Fall 2019

NURS 6456-001 Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) Diagnosis and Management: Concepts and Theory II

All students are responsible for checking their UTHSCSA Livemail account regularly (i.e., daily or several times every week) to obtain Official University Communication regarding their courses, program and student status.

Students are expected to follow all policies related to COVID-19 found on the university webpage: https://wp.uthscsa.edu/coronavirus/.

NOTE: Our campus has enabled the CANVAS MOBILE LEARN application. CANVAS tools such as discussions, quizzes or videos May or May NOT function on all mobile devices. This is because mobile devices are available with rapidly changing and different configurations. Hence, students must not depend on only a mobile device to access course materials. Students must have access to a laptop or desktop device to access course materials and complete assignments.

This course is Web Enhanced with WebCT icon
Please be sure to check the Current Computer Requirements

Link to Graduate Clinical Experiences and Typhon guidelines: http://nursing.uthscsa.edu/gradclinical/

Welcome to 6456 AG-ACNP Diagnosis and Management: Concepts and Theory II!

This course is the last of 2 courses teaching concepts and theory in the diagnosis and management of acutely ill Adult and Gerontology patients Successful completion of this course is required to progress to the NURS 6655 and NURS 6656 clinical course

As your faculty,Tom Vorpahl and I are committed to your success in this course and the start of your career as an AG-ACNP

We are looking forward to a busy productive semester of learning utilizing lecture, case based learning, and online modules and readings to enhance your learning. 


April Ferrell, MSN, RN, ACNP-BC
Course Coordinator, AG-ACNP Track
Assistant Professor, Clinical
UT Health School of Nursing
Contact: Cell # 210-445-8389
Office: SON 2.368     Office Hours: By appointment (Thurs Afternoon)

Tom Vorpahl, MSN, RN, ACNP-BC

Faculty AG-ACNP Track
Interventional Radiology
Contact: cell #210-216-5352
Office Hours: By appointment only


This course fosters the progression of the Adult-Gerontology Acute Care Nurse Practitioner student’s role transition in the areas of health promotion, disease prevention, diagnosis and management in high acuity practice settings for the young adult, adult and older adult with complex acute, critical and chronic health conditions.  Using problem-based and self-directed learning strategies, disorders of the physiologic systems are presented and build on the information presented in AG-ACNP Diagnosis and Management Concepts and Theory I.  Emphasis is placed on using evidence-based practice to formulate individualized plans of care and developing collaborative partnerships with patients, their families and inter-professional teams.


Credit hour allocation: 4 semester credit hours
Clock hour allocation: 60 clock hours class



Upon completion of the Master of Science in Nursing Program (MSN) students will:

  1. Integrate scientific findings from nursing and related sciences, including genetics and genomics, into the delivery of advanced nursing care to populations in diverse settings.
  2. Demonstrate organizational and systems leadership to assure ethical and critical decision-making at all systems’ levels for quality and patient safety.
  3. Incorporate performance improvement strategies for quality, safety, and patient-centered care delivery.
  4. Use improvement science to achieve optimal patient care and care environment outcomes.
  5. Integrate meaningful and usable information systems and healthcare technologies to support safe, quality patient care and healthcare systems effectiveness.
  6. Advocate for policy changes that influence healthcare at appropriate levels.
  7. Lead interprofessional teams using collaborative strategies to effect quality patient care and population health outcomes.
  8. Analyze and incorporate broad ecological and social health determinants to design and deliver evidence-based clinical prevention and population healthcare and services to individuals, families, and aggregates/identified populations.
  9. Integrate the advanced competencies expected of a master’s prepared nurse to design, deliver, and evaluate outcomes of systems of care for individuals, families, and diverse populations.


  1. Apply theoretical concepts of health promotion and disease prevention services to the young adult, adult and older adult patients who are healthy of have acute and chronic conditions, based on age, developmental stage, family history and ethnicity.
  2. Demonstrate progressive self-directed learning of course concepts by applying knowledge of common acute and chronic illnesses in young adults, adults and older adults as health status changes, including complex, urgent and emergency situations.
  3. Integrate history and physical examination data while using Pathophysiology of common acute and chronic disease in young adults, adults and older adults to develop appropriate differential diagnoses and initiate appropriate customized interventions, to include the initiation of consultation and referrals to other healthcare providers.
  4. Integrate traditional and complementary pharmacological interventions into the treatment and management of common illnesses.
  5. Integrate social, cultural, and spiritual components in a holistic customized plan of care for patients and their families.
  6. Demonstrate core professional values and ethical/legal standards in the implementation of the Adult-Gerontology Acute Care Nurse Practitioner role.
  7. Continue to identify and integrate evidence-based findings in the diagnosis and management of common illnesses in the young adult, adult and older adult patient, including pain management, palliative care and the dying experience.
  8. With progressive competence, continue to demonstrate professional development in the role of the Adult-Gerontology Acute Care Nurse Practitioner in the diagnosis and management of health and wellness as well as common acute and chronic illnesses in the young, adult and older adult patient.
  9. Analyze patient safety, quality indicators, and outcome measures in the delivery of quality acute/critical care in a high acuity setting.


A = 4 points (90-100)
B = 3 points (80-89)
C = 2 points (75-79)
D = 1 point (66-74)
F = 0 points (65 or below)


Students are advised to upload their assignments in the assignment drop-box inside Canvas prior to the deadline on each due date. 

Do not wait until the last few minutes before starting to uploading assignments.  Assignments received late will result in a grade of zero unless, due to extreme circumstances, a written request to the faculty is received and approved prior to the due date and time that it is due.


Class Participation:

The student will come to class prepared through extensive reading and thoughtful contemplation of daily content/topics.  Whenever possible, case examples from practice and reading will be added to discussions.  Students will be responsible for their own learning and the enlightenment of others.  Graduate students, as professionals, are expected to arrive for class at least 10 minutes before class time and be settled in their seats prior to class.  Late arrivals and early departures interrupt faculty and guest speakers.  All cell phones are to be off during the class.  Class attendance is a requirement and unexcused absences can be grounds for dismissal from the program. If there are extreme circumstances, a written request to the faculty must be received and approved prior to the date of the on campus meeting date. 
Grading Scale:
A = 4 points (90-100)
B = 3 points (80-89)
C = 2 points (75-79)
D = 1 point (66-74)
F = 0 points (65 or below

Late assignments will be given a grade of '0' (zero) unless arrangements are made PRIOR TO THE ASSIGNMENT DUE DATE/ TIME with faculty. 

At Faculty discretion, alternate due dates/ times will be allowed. 

Late Assignments will be graded as follows:

        1 day late - 10 pts

        2 days late - 20 pts

        3 days late - 30 pts

        After 3 days- assignment grade of 0 will stand

Canvas Online Learning:


This course is web-enhanced.  Students are required to engage in the Canvas components as outlined in the assignments and this course packet.  Learning modules are to be completed on time in the appropriate week scheduled and prior to classroom topic presentation.  Extensive reading,as mentioned above, is required for success in this course.  Students are expected to read assigned readings in the week assigned and prior to classroom topic presentation.  Not all material will be covered in class,therefore online modules and reading assignments are critical to your learning.  Materials from modules, EKG worksheet, face to face classroom content, and assigned readings will be covered in the examinations


Attendance in class is an expectation of each student.


  1. If written assignments are made in a course they are required.
  2. Students are expected to submit written work on the scheduled date and time.
  3. The student must notify the course coordinator prior to the scheduled due date and time if they are unable to submit the written work as scheduled. Failure to make this notification in advance will result in a "zero" for that written work.
  4. If the excuse is accepted as reasonable and necessary, arrangements will be made for an alternative due date and time.
  5. Each student is responsible for making sure that he or she has completed the written work prior to submission.
  6. Late work will be accepted with consequences as outlined per course syllabi.


The APA Publication Manual 7th edition is required for use in all nursing school programs. 


Students are expected to be above reproach in all scholastic activities. Students who engage in scholastic dishonesty are subject to disciplinary penalties, including the possibility of failure in the course and dismissal from the university. "Scholastic dishonesty includes but is not limited to cheating, plagiarism, collusion, and submission for credit of any work or materials that are attributable in whole or in part to another person, taking an examination for another person, any act designed to give unfair advantage to a student or the attempt to commit such acts." Regents Rules and Regulations, Part One, Chapter VI, Section 3, Subsection 3.2, Subdivision 3.22.


Students who are nurses or are preparing to enter the profession of nursing are expected to treat others with respect and compassion. “The principle of respect for persons extends to all individuals with whom the nurse interacts. The nurse maintains compassionate and caring relationships with colleagues and others with a commitment to the fair treatment of individuals, to integrity-preserving compromise and to resolving conflict. This standard of conduct precludes any and all prejudicial actions, any form of harassment or threatening behavior, or disregard for the effects of one’s actions on others” (American Nurses Association Code for Nurses, Interpretive Statement 1.5).

The students, faculty, Department Chairs, Associate Deans, and the Dean of the School of Nursing of the University Texas Health Science Center San Antonio subscribe to the highest standards of conduct. Our aim is professional behavior beyond reproach. Failure to abide by the signed code of professional conduct may lead to suspension and/or permanent dismissal from the UTHSCSA SON. In particular, we subscribe to the provisions of the Code of Ethics for Nurses (http://bit.ly/1mtD5p2) and the following points of conduct.


School of Nursing Netiquette Guidelines for Online Interaction

Netiquette guidelines provide information for behaving properly online, when using email, tweets or texts so that you may successfully communicate your thoughts in a manner that is respectful and avoids misunderstandings with others.


Any student seeking reasonable accommodations through the Americans with Disabilities Act (ADA) should contact either the Associate Dean for Admissions and Student Services within the first week of the semester or schedule a meeting with the UTHSCSA ADA Compliance Office so that appropriate accommodations may be arranged. A request for accommodations (Form ADA-100: http://uthscsa.edu/eeo/form100-Faculty-student-resident.pdf) must be completed and submitted to the Executive Director of the ADA Compliance Office before accommodations can be provided. Additional information can be provided in the Student Success Center, Room 1.118 or through the ADA Compliance Office website: http://uthscsa.edu/eeo/request.asp.


Fauci, A., Kasper, D., Hauser. S.T., Longo, D., Jameson, J., Loscalzo, J. (2018). Harrison’s Principles of Internal Medicine (20th Ed). Medical Education: McGraw-Hill


Papadakis, M. A., McPhee, S. J., & Rabow, M. W. (2018). Current Medical Diagnosis and Treatment (58th Ed.). McGraw-Hill: New York. ISBN-13: 978-1259585111


Goolsby, M. & Grubbs, L. (2015) Advanced assessment: Interpreting Findings and Formulating Differential Diagnoses (3rd Ed.).. ISBN 13: 970803643635

Knechtel, M. (2017). 12 Lead EKG for the Nurse Practitioner and Physician’s Assistant (2nd Ed.). Springer: New York. ISBN-13: 978-0826168887

Marino, Paul L. (2014) The ICU Book (4th Ed). Wolters Kluwer/ LIppincott Williams and Wilkins: Philadeplphia. ISBN-13: 978-1451121186


Sabatine, J.  (2017)  Pocket Medicine, Massachusetts General Hospital Handbook of Internal Medicine. (6th Ed) .  Wolters Kluwer/Lippincott Williams and Wilkins: Philadelphia. 

ISBN-13: 978-1496349484

Williams, Chang, Landefeld, Ahalt, Conent, Chen (2nd Ed). Current Geriatric Diagnosis and Treatment. McGraw-Hill. ISBN-13: 978-0071792080


(Needed for NURS 6655 and 6656 Clinical courses but are helpful for case studies in NURS 6455 and 6456)

Desai, Samir. Clinician's Guide to Laboratory Medicine. (3rd. Ed.).. ISBN13:9780972556187

Goodman, L.R. (2015). Felson's Principles of Chest Roentgenology, A Programmed Text (4th Ed). ISBN-13: 978-1455774838


Sanford Guide to Antimicrobial Therapy 
Tarascon Internal Medicine & Critical Care Pocketbook 
Tarascon Hospital Medicine Pocketbook
Tarascon Adult Emergency Pocketbook


Content Outline

1.    Common Problems inAcute Care     

a.    Fever

b.    Wound management

c.    Palliative care(end-of-life care)

d.    Common problems inacute care unique to the older adult


2.    Dermatology      

a.    Psoriasis

b.    Malignant melanoma

c.    Basal and squamous cellcarcinoma

d.    Rashes

e.    Cellullitis

f.     Skin lesions

g.    Steven JohnsonSyndrome/Toxic Epidermal Necrosis

h.    Dermatologicaldisorders unique to the older adult


3.    Gastrointestinal 

a.    Gastritis/enteritis

b.    Gastroesophageal reflux

c.    Diarrhea (viral,parasitic infections)

d.    Inflammatory boweldisease

e.    Ulcerative colitis

f.     Crohn’s disease

g.    Peptic ulcer disease (includinghelicobacter pylori)

h.    Cholecystitis

i.      Pancreatitis

j.      Constipation

k.    Gastrointestinalbleeding

l.      Diverticulitis/diverticulosis

m.  Appendicitis

n.    Hemorrhoids

o.    Colon cancer

p.    Toxic megacolon

q.    Hepatic failure

r.     Hepatitis

s.    Peritonitis

t.     Mesenteric ischemia

u.    Bowel obstruction

v.    Esophageal varices

w.   Gastrointestinaldisorders unique to the older adult


4.    Hematology/Oncology 

a.    Anemia

b.    Overview of commoncancers

c.    Sickle cell disease

d.    Disseminatedintravascular coagulation

e.    Idiopathicthrombocytopenia purpura

f.     Heparin inducedthrombocytopenia

g.    Coagulopathies

h.    Hematology/Oncologydisorders unique to the older adult


5.    Immunology       

a.    Rheumatoid arthritis

b.    Osteoarthritis

c.    Polymyalgia rheumatic

d.    Osteoporosis

e.    Gout

f.     Temporal arteritis

g.    Human Immunodeficiency Virus/AcquiredImmune Deficiency Syndrome

h.    Sjogren’s disease

i.      Systemic LupusErythematosus

j.      Scleroderma

k.    Sarcoidosis/Amyloidosis

l.      Immunosuppression –solid organ transplant

m.  Immunological disordersunique to the older adult


6.    Musculoskeletal

a.    Traumatic injuries

b.    Degenerative jointdisease

c.    Rhabdomyolysis

d.    Herniated disk

e.    Low back pain

f.     Musculoskeletaldisorders unique to the older adult


7.    Neurology          

a.    Neurodegenerativediseases 

b.    Seizure disorders

c.    Brain and spinal cordtumors

d.    Arterio-VenousMalformations

e.    Trauma (spinal cordinjury, traumatic brain injury)

f.     Neurological systemicdiseases

g.    Spinal cord disorders

h.    Increased IntracranialPressure

i.      Headaches (migraine, cluster,tension)

j.      Dizziness

k.    Cerebral vascularaccidents

l.      Transient ischemicattacks

m.  Cerebral Aneurysm

n.    Myasthenia gravis

o.    Guillain-Barre'syndrome

p.    Meningitis

q.    Encephalopathy

r.     Balance disorders

s.    Peripheral neuropathy

t.     Altered mental status(delirium, dementia, psychosis, encephalopathy)

u.    Neurological disordersunique to the older adult


8.    Genitourinary    

a.    Pyelonephritis

b.    Bladderdysfunction/incontinence (stress, urge, overflow)

c.    Renal calculi

d.    Prostate cancer

e.    Urinary tract infection

f.     Chronic and end-stagerenal disease

g.    Acute kidney injury

h.    Benign prostatichypertrophy

i.      Renal artery stenosis

j.      Sexually Transmitted Diseases

k.    Incontinence

l.      Genitourinary disordersunique to the older adult

m. testicular diseases


9.   Infectious Diseases

            a. Sepsis

            b. Overview of bacterial vial and fungal infections

            c. Use of antibiotics

            d. Influenza

            e. Nosocomial infections

            f.  Cellulitis

CALENDAR - 1st Day Only

Please check the schedule for recent updates on Class Dates & Room.

Week 1
Off Campus (No Class)
Geriatric Learning Modules-Canvas

Week 2
On Campus Lecture Room TBA (See SON Schedules & Syllabi link)

Clinical placement (Cindy Urshan)

Course Overview (April Ferrell)

Palliative Care 

Wound care 

Diabetic foot ulcers (Dr. Wallace)

Quiz: Nutrition Quiz #1- from home, open book due (9/1/19)

On line Module/ Self-Study:
Nutritional management of the hospitalized, adult/geriatric, and critically ill patient

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