WK 6 NURSING PHYSICAL ASSESSMENT QUESTION?

1-  What are some ways to create a physically and psychologically comfortable environment for both patient and practitioner during breast exams?

2-  A 22-year-old female complains of 3 days of watery diarrhea with 7 to 8 stools per day. She is drinking approximately “3 sodas a day” because she is “trying not to get dehydrated.” She has had very little other intake because “eating makes me have to go to the bathroom.” She denies other symptoms or allergies.From the information provided, list your differential diagnoses in the order of “most likely” to “possible but unlikely.”

 

3-A 19-year-old male complains of “burning sometimes, when I pee.” He is sexually active and denies using any contraceptive method. He denies other symptoms, significant history, or allergies.From the information provided, list your differential diagnoses in the order of “most likely” to “possible but unlikely.”

4- A 23-year-old female complains of severe left lower abdominal/pelvic pain for 6 hours. She states her last menstrual period was “about 3 or 4 weeks ago.”She is sexually active and denies using any contraceptive method. She denies other symptoms, significant history, or allergies.In order of importance, describe three (3) questions that you would like to ask this patient and give a brief explanation of why? Which lab or imaging tests would you order for this patient and give a brief explanation of why?

 

5- A 28-year-old female presents with a “severe headache” for the past 9 hours. She states the pain is over the left temporal area and is “throbbing” in nature. These symptoms have occurred before but not as bad.What are some clinical assessment tools or techniques that you could use to help diagnose this patient’s condition?In order of importance, describe three (3) questions that you would like to ask this patient and give a brief explanation of why?

6- A 58-year-old obese man complains of pain in his left knee. The pain seems to be unrelenting. He says his knee is better when he rests, but it gets stiff when he rests too long. He denies other symptoms, significant history, or allergies.From the information provided, list your differential diagnoses in the order of “most likely” to “possible but unlikely.”

Coughs are the body’s way of clearing airways via forceful expiration.

Respond on two different days who selected a different scenario than you, in one or more of the following ways:

Share insights on how the factor you selected impacts the disorder your colleague identified.

Ask a probing question regarding the disorder that your colleague identified.

Suggest an alternative disorder for the scenario your colleague selected.

Main Post

Scenario 3:

 

Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-producing cough. She denies any rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Maria has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.

Acute Cough

Coughs are the body’s way of clearing airways via forceful expiration.  Inflammation, inhaled particles, accumulated mucus, or foreign bodies stimulate a cough reflex by irritant receptor stimulation in the airway.  An acute cough is classified as lasting 2-3 weeks, and chronic cough is greater than three weeks in a non-smoker. Frequent cough causes are allergic rhinitis, upper respiratory infections, pneumonia, aspiration, pulmonary embolus, and congestive heart failure.  Due to the above-listed scenario, this cough would be diagnosed as acute cough due to timeframe, cough characteristics, and patient history (Huether & McCance, 2019).

Green Sputum

Sputum contains immune cells and white blood cells from the lower respiratory tract that protect the airway from infections.  Sputum can be clear or colored.  Color sputum may be yellow, white, green, red or blood-tinged, or pink.  Neutrophils are white blood cells that can take on a green color.  This color sputum can be indicative of bacterial infections of the lower respiratory tract.  Pneumonia and cystic fibrosis can produce this color sputum.  To indeed rule out something benign, a sputum culture would need to be obtained and tested (Verywell Health, 2019).  At three weeks in, it would likely be premature to order cultures with limited symptoms.

Treatment

Due to the timeframe of cough and only accompanying symptom being green sputum, as a practitioner, I would prescribe an expectorant and schedule a follow up if symptoms persist or worsen.  Teaching should include that adverse effects of expectorants might be GI upset, headache, drowsiness, and dizziness.  Advise patient that expectorants are designed to be short-term (Arcangelo, Peterson, Wilbur, & Reinhold, 2017). Additional home treat to loosen secretions would be a humidifier, staying adequately hydrated and warm salt water gargles if sore throat should appear (Barkley, 2018).

Patient Factors- Behavior and Age

Maria is an otherwise, healthy 36-year-old female.  Due to her age and symptom status, Maria would be treated conservatively.  Maria is a non-smoker and takes no prescribed medications.  Further investigation would be required if she was a smoker, currently on prescriptions medications, had current disease processes that may factor into the treatment plan.

References

Arcangelo,  V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (Eds.).  (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams  & Wilkins.

Barkley, T.  (2018).  Adult-gerontology primary care nurse practitioner.  West Hollywood, CA:  Barkley & Associates.

Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Verywell Health.  (2019). What causes the amount of sputum to increase?  Retrieved from https://www.verywellhealth.com/what-is-sputum-2249192

located in the Student Success Center.

Search the GCU Library and find two new health care articles that use quantitative research. Do not use articles from a previous assignment, or articles that appear in the Topic Materials or textbook.

Complete an article analysis for each using the “Article Analysis: Part 2” template.

Refer to the “Patient Preference and Satisfaction in Hospital-at-Home and Usual Hospital Care for COPD Exacerbations: Results of a Randomised Controlled Trial,” in conjunction with the “Article Analysis Example 2,” for an example of an article analysis.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Recognize the influence that developmental stages have on physical

Purpose

This week’s graded topics relate to the following Course Outcome (CO).

  • CO 2 – Recognize the influence that developmental stages have on physical, psychosocial, cultural, and spiritual functioning. (PO #1)

The Assignment

This week you have two options for your initial discussion post. Select the option that is best for you! Please remember to use and credit the lesson or required NIH website (there was not a textbook reading this week), AND one outside scholarly source.

Option #1 – Case Study to Consider

Ann and Michael have been married for 55 years. Ann is 80 years-old, and suffers from lung cancer and advanced Alzheimer’s disease. She currently resides in a nursing home, and often does not recognize Michael when he visits. Last night she was admitted to the hospital with difficulty breathing. Today, you are the nurse caring for Ann, and her physician is suggesting surgery to remove part of her lung to potentially slow the progression of her cancer. Michael is feeling unsure about this course of treatment, and asks for your advice and guidance.

How would you respond to Michael and serve as advocate for your patient?

Option #2 – Share a Related Experience

Share with your classmates a time when you cared for a patient at the end of their life. This may be a time when you assisted the patient (or their support system) with decisions related to end of life care; or a time when you were present for the death of a patient.

What were your observations related to this experience? Do you believe it was a peaceful death? What went well? Can you think of anything that could have made the experience better for the patient and/or family?

Week 5: Assignment 1: “Captain Of The Ship” Project – Bipolar Disorders

In 4 pages, write a treatment plan for your client. In which you do the following:

Introduction and Theses statement

Describe the HPI and clinical impression for the client.

Recommend psychopharmacologic treatments and describe specific and therapeutic end points for your psychopharmacologic agent. (This should relate to HPI and clinical impression.).

Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.

Identify medical management needs, including primary care needs, specific to this client.

Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.

Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

Summary

Individual Success Plan

Planning is the key to successful completion of this course and your overall program of study. The Individual Success Plan (ISP) assignment requires early collaboration with the course faculty and your course mentor. You will need to establish a plan for successful completion of (1) deliverables associated with weekly course objectives, (2), required practice immersion hours, and (3) deliverables associated with your capstone project.

Access the “Individual Success Plan” resource in the Topic Materials. Read the information in the resource, including student expectations and instructions for completing the ISP document.

Use the “Individual Success Plan” to develop a personal plan for completing your practice hours and how topic objectives will be met. Include the number of hours you plan to set aside to meet your goals.

A combination of 100 supervised clinical hours in community health and leadership areas will be obtained through the application of the objectives listed in the Guidelines for Undergraduate Field Experiences manual.

Practicum immersion experiences are required in a community health setting. Community-based settings should encourage community integration and involvement; expand accessibility of services and supports; promote personal preference, strengths, dignity; and empower people to participate in the economic mainstream.

According to HealthyPeople.gov, educational and community-based programs and strategies are designed to reach people outside of traditional health care settings. These settings may include schools, worksites, health care facilities, and communities. Community health and leadership practice immersion can occur in the same site and in conjunction with the evidence-based project in the NRS-490 course.

If you are a registered nurse in Washington, your practicum experience must include a minimum of 50 hours in a community health setting.

Students should apply concepts from prior courses to critically examine and improve their current practice. Students should also integrate scholarly readings to develop case reports that demonstrate increasingly complex and proficient practice.

Consider the challenges you expect to encounter as you continue the practice hour and competency requirements throughout this course. How might you overcome these challenges?

You can renegotiate these deliverables with your faculty and mentor throughout this course and update your ISP accordingly.

Once your ISP has been developed and accepted by your course faculty, you will have your course mentor sign it at the beginning of, and upon completion of, each assignment that incorporates practice immersion hours. You will track all course practice immersion hours in the ISP.

APA format is not required, but solid academic writing is expected.

You are not required to submit this assignment to LopesWrite.

AttachmentsNRS-490-RS-IndividualSuccessPlan.docx

Discussion: Brittany Maynard Case

After reading the Brittany Maynard case, create an original post that compares your professional and personal positions on the case. What are the code of ethics, professional regulations, and policies that support your professional position? Explain how to work through ideas when your professional and personal positions come into conflict.

In your responses to at least two peers, suggest codes of ethics, professional regulations, or policies that contradict the position proposed in their post.

Brittany Manyard Case Link

https://time.com/3678199/brittany-maynard-death-with-dignity-legislation-california/

This video contains a news story about 29-year-old Brittany Maynard and physician-assisted suicide.

https://www.youtube.com/watch?v=KcuRh-zQB6o

Apply improvement methods, based on data from the outcomes of care processes

Purpose

This week’s graded discussion topic relates to the following Course Outcome (CO).

  • CO 5: Apply improvement methods, based on data from the outcomes of care processes, to design and test changes to continuously improve the quality and safety of healthcare. (PO 8)

The Assignment

In Huston’s (2010) brief, but impressive article (required reading this week), the author outlines several leadership competencies that EVERY nurse leader will need for 2020. That year is not too far in the future, is it?

  1. Select one of the eight leadership competencies Huston described and relate it to your own leadership of nurses and nursing. This should promote a robust discussion as we come from different clinical and nonclinical perspectives.
  2. Discuss how the BSN-prepared nurse can assist a nurse leader in the budgeting process by contributing data readily available to the staff nurse.

Huston, C. (2010). What skills will the nurse leaders of 2020 need? (2010). Kai Tiaki Nursing New Zealand, 16(6), 14–15. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105060080&site=ehost-live&scope=site (Links to an external site.)Links to an external site.

Discuss the use of Evidence-based Guidelines in Practice by Patient Provider, Healthcare Agency

Discuss the use of Evidence-based Guidelines in Practice by Patient Provider, Healthcare Agency

 

. 250-word minimum

·  At least 1 outside scholarly reference is required besides the course textbook .

·  Must answer the discussion question

. Turnit it similarity maximum 20%

Soap Note 2 Chronic Conditions

Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

Example:

PATIENT INFORMATION

Name: Mr. W.S.

Age: 65-year-old

Sex: Male

Source: Patient

Allergies: None

Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime

PMH: Hypercholesterolemia

Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago.

Surgical History: Appendectomy 47 years ago.

Family History: Father- died 81 does not report information

Mother-alive, 88 years old, Diabetes Mellitus, HTN

Daughter-alive, 34 years old, healthy

Social Hx: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone.

SUBJECTIVE:

Chief complain: “headaches” that started two weeks ago

Symptom analysis/HPI:

The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness.He states that he has been under stress in his workplace for the last month.

Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.

ROS:

CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizzeness as describe above. Denies changes in LOC. Denies history of tremors or seizures.

HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing.

Respiratory:Patient denies shortness of breath, cough or hemoptysis.

Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal

dyspnea.

Gastrointestinal:Denies abdominal pain or discomfort.Denies flatulence, nausea, vomiting or

diarrhea.

Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.

MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.

Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.

Objective Data

CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 0/10.

General appearance: The patient is alert and oriented x 3. No acute distress noted.NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.

HEENT:Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,.Lids non-remarkable and appropriate for race.

Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses.

Cardiovascular:S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec.

Respiratory:No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation.

Gastrointestinal:No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no reboundno distention or organomegaly noted on palpation

Musculoskeletal:No pain to palpation. Active and passive ROM within normal limits, no stiffness.

Integumentary:intact, no lesions or rashes, no cyanosis or jaundice.

Assessment

Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed.

Differential diagnosis:

Ø Renal artery stenosis(ICD10 I70.1)

Ø Chronic kidney disease(ICD10 I12.9)

Ø Hyperthyroidism (ICD10 E05.90)

Plan

Diagnosis is based on the clinical evaluation through history, physical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease.

These basic laboratory tests are:

· CMP

· Complete blood count

· Lipid profile

· Thyroid-stimulating hormone

· Urinalysis

· Electrocardiogram

Ø Pharmacological treatment:

The treatment of choice in this case would be:

Thiazide-like diuretic and/or a CCB

· Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily.

 

Ø Non-Pharmacologic treatment:

· Weight loss

· Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat

· Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults

· Enhanced intake of dietary potassium

· Regular physical activity (Aerobic): 90–150 min/wk

· Tobacco cessation

· Measures to release stress and effective coping mechanisms.

Education

· Provide with nutrition/dietary information.

· Daily blood pressure monitoring at home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP

· Instruction about medication intake compliance.

· Education of possible complications such as stroke, heart attack, and other problems.

· Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all

Follow-ups/Referrals

· Evaluation with PCP in 1 weeks for managing blood pressure and to evaluate current hypotensive therapy. Urgent Care visit prn.

· No referrals needed at this time.

References

Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017 (25th ed.). Print (The 5-Minute Consult Series).

Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.). ISBN 978-0-8261-3424-0