Summer 2020

NURS 6455-001 Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) Diagnosis and Management: Concepts and Theory I

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:

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:

Welcome Letter

Hello and welcome to the AG-ACNP Program at UT Health School of Nursing. I am April Ferrell, MSN,RN, ACNP-BC and I am the track coordinator for the course. There are two other esteemed faculty: Wen Pao, MSN, RN, ACNP-BC, and Tom Vorpahl, MSN, RN, ACNP-BC and we will be working together as a team to prepare you for a solid start to your career as an AG-ACNP. We are all full time practicing ACNP's and are committed to providing you with an excellent education. Additional faculty may be coming soon so stay tuned!
The course meets on some Mondays beginning 5/11/2020, other weeks you will have online modules to complete. Our first class meeting day will be 5/11/20 at 1700, and we will be meeting virtually until further notice. Once UT Health SON has allowed face to face classes to resume, you will be notified and the on campus classes will resume. Please look for details in Canvas and your emails prior to the first day of class regarding how to log in but please . We will have a brief introduction to the course on the first day, then start lectures on approaching the acutely ill patient.  The course calendar and course packet will be posted in Canvas and emailed prior to the first day of class. 
Please remember that on campus class or 'virtual' attendance is a requirement for this course. I do understand that there are extenuating circumstances that may arise but work and vacations should be scheduled around your on campus lecture days. This is part of your commitment to your education and this course. You must e-mail me, prior to the start of class, with the circumstances of your need to miss lecture and it will be faculty discretion whether this is an excused or unexcused absence. Unexcused absences can be grounds for dismissal from the program. We feel this is necessary to your comprehension and later application of the topics covered in class. We look forward to a wonderful start to the didactic courses on your journey to being a competent AG-ACNP!


April Ferrell, MSN, RN, ACNP-BC
Assistant Professor, Clinical
Track Coordinator, AG-ACNP
School of Nursing
Contact: Cell # 210-445-8389
Office Hours: Thursday afternoons, by appointment
Faculty AG-ACNP Track
Division of Pulmonary Medicine/ Critical Care
Department of Medicine, UT Health
Contact: Cell # 210-601-3423
Office Hours: By appointment only
Tom Vorpahl, MSN, RN, ACNP-BC
Faculty AG-ACNP Track
Department of Interventional Radiology, UT Health
Contact: cell #210-216-5352
Office Hours: By appointment only



This course introduces the students to the principles of diagnostic and treatment strategies utilized in acute/critical care settings by the Adult-Gerontology Acute Care Nurse Practitioner.  The Use of evidence based practice is encouraged to develop a strong scientific foundation for independent and collaborative practice as the registered nurse transitions to the role of the Adult-Gerontology Acute Care Nurse Practitioner.  The focus is in health promotion, disease prevention, diagnosis and management of common illnesses seen in the acute care setting affecting the young adult, adult and older adult populations.  In addition, this course emphasizes collaborative partnership development between 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. Survey the role of the Adult-Gerontology Acute Care Nurse Practitioner in the current healthcare system.
  2. Apply theoretical concepts of health promotion and disease prevention services to young adult and older adult patients with acute and chronic conditions, based on age, developmental stage, family history and ethnicity.
  3. Summarize anticipatory guidance recommendations in comprehensive treatment plans with respect to both primary and secondary prevention for the young adult, adult and older adult populations.
  4. Apply knowledge of common acute and chronic illnesses for the diagnosis and management of patients and their families as health status changes in the young adult, adult and older adult patient.
  5. Integrate history, presenting symptoms, physical examination data, and diagnostic information with the knowledge of Pathophysiology for common acute and chronic diseases 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.
  6. Integrate traditional and complementary pharmacological interventions into the treatments and management of common illnesses for the young adult, adult and older adult populations.
  7. Integrate social, cultural, and spiritual components in a holistic customized plan of care for the young adult, adult and older adult patients and their families.
  8. Demonstrate core professional values and ethical/legal standards in the implementation of the Adult-Gerontology Acute Care Nurse Practitioner role.
  9. Identify and integrate evidence-based findings to the diagnosis and management of common illnesses in the young adult, adult and older adult patient, including pain management, and the dying experience (palliative care).
  10. Examine, evaluate, and demonstrate professional development in the role of the Adult-Gerontology Acute Care Nurse Practitioner in the promotion of health and wellness as well as management of common acute and chronic illnesses in the young adult, adult and older adult patient.
  11. 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)


Course Grading Criteria – Due Dates & Times:

Weighting Percent of Final Grade
Due Date & Time
Quizzes/ Modules (to include in lecture participation in active learning activities)5%See course Calendar
Case Study #1
See course calendar
Case Study #2
See course calendar
Case Study #3 20%
See course calendar (cumulative grade)
Test #1
See course calendar
Test #2
See course calendar

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 and active learning via in class or online activities will be utilized to enhance learning. Multimodal learning techniques may be utilized requiring collaboration with other students in class. Please bring your laptop or tablet to class when on campus. Students will be responsible for their own learning and collaborative learning may be utilized both in class and online. Graduate students, as professionals, are expected to arrive for class on time.  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 in order for the absence to be deemed 'excused'.
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

Canvas Online Learning:


This course is web-enhanced.  Students are required to engage in the Canvas components as outlined in the assignments and the 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 and be prepared to active learning in on campus and online class time.  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 on 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 ( 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: 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:


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: Philadelphia. 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.  Acute and Chronic Pain Management 
     a.  Theories of pain management
     b.  Pain management issues specific to the older adult
     c.  Responsible Opioid prescribing
2.  Cardiovascular 
     a.  EKG interpretation
     b.  Angina
     c.  Coronary artery disease
     d.  Acute coronary syndrome
     e.  Hypertension
     f.  Congestive heart failure
     g.  Dysrhythmias
     h.  Valvular diseases
     i.  Dyslipidemia
     j.  Peripheral vascular disease
     k.  Venous thromboembolism
     l.  Infective cardiac processes
     m.  Care of the cardiovascular surgical patient
     n.  Cardiomyopathy
     o.  Aortic aneurysms
     p.  Anticoagulation therapy
     q.  Shock
     r.  Hemodynamic monitoring
     s. Cardiovascular disorders and assessments unique to the older adult
3.  Endocrine 
     a.  Diabetes
     b.  Thyroid Disorders
     c.  Pituitary abnormalities
     d.  Addison’s and Cushing’s diseases
     e.  Syndrome of inappropriate antidiuretic hormone
     f.  Diabetes insipidous
     g.  Pheochromocytoma
     h.  Endocrine disorders and assessments unique to the older adult
4.  Fluid and Electrolytes 
     a.  Osmolality
     b.  Intravenous Fluids
     c.  Acid/base disorders
     d.  Fluid and Electrolyte disorders and assessments unique to the older adult
5.  Drug toxicities
6.  Poisoning
7.  Head, Ears, Eyes, Nose & Throat
     a.  Epiglottitis
     b.  Hearing loss
     c.  Epistaxis
     d.  Laryngitis
     e.  Pharyngitis
     f.  Otitis media/externa
     g.  Sinusitis
     h.  Conjunctivitis
     i.  Corneal abrasion
     j.  Glaucoma
     k.  Ocular emergencies
     l.  Macular degeneration
     m.  Vision loss
     n.  Head, Ears, Eyes, Nose and Throat disorders and assessments unique to the older adult
8.  Health Promotion/Disease prevention
     a.  Screening
     b.  Maximization of functional status
     c.  Risk factor assessment and modifications
     d.  Immunizations
     e.  Epidemiological assessment of populations.
     f.  Health Promotion/Disease prevention unique to the older adult
9.  Pulmonary 
     a.  Asthma
     b.  Bronchiectasis
     c.  Chronic obstructive pulmonary disease
     d.  Pneumonia
     e.  Tuberculosis
     f.  Acute respiratory distress syndrome
     g.  Pulmonary embolism
     h.  Pulmonary function testing
     i.  Mechanical ventilation
     j.  Pleural effusions
     k.  Pulmonary hypertension
     l.  Arterial blood gas interpretation
     m.  Pulmonary disorders and assessments unique to the older adult
10.  Care of the surgical patient
11. Delirium and Dementia
Assigned Readings:
Assigned readings and objectives will be posted within each Canvas module topic. There will not be pages assigned for readings but topics and appropriate texts for the readings. Students are responsible for completing the assigned readings and modules prior to class and be prepared to complete in class modules and activities on the topics based on the assigned readings.

CALENDAR - 1st Day Only

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

May 11, 2020- 1700, online, details via Canvas

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