N582

Assignment 2
A 6o-year-old white man presents with an accelerated decline in lung function. Last year he was diagnosed with metastatic ling cancer. Today
he is dyspneic,
pale, and seems almost listless. He continues to smoke and his pack-year history is 40 years. He says “I am tired of this fight”.
CC: “I have to sleep in my recliner because I can’t lie in bed, and I have no energy to do anything—I don’t even have energy to eat, I just want
to die.”
Physical exam: Blood pressure, 120/74; pulse rate, 120 beats/min; respiration rate, 36/min
Height, 5΄9΄΄; weight, 130 lbs.
AP to lateral diameter: 1:1
Cough with clear mucoid sputum
Diminished breath sounds
Dullness overright lower and middle lung fields on percussion and use of accessory muscles during respiration
Chest x-ray film: Mass noted RML and RLL, tracheal shift to left, no cardiomegaly
Arterial blood gases: pH 7.2, PaO2 55, pCO2 60, HCO3 26
Questions:
1. What additional subjective data do you think the patient will share?
2. What additional objective data will you be assessing for?
3. What National Guidelines are appropriate to consider?
4. What tests will you order?
5. Will you be looking for a consult? If so with whom?
6. What are the medical and nursing diagnoses?
7. Are there any legal/ethical considerations?
8. What is your plan of care?
medical
nursing
complementary therapies
9. Are there any Healthy People 2020 objectives that you should consider?
10. Using the Circle of Caring, what or who else should be involved to truly hear the patient’s voice, getting him and the family involved in the
care to reach optimal health?
11. What additional patient teaching may be needed?
12. What billing codes would you recommend?
Criteria 10 Points 8 Points 6 Points 0 Points

Assessment Develops and
demonstrates a clear &
precise assessment plan
supported with
professional literature
and includes objective
and subjective data.
Develops and
demonstrates an
assessment plan but not
fully supported with
professional literature
may be missing one
important piece of data
Develops and
demonstrates a brief &
vague assessment plan
while missing important
details of the
assessment data;
supported with minimal
professional literature.
No paper submitted or
content missing
/10
Guidelines/Evidence Thoroughly describes all
relevant practice
guidelines. Clearly
defines and delineates
the levels of evidence
that support the
guidelines.
Describes relevant
practice guidelines
and/or describes levels
of evidence to support
guidelines but does not
do both.
Describes a brief &
vague treatment plan
but lists no guidelines
and does not level
evidence.
No paper submitted or
content missing
/10
Diagnostics Clearly describes all
appropriate diagnostics
(including sensitivity
and specificity). Clearly
differentiates the
difference between a
positive and a negative
finding and APN
considerations
Describes all
appropriate diagnostics
but does not discuss
the difference between
a positive and negative
finding or lacks a
discussion of specificity
and sensitivity for each
diagnostic
Simply lists some
diagnostics but does
not discuss specificity,
sensitivity, negative, or
positive and APN
considerations
No paper submitted or
content missing
/10
Treatment Plan Develops and provides a
clearly written set of
orders inclusive of all
essential elements in a
treatment plan.
Develops a clear set of
written orders but omits
an important order for
the diagnosis
Develops and provides a
brief set of orders for
the treatment plan with
more than one
omission.
No paper submitted or
content missing
/10
Evaluation Develops and
demonstrates a clear &
precise evaluation plan
for the next office visit
inclusive of data that
will indicate no change
necessary in plan or
changes necessary in
the plan
Develops a evaluation
plan for next office
visit. Includes data but
does not describe
predictive changes
Develops a vague
evaluation plan. There
is no data identified or
plan
No paper submitted or
content missing
/10
Criteria 10 Points 9 Points 7 Points 0 Points
Healthy People 2020
Health Promotion
Develops and
demonstrates a clear &
precise description of
the Healthy People 2020
goals and specifically
relates one goal to
current case.
Develops a Health
Promotion plan and/or
discusses Healthy
People 2020 and the
relation to the case
Describes Health
Promotion but does not
relate back to the case
No paper submitted or
content missing
/10
Patient/Family Teaching Develops and
demonstrates a clear &
precise educational plan
for the patient and
family.
Educational topics are
described but no plan is
developed for the
patient and family
A general educational
plan is shared but is not
specific to the current
case..
No paper submitted or
content missing
/10
Billing Discusses all levels of
billing that apply to the
case and most likely
appropriate level for
first visit and one follow
up visit
Discusses only the
billing level that the
APN may utilize without
rationalization and the
differences in initial and
follow up
Discusses billing levels
however provides
inaccurate levels or
rationalization
No paper submitted or
content missing
/10

Follow up Develops a follow up
plan that specifically
identifies the data that
will need to be reviewed
during the follow up
visit. (This may function
as communication to
the team…i.e. check BP,
cholesterol, and EKG
next visit)
Discusses a general plan
for follow up but no
specific data is listed.
May not indicate when
follow up should occur
or why?
Describes a generalized
follow up plan that
applies to all patients
not the specific case.
No paper submitted or
content missing
/10
5 Points 4 Points 2 Point 0 Points
Grammar, spelling, and
punctuation
There are no errors in
grammar, spelling, and
punctuation
There are a few minor
errors in grammar,
spelling, and
punctuation that do not
detract from the
meaning
There are major errors
in grammar, spelling,
and punctuation that do
not reflect scholarly
writing
No submission /5
APA The paper meets APA
format guidelines
There are minor APA
format errors
There are significant
errors in format
No Submission /5
Total Points Possible = 100
Submission status

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