once collaborated with a
colleague who was and noted that these barriers are real.
However, they do not motivate me from becoming an APN.
These barriers are restraint of trade that interferes with the
ability of nurses to fairly compete with other healthcare
professionals, primarily physicians, in offering healthcare.
Further, they reduce the ability of the healthcare system to
provide quality healthcare to members of the public. Nurse
ought to work in unison to outdo these barriers not only to save
their professionals but also advance the quality of care offered
by the healthcare system. One way of doing this is by
incorporating patient-centered care and evidence-based practice.
References
Hain, D., & Fleck, L. (2014). Barriers to nurse practitioner
practice that impact healthcare redesign. OJIN: The Online
Journal of Issues in Nursing, 19(2).
https://www.nursingworld.org/MainMenuCategories/ANAMarke
tplace/ANAPeriodicals/OJIN/TableofContents/Vol-19-
2014/No2-May-2014/Barriers-to-NP-
Practice.html?_ga=2.134268146.2009056991.1515456000-

1263479451.1515456000 (Links to an external site.)
Melnyk, B. M., Gallagher‐Ford, L., Long, L. E., &
Fineout‐Overholt, E. (2014). The establishment of
evidence‐based practice competencies for practicing registered
nurses and advanced practice nurses in real‐world clinical
settings: proficiencies to improve healthcare quality, reliability,
patient outcomes, and costs. Worldviews on Evidence‐Based
Nursing, 11(1), 5-15.
https://sigmapubs.onlinelibrary.wiley.com/doi/full/10.1111/wvn
.12021
· PO #3: Engage in lifelong personal and professional growth
through reflective practice and appreciation of cultural diversity
(Cultural Humility)
AACN MSN Essentials
· Essential II: Organizational and Systems Leadership
· Leadership CompetenciesExemplar VII NR 511 Differential
Diagnoses and Primary Care Week 6
H& P Findings
The patient is a 56 year-old Caucasian female who presents with
generalized fatigue that is worsening since onset two to three
months ago. The constant fatigue is progressively worsening
and does not subside even after sleeping eight hours at night.
The problem is aggravated by exertion but there is no
identifiable relieving factor. Although the patient denies pain,
she has missed work for two weeks due to inability to wake up
out of her bed. The patient’s child is 24 years old and has a
history of bipolar depression. She is currently taking Prozac
20mg, daily vitamin B-complex, and Bisoprolol-HCTZ, calcium,
and vitamin D3. She drinks on occasion and is a non-smoker.
She has an allergy to iodine dyes.
On reviewing her symptoms, the patient denies having had
fevers, chills or any recent illness. However, she has weight has
increased +5lb for the past six months. There are no visual

changes on eyes or diplopia, n lymph tenderness or swelling, no
chest pain, ear pain or rhinorrhea. As a child she had
tonsilectoctomy and has no current sleep apnea or snoring. The
GIT is okay with no constipation or N/V/D. There also no skin,
hair or nail changes and the endocrine system is fine with no
challenges of polydipsia, polyuria or cold intolerance. However,
her psych is worsening as seen by depressive symptoms as she
thinks she is unproductive. She denies suicidal thoughts. Also,
the musculoskeletal system is weak with intermittent muscle
cramping in calves.
Physical showed most vital signs normal including temp 98.2,
R- 16, BP- 146/95, p-74, weight-180 pounds, height -5’7. The
head is Normocephalic, and atraumatic, eyes PERRLA, ears are
intact with light reflex and tympanic membrane gray. The nasal
drainage is clear without swelling on nasal turbines and nares
patent. The neck is also supple without palpable masses and
lymphadenopathy; abdomen soft, BS active and non-tender. The
skin is dry, no ridging of the nails. Strength full throughout
musculoskeletal and DTRs 2+ at biceps, 1+ at the ankles and
knees.
Diagnosis
Hypothyroidism- This is a disorder characterized by reduction
in the amount of circulating free thyroid hormones (TH) which
interjects energy metabolism. This can have great affect on all
major organ systems within the body. . Its major clinical
manifestations are fatigue, lethargy, cold intolerance, slowed
speech and intellectual function, slowed reflexes, hair loss, dry
skin, weight gain, and constipation. It is more prevalent in
women than men. The body needs suitable circulating thyroid
hormones, T3 and T4, to determine the body’s metabolic rate.
Thyroid-stimulating hormone (TSH) regulates the thyroid gland
to release these hormones. When T$ is low, this causes the
thyroid to enlarge due tot the increase of TSH. When TSH is
high, the thyroid received a signal to stop secreting T3 and T4,
this leads to hypothyroidism. hypothyroidism involves
dysfunction of the thyroid gland itself, decreasing its ability to

synthesize TH (McCance & Huether, 2014). There are many
reasons for hypothyroidism including Hashimoto’s disease (an
autoimmune disorder), iodine deficiency, trauma, injury or
surgery to the thyroid gland, inflammation, medications, and
tumors (Biondi & Wartofsky, 2014). Positive findins for this
patient include fatigue, constipation, cold intolerance, dry skin,
weight gain DTRs diminished in lower extremities, female,
signs of depression. Negatives for this patient include, no
history or family history, no mass or enlarged thyroid.
Major depressive disorder (MDD)- MDD is from
neurotransmitter deficiency, such as serotonin, norepinephrine,
and acetylcholine, in the brain (Lee & Kim, 2017). When there
is a decrease in neurotransmitters, patients can experience a
wide variety of negative emotional experiences, ranging from
sadness to decreased interest in activities they typically enjoy.
These feelings can be accompanied by multiple symptoms such
as insomnia or sleep disturbances, loss of appetite and body
weight. Functional ability and concentration can also be
compromised. These depressive episodes may happen suddenly
or gradually and continue for weeks or even months (Lee &
Kim, 2017). Positive findings for this patient include, Fatigue,
no energy for daily activities, hx of depression, weight gain,
gradually getting worse. Negative findings for this patient
include negative self-assessment of being depressed and
currently on medication for depression
Anemia- fatigue is a classic symptom of anemia. In this disease,
the patient’s body lacks enough healthy red blood cells to carry
oxygen to body tissues. Due to the inadequacy of oxygen in
muscles tissue, they are not able to carry out their functions
normally. The muscle tissue change from aerobic to anaerobic
respiration which results in the buildup of lactic acid
(Prochaska et al., 2017). The lactic acid is the primary cause of
fatigue. Positive findings for this patient include fatigue and dry
skin. Negative findings for this patient include, no family
history and no tachycardia

Rank
· Hypothyroidism
· Major depressive disorder (MDD)
· Anemia
Additional Tests
The patient’s subjective and objective finding warrant the need
for labs to check the thyroid function. These labs include, serum
TSH and free T4 (FT4) level. Primary hypothyroidism is
indicated if the TSH level is elevated and the T4 level is low.
Other needed test include CBC, vitamin B12, and ferritin to rule
out anemia. Lastly, the Patient Health Questionnaire-9 (PHQ-9)
to measure the severity of depression should be completed.
References
Biondi, B., & Wartofsky, L. (2014). Treatment with thyroid
hormone. Endocrine Reviews, 35(3), 433-512.
Lee, H., & Kim, Y. (2017). Pathophysiology and Treatment
Strategies for Different Types of Depression. Understanding
Depression, 167-176. doi:10.1007/978-981-10-6580-4_14
Prochaska, M. T., Newcomb, R., Block, G., Park, B., & Meltzer,
D. O. (2017). Association Between Anemia and Fatigue in
Hospitalized Patients: Does the Measure of Anemia
Matter?. Journal of hospital medicine, 12(11), 898.
McCance, K.L., & Huether, S.E. (2014). Pathophysiology: The
biologic basis for disease in adults and children (7th ed.,
pp.1488). St. Louis, MO: Mosby.
AACN MSN Essentials
· Essential V: Informatics and Healthcare Technologies
· Essential IX: Master’s-Level Nursing Practice

· Quality Competencies
· Reflection
· The past eight weeks have presented several new learning
opportunities that have given me a wide variety of experience.
My preceptor was very educated and allowed me to have a lot of
hand on experience. She was also open with sharing her
knowledge with me.
· Gaps in Patient Experience
· There is a wide range of age group populations. However, I
this clinical site does not see patients under 12. Throughout
completing the 125 credit hours. While I feel as if I was able to
see a wide variety of patients with multiple complications as
well as a variety of different age groups, I do have gaps in
seeing pediatric patients. Also, my preceptor just started doing
pap smears my last week of practicum, so I only got to see a
small amount of women health patients, nor did I get to perform
a pap smear solo. My plan is to find a women’s health and
pediatrics rotation site for Sept and November. This will assist
me with getting the hours as well as the patient experience that
is needed to be more well-rounded in my practice. For the July
session, I will be continuing on with the same preceptor.
· Progression in Clinical
· My progression in this course has been great in my opinion.
My well-rounded nursing background has contributed to this.
While my specialist is in Labor and Delivery/Women’s health.
I also have some experience in the adult world. However, this
experience is allowing me to touch up on my adult assessment
skills. My self-made goals for this session were to be able to
independently assess, diagnose, and treat a patient correctly. I
was able to meet these goals 100% by week 4 with the
assistance of my preceptor and the way she allowed me to
perform independently which pushed me to critically think. I
hope to become even better with assessment findings, as well as
treatment plans and medication management. I will achieve
these outcomes by continuing to ask questions and expanding on
different patient interactions when the opportunity present

itself.
· Areas of Weakness
· My area of weakness is with diagnoses. I seem to find a
diagnosis that is very close to the correct one or at times,
missing one of the dual diagnoses or stating the complete
diagnosis. At times my diagnoses do not always coincide with
my preceptors diagnoses and plan. The site that I am at see’s a
lot of patients with acute symptoms. When prescribing
medications for these patients that usually have multiple
chronic diseases, I do not always think about the drug
interactions for the medications that I am suggesting prescribing
against the medications they are currently on. My preceptor has
shown me different ways of identifying these interactions, so I
hope to be better with this next semester. There seems to be
multiple possibilities with medications and diagnosis, and I was
lacking in choosing the correct ones.
· NONPF Competencies
· After reviewing the National Organizations of Nurse
Practitioner Faculties (NONPF) competencies, my weaknesses
were noted. I will discuss two areas in which I still need to
improve on. Billing, and quality side of care. Billing and
coding and is something new to me, as I have never been
required to do it in the past. While this was overwhelming in
the beginning, I am now competent with CPT and ICD-10 codes.
At this clinical setting, the practitioners bill and code the same
as well as have a billing clerk that works for them to ensure
they are not missing anything as well as coding correctly to
prevent fraud. While this site has a clerk, it is still extremely
important for reimbursement to take full advantage of your
skills with billing and coding. As practitioners, we are
anticipated to be talented to properly assess patient affairs in
favors to access, cost, quality, and safety (Thomas et Al., 2014).
In order to ensure that my patients always receive the best care
possible, these will be influences to note going forward. The
next competency section “Quality Competencies” number 1
through 4 is the second one I have chosen to speak about. This

entails applying the best quality evidence to improve clinical
practice (Thomas et Al., 2014). This was applied in this current
class through my clinical practice guideline (CPG) on Allergic
Rhinitis. Exposing myself to more situations and obtaining
further clinical experience will assist with my clinical strength.
· Conclusion
· Overall, I am very satisfied with the involvements that I
have encountered during the past 8 weeks. I am excited to apply
all that I have learned in NR 601.
· References
· Thomas, A., Crabtree, M.K., Delaney, K., Dumas, M.,
Kleinpell, R., Marfell, J…Wolf, A. (2014). Nurse practitioner
core competencies content a delineation of suggested content
specific to the NP core competencies 2014. NP Core
Competencies Content Work Group. Retrieved
from http://c.ymcdn.com/.../NPCoreCompsContentFinalNov20.p
dfExemplar VIII: NR 601 Primary Care of the Maturing and
Ageing Family Week 2
In healthcare, some issues cause many controversies. One of the
issues is polypharmacy. The issue affects many people as they
seek to cure their illnesses and the individuals that are most at
risk are the elderly. The term has several definitions. One
definition is that polypharmacy is the use of additional
medications other than the clinically prescribed or the use of
several medications to treat a single condition. In some cases,
the definition of polypharmacy is the chronic prescription of a
number of drugs to patients suffering from multiple chronic
illnesses (Hovstadius, & Petersson, 2012).
Polypharmacy is an issue that needs urgent consideration
because of its effects on people, especially on their health.
Several risk factors can lead to polypharmacy. One factor is
age. The elderly are most likely to have polypharmacy because
of the numerous ailments that they experience. The numerous
diseases need different medications for effective treatment and
therefore the situation might lead to polypharmacy. The other
risk factor is multiple providers. Patients that receive care from

multiple providers might experience polypharmacy. The reason
for the situation is that the providers can prescribe different
kinds of medication to treat the same conditions leading to
polypharmacy.
Another risk factor is self-medication. People that self-medicate
tend to use different medications to try to cure their illness. The
situation leads to polypharmacy especially with numerous use of
over-the-counter medication and herbal medicine to try to find a
cure for a persistent ailment. Healthcare providers can prevent
polypharmacy by taking several action steps. According to
Scott, Hilmer, Reeve, Potter, Le Couteur, Rigby, & Jansen
(2015), one of the action steps is patient education. The
providers should take time to educate their patients on the
dangers of polypharmacy and give them advice on the steps that
they should take to prevent the occurrence of polypharmacy.
The other action step is medication therapy management. The
providers should conduct a review of the kinds of medication
taken by patients on a yearly basis together with other
professionals to help prevent the occurrence of polypharmacy.
An additional action step to prevent polypharmacy is using an
electronic prescription. Providers can have a system that offers
prescriptions to patients and therefore prevent a situation where
there is the prescription of numerous medications. In addition,
providers can present information showing the occurrence of
polypharmacy in the elderly and ways to prevent it. An example
of how my clinical preceptors has addressed polypharmacy is by
educating the patient and family on the issue of polypharmacy
and its effects on patients. Also, during intake, the Medical
Assistant questions the patient at every visit on what
medications they are taking, including OTC medications and
provides reason as to why this information is important. In
conclusion, polypharmacy is a situation that can lead to health
complications, especially in elderly patients. It is essential to
understand all the aspects of the topic to prevent its occurrence.
References

Hovstadius, B., & Petersson, G. (2012). Factors leading to
excessive polypharmacy. Clinics in geriatric medicine, 28(2),
159-172
Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur,
D., Rigby, D., & Jansen, J. (2015). Reducing inappropriate
polypharmacy: the process of deprescribing. JAMA internal
medicine, 175(5), 827-834
practice (Extraordinary nursing)
AACN MSN Essentials
Patient and Population Health Outcomes
· Ethics Competencies
· In general, this course has made me focus on the MSN
program outcome, MSN essentials, nurse practitioner
competency as well as ethic competencies. Through the help of
the course, I am able to offer positive health outcome by use of
compassionate, collaborative, evidence-based practice advanced
nursing practices (Buppert, 2018). Through the objective of the
course I have learned over the past seven weeks, I am in the
right position to advocate for the patient's wellbeing. As a result
of advocating for quality care for the patient, I have been able
to build a trusting relationship. Promoting evidence-based
practice for the patient has improved the patient care outcome.
· The course has enabled me to use patient-centered
and culturally sensitive techniques in the course of providing
care. Involving and considering responsive cultural strategies
while offering care is important and justify the patient's
interest. Another aspect provided under masters essential is the
integration of the clinical prevention as well as population
health concept in the delivery of the advanced culturally vital as
well as linguistically relevant health education, interventions,

and communication strategies. This courses
provided various data related to different ethnic and age groups
to form health education intervention.
· This course has helped to apply the ethical principle in the
course of making a decision. As a nurse practitioner, using the
facet of autonomy while the delivery of the services is essential.
Taking away the independence denies the patient right to take
part in decision making (Blomberg et al. 2016). The decision
made by the nurse while providing the care to the patient might
lead to harm. As such, the nurse practitioner should be aware
of the ethical dilemma or consequences the whole case carries.
Therefore, assessing risk is essential. As a nurse practitioner, I
will thoroughly assess the treatment or any other
intervention before delivering care. One thing I am
always careful with is to take consideration of the
patient’s ethical principle such as race, religious beliefs and
age. The care should be offered holistically on an individual
basis and not by using assumptions.
·
· References
· Blomberg, K., Griffiths, P., Wengström, Y., May, C., &
Bridges, J. (2016). Interventions for Compassionate nursing
care: A systematic review. International Journal of
Nursing Studies, 62, 137-155.
doi:10.1016/j.ijnurstu.2016.07.009
· Buppert, C. (2018). Nurse practitioner's business practice and
legal guide (6th ed.). Burlington,
MA: Jones & Bartlett Learning.
· Melnyk, B. M., & Fineout-Overholt, E. 2. (2015). Evidence-
based practice in nursing & Healthcare: A guide to best
practice(2nd ed.). Philadelphia, PA: Lippincott Williams &
Wilkins.
Exemplar IX: NR 602 Primary Care of the Childbearing and
Childbearing Family Week 3
Sick Child Clinical Case Presentation
· My Case Study this week is pertaining a 12-year-old boy

whose mother brought him to the Clinic because she is
concerned that he is eating all of the time, drinking large
amounts of fluid, and urinating various times in a single day.
She reports that he also wets the bed every night and has had a
few daytime accidents as well. She has quite recently chalked it
up to the antihistamines he is on for his ceaseless
hypersensitivities making him extremely parched; yet she feels
that it is improving. She reports that the patient has
"consistently been like this," however the duration has begun to
concern her.
The patient's height is 60 inches, which puts him at 65% on the
growth graph; weight is 87 pounds, which puts him at 50% on
the growth chart; his BMI is 17; he is at Tanner stage 2. The
patient has no complaints, other than his history of
hypersensitivities, his mom expresses that he has no issues. He
was born full-term without any inconveniences with delivery.
Mother reports that he had a few ear diseases when he was a
baby and child, however, has not had one in over a year. He has
watery, bothersome eyes on the off chance that he misses a
portion of his antihistamine prescription and that he will cough
a considerable amount during that time. Mom states it clears up
immediately when he is back on his medicine routinely. He has
never had tonsillitis or some other diseases including the throat.
The majority of his ailments have consistently been identified
with ear contaminations and hypersensitivity indications. He
has no cardiovascular issues, no stomach issues, however, his
mother said that when he was a newborn child he had lactose
intolerance issues, yet expresses that he is by all accounts able
to tolerate at this point. He has never had a urinary tract disease
and never complains that it hurts when he pees. He has had no
broken bones or cuts.
Upon physical test, his head was symmetrical with ordinary
designed hair all through. His eyes were average with no
seepage, pink conjunctiva, and white sclera. His nose was
bright, septum midline. His mouth was pink and moist, tonsils
1+ without erythema or exudate, oropharynx pink with some

proof of cobblestoning, yet no current postnasal drip. Bilateral
ear cannel clear, no cerumen, the two TMs magnificent dim and
versatile, all structures noticeable, with some proof of slight
scarring to both. No lymphadenopathy noted, neck supple. S1
and S2 present without any mumbles, rubs, or gallops; ordinary
rate and beat. Breath sounds clear in all fields. Stomach
delicate, marginally round, normoactive bowel says in all
quadrants, no delicacy to palpation. Full ROM in all limits
without any disfigurements noted; Skin perfect, pink, warm,
dry. There were no lab or diagnostic test available as this was
the initial visit for the above mentioned concerns.
AACN MSN Essentials
Patient and Population Health Outcomes.
· Ethics Competencies
· With the experience I have heard in regards to the clinical
field in this course, I have listened to an understanding that
there are many ways of providing patient-centered care that is
of high quality. Every encounter with a patient should mainly
focus on the provision of holistic care that is safe. A good
instance that i saw to be outstanding in the class is in regards to
a patient who had an experience of a viable experience after
many years of experiencing infertility as well as various
miscarriages. With the assistance of current guidelines and
evidence-based practices related to care, we were in a position
to provide a healthy environment that is safe and fostering a
discussion of the various concerns that the patient had. It was
an engaging task since it required emotional and empathy
support to make her feel confident. With the application of a

holistic approach, we successfully addressed here social,
physical, spiritual, and emotional needs (Greutmann, 2018).
· MSN Essential VII
· The session brought about a big opportunity of having
a taste of collaboration and its importance among all the
providers of health care. The office looked quite different in
terms of the organization in comparison to my past clinical
experience. A nurse practitioner would share an office with a
representative of the patient service whose work was scheduling
and insuring during the day (Reeves, 2017). A medical assistant
was also situated in the same room. Having all the professionals
in one room enhances cohesive communication in regards to
what’s best for patients in comparison to my past clinical
setting.
· Every day at 9. 00 am, there would be a meeting
whereby all the professionals would meet and discuss any issue
that was challenging and chat the way forward on how they
would enhance collaboration to provide the best outcome
possible. According to my understanding, this was a good
organizational setting since I had never had such an encounter
in the past, and it looked like the best way to approach any
health care problems. With such an approach, they would attend
to many patients as possible in comparison to the previous
setting.
· # 8 Ethics Competencies
· Applying ethical principles is crucial in the making of
decisions.This is an important course that has helped me in
making sure that the nursing ethical principles are part of my
decision making process. An important aspect of inpatient care
is the incorporation of patient autonomy. Through patient
autonomy, I was able to allow my patients to make their
decisions. This builds trust among patients and gives them the
will to follow advice relate to health care recommendations and
advice. My current hospital focuses on ICARE, which stands for
Integrity, Comparison, Respect, and Excellence.
· All the decisions made by nursing professionals can be of

harm to patients, and thus, they need to be aware of all the
ethical consequences, which are regarded as another
competency that is ethical, which is a type of malfeasance
(Buppert, 2017). I do make sure that I am thorough in what I do
in regards to treatment, keeping I mind that the treatment might
have an adverse effect. Thus the need for patient follows- up.
· I have experienced many problems with other practitioners
who had made me quite cautious during patient treatment. One
complex fact that I have adopted best during the course I how to
deal with any patient who fails to adhere treatment of advice
due to her religious beliefs or ethnic background even though
they must be a consideration. It is, therefore, crucial to provide
holistic care and also not make assumptions in regards to
patients.
·
· References
· Buppert, C. (2017). Nurse practitioner's business practice and
legal guide. Jones & Bartlett Learning.
· Greutmann, M., Theile, G., & Tobler, D. (2018). Holistic Care
and Palliation. In Heart Failure in Adult Congenital Heart
Disease (pp. 241-250). Springer, Cham.
· Reeves, S., Pelone, F., Harrison, R., Goldman, J., &
Zwarenstein, M. (2017). Interprofessional collaboration to
improve professional practice and healthcare outcomes.
Cochrane Database of Systematic Reviews, (6).
Exemplar X: NR 603 Advanced Clinical Diagnosis and Practice
Across the Lifespan Practicum Week 6
Obsessive-Compulsive Disorder (OCD)
It is a common disorder that results from severe instances of
trauma or stress and it entails the exhibition of hyperactivity in
case of occurrence of the former. In many cases, the causative
situation may a sort of emotional response to stress, multiple
reactions to the deep distresses degeneration into post-traumatic
illness signs (American Psychological Association, 2017).
Usually, symptoms occur within days or months

of the occurrence of the traumatizing incident, exceptional cases
taking years before a patient experiences the indicators. Experts
group signs and symptoms into four, the first category involving
frequent remembrance of the traumatizing event(s), while the
second one entails avoidance of reminders of the
unfortunate incident. The third is associated with non-jovial
mood as a result of remembrance of the undesirable incident,
whereas the last one has to do with hyperactivity. In rare
instances, however, individual culprits may encounter alienation
in addition to reporting multiple instances of nightmares and
avoidance of symptom triggers, a significant one being
traveling.
Major Depressive disorder (MDD)
It is clinical depression that affects a culprit’s moods and
behaviors, often extending to interference with physical
activities, the most common of the undertakings being sleep and
appetite. Notably, patients exhibit a general tendency towards a
loss of interest in activities that they enjoyed previously. The
encouraging bit is that medications assist persons with the
disorder to manage symptoms therein for a relatively normal
life.
Usually, patients show a wide range of signs and symptoms, and
the diagnosis criteria entail possessing at least five of all the
possible manifestations. Some of the indicators include sadness
and irritability for the better part of the day, a loss of interest in
formerly favorite pursuits, sudden weight gain or loss,
and a general feeling of restlessness (Healthline Media, 2019).
Others may be unusual tiredness and a lack of energy, a feeling
of worthlessness or guilt, concentration challenges, inability to
make sound decisions, and unfortunate thoughts regarding
harming oneself or suicide.
The surprising bit is that the disorder’s exact cause remains
unknown, scientists being left to speculate and research on
triggers. Some of the activates include excessive drug and
alcohol use, certain severe medical conditions, and some
medication types, primary care often involving the use of

antidepressants that control the production of the brain chemical
responsible for the control of moods. The common drugs
applied in the management of the condition include fluoxetine
and citalopram, their major benefits over others being that they
have low incidences of side effects.
Generalized Anxiety Disorder (GAD)
It is a common anxiety disorder that differs from having a
phobia about an occurrence and affects about 3%
of the American adult population. Other interesting patterns
include the fact that it mainly affects persons between
childhood and middle age, women having a higher likelihood of
suffering from the disorder, which is twice as much as that of
men. The disorder entails a general feeling of unease regarding
life in general as opposed to the fear of specific items and
animals (Gregory, 2019). The worrying bit is that a person
suffering from the disorder has a likelihood of suffering from
other mental illnesses as such persons constantly live with
concerns about anything and everything.
The disorder may manifest both physically and mentally, some
of its symptoms being constant anxiety, relaxation inability,
unexplained tension, avoiding stressing circumstances, and
inability to concentrate. Others include frequent feelings of
dread, inability to control emotions, fatigue, and stomach
upsets. Just like the preceding case, the exact cause of the
disorder is not known, speculation being that it is caused by a
combination of genetic and behavioral elements. Some
identifiable triggers include tobacco and cocaine, medications
and therapy serving to reduce the incidences of the disease.
Physicians’ intervention aside, certain personal practices may
mitigate the problem, some of them being daily exercise,
partaking well-balanced diet, and stress management
methodologies.
References
American Psychological Association. (2017). Clinical Practice
Guideline for the Treatment of Posttraumatic Stress
Disorder (PTSD) in Adults. American Psychological

Association, 1-119.
Genetics, I. O. C. D. F., Arnold, P. D., Askland, K.
D., Barlassina, C., Bellodi, L., Bienvenu, O. J., ... & Camarena,
B. (2018). Revealing the complex genetic architecture of
obsessive-compulsive disorder using meta-analysis. Molecular
psychiatry, 23(5), 1181.
Gregory, C. (2019). Generalized Anxiety Disorder (GAD): What
is GAD? Why do I have it? How do I
cope? PSYCOM. Retrieved
from https://www.psycom.net/bookstore.anxiety.html (Links to
an external site.)
Healthline Media (2019). Major Depressive Disorder (Clinical
depression). Healthline. Retrieved
from https://www.healthline.com/health/clinical-
depression (Links to an external site.).
· PO #4: Integrate professional values through scholarship and
service in health care (Professional identity)
AACN MSN Essentials
· Essential III: Quality Improvement and Safety
· Essential IV: Translating and Integrating Scholarship into
Practice
Health Delivery Systems Competencies
The course has recorded positive outcomes as key lessons are
learnt from the entire practice. The key nursing competencies
that were supposed to be observed during the class were
perfectly integrated leading to the creation of a dominant
practice that mainly focuses on the interest of the public which
is a key matter of concern in this case.
Master’s Program Outcome #4: Integrating professional values
via scholarship and the provision of service in healthcare
The healthcare delivery systems are perfectly described to
depict positive appearances. The course perfectly applies
organizational practices that focus on the creation of clear

structures that would lead to the better delivery of services. The
activity entails effective collaboration with other medical
practitioners to ensure that the complex systems are simplified
to create a better operational network that the company could
apply to create advanced systems that works positively for the
healthcare systems of the country (Arnott, 2017). The
knowledge base is important in the creation of policies that
focus on the interest of creating better systems for the health
care sector in the country.
Healthcare changes work at improving the existing
systems to ensure that advanced practices are perfectly
embraced by the company. It is a practice that entails effective
coordination that focus on the interest of the sector alone
(Arnott, 2017). The course explained the importance of skill
application in basic company activities such as negotiation,
partnering and consensus building which plays an effective role
in the promotion of order and understanding within the current
societal set up. Partnering with other sectors to ensuring that
better services are provided is a key element of the practice that
was taught during the entire course.
Master’s Essential IV: Transforming and incorporating
scholarship into practice
The minimization of the risks that patients often face while
seeking medical assistance within the healthcare facilities is a
key matter of concern. The captures ensure that perfect
practices that taught to the nursing practitioners to ensure that
they offer better services that focuses on the interest of the
public which is a key matter of concern that needs to be
perfectly addressed as the course teaches the importance of
having better systems (Taylor, 2015).. This is a perfect practice
that entails the emulation of practices that focus on the interest
of the public which is a key matter of concern.
The course plays an important role in facilitating the
general improvement of the healthcare sector which is a key
matter of concern that needs to be perfectly addressed when the
interest of the public is being highlighted. Ensuring that the

diverse healthcare needs of the public are addressed is a key
practice that leads to the reduction of complicated practices that
may fail to positively reflect on the interest of the patients
(Arnott, 2017). The improvement process is promoted through
effective collaborative practices that focuses on the interest of
the general public which is a key matter of concern that ought
to be clearly addressed.
The course provides a detailed evaluation on the impact
of healthcare delivery systems on the stakeholders, patients and
the providers which is a key matter of concern (Taylor, 2015).
The evaluation ensures that the existing systems are perfectly
aligned to reflect on the interest of the people which is a key
matter of concern that needs to be perfectly aligned with the
interest of the healthcare systems. Ensuring that key evaluation
tools are implemented are key matter of concern that needs to
be clearly addressed as it reflects on the necessity of making
necessary adjustments within the healthcare systems of the
country.
Nurse Practitioner Core Competency #7: Health Delivery
System Competencies
The course evaluates the perfect organizational structures
within the healthcare settings that needs to be aligned to ensure
that the interest of the healthcare providers are addressed. This
is a key activity that reflects on the interest of the people in a
complicated manner. The practice entails coming up with a
framework that may fail to reflect on the interest of the people.
Ideally, the development of major practices are reflected
positively with the recommended structures that the healthcare
sector may prefer and apply in its daily operations based on the
final outcome that comes with the process.
Collaboration is a key practice that leads to the positive
development of company practices. The activity comes with the
implementation of measures that focuses on the interest of the
company. Coming up with collaborative strategies with other
medical practitioners is the duty of a nurses. Through the course
proper elaborations are made on the perfect practice (Taylor,

2015). Through the course one understands the strategies that
the healthcare sector needs to clearly observed as it reflects on
the needs of the people in a positive way. The elimination of the
limitations is a key measure that comes with the process that
needs to be perfectly analyzed.
References
Taylor, H. (2015). Assessing the nursing and care needs of older
adults: A patient-centred approach. Oxford: Radcliffe Pub.
Arnott, J. (2017). Introduction to community nursing practice.
Maidenhead: McGraw Hill Open University Press.
Running Head: APN CAPSTONE PORTFOLIO PART 2
APN CAPSTONE PORTFOLIO PART 2 2
APN Capstone Portfolio Part 2
Name
Course
Instructor
Institution
Date

Table of Contents
APN Capstone Portfolio Part 2 1
Background 4
Exemplar #1: NR503 Population Health, Epidemiology &
Statistical Principles 5
Chamberlain Program Outcomes 7
AACN MSN Essentials 7
NONPF Core Competencies 7
Connect 8
Reflection 8
References 8
Exemplar #2: NR505 Advance Research Methods: Evidence-
Based Practice) 9
(Week 4; Research Literature, Design Approach and Sampling
Guidelines) 9
MSN Essentials 10
NONPF Competencies 11
Connection 11
Reflection 11
References 12
Exemplar #3: NR507 Advanced Pathophysiology 12
Connect 15
Reflection 15
References 16
Exemplar #4: NR508 Advanced Pharmacology 16
Connect 18
Reflection 18

References 19
Exemplar #5: NR509 Advanced Physical Assessments 20
Connect 22
Reflection 22
References 22
Exemplar #6: NR510: Leadership and Role of the Advanced
Practice Nurse 23
Connect 25
Reflection 25
Reference 26
Exemplar #7: NR 511 Differential Diagnoses and Primary Care
27
Connect 29
Reflection 29
References 30
Exemplar #8: NR601 Primary Care of the Maturing and Ageing
Family 30
Connect 32
Reflection 33
References 33
Exemplar #9: NR 602 Primary Care of the Childbearing and
Childbearing Family34

Connect 36
Reflection 36
References 37
Exemplar #10: NR 602 Advanced Clinical Care and Practice
Across the Lifespan Practinum 37
Connect 40
Reflection 40
References 41
References 42
Appendix 1: Tabulation of achieved program 0utcome, MSN
Essentials and NONPF Competencies 45
Background
On account of the intense and comprehensive nursing education
program that I have undergone at Chamberlain College of
Nursing, resulting into an award of Masters of Science in
Nursing, here is a compilation of a reflection through the
journey. The reflection entails the Program Outcomes, Master’s
Education Essentials and the Core Competencies of the National
Organization of Nurse Practitioners Faculties with the
abbreviations as PO, MSN Essentials, and NONPF. Further, this
documentation also covers ten exemplars with an assessment on

views of the right argument that all of the above requirements
have been covered.
Exemplar #1: NR503 Population Health, Epidemiology &
Statistical Principles
In #Week 6 of this course we conducted an Evaluation of
Epidemiological Problem. This assignment enabled the students
to meet different course outcomes. The assignment required
defining key terms in community health, epidemiology, and
population-based research. We also gained the knowledge and
skills to compare study designs used for obtaining population
health information from observation, surveillance, community,
and control trial-based research. The assignment also enabled us
to commonly used measures of health risk and identify
appropriate outcome measures and study designs applicable to
epidemiological subfields, for instance chronic disease,
infectious disease, reproductive health, environmental
exposures, and genetics. We were able to identify important
sources of epidemiological data and evaluate a public health
problem as regards to place, person, magnitude, and person.
The task was to discuss HIV/AIDS and give its background
information. The assignment was able to realize that HIV/AIDS
is both an infectious disease and an epidemic disease. Learning
that, since its onset, HIV/AIDS has claimed over 35 million
lives was very scaring. HIV is considered infectious because it
causes a severe impairment of the immune system, which then
leads to AIDS (Moyer, 2015). With a weak immune system,
AIDS patients become susceptible to other cancers, diseases and
infections – often called opportunistic infections since their
causal organisms only take advantage of the weakened immune
system (Maartens, Celum & Lewin, 2014).
I was able to learn about the worrying prevalence statistics of
AIDS with 23,304 people estimated to be living with HIV in
Houston Texas (Maartens, et al., 2014). I also established the
current surveillance techniques and strategies of HIV in the US
and a clear descriptive epidemiological analysis. Finally, I was
able to understand the screening and diagnosis methods of HIV.

I was then able to develop and action plan for dealing with the
disease or infection when I finished my MSN. Chamberlain
Program Outcomes
This assignment enabled me to meet course outcome PO #1:
Provide high quality, safe, patient-centered care grounded in
holistic health principles (Holistic Health & Patient-Centered
Care).The course was able to realize Program Outcome #1 by
calculating HIV prevalence in Houston Texas and breaking it
down to address particular interests of the populations. The
assignment discussed the surveillance methods for HIV, which
is one of the techniques that support community intervention
plan. I was able to successfully suggest an intervention plan of
increasing health awareness on HIV to help in its
prevention.AACN MSN Essentials
This assignment met the AACN MSN Essential I: Background
for Practice from Sciences and Humanities. This MSN Essential
captures the importance of obtaining an understanding of a
disease and using an informed background for practice to
manage its prevalence. As demonstrated in the assignment, in
identifying HIV’s prevalence and designing an intervention for
Houston Texas, I relied on nursing scientific findings to
advocate for quality and improved health outcomes. NONPF
Core Competencies
The NONPF that I was able to demonstrate with this assignment
were Practice Inquiry, Scientific Foundation and Technology
and Information Literacy Competencies. I was able to think
critically while compiling data on HIV and being able to apply
evidence-based practice to design the intervention plan. I also
included research outcomes for practice improvement and
improving patient outcomes. I also had to include knowledge
from other disciplines as a way of practice inquiry. Using
spreadsheet application demonstrated technology and
information competency. Connect
The concepts that I can connect with from the exemplar are
screening and surveillance. In nursing context, screening is used
to refer to a test conducted to determine a health condition prior

to manifestation of symptoms. Screening helps to detect
diseases and conditions in their early periods to improve
treatment outcomes. This makes screening an essential part of
preventive care (Moyer, 2015).
On the other hand, disease surveillance refers to information-
oriented activity encompassing gathering, analyzing and
interpreting relevant health data from varied and different
sources (Houston Health Department. 2015). This requires the
use of informatics and technology to enhance surveillance and
enable real time analysis. Surveillance leads to effective disease
management and enhances preventive measures (Moyer,
2015).Reflection
This course was very insightful. It enables accomplishments of
Program Outcome #, which is to promote safe and high-quality
patient-driven care anchored in holistic health tenets. To
produce the document of HIV program, I had gone through
several scientific studies on HIV prevalence in Houston to
understand the disease’s status in the target population. I also
had to compare different studies to conclude on the prevalence
and determine the incident rate. Understanding the
epidemiological perspective of the disease enabled proper
identification of the intervention plan. I was also able to apply
evidence-based practice in the work.References
Houston Health Department. (2015). HIV Surveillance Program.
HIV Infection in Houston: An Epidemiologic Profile 2010-2014.
Houston, Texas; 2015.
Maartens, G., Celum, C., & Lewin, S. R. (2014). HIV infection:
epidemiology, pathogenesis, treatment, and prevention. The
Lancet, 384(9939), 258-271.
Moyer, V. A. (2015). Screening for HIV: US preventive
services task force recommendation statement. Annals of
internal medicine, 159(1), 51-60.Exemplar #2: NR505 Advance
Research Methods: Evidence-Based Practice)(Week 4; Research
Literature, Design Approach and Sampling Guidelines)
In NR505 the assignment was Research methods and evidence-
based practice. In week #4 of about Research Literature, Design

Approach and Sampling Guidelines. I chose obesity in children
and adolescents as the phenomenon of interest in the evidence-
based practice project. The selected nursing issue for the project
was prevention of adolescent and childhood obesity, with the
overall aim being to prevent obesity’s co-morbidities. Child and
teenage obesity has become a key problem in our society today.
I was able to discuss the literature support research of the
research, as well as identify the appropriate theoretical
framework, research design and methodology including
sampling method procedure.
Literature support generated three key pieces of information.
The reviewed CDC (2017) document recommended the need for
multi-disciplinary research to help develop proper behavioral
interventions to prevent childhood obesity. The CDC document
also gave a conclusive perspective of diet and exercise as the
proper initiatives for obesity control. In a longitudinal study,
Cunningham, Kramer & Narayan (2014) agreed with the CDC
recommendation and suggestions. Kliegman, et al (2016)
suggested the Nelson Textbook of Pediatrics as the key resource
for approaches that can help pediatric care including obesity.
Lobstein, et al (2015) study concluded an improved governance
of food markets and food supply can help address the challenge
of obesity. However, it would be impractical to govern food
markets and supply, thus instead education should be improved.
The theoretical framework suggested for the study was
Henderson’s Needs Theory. The argument was that although the
theory works well with inpatients, it can support the problem of
helping obesity patients (Ahtisham & Jacoline, 2015). The
suggested research approach and design of the study would be
qualitative study with a non-experimental (descriptive) inquiry-
based design based on the Grounded Theory (GT). The research,
as suggested, use interviews and existing documents as its
primary data collection tools. Chamberlain Program Outcomes
The assignment enabled realization of program outcome (PO)
#5: Advocates for positive health outcomes through

practice (Extraordinary nursing). This is because, evidence-
based practice is one of the ways through which nurses can
advocate for desirable health outcomes. The assignment enabled
the application of the ability to design an evidence-based
research. The process involves selecting an appropriate research
article, summarizing and reviewing its relevance and
information, research design, methodology, sampling and
presentation of research findings. MSN Essentials
This assignment met MSN Essential VI: Health Policy and
Advocacy. I was able to engage in advanced research method,
and research critique, to inform health advocacy and policy as
to attain MSN Essential VI. It is evident that an MSN prepared
nurse can apply research outcomes, become a change agent,
resolve a nursing practice issues, and help disseminate research
findings. I concluded that being able to translate findings of a
nursing research is an important.NONPF Competencies
To achieve the assignment outcome, I needed such NONPF
Competencies as policy, scientific foundation and health
delivery systems. Policy and health delivery systems
competencies enabled me to use health informatics for
determining the best guidelines for managing critical health
issues. Through scientific foundation I was able to critique
different study findings to generate appropriate information for
the research. Through health delivery systems competency I was
able to synthesize nursing practice methods that would improve
patient outcomes.Connection
I was able to connect with two concepts from this exemplar –
research gap and research limitations. Research gaps are the
areas with inadequate information, which constraints the
research’s effective conclusion. A research gap often leads to
recommendation of a new research to further the information.
One can conclude there’s a research gap only after a
comprehensive literature review.
Research Limitation are the research aspects that inhibit a
researcher from attaining the full potential of the research
outcomes. It is assumed that every research has a given

limitation level such as resources, scope or knowledge.
Limitations are the conditions, which an investigator cannot
fully manage and will constraint the research’s conclusions and
methodology.Reflection
I thank this course for giving me insight on conducting
scientific research and critique. Through program Outcome #5 I
am now able for advocating for the realization of a positive
health outcome through engaging evidence-based compassionate
and collaborative advanced nursing practices that are evidence-
based. Having gone through this course, it is evident that nurses
could experience challenges in research critiques and general
research conduct. Nurses should therefore exhibit NONPF Core
Competencies particularly the scientific foundation
competencies.References
Centers for Disease Control and Prevention. (2017). Childhood
Obesity Facts. Division of Population Health, National Center
for Chronic Disease Prevention and Health Promotion.
Kliegman, R. M., Schor, N. F., St Geme III, J. M., & Behrman,
R. E. (2016). Nelson Textbook of Pediatrics. Philadelphia:
Elsevier.
Lobstein, T., Jackson-Leach, R., Moodie, M. L., Hall, K. D.,
Gortmaker, S. L., Swinburn, B. A., . . . Mc Pherson, K. (2015).
Childhood and adolescent obesity: Part of a bigger picture. The
Lancet, 2510-2520.
National Collaborative on Childhood Obesity Research. (2012).
Childhood Obesity in the United States. NCCOR.
Exemplar #3: NR507 Advanced Pathophysiology
The NR507 Course of Advance Pathophysiology was key in
realizing the Chamberlin trained nurse practitioner’s program
outcomes, master’s essentials, and core competencies.
Pathophysiology focuses on the symptoms and function of
diseased organs, to enable diagnosis and effective patient care.
The different between pathophysiology and pathology, is that
pathology studies all aspects of a disease, and not just the
organic function. The question that NR507 sought to answer is

how the study of pathophysiology help nurses in their practice.
Nurse practitioners must have the right information coupled
with practice knowledge and skills to be able to achieve the best
evidence-based, comprehensive quality patient outcomes.
Pathophysiology entails Disease and etiology, signs and
symptoms, investigation and diagnosis, treatment and prognosis.
Pathophysiology puts together all of these steps. Nurse
practitioners are expected to have a clear understanding of the
process from the etiology and symptoms, through to medical
testing, investigation, diagnosis and finally prognosis. It is clear
that pathophysiology works closely with evidence-based
practice. Thus, nurse can conduct more effective treatments
through pathophysiology especially in such situations where
anxious, scared patients don’t really understand their
conditions. Nurses can educate the patients and calm them
down.
There are cases where, through pathophysiology, nurses can
help generate a valuable discovery for a patient’s healthcare
team. Acting – in their usual crucial role – as their patients’
advocates, it is possible that nurses could catch some
overlooked signs or and make them know to the doctor. The
course sheds the light of pathophysiology as a way of
facilitating the nurses’ knowledge to enable them to
comfortably walk their patients through the process of disease
etiology, testing, diagnosing, treating and prognosis. Nurses
become effective in their work when they clearly understand the
different ways biological processes and human organs behave in
the presence of a disease. This experience and practice skills is
gained through. effective research. Chamberlain Program
Outcomes
I found this course highly critical since it concerns
understanding a disease, correct diagnosis, treatment and its
prognosis for effective and quality patient care through proper
professional identity. Thus, this course met two program
outcomes. It met PO #2: Create a caring environment for
achieving quality health outcomes (Care-Focused) and PO #4:

Integrate professional values through scholarship and service in
health care (Professional identity). Pathophysiology ensures that
the patient’s care environment is perfect for achieving quality
treatment outcomes. AACN MSN Essentials
The course managed to achieve MSN Essential IV: Translating
and Integrating Scholarship into Practice and MSNEssential
VIII: Clinical Prevention and Population Health for Improving
Health. These two essentials are connected to PO #4, which this
course was also able to meet. An MSN prepared nurse must be
able to integrate broad, effective patient-centered, culturally
competent and organizational concepts to assess, manage and
deliver proper clinical care to the patient. As an MSN prepared
nurse, I can use pathophysiology to manage a patient and the
disease following through all the necessary steps learned
throughout the nursing course with appropriate understanding to
achieve quality health outcome for the patient.NONPF Core
Competencies
To effectively achieve this course, it was imperative to have
such NONPF competencies as quality, independent practice and
health delivery systems Competencies. To be able to apply
pathophysiology, an MSN trained nurse must exhibit
independent practice competencies. It is only through
independent practice that the nurse can bring to the doctor’s
attention certain aspects of the disease that were overlooked.
This competency is supported by quality-oriented practice and
having a clear knowledge of the health delivery systems.
Connect
The Autonomic Nervous System, controls the body’s internal
organs functions. It controls body muscles and is also an
integral part of the peripheral nervous system (Tappen, 2016).
The renal system is comprised of body organs, which filter out
excess fluid and other substances from the bloodstream. It is
responsible for the production, storage and elimination of urine
is done. The kidneys, being key part of the renal system, help to
excrete excess fluid waste. Further, the kidney filters waste and
extra blood from the blood system (Tappen, 2016).Reflection

One among the many useful and important courses in MSN, this
this NR507 Advanced Pathophysiology course sought to answer
the question of how the study of pathophysiology help nurses in
their practice. It is now clear to me that through this course the
nurse can conduct more effective treatments especially in such
situations where anxious, scared patients don’t really
understand their conditions. I even learned that there are cases
where, through pathophysiology, nurses can help generate a
valuable discovery for a patient’s healthcare team. This course
was important in realizing two program outcomes: PO #2:
Create a caring environment for achieving quality health
outcomes (Care-Focused) and PO #4: Integrate professional
values through scholarship and service in health care
(Professional identity). Understanding pathophysiology is an
important aspect of nurse evidence-based treatment.
References
American Association of Colleges of Nursing. The Essentials
of Masters Education for Nursing (2011). Retrieved from
http://www.aacn.nche.edu/education-
resources/MastersEssentials11.pdf
Robinson, B. K., & Dearmon, V. (2013). Evidence-based
nursing education: Effective use of instructional design and
simulated learning environments to enhance knowledge transfer
in undergraduate nursing students. Journal of Professional
Nursing, 29(4), 203-209. doi: 10.1016/j.profnurs.2012.04.022
Tappen, R. M. (2016). Advanced nursing research: From theory
to practice. Jones & Bartlett Publishers.Exemplar #4: NR508
Advanced Pharmacology
The focus of this course is on advanced knowledge base and
practice skills of pharmacology across in different clinical
settings. It discusses the principles of clinical pharmacology,
pharmacokinetics, therapeutics, and drug metabolism. Being a
dynamic science, advanced Pharmacology as explained in
NR508, built upon the previous knowledge to augment our
understanding of treatment complexities with pharmacological
interventions. The whole of this course expands knowledge of

the principles of pharmacology specific to the APN’s role. As a
student I was able to explore, analyze, evaluate, and apply
common drugs used for treatment of chronic diseases and some
self-limiting acute conditions and apply evidence-based practice
for prescriptive intervention.
In reflection, through this course, and as an MSN trained nurse,
I can now compile patients’ information to provide appropriate
evidence-based diagnosis and treatment. I can boast of better
understanding of the integration and application of appropriate
and quality care to patients while also focusing on
organizational standards, and considering distinct and dynamic
individual and family populations. I have learned this important
aspect of treatment through pharmacokinetics and giving
patients appropriate drug choices it is possible to achieve
quality treatment.
Through completion of NR 508, I can discuss the principles and
concepts of pharmacokinetics, pharmacotherapeutics and
pharmacodynamics. I can also now demonstrate an
understanding of the key drug classifications with regards to
rationale, risks, indications, and efficacy for the
pharmacotherapeutic agents regularly prescribed in acute and
primary care settings. I also gained the knowledge to evaluate
relevant and current research findings to come up with prudent
and quality pharmacological interventions. This course has also
enabled me to be able to design suitable pharmacologic
interventions. This class was one of those that are both
enlightening and challenging. I gained the knowledge necessary
to arrive at definitive patient diagnosis and establish an apt a
treatment plan. Chamberlain Program Outcomes
I believe this course me program outcome (PO) #5: Advocates
for positive health outcomes through compassionate, evidence-
based, collaborative advanced nursing practice (Extraordinary
nursing). It is important that nurses communicate effectively to
patients on the drugs given and treatment plan offered. It is
possible that NR508 MET PO #5 because it is the only outcome
that champions for desirable health outcomes through

compassionate and evidence-based encompassed with
collaboration AACN MSN Essentials
The course attained AACN MSN Essential VII:
Interprofessional Collaboration for Improving Patient and
Population Health Outcomes. MSN Essential VII addresses
interprofessional collaboration that enhances patient outcomes
and quality of population health. As an MSN prepared nurse, I
now understand that to attain quality care, it is important to
collaborate with other healthcare professionals so as manage
and coordinate the care. NONPF Core Competencies
Through this course (NR508) it is evident that one needs to
show Health Delivery Systems Competencies and practice
competencies. These two competencies impact the
operationalization of public health and community programs.
Using these competencies, a nurse can engage inquiry to come
up with appropriate diagnosis, treatment plan and drug
prescription. You also need to eb culturally competent to
deliver appropriate healthcare and work with others in the
healthcare field for effective patient outcomes. Connect
Through this course, can connect with two terms – allergy and
NSAIDs.In the context of pharmacology an allergy is used to
refer to the immune system’s response – unnecessary – to a
harmless foreign substance (Lilley, Shelly & Snyder,
2019).NSAIDs, on the other hand are non-steroidal anti-
inflammatory drugs, which work by obstructing prostaglandins.
prostaglandins are the chemicals that trigger the inflammation
and pain signal. NSAIDs then help to relieve the inflammation
from pain (Lilley, Shelly & Snyder, 2019).Reflection
This course has benefitted me a lot. Other than knowing the
essentials and specific applications of advanced pharmacology,
I managed to attain PO #5, which advocates for desirable health
outcomes through compassionate and evidence-based approach
to nursing practice while elevating collaboration. It is
understandable that you cannot work alone when you are a nurse
practitioner and that you have to engage other practitioners in
the healthcare field to attain quality healthcare outcomes. The

course is also aligned toMSN Essential VII, which addresses
interprofessional collaboration for enhanced patient outcomes.
Thus, while conducting evidence-based and compassionate care,
elevating interprofessional collaboration also leads to enhanced
patient outcomes. References
Chamberlain College of Nursing. (2016). Graduate Program
Outcomes. Retrieved from http://www.chamberlain.edu
Chamberlain College of Nursing. (2017). Pharmacokinetics,
Pharmacodynamics, Art of Pharmacotherapeutics, Reproductive
System Medications and Drug-OTC-Herbal Interactions. Week 1
lesson. Retrieved from http://www.chamberlain.edu
Lilley, L. L., Shelly Rainforth Collins, P., & Snyder, J. S.
(2019). Pharmacology and the nursing process. Mosby.
Exemplar #5: NR509 Advanced Physical Assessments
The name and expectation of the NR509 course is far much
different from time one needs to successfully complete the
course. I never expected that this course would involve that
much activity and time. There is much study and practical
application in this course than any other MSN course. I was
even overwhelmed with the amount of documentation and
information involved with the patients.
This course is best for those planning to undertaking
autonomous practice. An FNP is an example of an autonomous
practicing nurse. They have the knowledge for emergency
nursing, primary care, night-nurse practitioners, community
matrons, critical care, occupational therapists, physiotherapists,
and working in different pre-surgical clinics, and day surgery,
among other places. The course aims to enable one, as a
practitioner, to develop advanced physical assessment skills and
apply them in a clinical context, including when working as an
autonomous practitioner.

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