COMPLEX CASE STUDY PRESENTATION

March 2, 2023/in Uncategorized /by Paul

Select a child/adolescent patient from your clinical experience that presents with a significant concern. Create a focused SOAP note for this patient using the template in the Resources. All SOAP notes must be . When you submit your SOAP note, you should include the complete SOAP note as a Word document and PDF/images of each page

Subjective

CC (chief complaint): I have been having difficulty sleeping and anxiety.

HPI: Patient is a 18-year-old African American woman with history of hypertension presents with experiencing anxiety symptoms and difficulty sleeping. Patient states symptoms of anxiety has gotten worse over the years, her jitteriness, chest pain, feeling of impending doom and anxiety get worse when she drinks caffeine or waiting for lab result, its gets bad she has to run for cover sometimes. She says her lack of sleep makes her irritable and hard for her to concentrate or function the next day. Patient states was prescribed Lexapro, Benadryl and Ambien in the past by PCP, not on any medication currently, she has two children, no legal issues, pastor wife, denies hallucination, denies suicidal ideation.

chest pain, diarrhea, increase heart rate, excessive worrying, difficulty sleeping, shaking trembling

Severity is estimated to be medium based on patient risk of morbidity without treatment and her description of interference with functioning

Past Psychiatric History:

● General Statement: The patient states that she has been experiencing anxiety and difficulty sleeping and panic for years. She states the following as her prevalent symptoms. Chest discomfort or chest pain when under stress, diarrhea, sleep disturbance that is, difficulty falling or staying asleep, increase in heart rate, excessive worrying, and shaking or trembling. The patient states that these symptoms occur daily.

● Caregivers (if applicable): family

● Hospitalizations: None

● Medication trials: Lexapro, Benadryl, Ambien.

● Psychotherapy or Previous Psychiatric Diagnosis: Has history with anxiety symptoms.

Substance Current Use and History: None

Family Psychiatric/Substance Use History: The patient’s mother had anxiety.

Psychosocial History: Patient was born in Nigerian and migrated to the America years ago, patient has history of hypertension anxiety symptoms, mother diagnosed with anxiety. She is married with four children including twins. Patient is a nurse practitioner by profession, she has no legal or criminal issues, she is a Christian and a pastor’s wife, denies substance use, smoking or drinking, denies physical, sexual, or emotional abuse, denies suicidal ideas or intention, denies homicidal intention or ideas.

. Create a focused SOAP note for this patient using the template in the Resources.

Then, based on your SOAP note of this patient, develop a video case study presentation. Set aside time to practice what you will say beforehand and ensure that you have the appropriate lighting and equipment to record the presentation.

Your presentation should include
objectives for your audience,
at least three possible discussion questions/prompts for your classmates to respond to, and at least five scholarly resources to support your diagnostic reasoning and treatment plan.

Record yourself presenting the complex case study for your clinical patient. In your presentation:

State 3–4 objectives for the presentation that are targeted, clear, use appropriate verbs from Bloom’s taxonomy, and address what the audience will know or be able to do after viewing.

Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management.

Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.

Pose three questions or discussion prompts, based on your presentation, that your colleagues can respond to after viewing your video.

Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

Objective: What observations did you make during the psychiatric assessment?

Assessment: Discuss their mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis, and why? Describe how your primary diagnosis aligns with DSM-5-TR diagnostic criteria and is supported by the patient’s symptoms.

Plan: What was your plan for psychotherapy (include one health promotion activity and patient education)? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Discuss an identified social determinate of health impacting this patient’s mental health status and provide your recommendation for a referral to assist this patient in meeting this identified need (students will need to conduct research on this topic both in the literature and for community resources).

Reflection notes: What would you do differently with this patient if you could conduct the session again? If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow-up, discuss what your next intervention would be. Please include objective for this paper.

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An older client was recently discharged from the hospital for evaluation of seizure activity.

March 2, 2023/in Uncategorized /by Paul

An older client was recently discharged from the hospital for evaluation of seizure activity. His history reveals that he has late-stage Alzheimer’s disease, Parkinson’s disease, hypertension, and type II diabetes mellitus, which is controlled by diet. He lives at home, where his wife and daughter take care of him. His discharge medications include phenytoin (Dilantin), 100 mg BID; hydrochlorothiazide (HydroDIURIL), 50 mg QD; levodopa (Sinemet), 25/100 TID; and haloperidol (Haldol), 1 mg before bed. The client has been referred for home care nursing follow-up.

Questions:

On the initial home visit by the nurse, what assessments should be made?
The wife and daughter need teaching about his antiepileptic medication. What teaching should be included?
During the initial home visit, the client experiences a generalized seizure. What action should the nurse take?

The nurse should assess his nutrition status, urinary habits, and hygiene status on the initial home visit. The nurse should also assess his skin integrity since he is bedridden and immobile. Also, he needs to be assessed to determine his stage of Parkinson’s disease. In addition, his range of motion, ability to perform ADLs, and strength should be assessed. A significant safety concern for this patient is a fall risk, so fall precautions must be implemented, and his home should be checked for safety hazards. She should also assess the family to determine if anyone helps him with his ADLs and medication regimen. He is at risk for polypharmacy, so the nurse must ensure that he takes the proper doses. The nurse should also ask the patient if he takes any over-the-counter medications, vitamins, or herbal substances.

Assignment Scenario
After graduating from nursing school and passing your boards, you accepted a position as an RN in the emergency center at Rasmussen General Hospital (RGH). In the weeks ahead, your emergency center plans to implement a new initiative where clients diagnosed with low-risk deep vein thrombosis (DVT) will be sent home on 3 months of oral anticoagulation therapy with rivaroxaban.
Historically, clients diagnosed with DVTs in the emergency center were admitted to the hospital’s observation unit. However, when surveyed about their experiences, many clients reported that this was costly, time-consuming, and inconvenient. Under RGH’s new program, emergency center nurses will be responsible for educating clients about their new medication and administering the first dose to the client before discharge.
As part of this new initiative, all emergency center nurses at RGH must be trained to properly educate these clients on all aspects of their new medication regimen. Because you have demonstrated a keen interest in pharmacology, your manager has asked you to develop the educational tools that will be used to train the nurses at RGH.
It’s worth noting that the standard dosing for all low-risk DVTs is as follows:
15 mg BID, 12 hours apart, for 21 days
After 21 days, use 20 mg once per day
After 90 days, the client will follow up in the thrombosis clinic to evaluate if they meet criteria for discontinuing the medication
Assignment Instructions
Your manager explained that all of the emergency center nurses at RGH will be educated in small groups through a short, in-service training session. You have been asked to develop a professional-looking PowerPoint presentation that the trainers will use to guide the in-service sessions. Your PowerPoint will need to:
1. Be professional-looking, have a title slide, and 10-15 content slides.
2. Use the Speaker Notes feature in PowerPoint to reduce the amount of text that appears on the content slides.
-The Speaker Notes for each slide will contain the text that will guide what the trainer will say while presenting the slides during the in-service.
-The content slides themselves should be clear and easy to understand; they serve as an outline so the audience can follow along with what is being presented.
3. Be written using proper spelling/grammar and at a level that would be appropriate for the audience.
-Remember the purpose of the training is to help nurses learn to educate their clients about the use of a medication. With that in mind, it may be helpful to provide examples of how to explain the information to a client in an easy to understand way without complicated, technical terms.
4. Include APA formatted in-text citations for at least 3 scholarly references and present the sources in APA format on a References slide.
5. Contain content addressing the items below.
Pharmacotherapuetics:
State the drug name and its therapeutic category.
Pharmacodynamics – how does this drug work to achieve its intended response?
Pharmacokinetics – how is this drug absorbed, distributed, metabolized, and excreted?
Discuss dosage, scheduling, route, and length of therapy.
Describe what clients can expect regarding their therapeutic response and when it should develop.
Introduce nondrug measures that clients can do to enhance their therapeutic response (e.g., specific diet to follow, exercise requirements, substances to avoid, special precautions to take, etc.).
Side Effects, Adverse Effects, and Interactions
Explain the symptoms of common side effects, and what clients can do to minimize any discomfort.
Explain the symptoms of any major adverse effects, and what clients should do if they experience them.
List the major adverse drug-drug interactions and drug-food interactions that clients need to be made aware of.
Follow-up Care
Provide information regarding when clients should call their doctor for advice (e.g., questions, non-urgent symptoms, unpleasant side effects, etc.).
Emphasize any symptoms for which clients should seek immediate care (e.g., when to go to the emergency center or call 911).

A mother brings her 6-month-old daughter to the HCP for evaluation of possible colic. The mother says the baby has had many episodes of crying after eating and, despite having a good appetite, is not gaining weight. The mother says the baby’s belly “gets all swollen sometimes.” The mother says the baby tastes “salty” when the mother kisses the baby. Further work up reveals a diagnosis of cystic fibrosis. The mother relates that her 23-month-old son has had multiple episodes of “chest congestion” and was hospitalized once for pneumonia. The mother wants to know what cystic fibrosis is and she also wants to know if she should have any more children.
Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation:
The role genetics plays in the disease.
Why the patient is presenting with the specific symptoms described.
The physiologic response to the stimulus presented in the scenario and why you think this response occurred.
The cells that are involved in this process.
How another characteristic (e.g., gender, genetics) would change your response.

COMMUNITY HEALTH NURSING

March 2, 2023/in Uncategorized /by Paul

COMMUNITY HEALTH NURSING

Discussion Social Factors

There are many factors that make people healthy or ill. This week we will focus on the social factors and determinants that impact health.

It is time to get out into your community!

· Go online to the U.S. Census Bureau at https://www.census.gov/quickfacts/ Links to an external site. (*note, you will be using this website in the Week 2 assignment, so you can get started on collecting all the required data if desired)

· Input your local zip code, city, or county. Try to get as specific data as possible (city, township, county).

· Next, identify the:

· Total population

· Median income

· Percentage or number of persons living in poverty

· Go to your local grocery store, use a flyer, or app. Include the stores name, city, and state. Identify cost for the following items (please note whether items are organic):

· 1 gallon of milk

· 1 loaf of bread

· 1 bag of apples (include price per pound)

· 1 bag of carrots

· 1 large container of yogurt

· 1 2-liter of soda

· 1 bag of chips

· 1 package of cookies

· Utilizing the data collected, discuss social factors that might impact what groceries are purchased. Try to be as specific to your community as possible (location, availability, poverty levels, etc.).

· Discuss how a community health nurse (CHN) could use one of the 17 intervention categories from the Public Health Intervention Wheel to address areas of food security (Nies & McEwen, 2019).

· In your responses to classmates, include comparisons and contrasting information.

Your discussion post should look like:

· Paragraph one: Utilizing the data collected, discuss a social factor that might impact what groceries are purchased. Try to be as specific to your community as possible (location, availability, poverty levels, etc.)

· Paragraph two: Utilizing the data collected, discuss another social factor that might impact what groceries are purchased. Try to be as specific to your community as possible (location, availability, poverty levels, etc.)

· Paragraph three: Discuss how a community health nurse (CHN) could use one of the 17 intervention categories from the Public Health Intervention Wheel to address areas of food security

· Resources: Where did you find your data?

Please describe your involvement, service, leadership, or mentorship in the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual community

March 1, 2023/in Uncategorized /by Paul

1. Please describe your involvement, service, leadership, or mentorship in the Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual community.

2. Please describe your experience with issues related to sexual orientation, romantic attraction, sexuality, and/or gender expression.

3. Please describe your demonstrated commitment in the fields of math and/or science and how this interest fits into your career goals. As someone interested in Medecine

* 300 words each

Initial post 300 words with 2 references in apa

1

According to the New York Times article “Gay and Transgender Patients to Doctors. We’ll Tell. Just Ask.” By Jan Hoffman, May 29, 2017 (see attached), clinicians may have more sensitive interaction and thereby be able to provide better care by knowing if the patient is gay, lesbian, bisexual, transgender, or straight. Although federal agencies are pushing health care providers to ask, the majority of doctors, nurse practitioners and nurses do not. The belief that patients will refuse to disclose their sexual orientation seems untrue as only 10% of lesbian, gay, bisexual, and heterosexual in a randomized study said they would not answer a sexual orientation question.

Based on the New York Times article “Gay and Transgender Patients to Doctors: We’ll Tell. Just Ask.” and any other relevant literature (the Mayo Clinic, for example), discuss why you believe healthcare providers often “skip” the sexual orientation question. Furthermore, what do you suggest can/should be done to make it easier to disclose the information and open the line of communication? How may it improve care?

https://newsnetwork.mayoclinic.org/discussion/most-patients-comfortable-with-sexual-orientation-and-gender-identity-questions-research-finds/

Week One Discussion # 1 – Blockbuster vs. Netflix

March 1, 2023/in Uncategorized /by Paul

Respond to the two classmates’ postings with a minimum of 1-2 paragraphs. There is a penalty of loss of points for less than minimum posts.

Week One Discussion # 1 – Blockbuster vs. Netflix

Jenino Jao

The main disadvantage of Blockbuster was its inconvenience. The late fees were disappointing for people who might have just forgotten to return their rentals or might have just lost them. This was the very first disadvantage that Netflix exploited and turned into an advantage. Also, Netflix did not have to own physical stores with additional fixed and overhead costs. All the company has to think about was the cost of a first-class mail stamp. Convenience was their number one priority which is why they used stamped return mailers to enable subscribers to easily return rentals through the mail. Customers don’t need to drive to a physical store just to rent and return movies. Subscription-based service eliminated the need for late fees or due dates. Blockbuster did not anticipate the growth of DVD players due to their price and the lesser percentage of Americans who owned DVDs. Even though DVD player prices plummeted down, it was still not a decisive victory for Netflix but it was a big help for the company in its strategy. Blockbuster did not anticipate that the era of brick-and-mortar store video rental could come to an end because of the fast-changing world of technology. In addition, Netflix basically was the first to invent smart suggestion algorithms which are taken for granted nowadays because it feels natural and common. Netflix partnered up with the right partners and promotions such as Toshiba, Sony, HP, and other entertainment companies or movie studios. Rather, Blockbuster did not see the potential and partnered with someone else. Therefore, one of Blockbuster’s biggest mistakes was its decision not to partner up with Netflix. Another strategic advantage of Netflix was the diversification of its services such as video-on-demand and the development of mobile apps for customers to manage their rental queues. Technology is a fast-paced industry that Blockbuster did not see but instead insisted on resting on its laurels. Despite Blockbuster making its own foray into DVD mail service, it was a little too late for the company to recover and compete with Netflix. In the end, I can see complacency and inability to forecast the future as the main reasons for Blockbuster’s decline and eventual bankruptcy.

References

Business Casual. (2016, November 18). Netflix: How a $40 Late Fee Revolutionized Television. YouTube. https://www.youtube.com/watch?v=BrpEHssa_gQ

Tiffani Gottschalk

After the future CEO of Netflix forgot to turn in his movie rental prior to the due date enforced by Blockbuster, he was slapped with a late fee. This event sparked an idea in his mind and his company eventually revolutionized the way that billions of people now watch movies and television shows. Blockbuster, a brick-and-mortar movie rental company, dominated the market in the 90’s and early 2000’s. Blockbuster failed to adapt to the environmental and technological changes taking place at the time and Netflix was there to provide services to consumers that Blockbuster could not offer. The CEO of Netflix introduced a monthly DVD prescription to customers where there would be no late fees and titles would be mailed directly to the consumer. Netflix identified a new way to attract consumers, by giving them the ability to pay for and watch titles without even having to leave the house. Their choice to not enforce late fees also attracted subscribers and helped Netflix remaining competitive against Blockbuster before their downfall. In 2000, Netflix came to Blockbuster with a partnership proposal. Blockbuster walked away from the deal, a critical error that would eventually lead their company into bankruptcy. One notable environmental indicator that led to a high surge of Netflix subscribers was 9/11. With many people afraid to leave their homes after this event, Netflix saw a substantial increase in the number of subscribers during this time and finally reported their first profitable year in 2003.

As technology became more and more advanced during the late 90’s and 2000’s, Netflix strategically identified the consumer mindset shift that was about to happen and capitalized on it. To attract the modern consumer, they were able to provide a product that was convenient, flexible, and reasonably priced. In 2007, Netflix was known as a dominant competitor within their market and launched their streaming service. Fast forward to 2022, and Netflix now has over 230 million subscribers worldwide. When looking at the downfall of Blockbuster, it is clear to see that they became complacent and failed to identify numerous environmental shifts taking place during that time. “The more an organization knows about the future, the more successful its strategies are likely to be” (Moseley, 2017). First, they failed to identify how possible advances of technology would hurt their business. Secondly, they failed to identify the shift in consumer mindset and behavior towards convenience and flexibility that Netflix offered consumers at the time. Third, Blockbuster failed to see the future potential of their competitors business model and how it would have a negative impact on their company. As the movie and entertainment industry and the healthcare industry are both ever-changing and ever-evolving fields, planning and marketing plays an integral role in the future success of these types of organizations.

Business Casual. (2016, November 18). Netflix: How a $40 Late Fee Revolutionized Television. [Video]. YouTube. https://www.youtube.com/watch?v=BrpEHssa_gQ

III, G.B. M. (2017). Managing Health Care Business Strategy (2nd ed.). Jones & Bartlett Learning. https://online.vitalsource.com/books/9781284146202

Cesar Chavez was a prolific community organizer and a champion of social change. He used ten core values to guide his life. Using one or more of these core values with which you most identify, please discuss how you have contributed to equity and social justice at UC San Diego. How will you apply Cesar’s core values to create positive change in the Latinx community and the greater society?

March 1, 2023/in Uncategorized /by Paul

Cesar Chavez was a prolific community organizer and a champion of social change. He used ten core values to guide his life. Using one or more of these core values with which you most identify, please discuss how you have contributed to equity and social justice at UC San Diego. How will you apply Cesar’s core values to create positive change in the Latinx community and the greater society?

Cesar Chavez Essay Contest

The César E. Chávez Planning Committee at the University of California San Diego (UCSD) has established a UCSD Undergraduate Student Essay Contest Award in honor of César E. Chávez. The award will recognize students who have demonstrated commitment to the advancement of César’s core values at UCSD and abroad. Winners will receive the monetary prizes and recognition in UCSD media publications. Prize Recipients will also receive a special invitation to attend the César E. Chávez Celebration Kickoff Luncheon on Wednesday, April, 1^st in the Price Center Ballroom.

ELIGIBILITY:
Full time continuing student, with a 2.0+ GPA, who has demonstrated commitment to the advancement of César’s core values at UC San Diego and abroad.

The César E. Chávez Planning Committee at the University of California San Diego (UCSD) has established a UCSD Undergraduate Student Essay Contest Award in honor of César E. Chávez. The award will recognize students who have demonstrated commitment to the advancement of César’s core values at UCSD and abroad. Winners will receive the monetary prizes and recognition in UCSD media publications. Prize Recipients will also receive a special invitation to attend the César E. Chávez Celebration Kickoff Luncheon on Wednesday, April, 1^st in the Price Center Ballroom.