Patient with chest pain

Patient with chest pain
Please note that this Capstone project is not a research paper where you pick a topic and then write about it.
Instead, you need to pick an actual patient from your clinical rotation. Interview and assess that patient.
All the information on page 3 of your syllabus must be included in your project.
1. However, to get started, the first part you need to do is to introduce the patient, describe the case, interview the patient (collecting subjective data, history of present concern, personal health history, family history, life style and health practices, a complete review of systems)
2. Then physical assessment (assess the patient by collecting Objective data of all the systems).
3. Then review all medications and lab results.
4. Develop differential diagnosis
5. what diagnostic testing is needed and why?
6. Then conduct a literature review, utilize theoretical framework.
7. Provide patient education and teaching for primary problem and all comorbidities, health promotion plan.
8. Case outcome (include outcome/goals).
9. Discussion.
10. Conclusion/ Summary.
11. References.
12. Please note that the abstract can be added when the entire project is complete. Also, the H&P would then be rearranged as appendices when the project is completed.
Read page 3 -7 of your syllabus for more clarity.
**FYI: this is a 2-semester project:
NUR 757 completed by end of Fall,2017 (complete # 1- 5, start #6, and introduce the framework)
NUR 758 completed by end of Spring, 2018 (complete #6-12)


The scholarly paper expected for this course is one in which the author addresses a topic utilizing scholarly literature and analyzes, synthesizes and/or critiques this literature supporting his/her topic. The paper requires you to present a Case Study of a patient as seen in the clinical areas. It will be important to analyze and synthesize the literature as well as critique it, rather than just present it.

All necessary content comes from the guidelines below. This is the outline and are suggested headings for the paper

Abstract (in APA format). The Abstract will be placed in the student’s academic file.

Literature Review

Theoretical Framework

Description of Case (description of health problem; details of patient including all medical, social determinants of health such as cultural, economic factors, etc.)

Physical examination – the full H& 4 will appear as an addendum to the final paper)

Differential diagnosis

Diagnostic testing

Patient Management and Health Promotion Plan

Case Outcome (includes outcome/goals)

Discussion (in depth related to case; role/practice of NP impact on future of advanced nursing practice and policies related to practice)

Conclusions/Summary (includes need for further evidence; specifics on how NP can facilitate/influence these future needs).


Appendices -Complete H&P and if applicable any tables

Tables (signs and symptoms; differential dx; pertinent socio/demographic issues/problems etc. – if applicable to highlight the case,

General Guidelines

a. Submission must be typed according to the following specifications:
1) Written in Microsoft Word in 12-point Times New Roman font (or equivalent)
2) Top and bottom margins must be 1” wide and side margins must be 1” wide
3) Text must be double spaced
4) The paper should be 20-25 pages in length
5) Pages must be numbered

b. Must be submitted both electronically and final paper and abstract hard copy

c. Spelling, grammar, neatness and style will be considered.

d. It is the student’s responsibility to allow adequate time to address such problems as lost data, time conflict with other coursework due dates, etc.

e. Use of Wikipedia: As information submitted to Wikipedia is not vetted by professional sources, it is not considered appropriate academic reference material. Therefore,
references to Wikipedia entries are not permitted.

f. APA format for style (Publication Manual of the American Psychological Association,
(latest edition is 6th) will be used.

Grading Rubric:

Abstract: (5 pts) – APA format
Organization of paper; Grammar/Writing Style: (35 pts)
Paper is logically organized:
Paper proceeds from introduction to summary and appropriate thoughts/literature are presented in each sub-topic area
All sections of paper outline are discernable
APA format for scholarly paper – proper use of headings; professional writing style (no jargon, etc.); Ideas should be logically presented; No typos / spelling errors present.
Synthesis and Analysis (45 pts)
Literature is analyzed, critiqued and /or synthesized; use of theoretical framework; application/relevance of all interventions/patient management plan, patient outcome, patient social factors relevant to the case and role of nurse practitioner.
References (10 pts)
APA format. A variety of references are used incorporating literature form the major scholarly journals in nursing and healthcare. Current references within past 5 years (unless classic information is presented). Sometimes the literature is “weak”, or even non-existent, on a particular topic. If so, this should be stated.
Contribution (5pts)
Does the paper make a contribution to advanced practice nursing? Is it publishable? Does it extend the knowledge/thinking that exists? Is the view taken creative, innovative, etc.?


The guidelines below are for the student to follow to inclusion of appropriate content to be included/discussed in the final capstone paper.

These are not assignments but rather a guide. Course instructor will look for this content.

Establish timeline for drafts completion/submission – Communicate well and meets regularly with instructor as appropriate. Plan to submit at least 3 progressive drafts of final paper per semester. See outline for paper below.
Introduction to the project
• Identify the problem (Choose a complex case seen in clinical sites)
• Establish draft outline
Comprehensive Summary of Problem and Case Description
Description of the health problem
• Theoretical framework that informs this case
• Description of the case (patient – medical, social, cultural, ethical, legal and economic factors/social determinants of health)
• Elements relevant to the case
• Discuss in context the relevance to the NP role
Evidenced-based Systematic Review of the Literature (literature that used to support problem, case description
• Description of search process (keywords, databases searched, exclusion and inclusion criteria, search engines used, etc.)
• Use of multiple databases and wide breadth of data sources
• Literature review of documents and journal as pertains to case problem
• Supporting Statements & Critique of literature used
• Start initial APA Reference List
Formal H & P Format (will be Addendum in Final Paper)
• Include
1. Biographic Data
3. PMH
4. PSH/PFH/Social Hx
5. Meds/Allergies
6. ROS
7. Physical Exam
8. Review of labs and diagnostic imaging studies
Include all pertinent positives and negative
Discuss pertinent findings ONLY in the body of the paper and discuss any differential diagnoses and management plan – in-depth discussion of differential and plan in FINAL PAPER. THE FULL H&P WILL BE AN ADDENDUM TO THE PAPER.
Students are to ensure the Integration of all previous Core Course work (Core, Specialty) – it is incorporated throughout the paper – it is not written as a separate section of the paper. Course instructors will look for these as they are discussed or utilized throughout the paper.
• Theory, Statistics, Research, Informatics, Health Policy and Specialty Courses
Differential diagnostic evaluation on patients with undifferentiated condition Comprehensive Discussion of Differential Diagnoses for health problem of case study
• As related to patient findings
• Based on evidenced-based research from literature/scholarly reviews from both semesters
• Suggestion of likely diagnosis with evidence-based rationale
• . Include rationale for priority rule in and rule outs and your initial impression of the diagnosis.
Evidenced-Based Patient Management Plan using multiple modalities of care – must use the evidenced-based literature to support management plan
• Method of treatment including pharmacologic therapy, referrals, diagnostic work-up, collaboration with interdisciplinary health care providers is incorporated
• Describe follow-up plan for each active problem based on evidence-based medicine – must include expected outcome/goals at time of follow-up visits
• Discuss patient social determinants of health – social, cultural, ethical, legal and economic factors that have relevance to patient care management and health outcomes
• Address the clinical implications and treatment plan of patients with complex co-morbid conditions. Include follow-up plans and education.
• Referral decisions and collaborative networking. Decision-making that utilizes recommendations and documents theoretical patient follow-up and desired outcomes. Describe how collaboration/communication would be facilitated. Management and coordination of care for patients with complex co-morbid conditions utilizing specialist, other disciplines, community resources, family, including shared decision-making and teaching.
• Assessment and intervention for a patient/family with a condition that incorporates principles of epidemiological process or environment factors, contributing to risk/incidence of disease in a patient or family being served.
• Chronic illness management/coordination utilizing community resources and family, while including shared decision making and teaching.
• Identification of a potential genetic risk, diagnosis of a genetic condition, and intervention for risk reduction for the individual and implication for the family.
• Identification of gaps in access/reimbursement that compromised patient’s optimum care.
• Guiding the process for planning end of life care for a patient/family.
Discuss in depth of the following
• Relevance to the Nurse Practitioner Role and Practice
• The limitations of evidence-based research on this health problem and need for further research
• The future of the advanced practice nurse’s role in the context of the IOM Report on the Future of Nursing (must reference specific sections of report) and current health care policy changes (Affordable Health Care Act and Accountable Care Organizations)
Case Study Part 1

Case Study
Identifying Data:
Mr M is a good reliable historian. Speech is clear and coherent. Mr. M had appropriate eye contact throughout entire exam.

Chief Complaint:
Mr. M chief complaint is left elbow /knee pain as well chest pressure at night
Mr. M is a 56 year old white male who presents with two complaints. The first complaint is pain in his left elbow and left knee a 56 year old white male who presents with two complaints. The first complaint is pain in his left elbow and left knee. The patient states the pain has been gradually worsening over the past three months. The pain is located on his left medial elbow as well as his left knee under the kneecap. The pain does not radiate upwards to his shoulder or downward to his lumbar or lower extremities. The pain is described as being sharp at times and dull at other times. The pain is constant, worsens with increased activity and is relieved with rest and Advil. The pain at its worst is 5/10 and is usually a constant 2 for the past 5 days.
The patient’s second complaint is him waking up at night with a feeling of pressure on his chest. The patient denies the pressure being accompanied by any pain either in his back or left arm (other than his previous complaint of elbow pain). The patient denies any shortness of breath as well as any palpitations. The patient states that after taking some deep breaths and an Advil, the pressure went away gradually over a 15 min period. The patient states that this is the first time he has felt this kind of pressure on his chest.

Review of Symptoms
The patient has a contributory past medical history. Patient states he was hospitalized in 2002 for a cardiac stent/ablation, acid reflux and hypertension. Pt states his current medical regimen is as follows: aspiring 81mg daily, metoprolol 100mg daily, advil PRN pain. Pt denies any allergies to medication or food. Pt family history as follows: mother died at age 82 of natural causes and father died at age 56 from MI. The patient states that he is a chef at his own restaurant. He works seven days a week. Pt is married with three children who have all moved out. Pt denies smoking and drinks 3 glasses of wine per day, usually towards the end of his work shift

General- Patient is well groomed and alert and orientated times three, denies any shortness of breath, chest pain, palpitations.
Allergies: Denies allergies to medication or food
PMH: cardiac stent/ablation 2002