FORMATTING INSTRUCTIONS:

Your clinical application essay should be organized as follows:

1. First page:  The first page is the title page. The title page will include only the following centered and double-spaced in the middle of the page:
   NO running head – A running head IS NOT REQUIRED for student papers.
   Page number (in the upper RIGHT-hand corner) (All pages should be numbered.)
   The title of the paper in bold font (Tell the reader more than “Module 02 Clinical Application Assignment”)
   The author (That’s you …without credentials)
   The institution (The University of Alabama at Birmingham)
   The date the assignment is DUE (not the date submitted)
   DO NOT INCLUDE THE INSTRUCTOR’S NAME ON THE PAPER
2. Next pages:  The body of your paper. The body of the paper will include the following:
   A WELL ORGANIZED, detailed introduction providing all of the facts of the case (Note:  There is no unnecessary information in the scenario. The scenario provides significant clues for your rationale.)
3. Next to the last page:  TEACHING POINTS (Yes, teaching points go on a separate page.):  Include ONLY THREE teaching points. You must CRITICALLY THINK and determine WHAT IS THE MOST IMPORTANT you should EXPLAIN (teach) to the patient at THIS time. As the provider for this patient, you will have ample opportunity to provide further teaching at follow-up visits. Teaching points DO NOT need references. (Show us that you can follow instructions.) The teaching points are in YOUR words to the patient.
4. Last page:  The last page is the reference page. All references should be in APA (7th ed.) format. This textbook has authored chapters. The appropriate formatting for an authored chapter in a textbook without a DOI is found on p. 326, example 39, in the Publication Manual of the American Psychological Association, 7th ed.

Submit your work as a DOC or DOCX file through the assignment portal in Canvas.  ALL assignments (except the very last one) are due at 2330 Central Time.

INSTRUCTIONS:

Below is a clinical situation an advanced practice nurse might encounter. Although this case MAY APPEAR to be an obstetrical case, this case focuses on the pathophysiologic principles that apply to patients who are men or women, young or old. In NO MORE THAN FOUR PARAGRAPHS (not including the introduction), assess the situation and address the questions (logically and in order) that relate to the scenario. Be concise and clear in your presentation.

The first paragraph of the clinical application essay must include a complete introduction that presents the facts of the case so a reader not familiar with the case will understand what you are writing about. The next paragraphs should explain the pathophysiology that has caused the conditions of the case. Be sure that you answer each of the questions.

Be sure to check your spelling and grammar. Proper use of APA (7th ed.) formatting is required. DO NOT USE REFERENCES OTHER THAN THE REQUIRED TEXTBOOK (Norris (10th ed.). YOUR ESSAY SHOULD BE CONCISE, WELL ORGANIZED, AND NO MORE THAN FOUR PARAGRAPHS IN LENGTH (not including the introduction and teaching points.) Follow instructions. SEE THE RUBRIC FOR GRADING PARAMETERS. Use the rubric as a checklist before submission.

TEACHING POINTS

A teaching point is something you say directly to a patient, a parent, or other family members that TEACHES about the pathophysiology and/or treatment during the clinic or office visit that should be remembered after the visit. (“You will need a follow-up appointment” is an instruction, not a teaching point.)

Do not use jargon-not everyone you talk with will have the same level of education that you do. (Perhaps have a non-medical 13-year-old read your teaching points to see if they can understand what you are saying.) Teaching points do not need references.

If we were discussing the pathophysiology of GOUT, examples of teaching points are:

1. You have a condition called gout. When gout develops, uric acid can build up, forming sharp, needlelike urate crystals in joints or surrounding tissues that cause pain, inflammation, and swelling.
2. Normally, uric acid dissolves in your blood and passes easily through your kidneys into your urine. Accumulation of uric acid can occur when you produce too much uric acid, or your kidneys excrete too little uric acid.
3. You should modify your diet. Purines are substances found in foods such as red meat, organ meats, and liver. Purine-rich seafood includes anchovies, sardines, mussels, scallops, trout, and tuna. Alcoholic beverages, especially beer, and drinks sweetened with fruit sugar promote higher levels of uric acid. You should minimize or avoid these foods to prevent or reduce the frequency of your flair-ups.

Notice the teaching in the above points. Also, notice that ARABIC numbers (1, 2, 3) were used. If an instruction is given, as in example 3, then an explanation (teaching) is given about WHY the instruction is important.

NOT

1. I would tell the patient that he needs to modify his diet.
Write what you will say to the patient not what you will do.

2. It is important to keep your next scheduled visit.
This is an instruction and teaches the patient nothing about the disease process.

3. If you do not control your gout, damage to your joints may be so severe that amputation is necessary.
This is a bit harsh and a bit extreme. There are softer ways to teach about this.

SCENARIO

(The beauty of this scenario is that it combines elements of the hematologic and immunologic systems into one case.)

Kate is a 29-year-old Caucasian female who presents at 12-weeks gestation for initiation of appropriate prenatal care. She has been pregnant three times including this pregnancy. She has had one term delivery, one premature delivery, no miscarriages or abortions, and has two living children (G3 P1102). Kate is currently pregnant with their third child and is in good health. Edward, her husband, is the father of all of her pregnancies.

Her first pregnancy, labor, and delivery were uncomplicated. She delivered a 7lb 13 oz female infant with blood Type B, Rh-positive.

Kate’s second pregnancy was complicated by an emergency C-section for partial placental abruption at a 34-weeks gestation following an automobile accident. Her son weighed 4 pounds 3 ounces. The son suffered severe anemia attributed to a fetal-maternal hemorrhage (bleeding from the baby to mother) at the time of the accident. To restore blood volume and normalize the hematocrit, the neonate was treated with an appropriate volume of Type A, Rh-positive donor blood that was type-specific. There were no other perinatal complications.

At 12-weeks gestation In the current (third) pregnancy, Kate’s routine prenatal blood work revealed the following:

• Blood type: O; Rh-negative (O-)
• Antibody screen: 1:32 (NL is < 1:2)
• HIV: NEGATIVE
• Hepatitis B surface antigen (HBsAg): NEGATIVE
• Complete blood count: HCT 37% (NL); MCV 87 fL (NL); platelet count 165,000 (NL); WBC 10,600/mm3 (NL)

At 20-weeks gestation, a repeat antibody screen was 1:512. By ultrasound, the fetus was showing signs of early Rh disease of pregnancy (hydrops fetalis), a condition associated with significant fetal anemia, fetal ascites, increased fetal heart rate, and signs of heart failure. Kate is truly concerned and frightened about the condition of her fetus and has many questions.

From what you have learned in Module 04 about immunity and the hematopoietic system and using Norris (10th ed) as your only reference:

1. Explain the pathophysiology that has caused the positive maternal anti-D antibody screen. This should specifically address the specific maternal immune system response.
2. Explain the pathophysiology of Rh disease of pregnancy (hydrops fetalis) and why this has developed in the fetus. This should discuss the interaction between the mother and the fetus.

   In your discussion include which specific antibody(s) are responsible for the observed fetal pathophysiology and why. (NOTE:  In the current pregnancy, there has been no bleeding from the mother to the baby or from the baby to the mother.)

3. Based on the information in this scenario, identify and explain what the father’s blood type (A, B, AB, or O) and genotype (DD, Dd, dd) are and how you know this.
4. Based upon the information in the scenario, describe the possible blood types (A, B, AB, or O) and Rh (positive or negative) of the fetus and explain how you know this.

In your teaching points, explain to Kate and her husband and/or her family what Rh disease of pregnancy is and why this has occurred in this pregnancy. Make no speculation about obstetrical/post-partum care in the previous pregnancies. The scenario describes nothing of Kate’s educational background and understanding of medical terminology. Use terms that a non-medical, non-nursing person will understand.