Baby F continues to be followed by the practice and is a happy and thriving baby boy. His CLE remains asymptomatic, and his parents plan on moving back to London in the next year.
COMPETENCY DEFENSE
Domain 1, Competency 1. Evaluate patient needs based on age, developmen- tal stage, family history, ethnicity, and individual risk, including genetic profi le,
Chapter 10 Neonate With a Rare Congenital Lung Anomaly
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to formulate plans for health promotion, anticipatory guidance, counseling, and disease prevention services for healthy or sick patients and their families in any clinical setting.
Defense. Balancing management of this infant’s complex diagnosis and possible genetic component, along with his routine health promotion and developmental needs, was challenging. Acting as a child’s primary care provider from an early age, I feel it is imperative to promote a theme of fam- ily-centered care and not lose sight of the child behind the illness who must continue to thrive and meet his fullest potential. I was able to assess the family and child’s needs in this case and have each encounter include routine health surveillance, parental concerns, encouragement, support, and practical guid- ance on growth, nutrition, and development. The possible genetic component of CLE was discussed with the parents, and referral to a genetic counselor was initiated. The parents were made aware of the possible autosomal-dominant inheritance pattern for CLE, and the fact that the course of treatment will not be changed based on the genetics. Family histories were reviewed, and an infant death of unknown etiology was identifi ed, but at this time the parents do not wish to proceed with the genetic counselor appointment or the gene testing for themselves or their baby.
Domain 1, Competency 3. Formulate differential diagnoses, and diagnostic strategies and therapeutic interventions with attention to scientifi c evidence, safety, cost, invasiveness, simplicity, acceptability, adherence, and effi cacy for patients who present with new conditions and those with ambiguous or incomplete data, complex illnesses, comorbid conditions, and multiple diagnoses in all clinical settings.
Defense. From my fi rst meeting with Baby F, I carefully reviewed his symp- toms and evaluated, based on evidence, which diagnosis best fi t his clinical scenario, and what next step would guide his treatment. This was evident in my plan of care initiating in the WBN when I facilitated his transfer to the NICU, and continued as I ordered and implemented appropriate diagnos- tic tests and reviewed the results and the literature to formulate a safe and effective plan of care.
Domain 1, Competency 4. Appraise acuity of patient condition, determine need to transfer patient to higher acuity setting, coordinate and manage transfer to optimize patient outcomes.
Defense. I was able to act as this patient’s primary care provider from initial evaluation in the WBN, where, after careful assessment of his condition, I made the decision to transfer him to the NICU. I coordinated and managed his transfer through both written orders and verbal communication with both the WBN staff and the NICU staff, while taking responsibility to notify the parents and the designated pediatrician about my diagnosis of respiratory distress, and communicate my initial differential and plan for intervention.
Domain 1, Competency 5. Evaluate and direct care during hospitalization, and design a comprehensive discharge plan for patients from an acute care setting.
Defense. I was the nurse practitioner responsible for facilitating and imple- menting transfer of the infant to the NICU, based on his clinical presenta- tion and index of suspicion. I was responsible for his admission, inclusive of writing orders, drawing blood work, deciding upon and ordering appropriate diagnostic tests, coordinating care, and arranging for consultation with the appropriate specialists.
I was actively involved in this patient’s care from admission until dis- charge, and was able to meet with the parents to discuss discharge planning and anticipatory guidance, and arrange outpatient follow-up care based on the patient’s specifi c needs. I also provided the parents with a written discharge summary of Baby F’s inpatient course for outpatient providers to reference.
Domain 2, Competency 1. Assemble a collaborative interdisciplinary net- work, refer and consult appropriately while maintaining primary responsibil- ity for comprehensive patient care.
Defense. As this infant’s primary care practitioner on day one of life when he was fi rst diagnosed with CLE, I was able to initiate consultation with the pedi- atric surgeon. After this consultation, for which I was present and involved, along with the neonatologist on service, we were able to discuss the diagnosis, options, and recommendations as a team.
I also called and facilitated a cardiology, social work, and genetic consul- tation for this family. Communication among all members of this multidisci- plinary health care team remained open, with all recommendations discussed and reviewed by myself along with the neonatologist in order to formulate the most appropriate plan of care for this patient.
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Adolescent Female With Secondary Amenorrhea
This case describes the care I provided for a 17-year-old adolescent female with Medicaid HMO insurance who presented for her yearly physical examination complaining of amenorrhea and fear of pregnancy (Patient B). The case narra- tive focuses on two encounters and one telephone consultation that occurred over a period of six weeks in the ambulatory care setting. This case narrative demonstrates my ability to meet the following Columbia University School of Nursing Doctoral Competencies for Comprehensive Direct Patient Care.
DOMAIN 2, COMPETENCY 1
Assemble a collaborative interdisciplinary network, refer and consult appro- priately while maintaining primary responsibility for comprehensive patient care.
PO A. Initiate referral to other health care professionals while maintaining primary responsibility for patient care.
11
Lynne Beth WeissmanPO B. Accept referrals from other health care professions and communicate consultation fi ndings and recommendations to the referring provider and col- laborative network.
PO C. Utilize consultation recommendations for decision-making while main- taining primary responsibility for care.
PO D. Evaluate outcomes of interventions.
PO E. Provide ongoing patient follow-up and monitor outcomes of collabora- tive network interventions.
DOMAIN 3, COMPETENCY 2
Evaluate gaps in health care access that compromise optimal patient out- comes, and apply current knowledge of the organization and fi nancing of health care systems to ameliorate negative impact.
PO A. Identify gaps in access that compromise patient’s optimum care.
PO B. Identify gaps in reimbursement that compromise patient’s optimum care.
PO C. Demonstrate patient advocacy in the provision of continuous and comprehensive care.
PO D. Apply current knowledge of the organization to ameliorate negative impact.
PO E. Apply current knowledge of health care systems to ameliorate negative impact.