advanced practice nursing in primary care - ANSWERS1) nurse-pt relationship
2) integrating increased medical knowledge with nursing practice
3) evidence based practice (EBP)
4) patient centered care
5) wears many hats
primary care - ANSWERS1) foundation of health care delivery
2) provides general medical needs
3)first point of contact for patients
4) complex
5) to improve the health of individuals
diagnostic reasoning - ANSWERS1) critical thinking
2) intuitions sill applies
3) involves the diagnostic process
4) differential diagnosis
Differential Diagnosis (DDx) - ANSWERSall of the possible diagnoses based not he patient's signs
and symptoms
What is the Diagnostic Process? - ANSWERShistory taking -> examination -> labs/diagnostics ->
differential diagnosis
,Diagnostic Process definition - ANSWERSuse diagnostic reasoning to rule out differential
diagnosis to develop a final diagnosis
subjective data - ANSWERSWhat the patient says about himself or herself during history taking
Chief Complaint -> what the patient came in for in their own words
HPI -> history leading up to the complaint (detailed)
(OLD CART)
OLD CART - ANSWERSOnset
Location
Duration
Characteristics
Aggravating factors
Relieving factors
Treatment
history taking - ANSWERSPast Medical History
Past Surgical History
Health Maintenance
Medication List
Allergies
Family History
Social History
Review of Systems (neg/pos)
objective data (physical exam) - ANSWERSvitals, weight, height, BMI
, what is seen, felt, heard
what you examine based on the patient's complaint
objective data (diagnostic tests) - ANSWERSlabs, x-rays, scans, spirometry, etc.
consider which test is best (cost, convince, sensitivity, specificity)
what will make a difference in treatment?
what is the risk of missing the diagnosis?
treatment plan - ANSWERS-shared decision making = better outcomes and increased patient
satisfaction
-evidenced based on current practice guidelines
-education
-follow up
oral reporting - ANSWERS-case presentation
-purpose
-follow the diagnostic process
-communicate with the most pertinent information
how to give oral report? - ANSWERS1) opening statement (age, gender, cc)
2) report HPI (cardinal symptoms, pos/neg)
3) focused assessment with findings
4) synthesis statement of the differential diagnoses
5) final diagnosis and treatment you recommend
comprehensive history and physical - ANSWERScaptures entire medical history (complete
physical exam, diagnosis, diagnostic studies, initial plan of care for all problems)