The document discusses a clinical experience in rheumatoid arthritis for NUR 612. It asks the student to describe their clinical experience for the week, including any challenges or successes. It also asks the student to describe the assessment of a patient with rheumatoid arthritis, including signs and symptoms, assessment, plan of care, and possible differential diagnoses. Finally, it asks what the student learned from this clinical experience that will benefit them as an advanced practice nurse. The response must be at least 500 words and cite at least 2 academic sources using APA style.

1. NUR 612 Clinical Experience Rheumatoid Arthritis Discussion
NUR 612 Clinical Experience Rheumatoid Arthritis DiscussionNUR 612 Clinical Experience
Rheumatoid Arthritis DiscussionDescribe your clinical experience for this week.Did you face
any challenges, any success? If so, what were they?Describe the assessment of a patient,
detailing the signs and symptoms (S&S), assessment, plan of care, and possible differential
diagnosis.What did you learn from this week’s clinical experience that can beneficial for you
as an advanced practice nurse? your plan of care with the current peer-reviewed research
guideline.Submission Instructions:Your initial post should be at least 500 words, formatted
and cited in current APA style with from at least 2 academic sources.ORDER NOW FOR
CUSTOMIZED, PLAGIARISM-FREE PAPERS ADVANCED PRACTICE NURSING in the Care of
Older Adults SECOND EDITION ADVANCED PRACTICE NURSING in the Care of Older Adults
SECOND EDITION Laurie Kennedy-Malone, PhD, GNP-BC, FAANP, FGSA Professor of
Nursing, School of Nursing University of North Carolina at Greensboro Greensboro, North
Carolina Lori Martin-Plank, PhD, FNP-BC, NP-C, GNP-BC, FAANP Clinical Associate
Professor, College of Nursing University of Arizona Tucson, Arizona Evelyn Groenke Duffy,
DNP, AGPCNP-BC, FAANP Associate Professor Director of the Adult-Gerontology Primary
Care Nurse Practitioner Program Associate Director of the University Center on Aging and
Health Frances Payne Bolton School of Nursing Case Western Reserve University Cleveland,
Ohio F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com
Copyright © 2019 by F. A. Davis Company Copyright © 2019 by F. A. Davis Company. All
rights reserved. This book is protected by copyright. No part of it may be reproduced, stored
in a retrieval system, or transmitted in any form or by any means, electronic, mechanical,
photocopying, recording, or otherwise, without written permission from the publisher.
Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2
1 Senior Acquisitions Editor: Susan R. Rhyner Manager of Project and eProject Management:
Catherine H. Carroll Senior Content Project Manager: Christine Abshire Design and
Illustration Manager: Carolyn O’Brien As new scientific information becomes available
through basic and clinical research, recommended treatments and drug therapies undergo
changes. The author(s) and publisher have done everything possible to make this book
accurate, up to date, and in accord with accepted standards at the time of publication. NUR
612 Clinical Experience Rheumatoid Arthritis DiscussionThe author(s), editors, and
publisher are not responsible for errors or omissions or for consequences from application
of the book, and make no warranty, expressed or implied, in regard to the contents of the
book. Any practice described in this book should be applied by the reader in accordance

2. with professional standards of care used in regard to the unique circumstances that may
apply in each situation. The reader is advised always to check product information (package
inserts) for changes and new information regarding dose and contraindications before
administering any drug. Caution is especially urged when using new or infrequently
ordered drugs. Library of Congress Cataloging-in-Publication Data Names: Kennedy-Malone,
Laurie, 1957- author. | Plank, Lori Martin, author. | Duffy, Evelyn Groenke, author. Title:
Advanced practice nursing in the care of older adults [electronic resource] / Laurie
Kennedy-Malone, Lori Martin-Plank, Evelyn Groenke Duffy. Description: 2nd edition. |
Philadelphia : F.A. Davis Company, [2019] | Includes bibliographical references and index.
Identifiers: LCCN 2018038367 (print) | LCCN 2018039007 (ebook) | ISBN 9780803694798
| ISBN 9780803666610 (pbk.) Subjects: | MESH: Geriatric Nursing—methods | Advanced
Practice Nursing | Palliative Care | Geriatric Assessment Classification: LCC RC954 (ebook) |
LCC RC954 (print) | NLM WY 152 | DDC 618.97/0231—dc23 LC record available at
https://lccn.loc.gov/2018038367 Authorization to photocopy items for internal or personal
use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for
users registered with the Copyright Clearance Center (CCC) Transactional Reporting
Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive,
Danvers, MA 01923. For those organizations that have been granted a photocopy license by
CCC, a separate system of payment has been arranged.NUR 612 Clinical Experience
Rheumatoid Arthritis DiscussionThe fee code for users of the Transactional Reporting
Service is: 978-0-8036-66610/19 0 + $.25. I dedicate this book to my husband Chris and my
son Brendan for their unwavering during the writing of this book. To my parents, Nancy
and Edward Kennedy, you continue to be models of successful aging that motivate me to
continue to be passionate about advanced practice gerontological nursing. To graduates
that I have worked with over the years, your continued dedication and expertise in working
with older adults is appreciated and admired; thanks to those who also served as
contributors to this edition. —L.K.-M. To my husband Rick and daughter Erin, thank you
both for your patience and encouragement throughout the writing of this book. To my
patients, who are also my teachers, thank you for entrusting your health to me; it has been
my honor and privilege to serve you and to learn from you. —L.M.-P. To my husband Mark
who ed me as I worked on this book in New Zealand, England, Italy, Ireland, Colorado—on
every vacation we have taken. To my children Patrick, Colin, and Caitlin and my fabulous
GNP daughter-in-law Kristen—you bless me every day. To my Aunt Karleen Groenke Sime
who inspired me to become a nurse. To my father John and my in-laws Shirley and Art, who
continue to live vital lives in their late 80s. Finally, to all my patients who challenge me to be
the best provider I can be and my students who motivate me to constantly be better. —E. G.
D. Preface With the continued rapid growth of the older adult population, there remains an
increased demand for health-care providers to deliver age-specific care and direct disease
management. Advanced Practice Nursing in the Care of Older Adults will serve as a guide for
advanced practice nurses who are privileged to provide care to older adults. Designed as a
text for students, as well as a reliable source of evidence-based practice for advanced
practice nurses, this book contains information on healthy aging, comprehensive geriatric
assessment, and common symptoms and illnesses that present in older adults. NUR 612

3. Clinical Experience Rheumatoid Arthritis DiscussionGiven the complexity of prescribing for
older adults taking multiple medications, a new chapter on polypharmacy is included. The
book concludes with a chapter on care delivery for patients with chronic illnesses who face
end-oflife care. Throughout the book, case studies are included to provide further practice
and review. An important feature of this book is the use of the Strength of Recommendation
Taxonomy (SORT) [Ebell, M. H., Siwek, J., Weiss, B. D., Woolf, S. H., Susman, J., Ewigman, B., &
Bowman, M. (2004). Strength of recommendation taxonomy (SORT): A patient-centered
approach to grading evidence in medical literature American Family Physician, 69(3), 548–
556], which provides a direct reference to evidence-based practice recommendations for
clinicians to consider in the care of older adults. In Unit I, “The Healthy Older Adult,” the
first chapter, “Changes with Aging,” addresses the normal changes of aging, expected
laboratory values in older adults, presentation of illness, atypical disease presentation,
bimodal conditions, and the impact of chronic illness on functional capacity. In the second
chapter, “Health Promotion,” updated information pertaining to health promotion and
disease prevention strategies for older adults from Healthy People 2020 and the U.S.
Preventive Services Task Force (USPSTF) is provided, including an immunization schedule
and information on the Welcome to Medicare Visit. Also covered is an overview of physical
activity, sexual behavior, dental health, and substance use, as well as a section pertaining to
the older traveler. Recommendations for exercise and safe physical activity are provided in
this unit. Unit II, “Assessment,” opens with a detailed chapter on comprehensive geriatric
assessment. Information on physical, functional, and psychological health is delineated, and
information on quality of life measures is included. Next is the fifth chapter, “Symptoms and
Syndromes,” which provides the clinician with a concise description of more than 20
symptoms prevalent in older adults. A rapid reference detailing common contributing
factors and associated symptoms and clinical signs that should be worked up for each
presenting condition is included. Recommendations for diagnostic tests with accompanying
results are used to form a differential diagnosis. NUR 612 Clinical Experience Rheumatoid
Arthritis DiscussionUnit III, “Treating Disorders,” provides 11 chapters of concise, updated
information pertaining to disease management of illnesses common in older adults,
presented by body systems. Each chapter opens with an assessment section that provides
the reader with a focused review of systems and the physical examinations needed to obtain
pertinent information for diagnosis and treatment of the older adult. Signal symptoms
indicating atypical presentation of illness are highlighted at the beginning of each condition.
The discussion of each problem and disorder follows a consistent monograph format: ? ? ? ?
? ? ? ? ? ? ? ? ? ? ? ? ? Signal symptoms Description Etiology Occurrence Age Ethnicity Gender
Contributing factors Signs and symptoms Diagnostic tests Differential diagnosis Treatment
Follow-up Sequelae Prevention/prophylaxis Referral Education Unit IV, “Complex Illness,”
addresses complex management of patients requiring chronic illness management,
palliative care, and ive care at end of life, and includes a new chapter on polypharmacy.
The text concludes with two appendices—“Physiological Influences of the Aging Process”
and “Laboratory Values in the Older Adult”—both of which are ready references for the
busy practitioner. In addition to the content of the book, a Bonus Chapter, Nutritional in
the Older Adult, selected References, and other online resources to aid the user in practice

4. and review of the key concepts are available at DavisPlus. Case studies are provided to
critical thinking and are available for users to complete on their own or for educators to
incorporate into their course requirements. To enhance the delivery of competency-based
education, the case studies were mapped to the Adult-Gerontology Primary Care Nurse
Practitioner Competencies (2016). For the faculty, there are PowerPoint presentations and
a well-developed test bank located on DavisPlus. The vii viii Preface Active Classroom
Instructors’ Guide is an online faculty resource that maps the resources available with the
text and includes lecture notes and additional case studies.NUR 612 Clinical Experience
Rheumatoid Arthritis DiscussionThis book is written by and for advanced practice nurses
involved in the care of older adults across multiple settings of care. While intended as a
guide for the management of care for older adults, clinicians are encouraged to deliver
individualized, patient-centered care considering the latest clinical practice guidelines on
prevention and management of conditions common in older adults. REFERENCE National
Organization of Nurse Practitioner Faculties. (2016). AdultGerontology Acute Care and
Primary Care Nurse Practitioner competencies. Retrieved from
http://c.ymcdn.com/sites/www.nonpf.org/
resource/resmgr/competencies/NP_Adult_Geri_competencies_4.pdf. Contributors Sue A.
Anderson, PhD, RN, FNP-BC Lisa Byrd, PhD, FNP, GNP, FAANP Associate Professor, Family
Nurse Practitioner Program Coordinator Saint Mary’s College Notre Dame, Indiana
Epistaxis; Rhinitis; Asthma Practice Administrator Florida Health Care Plans Nurse
Practitioner, Assistant Professor University of South Alabama Lake Mary, Florida Bowel
Incontinence; Diarrhea; Fatigue; Urinary Incontinence; Wandering Louann Bailey, CRNP
Nurse Practitioner Inpatient Medical Services Akron, Ohio Chest Pain Tracy Ballard, MSN,
GNP-BC Nurse Practitioner Optum Greensboro, North Carolina Gastroenteritis Judith A.
Berg, PhD, RN, WHNP-BC, FAANP, FNAP, FAAN Clinical Professor The University of Arizona
College of Nursing San Diego, California Atrophic Vaginitis; Breast Cancer Sharon Biby, MSN,
APRN, ANVP-BC, AGPCNP-BC Nurse Practitioner, Advanced-Practice Stroke Nurse Cone
Health Greensboro, North Carolina Stroke Anna Wentz Boone, PhD, ANP-BC Adult Nurse
Practitioner Rockingham Gastroenterology, Cone Health Medical Group Reidsville, North
Carolina C. Difficile; Cholecystitis; Peptic Ulcer Disease; Gastritis Angela Brown, DNP, FNP-
BC, ANP-BC, CDE Clinical Assistant Professor, Family Nurse Practitioner University of
Arizona Tucson, Arizona Cellulitis; Hearing Loss Carol Calianno, RN, MSN, CWOCN, CRNP
Nurse Practitioner – Dermatology and Wound Ostomy Continence Specialist Philadelphia
VA Medical Center Philadelphia, Pennsylvania Skin Cancer Christina Coletta-Hansen, MSN,
ANP-BC, ACHPN Palliative Care Nurse Practitioner Einstein Medical Center Montgomery
Norristown, Pennsylvania Palliative and End of Life Care Kristin R. Curcio, DNP, AGPCNP-
BC, AOCNP Nurse Practitioner Cone Health Cancer Center at Wesley Long Greensboro,
North Carolina Lung Cancer; Bladder Cancer; NUR 612 Clinical Experience Rheumatoid
Arthritis DiscussionLiver Cancer; Brain Tumor; Pancreatic Cancer Nancy Dirubbo, DNP,
FNP-BC, FAANP, Certificate in Travel Health Director Travel Health of New Hamsphire, PLLC
Laconia, New Hampshire Travel and Leisure Brenda L. Douglass, DNP, APRN, FNP-BC, CDE,
CTTS DNP Program Director, Assistant Clinical Professor, Family Nurse Practitioner Drexel
University Philadelphia, Pennsylvania Chronic Obstructive Pulmonary Disease ix x

5. Contributors Janet DuBois, DNP, APRN, FNP-BC, FAANP, FNAP Debra A. Friedrich, DNP,
FNP-BC, CLS, BC-ADM, Associate Professor Loyola University New Orleans New Orleans,
Louisiana Pneumonia; Upper Respiratory Tract Infection FNLA, FAANP Diplomate,
Accreditation Council for Clinical Lipidology Assistant Professor University of South Florida
College of Nursing Tampa, Florida Hyperlipidemia Kristen Tomblin Duffy, CRNP Nurse
Practitioner Lehigh Valley Health Network Allentown, Pennsylvania Dysphagia; Hematuria
Renee E. Edkins, DNP, ANP-C, Fellow, American Society of Lasers in Medicine & Surgery
Director Laser Surgery Program, UNC Division of Plastic & Reconstructive Surgery, Medical
Laser Safety Officer University of North Carolina, Department of Surgery Chapel Hill, North
Carolina Burns Vaunette P. Fay, PhD, RNC, FNP, GNP Director, Continuing Education; Lead
Nurse Planner; Professor of Nursing The University of Texas Health Science Center at
Houston, Cizik School of Nursing Houston, Texas Dehydration; Pruritus Carrie Fernald, DNP,
AGPCNP-BC Nurse Practitioner PACE of Triad Greensboro, North Carolina Joint Pain;
Osteoarthritis Diana Filipek-Oberg, RN, BSN, MSN, AGACNP-BC Surgery APN Cooper
University Hospital Camden, New Jersey Clinical Adjunct Faculty Drexel University
Philadelphia, Pennsylvania Chapter 7 Case Study; Assessment of the Respiratory System;
Chapter 8 Case Study Nancy A. Fisher, RN, MSN, GNP-BC Nurse Practitioner, Rheumatology
Cleveland Department of Veterans Affairs Cleveland, Ohio Gout; Rheumatoid Arthritis
Cynthia Gerstenlauer, ANP-BC, GCNS-BC, CDE, CCD Nurse Practitioner Troy Internal
Medicine Troy, Michigan Osteoporosis Larry Ryan Gibson, MSN, AGNP-C Nurse Practitioner
Alliance Urology Specialists Greensboro, North Carolina Cystitis Eric Gill, DNP, AGNP-C
Nurse Practitioner Rockingham Gastroenterology Cone Health Medical Group Reidsville,
North Carolina Cirrohsis; Esophagitis; Gastroesophageal Reflux Disease; NUR 612 Clinical
Experience Rheumatoid Arthritis DiscussionIrritable Bowel Syndrome; Acute Pancreatitis;
Chronic Pancreatitis Mary Jane Griffith, RN, MSN, GNP-BC, ACHPN Nurse Practitioner LTC
Health Solutions Columbia, South Carolina Palliative and End of Life Care Mary Guhwe, DNP,
FNP-BC, SCRN Nurse Practitioner Duke University Hospital Durham, North Carolina
Dizziness Candace Currie Harrington, PhD, DNP, APRN, AGPCNP-BC, CDP Clinical Professor
East Carolina University Greenville, North Carolina Heart Failure Melodee Harris, PhD,
APRN, GNP-BC, AGPCNP-BC Assistant Professor University of Arkansas for Medical Sciences
College of Nursing Little Rock, Arkansas Delirium; Dementia Contributors Theresa C.
Hollander, CRNP Donna Behler McArthur, PhD, FNP-BC, FAANP, Nurse Practitioner
Jefferson Health Abington, Pennsylvania Ischemic Heart Disease FNAP Adjunct Clinical
Professor Vanderbilt University School of Nursing University of Arizona College of Nursing
& Department of Neurology, College of Medicine Tuscon, Arizona Headache; Seizure
Disorders Shelly Jesberger, MSN Nurse Practitioner Veterans Health Administration
Cleveland, Ohio Hemoptysis Carol G. Kelley, PhD, AGPCNP-BC Associate Professor Frances
Payne Bolton School of Nursing, Case Western Reserve University Cleveland, Ohio Falls
Nanette LaVoie-Vaughan, ANP-C, DNP Nurse Practitioner Geriatric Neuropsychiatry
Services Raleigh, North Carolina Agitation; Constipation; Failure to Thrive Sheree L. Loftus,
PhD, MSN, APRN-BC Nurse Scientist Mount Sinai Union Square New York, New York
Investigator CHEAR Center Bronx, New York Parkinson’s Disease; Restless Legs Syndrome
William J. Lorman, JD, PhD, MSN, PMHNP-BC, CARN-AP Vice President & Chief Clinical

6. Officer Livengrin Foundation Bensalem, Pennsylvania Alcohol Abuse; Prescription Drug
Abuse Denise Lucas, PhD, FNP-BC, CRNP, FAANP Chair, Advance Practice Programs
Duquesne University Pittsburgh, NUR 612 Clinical Experience Rheumatoid Arthritis
DiscussionPennsylvania Benign Prostatic Hyperplasia; Drug-Induced Impotence; Prostate
Cancer; Prostatitis Rhonda W. Lucas, MSN, AGNPC House Calls Provider Optum United
Healthcare Reidsville, North Carolina Herpes Zoster Sincere McMillan, ANP-BC Nurse
Practitioner Memorial Sloan Kettering Cancer Center New York, New York Colorectal
Cancer Laurie Lovejoy McNichol, MSN, RN, CNS, GNP, CWOCN, CWON-AP, FAAN Clinical
Nurse Specialist, WOC Nurse Cone Health Greensboro, North Carolina Pressure Injuries
Jennifer Mondillo, MSN, MBA, CRNP Clinical Instructor Villanova University Villanova,
Pennsylvania Assessment of the Cardiovascular System LaTroy Navaroli, DNP, FNP-BC, CWS
Nurse Practitioner Would Specialist Navaroli Medical Warren, Pennsylvania Oral
Nutritional Supplementation D. Che Navey, A-GNP, MSN, RN Neurohospitalist, Advanced
Practice Clinician Novant Health Presbyterian Medical Center Charlotte, North Carolina
Tremor Olivia Faith Ogburn, AGPCNP Nurse Practitioner Gastroenterology Oncology Clinic
Wake Forest Baptist Medical Center Winston Salem, North Carolina Gastric Cancer Loretta
Phillips, RN, NP-C, APRN, BC Nurse Practitioner Capital Nephrology Associates Raleigh,
North Carolina Acute Kidney Injury; Chronic Kidney Disease xi xii Contributors Sabrina
Pickens, PhD, RN, ANP-BC, GNP-BC Susan D. Ruppert, PhD, RN, FNP-C, ANP-BC, FNAP,
Assistant Professor – Tenure Track, Faculty University of Texas Health Science Center at
Houston Cizik School of Nursing Houston, Texas Elder Abuse FCCM, FAANP, FAAN
Professor, Associate Dean of Graduate Studies Cizik School of Nursing at The University of
Texas Health Science Center at Houston Houston, Texas Anemia of Chronic Disease; Anemia;
Iron Deficiency Allen V. Prettyman, PhD, FNP-BC, FAANP Associate Professor – College of
Nursing University of Arizona Tucson, Arizona Pulmonary Tuberculosis Valerie K. Sabol,
PhD, ACNP-BC, GNP-BC, ANEF, Nurse Practitioner/Clinical Associate Professor, School of
Nursing University of Virginia Health System Charlottesville, Virgina Peripheral Vascular
Disorders FAANP NUR 612 Clinical Experience Rheumatoid Arthritis Discussion