Category: Nursing

Nursing Essay Writing Grammar: Noun–Pronoun Agreement

Noun-Pronoun Agreement Basics

The purpose of a 
pronoun
 is to take the place or refer back to a noun in a 
sentence
. Just like subjects and verbs, nouns and pronouns should agree in number within a sentence.

Singular Noun, Singular Pronoun

When writing a sentence, using the same word more than once can get repetitive.

Example:
 Francine edited her
 
paper
 because her
 paper
 was full of errors.

Rather than repeating “paper”
 
twice, it is possible to use a pronoun.

Revision:
 Francine edited her 
paper
 because 
it
was full of errors. Nursing Essay Writing Grammar: Noun–Pronoun Agreement

Since “paper” is singular (there is only one), use a singular pronoun (“it”) to replace it.

BUY PLAGIARISM-FREE PAPER HERE

Remember to find the true subject of the sentence to determine if the pronoun should be singular or plural. See our webpage on 
subject–verb agreement
 for more on singular and plural subjects.

Example
: 
Each
 student must find 
his or her
 own note-taking strategy.

Since the subject is singular (“each
“
), the pronoun (“his or her”) must also be singular.

Example:
 
Neither
 Bob nor Alex believed 
he
 would receive the award.

Since the subject is singular (“neither”), the pronoun (“he”) must also be singular.

Example
: 
A community group
 of teachers is meeting tonight to see if 
it 
can find a way to help students improve their SAT scores.

Since the subject is singular (“a community group”), the pronoun (“it”) must also be singular.

Singular “They”

Recently, many academic and popular publications have started accepting the use of the pronoun “they” as a singular pronoun, meaning writers use “they” to correspond to singular subjects in an effort to avoid gendered pronouns. Although the pronoun “they” is only a plural pronoun in some style guides, APA encourages writers to use “they” as a singular or plural pronoun with the specific intention of embracing gender diversity. Nursing Essay Writing Grammar: Noun–Pronoun Agreement

According to the 
APA Style blog
, “when transgender and gender nonconforming people (including agender, genderqueer, and other communities) use the singular “they” as their pronoun, writers should likewise use the singular “they” when writing about them” (para. 1).

With this understanding in mind, when writers are specifically writing about a person or group of people who prefer the singular “they,” writers should also use the singular “they.” Where relevant, we recommend writers explicitly explain that they are using the singular “they” to follow the self-identifications of the people they are discussing.

Additionally, writers can often avoid the issue of gender-neutral singular pronouns by revising a sentence to make the subject plural:

Original sentence: 
A teacher
 should carefully choose professional development opportunities that address
 
her
gaps in knowledge. Nursing Essay Writing Grammar: Noun–Pronoun Agreement

Revised sentence: 
Teachers
 should carefully choose professional development opportunities that address 
their
 gaps in knowledge.

Plural Noun, Plural Pronoun

When the subject of the sentence is plural, the pronoun in the sentence becomes plural as well.

Example
:
 When
 
students
 arrive on the first day of school, 
students
 need help finding the right classroom.

Since “students” is plural, use a plural pronoun to replace it.

Revision: 
When 
students
 arrive on the first day of school, 
they
 need help finding the right classroom.

Remember to find the true subject of the sentence to determine if the pronoun should be singular or plural. See our webpage on 
subject–verb agreement
 for more on singular and plural subjects.

Example:
 When 
a supervisor and an employee
 disagree, 
they 
should discuss the situation.

Since the subject is plural (“a supervisor and an employee”), the pronoun (“they”) must also be plural.

Example
: The professor hoped that the 
students
 had reviewed 
their
 notes carefully.

Since the subject is plural (“students”), the pronoun (“their”) must also be plural.

Example
: 
Both
 Smith (2016) and Taylor (2017) believed 
their 
results would lead to social change.

Since the subject is plural (“both”), the pronoun (“their”) must also be plural. Nursing Essay Writing Grammar: Noun–Pronoun Agreement

Pronoun Ambiguity

Although pronouns are useful to help writers avoid repetition, they should be used sparingly to keep the meaning of the sentence clear. Take a look at this sentence:

Example:
 When Jeff and Brian joined the team members, 
they
 were scared.

The pronoun here (“they”) is unclear–to whom does it refer? Was the team scared? Were Jeff and Brian scared? In this example, because the pronoun “they
” 
is ambiguous, choosing a noun rather than a pronoun will help with clarity.

Revision:
 When Jeff and Brian joined the team members, 
the team members
 were scared.

Gender-Neutral Pronouns Policy

Walden University prides itself as an inclusive institution that serves a diverse population of students. Committed to broadening the university’s understanding of inclusivity and diversity, Walden will now accept gender-neutral pronouns in student writing. This practice acknowledges APA’s recent endorsement of the singular “they” and also embraces alternative pronouns currently in circulation (e.g., the nominatives xe, ve, ze/zir, ey, and zhe and their associated derivations). Walden recognizes that discussion around gender identity is ongoing. As such, the university will accept any pronoun in student writing so long as evidence can be provided that it is accepted as a respectful term by the community it represents. Nursing Essay Writing Grammar: Noun–Pronoun Agreement

http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.html

Alzheimer’s Disease

76-year-old Iranian Male

 

BACKGROUND

Mr. Akkad is a 76 year old Iranian male who is brought to your office by his eldest son for “strange behavior.” Mr. Akkad was seen by his family physician who ruled out any organic basis for Mr. Akkad’s behavior. All laboratory and diagnostic imaging tests (including CT-scan of the head) were normal.

According to his son, he has been demonstrating some strange thoughts and behaviors for the past two years, but things seem to be getting worse. Per the client’s son, the family noticed that Mr. Akkad’s personality began to change a few years ago. He began to lose interest in religious activities with the family and became more “critical” of everyone. They also noticed that things he used to take seriously had become a source of “amusement” and “ridicule.”

Over the course of the past two years, the family has noticed that Mr. Akkad has been forgetting things. His son also reports that sometimes he has difficult “finding the right words” in a conversation and then will shift to an entirely different line of conversation.

SUBJECTIVE

During the clinical interview, Mr. Akkad is pleasant, cooperative and seems to enjoy speaking with you. You notice some confabulation during various aspects of memory testing, so you perform a Mini-Mental State Exam. Mr. Akkad scores 18 out of 30 with primary deficits in orientation, registration, attention & calculation, and recall. The score suggests moderate dementia.

MENTAL STATUS EXAM

Mr. Akkad is 76 year old Iranian male who is cooperative with today’s clinical interview. His eye contact is poor. Speech is clear, coherent, but tangential at times. He makes no unusual motor movements and demonstrates no tic. Self-reported mood is euthymic. Affect however is restricted. He denies visual or auditory hallucinations. No delusional or paranoid thought processes noted. He is alert and oriented to person, partially oriented to place, but is disoriented to time and event [he reports that he thought he was coming to lunch but “wound up here”- referring to your office, at which point he begins to laugh]. Insight and judgment are impaired. Impulse control is also impaired as evidenced by Mr. Akkad’s standing up during the clinical interview and walking towards the door. When you asked where he was going, he stated that he did not know. Mr. Akkad denies suicidal or homicidal ideation.

Diagnosis: Major neurocognitive disorder due to Alzheimer’s disease (presumptive)

RESOURCES

§ Folstein, M. F., Folstein, S. E., & McHugh, P. R. (2002). Mini-Mental State Examination (MMSE). Lutz, FL: Psychological Assessment Resources.

Decision Point One

Select what you should do:

Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2 weeks

: Begin Aricept (donepezil) 5 mg orally at BEDTIME

Begin Razadyne (galantamine) 4 mg orally BID

http://cdnfiles.laureate.net/2dett4d/Walden/NURS/6521/05/mm/decision_trees/week_10/index.html

The case study is on a 76-year-old Iranian male patient that is suspected to have Alzheimer’s disease. The conclusion is based on the reports provided by his eldest son and there were no organic disease processes that were identified during the examination. The behavioral changes started two years ago, and included personality changes, apathy, which was followed by memory loss and challenges in finding the appropriate words during conversation. Confabulation is also noticed during the clinical interview, speech, and self-reported euthymic mood. The patient also has an impairment in his judgment and insight as well as absence of impulse control. There is no suicide ideation reported and the patient is diagnosed with neurocognitive disorder as a result of Alzheimer’s disease.

The first approach that will be taken will include Donepezil 5mg at bedtime. The use of donepezil among patients that have Alzheimer’s disease has been examined for decades. The medication is an acetylcholinesterase inhibitor, which increases the acetylcholine levels in the brain and compensates the reduced function of cholinergic neurons (Birks and Harvey, 2018). An assessment of randomized clinical trials analyzed the impact that donepezil has on patients with Alzheimer’s using randomized control trials. The findings showed that there is strong evidence that donepezil is effective in three major areas in the management of this condition, which include behavior, functional ability, and cognition (Li et al., 2018). These are the major areas that were affected in the patient and the goal was to limit their impact on his quality of life. As indicated in the case, he had significant personality changes that negatively impacted his engagement in activities of interest. However, there is a need to state that the National Institute of Aging has noted that there is still a poor comparison between different agents that are used as the first line of treatment for the patient (NIH, 2020).

The outcomes from donepezil differ as there can be development of complications along with limited clinical benefits. The patient complained of side effects such as loss of weight and appetite, vomiting, nausea, and diarrhea, which have been reported among patients using this medication (Kumar and Sharma, 2019).

The second decision was the use of cognitive behavioral treatment, which has been found studies to have a positive impact among patients with early stages of Alzheimer’s disease. Evidence supporting psychosocial interventions for patients with dementia has been identified in isolated cases (Forstmeier et al., 2015). However, there is still limited empirical data on these approaches. Some scholars have labelled behavioral interventions as appropriate among patients that have neuropsychiatric symptoms. Therefore, these will be used on the patient to improve behavior, and particularly targeted at reducing apathy and improving the self-control by the patient. Improvement of mood will positively impact the quality of life and the ability for the patient to engage in activities that will improve his cognitive status.

The third decision will be to include family members in the therapeutic process as this will help reinforce behaviors that will assist the patient. Studies illustrate that there is a high lack of adherence to care among elderly patients (Smith et al., 2017). This reduces the ability to evaluate the effectiveness of the interventions, as outcomes may be due to poor drug use. The goal is to increase the support system of the patient, and daily interactions as this has been found to positively impact the cognitive and emotional well-being of patients with dementia.

 

 

 

 

 

 

References

Birks, J. S., & Harvey, R. J. (2018). Donepezil for dementia due to Alzheimer’s

disease. 
Cochrane Database of systematic reviews
, (6).

Forstmeier, S., Maercker, A., Savaskan, E., & Roth, T. (2015). Cognitive behavioural

treatment for mild Alzheimer’s patients and their caregivers (CBTAC): study protocol for a randomized controlled trial. 
Trials
, 
16
(1), 526.

How is Alzheimer’s Disease Treated? (2020). NIH

Kumar, A., & Sharma, S. (2019). Donepezil. In 
StatPearls [Internet]
. StatPearls Publishing.

Li, Q., He, S., Chen, Y., Feng, F., Qu, W., & Sun, H. (2018). Donepezil-based multi

functional cholinesterase inhibitors for treatment of Alzheimer’s disease. 
European journal of medicinal chemistry
, 
158
, 463-477.

Smith, D., Lovell, J., Weller, C., Kennedy, B., Winbolt, M., Young, C., & Ibrahim, J. (2017).

A systematic review of medication non-adherence in persons with dementia or cognitive impairment. 
PloS one
, 
12
(2).

Assignment: Decision Tree for Neurological and Musculoskeletal Disorders

For your Assignment, your Instructor will assign you one of the decision tree interactive media pieces provided in the Resources. As you examine the patient case studies in this module’s Resources, consider how you might assess and treat patients presenting symptoms of neurological and musculoskeletal disorders.

Photo Credit: Getty Images/Science Photo Library RF

To Prepare

Review the interactive media piece assigned by your Instructor.

Reflect on the patient’s symptoms and aspects of the disorder presented in the interactive media piece.

Consider how you might assess and treat patients presenting with the symptoms of the patient case study you were assigned.

You will be asked to make three decisions concerning the diagnosis and treatment for this patient. Reflect on potential co-morbid physical as well as patient factors that might impact the patient’s diagnosis and treatment.

By Day 7 of Week 8

Write a 1- to 2-page summary paper that addresses the following:

Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented.

Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.

What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.

Explain any difference between what you expected to achieve with each of the decisions and the results of the decision in the exercise. Describe whether they were different. Be specific and provide examples.

You will submit this Assignment in Week 8.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK8Assgn+last name+first initial.(extension)” as the name.

Click the 
Week 8 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 8 Assignment 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK8Assgn+last name+first initial.(extension)” and click 
Open
.

If applicable: From the Plagiarism Tools area, click the checkbox for 
I agree to submit my paper(s) to the Global Reference Database
.

Click on the 
Submit
 button to complete your submission.

NURS_6521_Week8_Assignment_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Be specific.

Points Range:
18
(18%)
– 20
(20%)

The response accurately and thoroughly summarizes in detail the patient case study assigned, including specific and complete details on each of the three decisions made for the patient presented.

Points Range:
16
(16%)
– 17
(17%)

The response accurately summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.

Points Range:
14
(14%)
– 15
(15%)

The response inaccurately or vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented.

Points Range:
0
(0%)
– 13
(13%)

The response inaccurately and vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented, or is missing.

Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources.

Points Range:
23
(23%)
– 25
(25%)

The response accurately and thoroughly explains in detail how the decisions recommended for the patient case study are supported by the evidence-based literature.

The response includes specific and relevant outside reference examples that fully support the explanation provided.

Points Range:
20
(20%)
– 22
(22%)

The response accurately explains how the decisions recommended for the patient case study are supported by the evidence-based literature.

The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.

Points Range:
18
(18%)
– 19
(19%)

The response inaccurately or vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature.

The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.

Points Range:
0
(0%)
– 17
(17%)

The response inaccurately and vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature, or is missing.

The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.

What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources.

Points Range:
18
(18%)
– 20
(20%)

The response accurately and thorough explains in detail what they were hoping to achieve with the decisions recommend for the patient case study assigned.

The response includes specific and relevant outside reference examples that fully support the explanation provided.

Points Range:
16
(16%)
– 17
(17%)

The response accurately explains what they were hoping to achieve with the decisions recommended for the patient case study assigned.

The response includes relevant outside reference examples that lend support for the explanation provided that are accurate.

Points Range:
14
(14%)
– 15
(15%)

The response inaccurately or vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned.

The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided.

Points Range:
0
(0%)
– 13
(13%)

The response inaccurately and vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned, or is missing.

The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing.

Explain any difference between what you expected to achieve with each of the decisions and the results of the decisions in the exercise. Describe whether they were different. Be specific and provide examples.

Points Range:
18
(18%)
– 20
(20%)

The response accurately and clearly explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.

The response provides specific, accurate, and relevant examples that fully support whether there were differences between the decisions made and the decisions available in the exercise.

Points Range:
16
(16%)
– 17
(17%)

The response accurately explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.

The response provides accurate examples that support whether there were differences between the decisions made and the decisions available in the exercise.

Points Range:
14
(14%)
– 15
(15%)

The response inaccurately or vaguely explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise.

The response provides inaccurate or vague examples that may or may not support whether there were differences between the decisions made and the decisions available in the exercise.

Points Range:
0
(0%)
– 13
(13%)

vaguely explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise, or is missing.

The response provides inaccurate and vague examples that do not support whether there were differences between the decisions made and the decisions available in the exercise, or is missing.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.

Points Range:
5
(5%)
– 5
(5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

Points Range:
4
(4%)
– 4
(4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Points Range:
3.5
(3.5%)
– 3.5
(3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

Points Range:
0
(0%)
– 3
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time.

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

Points Range:
5
(5%)
– 5
(5%)

Uses correct grammar, spelling, and punctuation with no errors

Points Range:
4
(4%)
– 4
(4%)

Contains a few (1–2) grammar, spelling, and punctuation errors

Points Range:
3.5
(3.5%)
– 3.5
(3.5%)

Contains several (3–4) grammar, spelling, and punctuation errors

Points Range:
0
(0%)
– 3
(3%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.

Points Range:
5
(5%)
– 5
(5%)

Uses correct APA format with no errors

Points Range:
4
(4%)
– 4
(4%)

Contains a few (1–2) APA format errors

Points Range:
3.5
(3.5%)
– 3.5
(3.5%)

Contains several (3–4) APA format errors

Points Range:
0
(0%)
– 3
(3%)

Contains many (≥ 5) APA format errors

Total Points: 100

Nursing Essay Writing Proofreading

Introduction

Proofreading
 involves reading your document to correct the smaller typographical, grammatical, and spelling errors. Proofreading is usually the very last step you take before sending off the final draft of your work for evaluation or publication. It comes after you have addressed larger matters such as style, content, citations, and organization during revising. Like revising, proofreading demands a close and careful reading of the text. Although quite tedious, it is a necessary and worthwhile exercise that ensures that your reader is not distracted by careless mistakes.

Tips for Proofreading

BUY PLAGIARISM-FREE PAPER HERE

Distance yourself from your work.

Set aside the document for a few hours or even a few days before proofreading. Taking a bit of time off enables you to see the document anew. A document that might have seemed well written one day may not look the same when you review it a few days later. Taking a step back provides you with a fresh (and possibly more constructive) perspective.

Proofread at a specific time of day.

Make a conscious effort to proofread at a specific time of day (or night!) when you are most alert to spotting errors. If you are a morning person, try proofreading then. If you are a night owl, try proofreading at this time. Nursing Essay Writing Proofreading

Print a hard copy of the text.

Reviewing the document in a different format and having the ability to manually circle and underline errors can help you take the perspective of the reader, identifying issues that you might ordinarily miss. Additionally, a hard copy gives you a different visual format (away from your computer screen) to see the words anew.

Do not rely exclusively on grammar and spelling checkers.

Although useful, programs like 
Word’s spell-checker
 and 
Grammarly
 can misidentify or not catch errors. Although grammar checkers give relevant tips and recommendations, they are only helpful if you know how to apply the feedback they provide. Similarly, MS Word’s spell checker may not catch words that are spelled correctly but used in the wrong context (e.g., differentiating between 
their, they’re
, and 
there
). Beyond that, sometimes a spell checker may mark a correct word as wrong simply because the word is not found in the spell checker’s dictionary. To supplement tools such as these, be sure to use dictionaries and other 
grammar resources
 to check your work. You can also make 
appointments
 with our writing instructors for feedback concerning grammar and word choice, as well as other areas of your writing!

Read your text aloud and slowly.

Reading a text aloud allows you to identify errors that you might gloss over when reading silently. This technique is particularly useful for identifying run-on and other types of awkward sentences. If you can, read for an audience. Ask a friend or family member to listen to your work and provide feedback, checking for comprehension, organization, and flow.

Have someone else read aloud to you.

Hearing someone else read your work allows you to simply listen without having to focus on the written words yourself. You can be a more critical listener when you are engaged in only the audible words. Nursing Essay Writing Proofreading

Go through the paper backwards.

By reading the document backwards, sentence by sentence, you are able to focus only on the words and sentences without paying attention to the context or content.

Use a ruler or blank piece of paper.

Placing a ruler or a blank sheet of paper under each line as you read it will give your eyes a manageable amount of text to read.

Check for familiar errors.

If you can identify one type of error that you struggle with (perhaps something that a faculty member has commented on in your previous work), go through the document and look specifically for these types of errors. Learn from your mistakes, too, by mastering the problem concept so that it does not appear in subsequent drafts.

Proofread for one type of error at a time.

Related to the previous strategy of checking for familiar errors, you can proofread by focusing on one error at a time. For instance, if commas are your most frequent problem, go through the paper checking just that one problem. Then proofread again for the next most frequent problem.

Ask someone else to look over the document.

After you have finished making corrections, have someone else scan the document for errors. A different set of eyes and a mind that is detached from the writing can identify errors that you may have overlooked. Nursing Essay Writing Proofreading

Proofreading is not just about errors.

Remember that proofreading is not just about errors. You want to polish your sentences, making them smooth, interesting, and clear. Watch for very long sentences, since they may be less clear than shorter, more direct sentences. Pay attention to the rhythm of your writing; try to use sentences of varying lengths and patterns. Look for unnecessary phrases, repetition, and awkward spots. Nursing Essay Writing Proofreading

Diabetes and Drug Treatments

Diabetes mellitus (DM) is a disorder in the body’s metabolism characterized by altered glucose conversion into energy for cell use, defects in insulin secretion, or increased insulin resistance (Antonioli, Blandizzi, Csoka, Pacher, & Hasko, 2015). DM can occur in children and adults and is diagnosed by measuring glycosylated hemoglobin (HbA1C) levels, fasting plasma blood sugar (FPG) levels, 2-hour plasma blood sugar levels during oral glucose tolerance testing, or random blood sugar level; however HbA1C provides a more accurate and long-term measure of blood sugar control (Huether & McCance, 2017).

Types of Diabetes

Type 1 diabetes mellitus (T1DM), presents during childhood approximately before age 10, with a classic clinical onset of high blood sugar, excessive thirst, excessive urination, and weight loss resulting from an autoimmune dysfunction activating the CD4, CD8 T cell, and macrophages infiltrating the pancreas leading to chronic inflammation, pancreatic B-cell dysfunction, destruction, and death (Antonioli et al., 2015). Genetic susceptibility increases the risk of close relatives to a T1DM patient as a result of gene polymorphisms, whereas environmental exposure can trigger an immune response to genetically susceptible individuals destroying the insulin-producing B-cells in the pancreas (Levitsky & Misra, 2019).

Type 2 diabetes mellitus (T2DM) develops in genetically predisposed individuals as a result of advancing age, inactivity, and obesity resulting in high levels of blood sugar due to the body’s inability to produce insulin, use enough insulin, or use glucose for energy with signs and symptoms of fatigue, weight gain, slow healing wounds, frequent infections, visual changes, and altered sensation (Blair, 2016). Chronic-low grade inflammation, immune system activation, and infiltration in the pancreas results in B-cell dysfunction and progressively increased insulin resistance (Antonioli et al., 2015).

Gestational diabetes mellitus is high blood sugar levels with the onset or first detected during pregnancy; however according to the American Diabetes Association (ADA) (as cited by

Heather & McCance, 2017), women with gestational diabetes may have had undiagnosed pre-existing diabetes, so the ADA recommends that these women should receive a  T1DM or T2DM diagnosis instead of gestational diabetes.

Metformin Administration in Type 2 Diabetes

Biguanides such as Metformin is the first line of therapy for T2DM unless contraindicated because it inhibits the liver’s glucose production and increases muscle tissue insulin sensitivity (Blair, 2016).  Metformin comes in two oral preparations: a)  initial adult dose for the immediate-release tablet is 500 mg orally once or twice daily or 850 mg daily; should be administered with a meal to decrease gastrointestinal (GI)  upset; and gradual dosage increases usually every seven days to minimize adverse GI effects; and b) initial adult dose for the extended-release Metformin is 500 mg to 1 gram once daily with the evening meal and gradual dose titration to minimize adverse GI effects (UpToDate, n.d.). Contraindications to Metformin use are hypersensitivity to Metformin or any of its components, patients with eGFR < 30 mL/minute as it can result in lactic acidosis, acute, or chronic metabolic acidosis, and death  (UpToDate, n.d.). Short-Term and Long-Term Impact of Type 2 Diabetes and Effects of Drug Treatment             Short-term impact of T2DM are : a) hypoglycemia in individuals taking secretagogues such as sulfonylurea agents or exogenous insulin that requires immediate glucose replacement by mouth or intravenously; b) hyperosmolar hyperglycemic nonketotic syndrome (HHNKS), is less common but can result in high mortality rate particularly in the elderly who have comorbidities such as infections, cardiovascular, or renal disease which is characterized by very high blood sugar level resulting in severe dehydration, electrolyte imbalance, and neurologic impairment (Huether & McCance, 2017). The long-term impact of T2DM are categorized into: a) microvascular complications which are damages to small blood vessels leading to renal failure, retinopathy leading to blindness, and neuropathy leading to impotence and foot disorders; and b) macrovascular complications are damage to larger blood vessels leading to cardiovascular diseases (Blair, 2016). Monitoring recommendation for Metformin use are : a) Vitamin B12 levels  every two to three years especially in individuals with peripheral neuropathy or anemia because long-term Metformin use can result in Vitamin B12 deficiency; b) initial and yearly hematologic and renal function studies; and c) Bi-annual urine glucose, fasting blood sugar, and hemoglobin A1C in patients with stable glucose control and every four months for individuals not meeting glycemic control (UpToDate, n.d.). References Antonioli, L., Blandizzi, C., Csoka, B., Pacher, P., & Hasko, G. (2015). Adenosine signaling in diabetes mellitus—Pathophysiology and therapeutic considerations. Nature Reviews Endocrinology , 11 (4), 228-. Gale OneFile: Science. Blair, M. (2016). Diabetes mellitus review. Urologic Nursing , 1 , 27. https://doi.org/10.7257/1053-816X.2016.36.1.27 Huether, S. E., & McCance, K. L. (2017).  Understanding pathophysiology  (6th ed.). St. Louis, MO: Mosby Levitsky, L.L., & Misra, M. (2019, June 27). Epidemiology, presentation, and diagnosis of type 1 diabetes mellitus in children and adolescents. In A.G. Hoppin (Ed.), UpToDate. Retrieved March 25, 2020, from https://www.uptodate.com/ Metformin: Drug information—UpToDate . (n.d.). Retrieved March 25, 2020, from https://www.uptodate.com/   Discussion: Diabetes and Drug Treatments Photo Credit: [Mark Hatfield]/[iStock / Getty Images Plus]/Getty Images Each year, 1.5 million Americans are diagnosed with diabetes (American Diabetes Association, 2019). If left untreated, diabetic patients are at risk for several alterations, including heart disease, stroke, kidney failure, neuropathy, and blindness. There are various methods for treating diabetes, many of which include some form of drug therapy. The type of diabetes as well as the patient’s behavior factors will impact treatment recommendations. For this Discussion, you compare types of diabetes, including drug treatments for type 1, type 2, gestational, and juvenile diabetes. Reference: American Diabetes Association. (2019). Statistics about diabetes. Retrieved from http://diabetes.org/diabetes-basics/statistics/ To Prepare Review the Resources for this module and reflect on differences between types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Select one type of diabetes to focus on for this Discussion. Consider one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Then, reflect on dietary considerations related to treatment. Think about the short-term and long-term impact of the diabetes you selected on patients, including effects of drug treatments. By Day 3 of Week 5 Post a brief explanation of the differences between the types of diabetes, including type 1, type 2, gestational, and juvenile diabetes. Describe one type of drug used to treat the type of diabetes you selected, including proper preparation and administration of this drug. Be sure to include dietary considerations related to treatment. Then, explain the short-term and long-term impact of this type of diabetes on patients. including effects of drug treatments. Be specific and provide examples. By Day 6 of Week 5 Read a selection of your colleagues’ responses and respond to at least two of your colleagues on two different days who selected a different type of diabetes than you did. Provide recommendations for alternative drug treatments and patient education strategies for treatment and management. Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS_6521_Week5_Discussion_Rubric Grid View List View Excellent Good Fair Poor Main Posting Points Range: 45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Points Range: 40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Points Range: 35 (35%) – 39 (39%) Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors. Points Range: 0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. Main Post: Timeliness Points Range: 10 (10%) – 10 (10%) Posts main post by day 3 Points Range: 0 (0%) – 0 (0%) Points Range: 0 (0%) – 0 (0%) Points Range: 0 (0%) – 0 (0%) Does not post by day 3 First Response Points Range: 17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Points Range: 15 (15%) – 16 (16%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Points Range: 13 (13%) – 14 (14%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. Points Range: 0 (0%) – 12 (12%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited. Second Response Points Range: 16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. . Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Points Range: 14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. Points Range: 12 (12%) – 13 (13%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. . Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. Points Range: 0 (0%) – 11 (11%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited. Participation Points Range: 5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days. Points Range: 0 (0%) – 0 (0%) Points Range: 0 (0%) – 0 (0%) Points Range: 0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days Total Points: 100 Type 1 Diabetes Type 1 diabetes generally develops during childhood or adolescence, however type 1 can develop during adulthood (Rosenthal & Burchum, 2018). Previously called insulin dependent or juvenile diabetes, type 1 diabetes is caused by an autoimmune reaction that destroys pancreatic beta cells, which are the cells responsible for insulin synthesis and release into bloodstream. Type 2 Diabetes Type 2 diabetes accounts for 90-95% of diagnosed diabetes cases and approximately 22 million Americans have this disease (Rosenthal & Burchum, 2018).  Type 2 diabetes is non-insulin dependent diabetes or also known as adult-onset diabetes mellitus.  Insulin is still produced for patients with Type 2, the secretion is no longer tightly coupled to plasma glucose, which makes the release of insulin delayed and peak output is subnormal. A patient will have fasting labs and also check a hemoglobin A1C. Juvenile Diabetes An autoimmune disease where the pancreas stops producing insulin. Also, known as type 1 diabetes or insulin dependent. This is not related to lifestyle or diet. Early signs to watch for, include thirst and urination.  If having symptoms, the provider will test blood levels. Gestational Diabetes Diabetes that appears during pregnancy and then subsides after delivery is gestational diabetes (Rosenthal & Burchum, 2018). You want to monitor blood glucose and make sure it is well controlled with diet and insulin if prescribed. Gestational diabetes usually shows up in the middle of pregnancy, and providers test between 24-28 weeks of pregnancy (CDC, n.d.). The medication I chose is Metformin (Glucophage). Metformin is an oral agent that decreases glucose production by the liver and increases tissue response to insulin (Rosenthal & Burchum, 2018). Metformin is started once diagnosis of type 2 diabetes is made unless contraindicated.  Metformin is safe and has beneficial effects on A1C, weight management, and cardiovascular mortality (American Diabetes Association, 2018). Metformin can be used as monotherapy, unless A1C is greater than 9%, then consider dual therapy.  Keeping a healthy weight is important along with diet and lifestyle changes. Drug Class: Biguanides           Pharmacokinetics: Metformin is slowly absorbed from the small intestine and is not metabolized, but excreted unchanged by the kidneys (Rosenthal & Burchum, 2018). Metformin can accumulate to toxic levels.  Metformin can be used in patients with mild impairment in kidney function and in some patients with moderate kidney impairment (U.S. Food  & Drug, 2017).  Before started, obtain patients eGFR. Not recommended in patients with a eGFR <30. Side effects: decreased appetite, nausea, and diarrhea. Severe metabolic acidosis can occur with accumulation of Metformin and patients with significant renal impairment.  If a patient had any recent infection or illness they need to be aware to let the provider know and the medication might have to be stopped until feeling better.  Patients admitted in the hospital are usually stopped on their Metformin and resumed after discharge. Caution patients if drink alcohol, whether its acute or chronic, because alcohol potentiates the effects of Metformin on lactate metabolism.  Metformin can cause low blood sugar if patients do not eat enough, if they drink alcohol or if they take other medications that can lower blood sugar (U.S. Food & Drug, 2017).  Monitoring blood glucose levels are very important when  educating patients. Sarah References American Diabetes Association. (2018). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes-2018. Diabetes Care, 41(supplement 1), S73-S85. Retrieved from: https://care.diabetesjournals.org/content/diacare/41/Supplement_1/S73.full.pdf Centers for Disease Control and Prevention. (n.d.). Gestational Diabetes and Pregnancy.Retrieved from: https://www.cdc.gov/pregnancy/diabetes-gestational.html Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier U.S. Food & Drug. (2017). FDA Drug Safety Communication: FDA revises warnings regarding use of the diabetes medicine metformin in certain patients with reduced kidney function. Retrieved from: https://www.fda.gov/drugs/drug- safety- and-availability/fda-drug-safety-communication-fda-revises-warnings-regarding-use-diabetes-medicine-metformin-certain   response Great job on your discussion regarding Metformin and diabetes management! I did some additional research on Metformin so I could contribute and bring additional information to your chosen topic. I did my discussion post on sulfonylureas which is also an oral agent medication that can be used in the treatment of Type II Diabetes. Biguanides mechanism of action and potential side effects are different from those of sulfonylureas in that they do not usually result in hypoglycemia (when used alone) nor dot hey promote hyperinosemia or weight gain. Biguanides can be used as a first line of treatment in addition to diet and exercise or they can be combined with other oral agents or insulin. It is imperative that providers start patient’s out with a lose dose and gradually increase the dose every 1-2 weeks depending upon therapeutic goals. Metformin should be started at 500mg or 850mg daily or twice daily with a maximum dose of 2550mg. Dosing is most effective when taken before meals in the mornings and evenings (Arcangelo, Peterson, Wilbur & Reinhold, 2017, p. 792). In review of dietary recommendations and the use of Metformin I was unable to find any solid evidence on whether any dietary intakes affect the use of Metformin. It is noted that while taking the medication one should refrain from high fat diets and those that include a lot of sugar as a diet that consists of high fat and sugar are defeating the purpose of the medication being taken. Metformin taken with cimetidine increases the risk for hypoglycemic events and combination therapy with the use of metformin and glucocorticoids or alcohol can increase the risk of lactic acidosis. Studies have shown that metformin treatment when combined with healthy lifestyles has a long-term effect on the management of diabetes. According to Rojas & Gomes (2013), “Diabetes incidence 10 years since DPP randomization was reduced by 34% and 18% in the lifestyle and metformin group, respectively (Rojas & Gomes, 2013). Arcangelo, V. P. (2017). Pharmacotherapeutics for Advanced Practice. Philadelphia: Wolters Kluwer. Rojas, L. &. (2013). Metformin: an old but still the best treatment for type 2 diabetes. Diabetology & Metabolic Syndrome .

Nursing essays Academic Writing Expectations Checklist

NURS 4100: Weeks 1–6

 

The items noted below are areas where you can improve. Click on the links to access Writing Center resources:

 

Sentence-level skills

Using commas appropriately. See examples of the different
comma uses.

Ensuring that pronouns match their nouns. See this discussion of
noun-pronoun agreement.

Proofreading for grammar, mechanics, and spelling. Read these
proofreading tips.

BUY PLAGIARISM-FREE PAPER HERE

Comments:

 

Paragraph-level skills

Focusing each paragraph on one central idea (rather than multiple ideas). See an explanation of how
topic sentences
work.

Ordering sentences logically in a paragraph. See an explanation of how the
MEAL plan
builds a strong paragraph. Nursing essays

 

Comments:

 

Essay-level skills

Structuring the paper (with an introduction, body, and conclusion). See an explanation of
outlining
a paper to plan organization.

Making an overall argument. See description and examples of
thesis statements.

Using transitions to guide the reader and show relationships. See a guide to
transitional phrases
.

 

Comments:

 

Awareness of audience and discipline Nursing essays

Writing in an academic voice. See the different facets of an appropriately formal
tone
.

Formatting the paper according to APA style guidelines. See
the course paper template
for correct margins, spacing, font, and more.

 

Comments:

Use of evidence

Using readings, statistics, or data to effectively support a claim. See examples of
integrating evidence
in a paper.

Avoiding quotes. If used, enclose direct quotes in quotation marks. Read about the purpose of
quotation marks
.

Paraphrasing to avoid plagiarizing the source. See
paraphrasing strategies
. (Paraphrase rather than quote—no more than one quote)

Use the most
current evidence
(usually ≤ 5 years old). Nursing essays

 

Comments:

 

Credit to source

Using in-text citations appropriately. See examples of
citations
in APA style.

Setting up your reference list at the end of the paper or Discussion post. See this
reference list overview
.

Formatting the reference entries according to APA style. See common
reference examples
here.

 

Comments: Nursing essays

NURS 4100 / 4105 Position Paper on Health Policy: Death with Dignity Act

Now that you have analyzed many different aspects of health care policy, you are better able to form a comprehensive evidence-based opinion on its effectiveness. The policy you chose to focus on, like all policy, as you now well know, is a conglomeration of many different facets. Each of those facets is integral to the policy’s success, efficiency, and value.

As a nursing professional and advocate for change, having an all-inclusive understanding of health care policy (the Death with Dignity) is extremely important. Nurses have a tremendous amount of untapped power to make positive changes. NURS 4100 / 4105 Position Paper on Health Policy: Death with Dignity Act. Your knowledge of policy is just a first step. With this new process of breaking down and analyzing each of the pieces of health care policy, you have added another tool to your toolkit.

BUY PLAGIARISM-FREE PAPER HERE

To complete this Assignment, consider all of your findings from the Discussion in Week 1 and the Assignments in Weeks 2 and 3. Analyze your research on the policy, including costs, quality, and/or safety issues.

Address the following:

Introduce the topic by drawing from your previous work. Introduce the policy by providing an overview of the suggested or implemented policy: background of the topic, including main elements of the policy, costs, and quality/safety. Assert your main thesis statement.

Offer an evidence-based, informed opinion in support of the suggested or implemented policy. Describe at least two major contributions that this policy makes to health care, nursing, or health outcomes. Provide support with at least three sources of evidence. NURS 4100 / 4105 Position Paper on Health Policy: Death with Dignity Act

Discuss at least one opposing opinion to the suggested or implemented policy. Provide evidence and/or data to support the counterargument.

Present a final position on the policy. Support the final defensible argument with current literature.

Conclusion:

A. Restate your argument.

B. Provide a plan of action, but do not introduce new information. In total, your paper will be 4–5 pages in length, not including the title page or reference page.

Academic Writing Expectations Checklist

NURS 4100: Weeks 1–6

 

The items noted below are areas where you can improve. Click on the links to access Writing Center resources:NURS 4100 / 4105 Position Paper on Health Policy: Death with Dignity Act

 

Sentence-level skills

Using commas appropriately. See examples of the different
comma uses
.

Ensuring that pronouns match their nouns. See this discussion of
noun-pronoun agreement
.

Proofreading for grammar, mechanics, and spelling. Read these
proofreading tips
.

 

Comments:

 

Paragraph-level skills

Focusing each paragraph on one central idea (rather than multiple ideas). See an explanation of how
topic sentences
work.

Ordering sentences logically in a paragraph. See an explanation of how the
MEAL plan
builds a strong paragraph.

 

Comments:

 

Essay-level skills

Structuring the paper (with an introduction, body, and conclusion). See an explanation of
outlining
a paper to plan organization.

Making an overall argument. See description and examples of
thesis statements
.

Using transitions to guide the reader and show relationships. See a guide to
transitional phrases
.

 

Comments:

 

Awareness of audience and discipline

Writing in an academic voice. See the different facets of an appropriately formal
tone
.

Formatting the paper according to APA style guidelines. See
the course paper template
for correct margins, spacing, font, and more.

 

Comments:

Use of evidence

Using readings, statistics, or data to effectively support a claim. See examples of
integrating evidence
in a paper.

Avoiding quotes. If used, enclose direct quotes in quotation marks. Read about the purpose of
quotation marks
.

Paraphrasing to avoid plagiarizing the source. See
paraphrasing strategies
. (Paraphrase rather than quote—no more than one quote)

Use the most
current evidence
(usually ≤ 5 years old). NURS 4100 / 4105 Position Paper on Health Policy: Death with Dignity Act

 

Comments:

 

Credit to source

Using in-text citations appropriately. See examples of
citations
in APA style.

Setting up your reference list at the end of the paper or Discussion post. See this
reference list overview
.

Formatting the reference entries according to APA style. See common
reference examples
here.

 

Comments:

 

 

Rubric Detail

 

Select 
Grid View
 or 
List View
 to change the rubric’s layout.

Name: 
NURS_4105_Week5_Assignment_Rubric

Grid View

List View

Show Descriptions

Required Content “Introduction presents overview of policy, including background, main policy elements, costs and quality/safety elements.

“
—

Excellent 45 (15%) – 50 (16.67%)

Proficient 40 (13.33%) – 44 (14.67%)

Basic 35 (11.67%) – 39 (13%)

Needs Improvement 0 (0%) – 34 (11.33%)

Required Content Policy is supported with an evidence-based argument. A minimum of two major contributions to health care, nursing, and/or health outcomes are presented.
—

Excellent 76 (25.33%) – 85 (28.33%)

Proficient 68 (22.67%) – 75 (25%)

Basic 59 (19.67%) – 67 (22.33%)

Needs Improvement 0 (0%) – 58 (19.33%)

Required Content An opposing opinion to the suggested policy is presented with evidence.
—

Excellent 36 (12%) – 40 (13.33%)

Proficient 32 (10.67%) – 35 (11.67%)

Basic 28 (9.33%) – 31 (10.33%)

Needs Improvement 0 (0%) – 30 (10%)

Required Content Final position stated supported with current literature.
—

Excellent 36 (12%) – 40 (13.33%)

Proficient 32 (10.67%) – 35 (11.67%)

Basic 28 (9.33%) – 31 (10.33%)

Needs Improvement 0 (0%) – 30 (10%)

Required Content A plan of action with conclusion is presented.
—

Excellent 23 (7.67%) – 25 (8.33%)

Proficient 20 (6.67%) – 22 (7.33%)

Basic 18 (6%) – 19 (6.33%)

Needs Improvement 0 (0%) – 17 (5.67%)

Academic Writing Expectations (AWE 3) 4000 Level “Displays sentence and paragraph level skills: Constructs simple, complex and compound sentences; Writes without spelling, grammatical or syntax errors; Writes without sentence fragments or run on sentences; Uses punctuation appropriately; Writes appropriate introductions and conclusions. Demonstrates essay level skills: Cohesion and flow by using transition sentences; Precision, clarity and academic tone; Awareness of discipline specific audience. NURS 4100 / 4105 Position Paper on Health Policy: Death with Dignity Act. Displays academic expression: Scholarly voice: evidence of the student’s own ideas with a well-organized presentation of evidence; Synthesizes resources by using own words; Uses evidence from course learning resources, scholarly resources and seeks additional resources to support content as required in the assignment, Provided support with 5 additional scholarly articles as sources of evidence. “
—

Excellent 27 (9%) – 30 (10%)

Proficient 24 (8%) – 26 (8.67%)

Basic 21 (7%) – 23 (7.67%)

Needs Improvement 0 (0%) – 20 (6.67%)

APA

“APA Formatting: cover page, title of paper on second page, level headings, Times New Roman 12 font, 1″” margins, and page numbers. APA References: Uses in-text citations appropriately and format correctly. Paraphrases to avoid plagiarizing the source.

Reference list is in alphabetical order, hanging indent, double spaced in format. Each specific entry contains all information required by APA format including author, year of publication, title of publication, pages, DOI, website, as appropriate.” NURS 4100 / 4105 Position Paper on Health Policy: Death with Dignity Act

Excellent 27 (9%) – 30 (10%)

Proficient 24 (8%) – 26 (8.67%)

Basic 21 (7%) – 23 (7.67%)

Needs Improvement 0 (0%) – 20 (6.67%)

Total Points: 300

Name: 
NURS_4105_Week5_Assignment_Rubric

Streptococcal Pharyngitis NURS 6501 Week 1 Discussion: Alterations in Cellular Processes

Week 1 Discussion: Streptococcal Pharyngitis

Streptococcal Pharyngitis

Streptococcal pharyngitis, also known as Strep throat, is a bacterial infection in the throat. The type of bacteria commonly identified in strep throat is group A streptococcus. It presents with symptoms such as sore throat, dysphagia, white exudate on tonsils, enlarged tonsils, fever, and adenopathy. Streptococcal bacteria are contagious and can spread through airborne droplets. Treatment includes oral antibiotics, acetaminophen, and ibuprofen (Strep throat, 2018).

BUY PLAGIARISM-FREE PAPER HERE

It has been found that patients that frequently contract strep throat are correlated with recurrent tonsillitis and a weak immune response to group A streptococcus. Some people are carriers of the Group A strain and there could also be a family history of recurrent streptococcal pharyngitis (Citroner, 2019). Streptococcal Pharyngitis NURS 6501 Week 1 Discussion: Alterations in Cellular Processes

The patient develops a fever in response to the immune system trying to fight the infection. The streptococcal bacteria caused the sore throat, the reddened posterior pharynx, the white exudate on tonsils that were enlarged, and anterior and posterior adenopathy.

The patient was prescribed an antibiotic called Amoxicillin to treat his strep throat. The physiological response to him taking the antibiotic was swelling of the tongue and lips with difficulty breathing; which is known as an allergic reaction. This response occurred due to the immune system overreacting to the allergen, which was the antibiotic. The body produces antibodies called Immunoglobulin E that travel to cells that release a chemical called histamine that caused the symptoms such as difficulty breathing and swelling of the tongue and lips (Allergies 2018).

The cells that are involved in strep throat include epithelial cells, neutrophils, macrophages, and dendritic cells. Epithelial cells are one of the first cells that encounter group A streptococcus pyogenes, also known a GAS, during pharyngeal infection. They enact barrier defenses, secretion of antimicrobial peptides, and innate immune signals (Soderholm et al., 2018). Neutrophils begin to multiple and entrap and kill invading bacteria, such as GAS. Macrophages and dendritic cells activate inflammatory signaling pathways and pathogen recognition to fight against GAS infection (Valderrama & Nizet, 2018).

Children age five through fifteen are more likely to get strep throat. Since the bacteria is highly contagious, close contact with other people such as in schools and daycares increases the risk of getting and spreading the infection. Children also don’t cover their mouth and nose when they sneeze or wash their hands frequently, which contributes to spreading the infection (Worried your sore throat may be strep, 2018).

 

References

Allergies. (2018, January 06). Retrieved June 03, 2020, from https://www.mayoclinic.org/diseases-conditions/allergies/symptoms-causes/syc-20351497

Citroner, G. (2019, February 11). Here’s Why Certain Kids Repeatedly Get Strep Throat. Retrieved June 03, 2020, from https://www.healthline.com/health-news/why-your-kid-keeps-getting-strep-throat

Soderholm, A. T., Barnett, T. C., Korn, O., Rivera-Hernandez, T., Seymour, L. M., Schulz, B. L., . . . Walker, M. J. (2018). Group A Streptococcus M1T1 Intracellular Infection of Primary Tonsil Epithelial Cells Dampens Levels of Secreted IL-8 Through the Action of SpyCEP. 
Frontiers in Cellular and Infection Microbiology,
 
8
. doi:10.3389/fcimb.2018.00160

Strep throat. (2018, September 28). Retrieved June 03, 2020, from https://www.mayoclinic.org/diseases-conditions/strep-throat/symptoms-causes/syc-20350338

Valderrama, J. A., & Nizet, V. (2018). Group A Streptococcus encounters with host macrophages. 
Future Microbiology,13
(1), 119-134. doi:10.2217/fmb-2017-0142

Worried your sore throat may be strep? (2018, November 01). Retrieved June 03, 2020, from https://www.cdc.gov/groupastrep/diseases-public/strep-throat.html

Discussion: Alterations in Cellular Processes

Photo Credit: Getty Images

At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally.

Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans.

For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts.

To prepare:

By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

By Day 3 of Week 1

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.

Read
 a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond
 to 
at least two
 of your colleagues on 
2 different days 
and respectfully agree or disagree with your colleague’s assessment and explain your reasoning. In your explanation, include why their explanations make physiological sense or why they do not

Note:
 For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on 
Submit! Streptococcal Pharyngitis NURS 6501 Week 1 Discussion: Alterations in Cellular Processes

NURS_6501_Discussion_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Main Posting

45 
(45%)
 – 50 
(50%)

Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

40 
(40%)
 – 44 
(44%)

Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Streptococcal Pharyngitis NURS 6501 Week 1 Discussion: Alterations in Cellular Processes

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

35 
(35%)
 – 39 
(39%)

Responds to some of the Discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

0 
(0%)
 – 34 
(34%)

Does not respond to the Discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness

10 
(10%)
 – 10 
(10%)

Posts main post by Day 3.

0 
(0%)
 – 0 
(0%)

N/A

0 
(0%)
 – 0 
(0%)

N/A

0 
(0%)
 – 0 
(0%)

Does not post main post by Day 3.

First Response

17 
(17%)
 – 18 
(18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of Learning Objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

15 
(15%)
 – 16 
(16%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

13 
(13%)
 – 14 
(14%)

Response is on topic and may have some depth.

Responses posted in the Discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

0 
(0%)
 – 12 
(12%)

Response may not be on topic and lacks depth.

Responses posted in the Discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited. Streptococcal Pharyngitis NURS 6501 Week 1 Discussion: Alterations in Cellular Processes

Second Response

16 
(16%)
 – 17 
(17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of Learning Objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.

14 
(14%)
 – 15 
(15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

12 
(12%)
 – 13 
(13%)

Response is on topic and may have some depth.

Responses posted in the Discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

0 
(0%)
 – 11 
(11%)

Response may not be on topic and lacks depth.

Responses posted in the Discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Streptococcal Pharyngitis NURS 6501 Week 1 Discussion: Alterations in Cellular Processes

Participation

5 
(5%)
 – 5 
(5%)

Meets requirements for participation by posting on 3 different days.

0 
(0%)
 – 0 
(0%)

N/A

0 
(0%)
 – 0 
(0%)

N/A

0 
(0%)
 – 0 
(0%)

Does not meet requirements for participation by posting on 3 different days.

Total Points: 100

 

Discussion Post 1

The patient is presenting signs consistent with positive symptoms of sore throat or better called streptococcal pharyngitis. This disease condition is caused by group A streptococcus pyrogen. The infection is indicated by elevated temperature of 99.9, redness of the pharynx which may include exudate, tonsils that are enlarged lymph nodes. Other symptoms of strep throat include pain, difficulty swallowing and breathing problems. Streptococcal Pharyngitis NURS 6501 Week 1 Discussion: Alterations in Cellular Processes

The role genetics plays in the disease:
 It is important to note that genetics play a very important role in the disease process (Keene, Christiensen, & Stiller, 2018). Variations in the DNA and differences in how the DNA function which includes coding for structural proteins that stimulate the biochemical pathways that lead to disease conditions. In the case of sore throat the genetics involvement in the disease process is not clear. It is possible that some families are more susceptible to this disease than others

Why the patient is presenting with the specific symptoms described:
 This disease is usually transmitted through contact with infected person. The person described in the scenario is infected with the bacteria which survives in the pharynx of an infected person. The infection is the reason for the symptoms.

The physiologic response to the stimulus presented in the scenario and why you think this response occurred
: The human body naturally increase body temperature as an innate immune response to fight the growth of any foreign objects found in the body. The toxins produced by the bacteria released into the bloodstream can lead to systemic immune response. The physiologic response here is because of anaphylactic reaction which can be a form of allergic reaction to amoxicillin. The medication acted as allergen and caused the release of histamines and prostaglandins. The swelling, difficulty breathing and other symptoms are signs of allergic reaction.

The cells that are involved in this process
: According to Hammer & Mcphee, (2014) the bacteria pathogen that causes strep throat arrange itself in fragment of red blood cells to avoid detection. It was discovered that Group A Streptococcus (GAS) produces protein named S protein which binds to red blood cells to avoid being destroyed by phagocytic immune cells (Bergamini, 2019)

How another characteristic (e.g., gender, genetics) would change your response:
The condition is most common in children 5- 15 years old. Adults suffer from the condition but at much lower rate. There is no evidence at this time to suggest that gender is a risk factor. As per genetics, it is possible that some family lineage can be more vulnerable to certain disease than others. Streptococcal Pharyngitis NURS 6501 Week 1 Discussion: Alterations in Cellular Processes

 

References

Bergamini, A. (2019). The allergic reaction to carboplatin. 
Cancer & Chemotherapy

            Reviews
, 
14
(4), 69–72.

Hammer, G. D. & Mcphee, S. J. (2014). 
Pathophysiology of Disease: An Introduction to Clinical

            Medicine
 (7th ed.). New York, NY: Mc Graw Hills

Keene, K., Christiensen, T., & Stiller, J. (2018). From DNA to Proteins. 
Science Teacher
, 
86
(1),

35–39. Streptococcal Pharyngitis NURS 6501 Week 1 Discussion: Alterations in Cellular Processes

Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation

Transcript

All Lines (645)
Interview Questions (210)
Statements (41)
Exam Actions (394)

Hello, my name is . I will be conducting an interview and later perform a physical exam.

Greet

07/22/20 5:37 PM EDT

Hey.

What is your name?

Question

07/22/20 5:37 PM EDT

Tina Jones.

Your date of birth?

Question

07/22/20 5:37 PM EDT

February 17th.

How old are you?

BUY PLAGIARISM-FREE PAPER HERE OR SHADOW HEALTH HELP

Question

07/22/20 5:43 PM EDT

I’m 28.

What brought you into the clinic today?

Question

07/22/20 5:43 PM EDT

I came in because I’m required to have a recent physical exam for the health insurance at my new job.

Do you have any current health problem?

Question

07/22/20 5:44 PM EDT

I don’t have anything specific going on today. I mean, I still have asthma and diabetes, but both of those are under control. I’m taking good care of my health these days.

What is your new job? Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation

Question

07/22/20 5:44 PM EDT

I’m going to be an Accounting Clerk at Smith, Stevens, Stewart, Silver & Company. I’ll be helping a more experienced accountant with her clients, and then eventually I’ll get more responsibility, and build my own client list. I start in two weeks–I’m really excited!

That is great.

Empathize

07/22/20 5:45 PM EDT

Thanks.

When was your last physical exam?

Question

07/22/20 5:45 PM EDT

Let’s see . . . I had two doctor’s appointments earlier this year. About five months ago, I came in here for a check-up, and the nurse practitioner got me on metformin. Then a few weeks later I saw a gynecologist for a pap smear.

What did your gynecologist say?

Question

07/22/20 5:45 PM EDT

She said everything looked good, except that I had PCOS, which the nurse here had said was possible. She started me on birth control, and it seems to be helping things.

How often do you take birth control?

Question

07/22/20 5:48 PM EDT

I take it every morning, with breakfast.

What is the name of the birth control pill you took?

Question

07/22/20 5:49 PM EDT

They’re called Yaz.

Has your menstrual cycle improved since taking Yaz?

Question

07/22/20 5:50 PM EDT

Now that I’m on the pill I’m getting my period every month.

That is great. I am glad you are having your period every month.

Empathize

07/22/20 5:50 PM EDT

Thanks.

How long have you had asthma.

Question

07/22/20 5:51 PM EDT

I’ve had asthma a long time. . . since I was really little.

What age were you diagnosed with asthma?

Question

07/22/20 5:51 PM EDT

My doctor told me when I was pretty little… I think I was about two and a half? I used to have a lot of trouble with asthma attacks back then.

I am sorry about the experience.

Empathize

07/22/20 5:52 PM EDT

Thanks.

How do you manage your asthma?

Question

07/22/20 5:52 PM EDT

I try to avoid things that give me breathing problems, but when my asthma starts to act up, I just use my inhaler.

What are your triggers for asthma?

Question

07/22/20 5:53 PM EDT

Being around cats is the worst, but dust and running up stairs can make my breathing bad, too. I haven’t had a full asthma attack in years, though.

It is important to stay away

Educate

07/22/20 5:54 PM EDT

Thanks for telling me.

What happens when you are

Question

07/22/20 5:54 PM EDT

I used to have a reaction when I was in a dusty house for a long time. . . I would get allergies, like sneezing and stuff, and then my asthma would act up. But that hasn’t happened since I got my daily inhaler.

What

Question

07/22/20 5:59 PM EDT

The daily

How often do you use

Question

07/22/20 6:00 PM EDT

Twice a day.

When did you most recently use the flovent inhaler?

Question

07/22/20 6:01 PM EDT

I use my Flovent inhaler two times a day.

When did you last use your inhaler?

Question

07/22/20 6:03 PM EDT

I used my … problems. Once three months ago, and before that it had been months, too.

How much Albuterol do you use?

Question

07

 

 

 

I have a few friends I’ve known since middle or high school, and we’re all pretty close. Plus I have my friends from church.

What is your relationship like with your family?

Question

07/22/20 7:39 PM EDT

Things are pretty good between all of us–we’re a tight knit family. I think we’re pretty special, the way we all get along.

That is great.

Empathize

07/22/20 7:39 PM EDT

Thanks.

Are you involved in church?

Question

07/22/20 7:39 PM EDT

Yeah. We go to First Baptist, and we do a lot with our church community. We socialize before and after church, and I go to Bible study on Wednesdays, too.

Are you feeling stressed?

Question

07/22/20 7:40 PM EDT

I’m actually feeling really good lately. . . not stressed at all.

How do you cope with stress?

Question

07/22/20 7:40 PM EDT

I’ve realized that I got kind of overwhelmed with everything back when I was having those sleep problems. Just coming in and talking to someone here about it helped a little because I felt like I was doing something. So I’ve been trying to address problems as they come when I can, and that helps. That, plus the stuff I’ve always done–going to church, especially–is all working well for me.

That is good to hear.

Empathize

07/22/20 7:40 PM EDT

Thanks.

Are you feeling depressed?

Question

07/22/20 7:41 PM EDT

No, I’m actually feeling really good these days.

How do you feel about your life?

Question

07/22/20 7:41 PM EDT

Well, I’m starting my new job in two weeks, and I’m really excited about that. I’m going to be an Accounting Clerk at this really nice accounting firm. I’m hoping I’ll learn a lot in that position, and within a couple years, I’ll get promoted and be given new responsibilities. I just always want to be learning new things and getting better at my job.

Are you feeling anxious?

Question

07/22/20 7:41 PM EDT

I guess I had anxiety back when I was having those sleep problems. . . I’ve been feeling much better lately, though.

Do you have sleeping problems?

Question

07/22/20 7:42 PM EDT

I’m sleeping a lot better now, which is a relief.

Good to hear.

Empathize

07/22/20 7:42 PM EDT

Thanks.

How many hours are you sleeping a night?

Question

07/22/20 7:42 PM EDT

I’m usually asleep by 11:30, and I wake up at 8, so. . . about 8 or 9 hours a night.

That is great.

Empathize

07/22/20 7:42 PM EDT

Thanks.

Have you ever smoked tobacco?

Question

07/22/20 7:43 PM EDT

No. I think it’s gross.

Have you ever used cocaine?

Question

07/22/20 7:43 PM EDT

No way, I have no interest in that. That stuff can mess you up.

Have you ever used heroin?

Question

07/22/20 7:49 PM EDT

Uh, no.

Have you ever used illegal drugs?

Question

07/23/20 3:17 PM EDT

Well, I used to smoke pot. . . but I don’t do that anymore.

What was the last time you smoked pot?

Question

07/23/20 3:17 PM EDT

I haven’t smoked pot since I was twenty or twenty-one.

Do you have any family history of mental illness?

Question

07/23/20 3:18 PM EDT

No. They’re crazy, but nobody’s diagnosed with anything.

Have you had suicidal thoughts?

Question

07/23/20 3:19 PM EDT

No, I’ve never done that.

Any new family medical history report?

Question

07/23/20 3:20 PM EDT

My mom has some issues, and I think some of my grandparents did, too.

How old is your mom?

Question

07/23/20 3:21 PM EDT

Mom is 50.

What medical problems does your mum have?

Question

07/23/20 3:21 PM EDT

Mom has high cholesterol and blood pressure, I think. She seems to be doing okay though.

What medical problems did your father have?

Question

07/23/20 3:22 PM EDT

He had high blood pressure and cholesterol, and diabetes too…the same kind as me.

How old is your brother?

Question

07/23/20 3:24 PM EDT

He’s almost 27.

Does he have any medical issue? (Clarified to Does your younger sister have health problems?.)

Question

07/23/20 3:25 PM EDT

She’s pretty healthy. She has asthma too, but she almost never has attacks. (Clarified to if my younger sister has health problems.)

Does your bother have health issues? (Clarified to Does your brother have medical problems?.)

Question

07/23/20 3:25 PM EDT

No, I don’t think so. He’s a little big, maybe. (Clarified to if my brother has health issues.)

How old is your maternal grandmother?

Question

07/23/20 3:26 PM EDT

Nana was 73 when she died of a stroke about five years ago. I think she had high blood pressure and cholesterol, too.

How old is your maternal grandfather?

Question

07/23/20 3:27 PM EDT

Poppa died of a heart attack when he was 80. . . he had some blood pressure and cholesterol issues when he was alive, too.

Any medical history for your paternal grandmother?

Question

07/23/20 3:30 PM EDT

She takes some blood pressure pills, and I think she has high cholesterol, but Granny’s doing great for 82.

Does your dad’s father have health issues?

Question

07/23/20 3:30 PM EDT

Grandpa Jones had colon cancer, and that caused all kinds of problems for him. Plus, he had high blood pressure, and…I’m pretty sure he had diabetes.

Have you had any recent illness?

Question

07/23/20 3:31 PM EDT

No. . . the last time I was sick was when I was having those heartburn problems a while ago.

Any fever?

Question

07/23/20 3:32 PM EDT

I haven’t had a fever.

Any chills?

Question

07/23/20 3:32 PM EDT

Nope, no chills.

Any acne?

Question

07/23/20 3:32 PM EDT

I took something for my acne. . . tetracycline, I think, back in high school. Since then I’ve just washed my face, I haven’t used anything special. But my zits have gotten better, and I think it’s because I’m on birth control now.

Has your body hair improved?

Question

07/23/20 3:32 PM EDT

I think I have a little less body hair than I used to.

Do your eyes feel itchy?

Question

07/23/20 3:33 PM EDT

They haven’t been itchy lately at all.

Are you having any redness in your eyes?

Question

07/23/20 3:33 PM EDT

My eyes haven’t been red lately. . . not since I came in with those allergies a while ago.

Are your eyes dry?

Question

07/23/20 3:34 PM EDT

My eyes don’t feel dry.

Do you have any pain in your eyes?

Question

07/23/20 3:34 PM EDT

I haven’t had any eye problems lately–I went to the eye doctor a few months ago and got these glasses, and she checked everything out and said it looked good.

Are you having any ear problems?

Question

07/23/20 3:34 PM EDT

My ears feel fine.

Any changes in your hearing?

Question

07/23/20 3:36 PM EDT

My hearing is good.

Any ear pain?

Question

07/23/20 3:36 PM EDT

My ears feel fine.

Ear drainage? (Clarified to Do you have drainage from your ears?.)

Question

07/23/20 3:36 PM EDT

Nothing is coming out of my ears. (Clarified to if I have ear drainage.)

Any changes in your sense of smell?

Question

07/23/20 3:46 PM EDT

No.

Any nose bleeds?

Question

07/23/20 3:47 PM EDT

Nope, my nose isn’t bleeding at all.

Any sinus pressure?

Question

07/23/20 3:47 PM EDT

My sinuses have been fine.

Has your sense of taste changed?

Question

07/23/20 3:47 PM EDT

No, I think my sense of taste is fine.

Are you having dry mouth?

Question

07/23/20 3:48 PM EDT

My mouth hasn’t been dry.

ANY pain in your mouth?

Question

07/23/20 3:48 PM EDT

No, my mouth feels fine.

ANY sore throat?

Question

07/23/20 3:49 PM EDT

No, it’s fine.

Any issue with your gums?

Question

07/23/20 3:49 PM EDT

My gums have been fine.

Any issue with your tongue?

Question

07/23/20 3:49 PM EDT

My tongue feels fine.

Any difficulties when swallowing?

Question

07/23/20 3:50 PM EDT

I can swallow fine.

SORE throat?

Question

07/23/20 3:50 PM EDT

No, it’s fine.

Any voice changes?

Question

07/23/20 3:50 PM EDT

My voice has been fine.

Any swollen lymph nodes?

Question

07/23/20 3:52 PM EDT

My lymph nodes seem fine.

Are you having any nausea?

Question

07/23/20 3:52 PM EDT

No, I haven’t been nauseous at all.

Any vomiting?

Question

07/23/20 3:53 PM EDT

No.

ANY pain in the abdomen?

Question

07/23/20 3:53 PM EDT

I haven’t really had any stomach problems since I came in with them a while ago.

Any constipation?

Question

07/23/20 3:53 PM EDT

I don’t have that problem.

Any diarrhea?

Question

07/23/20 3:54 PM EDT

I haven’t had any problems with diarrhea.

Excessive flatulence?

Question

07/23/20 3:54 PM EDT

I haven’t been having any gas lately. I had a little when I first started metformin, but I found out I could eat yogurt to help it, and it seems to have worked.

flatulence is one of the side effect of metformin

Educate

07/23/20 3:55 PM EDT

Thanks for telling me.

Any food intolerance

Question

07/23/20 3:56 PM EDT

I can eat just about anything.

Any burning sensation when you urinate?

Question

07/23/20 3:56 PM EDT

No, it doesn’t burn when I pee.

Any blood in your urine?

Question

07/23/20 3:57 PM EDT

No! That doesn’t sound like it would be good.

Are you having any pain right now?

Question

07/23/20 3:57 PM EDT

I don’t have any pain anywhere.

Any vaginal discharge?

Question

07/23/20 3:58 PM EDT

My discharge is normal, I think. . . I have a little, and it’s kind of clear, sometimes white-ish.

Any vaginal itching?

Question

07/23/20 3:58 PM EDT

No, it feels normal.

Do you have any problem with your breasts?

Question

07/23/20 3:59 PM EDT

No, my breasts feel fine.

Any pain in the breasts?

Question

07/23/20 3:59 PM EDT

No, my breasts feel fine.

Are you having any dizziness/

Question

07/23/20 3:59 PM EDT

I haven’t been getting dizzy at all.

Any lightheadedness?

Question

07/23/20 4:00 PM EDT

No, I don’t really get lightheaded.

Any tingling?

Question

07/23/20 4:00 PM EDT

Nope, no tingling.

Any loss of balance?

Question

07/23/20 4:00 PM EDT

My balance is fine.

Any changes in sensation?

Question

07/23/20 4:00 PM EDT

I haven’t noticed any changes.

Any seizures?

Question

07/23/20 4:01 PM EDT

No, I’ve still never had problems with seizures, fortunately.

Do you have memory problems?

Question

07/23/20 4:01 PM EDT

I think my memory has been fine.

Any muscle pain?

Question

07/23/20 4:01 PM EDT

My muscles have felt great, especially since I started exercising more.

Joint pain?

Question

07/23/20 4:02 PM EDT

My joints always seem fine.

Any muscle weakness?

Question

07/23/20 4:02 PM EDT

No, I haven’t felt weak at all.

Any swelling?

Question

07/23/20 4:03 PM EDT

Nothing is swollen.

 Performed pulse oximetry

Exam Action

07/24/20 10:01 AM EDT

 Performed spirometry

Exam Action

07/24/20 10:01 AM EDT

 Inspected scalp

Exam Action

07/24/20 10:01 AM EDT

 Inspected scalp

Exam Action

07/24/20 10:01 AM EDT

 Inspected hair on scalp

Exam Action

07/24/20 10:01 AM EDT

 Inspected scalp

Exam Action

07/24/20 10:01 AM EDT

 Inspected right eyebrow and orbital area

Exam Action

07/24/20 10:02 AM EDT

 Inspected left eyebrow and orbital area

Exam Action

07/24/20 10:02 AM EDT

 Inspected mouth: Oral mucosa moist. Comprehensive Assessment
Tina Jones Shadow Health
Transcript, Subjective, Objective & Documentation

Exam Action

07/24/20 10:02 AM EDT

 

 

 

 

Subjective Data Collection: 50 of 50 (100.0%)

Hover To Reveal…

Hover over the 
Patient Data
 items below to reveal important information, including 
Pro Tips
 and 
Example Questions
.

Found:

Indicates an item that you found.

Available:

Indicates an item that is available to be found.

Category

Scored Items

Experts selected these topics as essential components of a strong, thorough interview with this patient.

Patient Data

Not Scored

A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.

Current Health Status

Finding:

Confirmed reason for visit

Finding:

Reports needing a pre-employment physical

Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation(Found)

Pro Tip: Initially establishing a chief complaint allows the patient to express their reason for seeking care, primary concerns, or condition they are presenting with.

Example Question:

Can I confirm that you are here for a physical?

Finding:

Reports no current acute health problems

(Found)

Pro Tip: Initially establishing a chief complaint allows the patient to express their reason for seeking care, primary concerns, or condition they are presenting with.

Example Question:

Do you have any current health problems?

Finding:

Asked about last visit to a healthcare provider

Finding:

Last visit to a healthcare provider was 4 months ago

(Found)

Pro Tip: Establishing a timeline for which healthcare providers Tina has seen will allow you to develop a comprehensive health history.

Example Question:

When did you see a healthcare provider?

Finding:

Reason for last visit was annual gynecological exam

(Found)

Pro Tip: Establishing a timeline for which healthcare providers Tina has seen will allow you to develop a comprehensive health history. Asking Tina why she saw a healthcare provider might indicate any recent health concerns or problems.

Example Question:

Why did you see a healthcare provider?

Finding:

Last general physical examination was 5 months ago when she was prescribed metformin and daily inhaler

(Found)

Pro Tip: Establishing a timeline for which healthcare providers Tina has seen will allow you to develop a comprehensive health history.

Example Question:

When was your last physical exam? Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation

Finding:

Asked about current prescription medications

Finding:

Reports taking diabetes medication

(Found)

Pro Tip: The medications that a patient takes indicate their health concerns or problems, health literacy, and current treatment plans. Asking Tina if she has been taking medication for her diabetes will indicate her treatment plan and the degree to which she is following it.

Example Question:

Have you been taking medication for your diabetes?

Finding:

Reports using a daily inhaler

(Found)

Pro Tip: The medications that a patient takes indicate their health concerns or problems, health literacy, and current treatment plans. Asking Tina if she still has her inhaler will indicate her treatment plan and the degree to which she is following it.

Example Question:

Do you use a daily inhaler?

Finding:

Reports taking prescription birth control pills

(Found)

Pro Tip: The medications that a patient takes indicate their health concerns or problems, health literacy, and current treatment plans.

Example Question:

Are you taking any form of birth control?

Finding:

Followed up about diabetes medication

Finding:

Medication is metformin

(Found)

Pro Tip: Follow up questions about Tina’s medication history will help you to understand her treatment plan and recent health history.

Example Question:

What is the name of your diabetes medication?

Finding:

Started taking metformin 5 months ago

(Found)

Pro Tip: Follow up questions about Tina’s medication history and timeline will help you to understand her treatment plan and recent health history.

Example Question:

How long have you been taking metformin?

Finding:

Reports that eating probiotic yogurt helps with side effects and they have abated over time

(Found)

Pro Tip: Follow up questions about Tina’s medication history and timeline will help you to understand her treatment plan and recent health history.

Example Question:

Have you noticed any side effects from the metformin?

Finding:

Followed up on metformin frequency and dose

Finding:

Reports taking metformin twice daily

(Found)

Pro Tip: Follow up questions about Tina’s medication history and timeline will help you to understand her treatment plan and recent health history.

Example Question:

How many times a day do you take metformin?

Finding:

Metformin dose is 850 mg

(Found)

Pro Tip: Follow up questions about Tina’s medication history and timeline will help you to understand her treatment plan and recent health history.

Example Question:

What is the dose of your metformin?

Finding:

Asked about asthma medication

Finding:

Reports using Flovent inhaler twice daily

(Found)

Pro Tip: Asthma exacerbation can result in increased wheezing, shortness of breath, and chest tightness. Asking if Tina’s been using her inhaler more frequently since exacerbation can indicate how she’s been treating her symptoms since exacerbation. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation

Example Question:

How often do you use your daily inhaler?

Finding:

Has a Proventil rescue inhaler

(Found)

Pro Tip: The medication that a patient takes reveals a current treatment plan and healthcare access. Asking Tina if she has a rescue inhaler for her asthma will indicate her treatment plan and the degree to which she complies with it.

Example Question:

Do you have a rescue inhaler?

Finding:

Last use of Proventil inhaler was three months ago

(Found)

Pro Tip: Soliciting a shallow history of a patient’s medication history can reveal recent exacerbation. Asking Tina when she last used her inhaler will indicate when her symptoms most recently required medical treatment.

Example Question:

When did you last use your rescue inhaler?

Finding:

Has used Proventil inhaler twice in the last year

(Available)

Pro Tip: Asthma exacerbation can result in increased wheezing, shortness of breath, and chest tightness. Asking if Tina’s been using her inhaler more frequently since exacerbation can indicate how she’s been treating her symptoms since exacerbation.

Example Question:

How often do you use your rescue inhaler?

Finding:

Followed up about birth control prescription

Finding:

Started taking birth control 4 months ago

(Found)

Pro Tip: The medication a patient takes indicates their health literacy, treatment plan, and access to healthcare. Asking Tina how long ago she started taking birth control establishes a timeline of her current treatment plan.

Example Question:

How long ago did you start taking birth control?

Finding:

Reason for birth control was to manage PCOS symptoms

(Found)

Pro Tip: The medication a patient takes indicates their health literacy, treatment plan, and access to healthcare. Asking Tina why she started taking birth control will allow Tina to express any concerns or problems in her own words.

Example Question:

Why did you decide to start taking birth control?

Finding:

Birth control type is Yaz (drospirenone and ethinyl estradiol)

(Found)

Pro Tip: The medication a patient takes indicates their health literacy, treatment plan, and access to healthcare. Confirming the name of Tina’s birth control pill will solicit information about her health history and current treatment plan. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation

Example Question:

What type of birth control do you use?

Finding:

Takes birth control pill daily

(Found)

Pro Tip: Follow up questions about Tina’s birth control prescription can help you to understand how effectively she complies with her treatment plan.

Example Question:

How often do you take your birth control pill?

Finding:

Takes birth control pill at the same time every day

(Found)

Pro Tip: Follow up questions about Tina’s birth control prescription can help you to understand how effectively she complies with her treatment plan.

Example Question:

Do you take your pill at the same time every day?

Finding:

Reports no skipped days

(Available)

Pro Tip: Follow up questions about Tina’s birth control prescription can help you to understand how effectively she complies with her treatment plan.

Example Question:

Have you missed any days of your birth control pill?

Finding:

Asked about current non-prescription medications

Finding:

Reports rare Advil use for cramps

(Found)

Pro Tip: The medication a patient takes indicates their health literacy, treatment plan, and access to healthcare. Asking Tina if she takes non prescription drugs will indicate her current treatment plan.

Example Question:

Do you take Advil?

Finding:

Reports no OTC herbal products

(Found)

Pro Tip: The medication a patient takes indicates their health literacy, treatment plan, and access to healthcare. Asking Tina if she takes herbal products will indicate her current treatment plan.

Example Question:

Do you use any herbal products?

Finding:

Reports no OTC vitamins

(Found)

Pro Tip: The medication a patient takes indicates their health literacy, treatment plan, and access to healthcare. Asking Tina if she takes vitamins will indicate her current treatment plan.

Example Question:

Do you take any vitamins?

Finding:

Reports no OTC supplements

(Found)

Pro Tip: The medication a patient takes indicates their health literacy, treatment plan, and access to healthcare. Asking Tina if she takes supplements will indicate her current treatment plan.

Example Question:

Do you take any supplements?

Finding:

Asked about allergies

Finding:

Confirms allergies

(Found)

Pro Tip: Discerning what’s making Tina’s asthma worse can point to possible triggers like environmental factors, bodily positions, allergies, or movement that may have a bearing on Tina’s breathing. Asking Tina what triggers her allergies will indicate, in part, Tina’s health literacy.

Example Question:

Can you confirm your allergies?

Finding:

Reports no new allergies

(Found)

Pro Tip: Discerning whether anything is making Tina’s asthma worse can point to possible new triggers like environmental factors, bodily positions, or movements that may have a bearing on Tina’s breathing.

Example Question:

Have you noticed any new allergies?

Finding:

Followed up on seasonal allergies

Finding:

Reports no recent seasonal allergy symptoms

(Found)

Pro Tip: Discerning whether anything is making Tina’s asthma worse can point to possible triggers like environmental factors, bodily positions, or movements that may have a bearing on Tina’s breathing.

Example Question:

Have you been having seasonal allergies?

Finding:

Reports no current medication for allergies

(Found)

Pro Tip: Tina’s response to a question about managing her allergies will reveal the severity of her symptoms, her health literacy, and the way she’s complied with previous treatment plans.

Example Question:

Are you taking any medication for your allergies?

Finding:

Asked about diabetes

Finding:

Reports managing diabetes with diet and exercise in addition to medication

(Found)

Pro Tip: Tina’s response to a question about managing her diabetes will reveal the severity of her symptoms, her health literacy, and the way she’s complied with previous treatment plans. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation

Example Question:

How are you managing your diabetes?

Finding:

Asked about blood glucose monitoring

Finding:

Reports checking blood sugar once a day

(Found)

Pro Tip: Tina’s response to a question about managing her diabetes will reveal the severity of her symptoms, her health literacy, and the way she’s complied with previous treatment plans.

Example Question:

How often do you monitor your blood glucose?

Finding:

Checks sugar in the morning

(Found)

Pro Tip: Tina’s response to a question about managing her diabetes will reveal the severity of her symptoms, her health literacy, and the way she’s complied with previous treatment plans.

Example Question:

When do you check your blood glucose?

Finding:

Blood sugar number is usually around 90

(Found)

Pro Tip: Tina’s response to a question about managing her diabetes will reveal the severity of her symptoms, her health literacy, and the way she’s complied with previous treatment plans.

Example Question:

What is your average blood sugar number?

Finding:

Reports having adequate supplies

 

 

Objective Data Collection: 70 of 73 (95.9%)

Hover To Reveal…

Hover over the 
Patient Data
 items below to reveal important information, including 
Pro Tips
.

Found:

 Indicates an item that you found.

Available:

 Indicates an item that is available to be found.

Category

Scored Items

Experts selected these examinations as essential components of objective data collection for this patient.

Patient Data

Not Scored

Thorough examinations will yield better patient data. The following actions reveal the objective data of the patient’s case. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation

HEENT

Finding:

Inspected head and neck

Finding:

Scattered pustules on face and facial hair on upper lip

(Found)

Pro Tip: Inspecting the facial skin for the presence of discoloration, lesions, or abnormal hair growth assesses for underlying medical problems.

Example Question:

Finding:

Head is normocephalic, atraumatic

(Found)

Pro Tip: Because your patient may have unknowingly hit her head during her fall, giving special attention to your observation of the size and the shape of your patient’s head can identify any indications of trauma.

Example Question:

Finding:

Normal scalp hair distribution

(Found)

Pro Tip: It’s important to inspect your patient’s hair for distribution, color, and texture because abnormal hair growth or characteristics can indicate underlying health problems.

Example Question:

Finding:

Acanthosis nigricans noted on neck

(Available)

Pro Tip: Skin changes are common in patients with uncontrolled diabetes. A thorough inspection should be conducted of your patient’s skin, especially in folds around the neck, axilla, and groin.

Example Question:

Finding:

Inspected eyebrows and orbital area

Finding:

Right eye: equal hair distribution on lashes and eyebrows, lids without lesions, no ptosis or edema

(Found)

Pro Tip: Examining the external eye for hair distribution, coloration, edema, lesions, and ptosis identifies abnormalities that can indicate infection or underlying conditions.

Example Question:

Finding:

Left eye: equal hair distribution on lashes and eyebrows, lids without lesions, no ptosis or edema

(Found)

Pro Tip: Examining the external eye for hair distribution, coloration, edema, lesions, and ptosis identifies abnormalities that can indicate infection or underlying conditions.

Example Question:

Finding:

Palpated scalp

Finding:

No masses

(Found)

Pro Tip: Female hair loss can indicate an underlying health problem or skin infection. Inspecting the scalp and hair for texture, distribution, and quantity helps to identify lesions or masses.

Example Question:

Finding:

Palpated sinuses

Finding:

No frontal sinus tenderness

(Found)

Pro Tip: Palpating the frontal sinuses checks for sinusitis.

Example Question:

Finding:

No maxillary sinus tenderness

(Found)

Pro Tip: Palpating the maxillary sinuses checks for sinusitis.

Example Question:

Finding:

Palpated jaw

Finding:

No clicks, full ROM

(Found)

Pro Tip: Palpating the jaw checks for crepitus can identify TMJ or injury.

Example Question:

Finding:

Palpated lymph nodes

Finding:

No axillary lymphadenopathy

(Found)

Pro Tip: Palpating the lymph nodes helps to identify characteristics relaying information about inflammation, infection, and malignancy.

Example Question:

Finding:

No supraclavicular lymphadenopathy

(Found)

Pro Tip: Palpating the lymph nodes helps to identify characteristics relaying information about inflammation, infection, and malignancy. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation

Example Question:

Finding:

Palpated thyroid

Finding:

Thyroid smooth without nodules, no goiter

(Found)

Pro Tip: Palpating the thyroid gland for size, shape, and consistency, and noting any nodules or tenderness, helps to identify signs of a thyroid disorder.

Example Question:

Finding:

Inspected eyelids and conjunctiva

Finding:

Upper eyelids: conjunctiva pink, no lesions, white sclera

(Found)

Pro Tip: Inspecting the conjunctiva and sclera for color changes, swelling, and increased vascularity helps to identify an infection or underlying condition.

Example Question:

Finding:

Lower eyelids: conjunctiva pink, no lesions, white sclera

(Found)

Pro Tip: Inspecting the conjunctiva and sclera for color changes, swelling, and increased vascularity helps to identify an infection or underlying condition.

Example Question:

Finding:

Tested PERRL with penlight

Finding:

Right pupil: equal, round, reactive to light

(Found)

Pro Tip: When inspecting the pupils for size, shape, symmetry, and reaction to light, unequal or unreactive pupils can indicate significant underlying health problems.

Example Question:

Finding:

Left pupil: equal, round, reactive to light

(Found)

Pro Tip: When inspecting the pupils for size, shape, symmetry, and reaction to light, unequal or unreactive pupils can indicate significant underlying health problems.

Example Question:

Finding:

Tested eye movements

Finding:

Normal convergence

(Found)

Pro Tip: This test accommodation assesses the eye’s ability to focus on close objects.

Example Question:

Finding:

EOMs intact bilaterally, no nystagmus

(Found)

Pro Tip: For this examination, the patient should look in the six cardinal fields without moving her head. Lag, nystagmus, and deviations may indicate neurologic conditions.

Example Question:

Finding:

Tested peripheral vision

Finding:

Peripheral vision intact in both eyes, all fields

(Found)

Pro Tip:

Example Question:

Finding:

Inspected interior eyes with ophthalmoscope

Finding:

Mild retinopathic changes on right

(Found)

Pro Tip: Patients with diabetes are at risk for diabetic retinopathy. By visualizing the fundus, you can look for any retinopathic changes.

Example Question:

Finding:

Left fundus with sharp disc margins, no hemorrhages

 

 

 

 

Finding:

Palpated abdomen – deep

Finding:

Right upper quadrant: no masses, guarding or rebound

(Found)

Pro Tip: Performing deep palpation determines the shape, consistency, tenderness, and pulsations of abdominal masses.

Example Question:

Finding:

Right lower quadrant: no masses, guarding or rebound

(Found)

Pro Tip: Performing deep palpation determines the shape, consistency, tenderness, and pulsations of abdominal masses. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation

Example Question:

Finding:

Left upper quadrant: no masses, guarding or rebound

(Found)

Pro Tip: Performing deep palpation determines the shape, consistency, tenderness, and pulsations of abdominal masses.

Example Question:

Finding:

Left lower quadrant: no masses, guarding or rebound

(Found)

Pro Tip: Performing deep palpation determines the shape, consistency, tenderness, and pulsations of abdominal masses.

Example Question:

Finding:

Palpated organs

Finding:

Liver: palpable 1 cm below right costal margin

(Found)

Pro Tip: Palpating the liver identifies enlargement, displacement, tenderness, and consistency, which can indicate important health problems.

Example Question:

Finding:

Spleen: not palpable

(Found)

Pro Tip: Palpating the spleen identifies enlargement or displacement, which can indicate a number of serious health conditions.

Example Question:

Finding:

Right kidney: not palpable, no masses

(Found)

Pro Tip: Healthy kidneys are not usually palpable. Attempting to palpate the kidney helps determine enlargement or tenderness.

Example Question:

Finding:

Left kidney: not palpable, no masses

(Found)

Pro Tip: Healthy kidneys are not usually palpable. Attempting to palpate the kidney helps determine enlargement or tenderness.

Example Question:

Musculoskeletal

Finding:

Inspected neck

Finding:

Neck without swelling, masses, or deformity

(Available)

Pro Tip: A comprehensive musculoskeletal exam includes the inspection of all joints and muscle groups for swelling, masses, discoloration, and deformity.

Example Question:

Finding:

Inspected upper extremities

Finding:

Right shoulder without swelling, masses, or deformity

(Found)

Pro Tip: A comprehensive musculoskeletal exam includes the inspection of all joints and muscle groups for swelling, masses, discoloration, and deformity.

Example Question:

Finding:

Right arm without swelling, masses, or deformity

(Found)

Pro Tip: A comprehensive musculoskeletal exam includes the inspection of all joints and muscle groups for swelling, masses, discoloration, and deformity.

Example Question:

Finding:

Right elbow without swelling, masses, or deformity

(Found)

Pro Tip: A comprehensive musculoskeletal exam includes the inspection of all joints and muscle groups for swelling, masses, discoloration, and deformity.

Example Question:

Finding:

Right wrist and hand without swelling, masses, or deformity

(Found)

Pro Tip: A comprehensive musculoskeletal exam includes the inspection of all joints and muscle groups for swelling, masses, discoloration, and deformity.

Example Question:

Finding:

Left shoulder without swelling, masses, or deformity

(Found)

Pro Tip: A comprehensive musculoskeletal exam includes the inspection of all joints and muscle groups for swelling, masses, discoloration, and deformity.

Example Question:

Finding:

Left arm without swelling, masses, or deformity

(Found)

Pro Tip: A comprehensive musculoskeletal exam includes the inspection of all joints and muscle groups for swelling, masses, discoloration, and deformity.

Example Question:

Finding:

Left elbow without swelling, masses, or deformity

(Found)

Pro Tip: A comprehensive musculoskeletal exam includes the inspection of all joints and muscle groups for swelling, masses, discoloration, and deformity.

Example Question:

Finding:

Left wrist and hand without swelling, masses, or deformity

(Found)

Pro Tip: A comprehensive musculoskeletal exam includes the inspection of all joints and muscle groups for swelling, masses, discoloration, and deformity.

Example Question:

Finding:

Fingernails: no ridges or abnormalities in nails, pink nailbeds

(Found)

Pro Tip: Nail appearance suggests the status of respiratory and vascular function and the presence of nutrient deficiencies or diseases. This is especially important to assess in your patient because diabetics are at risk for peripheral vascular disease. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation

Example Question:

Finding:

Inspected hips

Finding:

Hips without swelling, masses, or deformity

(Found)

Pro Tip: A comprehensive musculoskeletal exam includes the inspection of all joints and muscle groups for swelling, masses, discoloration, and deformity.

Example Question:

Finding:

Inspected lower extremities

Finding:

Right leg without swelling, masses, or deformity

(Found)

Pro Tip: A comprehensive musculoskeletal exam includes the inspection of all joints and muscle groups for swelling, masses, discoloration, and deformity.

Example Question:

Finding:

Right knee without swelling, masses, or deformity

(Found)

Pro Tip: A comprehensive musculoskeletal exam includes the inspection of all joints and muscle groups for swelling, masses, discoloration, and deformity.

Example Question:

Finding:

Right ankle without swelling, masses, deformity, or discoloration

(Found)

Pro Tip: A thorough inspection of your patient’s affected ankle aids in the estimation of the extent of tissue injury and disability.

Example Question:

Finding:

Right foot without swelling, masses, or deformity

(Found)

Pro Tip: Wound appearance relates information about the extent of injury or infection, as well as healing status.

Example Question:

Finding:

Left leg without swelling, masses, or deformity

(Found)

Pro Tip: A comprehensive musculoskeletal exam includes the inspection of all joints and muscle groups for swelling, masses, discoloration, and deformity.

Example Question:

Finding:

Left knee without swelling, masses, or deformity

(Found)

Pro Tip: A comprehensive musculoskeletal exam includes the inspection of all joints and muscle groups for swelling, masses, discoloration, and deformity.

Example Question:

Finding:

Left ankle without swelling, masses, or deformity

(Found)

Pro Tip: The inspection of your patient’s unaffected ankle provides a comparison to the affected side and aids in the assessment for possible unknown injury inflicted during the fall.

Example Question:

Finding:

Left foot without swelling, masses, or deformity

(Found)

Pro Tip: Your patient has diabetes and may unknowingly have wounds on her unindicated foot due to possible neuropathy.

Example Question:

Finding:

Toenails: no ridges or abnormalities in nails, pink nailbeds

(Found)

Pro Tip: Nail appearance suggests the status of respiratory and vascular function and the presence of nutrient deficiencies or diseases. This is especially important to assess in your patient because diabetics are at risk for peripheral vascular disease.

Example Question:

Finding:

Tested ROM for upper extremities

Finding:

Right and left shoulders: full ROM

(Found)

Pro Tip: Assessing range of motion of each major joint noting any limitations in mobility, pain, or crepitation can identify joint disease or injury. The assessment should also include the comparison of bilateral sides.

Example Question:

Finding:

Right and left elbows: full ROM

(Found)

Pro Tip: Assessing range of motion of each major joint noting any limitations in mobility, pain, or crepitation can identify joint disease or injury. The assessment should also include the comparison of bilateral sides.

Example Question:

Finding:

Right and left wrists: full ROM

(Found)

Pro Tip: Assessing range of motion of each major joint noting any limitations in mobility, pain, or crepitation can identify joint disease or injury. The assessment should also include the comparison of bilateral sides.

Example Question:

Finding:

Tested ROM for spine

Finding:

Rotate left: full ROM

(Found)

Pro Tip: Assessing range of motion of each major joint noting any limitations in mobility, pain, or crepitation can identify joint disease or injury. The assessment should also include the comparison of bilateral sides.

Example Question:

Finding:

Rotate right: full ROM

(Found)

Pro Tip: Assessing range of motion of each major joint noting any limitations in mobility, pain, or crepitation can identify joint disease or injury. The assessment should also include the comparison of bilateral sides.

Example Question:

Finding:

Extension: full ROM

(Found)

Pro Tip: Assessing range of motion of each major joint noting any limitations in mobility, pain, or crepitation can identify joint disease or injury. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation

Example Question:

Finding:

Flexion: full ROM

 

 

 

 

Documentation / Electronic Health Record

Documentation

Vitals

Student Documentation

Model Documentation

128/82 mm Hg (97.3 MAP) HR 78 SpO2 99% RR 15 Temperature 37.2 c Weight 84 kgs

• Height: 170 cm • Weight: 84 kg • BMI: 29.0 • Blood Glucose: 100 • RR: 15 • HR: 78 • BP:128 / 82 • Pulse Ox: 99% • Temperature: 99.0 F

Health History

Student Documentation

Model Documentation

Identifying Data & Reliability

The patient is a 28-year-old female who presented for a pre-employment physical exam. She provided the health information freely during the interview. Ms. Jones’ speech is clear and coherent

Ms. Jones is a pleasant, 28-year-old African American single woman who presents for a pre-employment physical. She is the primary source of the history. Ms. Jones offers information freely and without contradiction. Speech is clear and coherent. She maintains eye contact throughout the interview.

General Survey

Ms. Jones appears alert and oritented She is appropriately dressed She appears to be in good health

Ms. Jones is alert and oriented, seated upright on the examination table, and is in no apparent distress. She is well-nourished, well-developed, and dressed appropriately with good hygiene.

Reason for Visit

Ms. Jones visited to have a physical exam for the health insurance at her new workplae

“I came in because I’m required to have a recent physical exam for the health insurance at my new job.”

History of Present Illness

Ms. Jones reported that she recently got a job at a new place and she is required to obtain a physical examination. She does not have any acute cincerns She was diagnosed with PCOS and oral contraceptives were prescribed She had type 2 diabetes and asthma She reports positive lifestyle modifications

Ms. Jones reports that she recently obtained employment at Smith, Stevens, Stewart, Silver & Company. She needs to obtain a pre-employment physical prior to initiating employment. Today she denies any acute concerns. Her last healthcare visit was 4 months ago, when she received her annual gynecological exam at Shadow Health General Clinic. Ms. Jones states that the gynecologist diagnosed her with polycystic ovarian syndrome and prescribed oral contraceptives at that visit, which she is tolerating well. She has type 2 diabetes, which she is controlling with diet, exercise, and metformin, which she just started 5 months ago. She has no medication side effects at this time. She states that she feels healthy, is taking better care of herself than in the past, and is looking forward to beginning the new job.

Medications

Metformin 850 PO BID Flovent 2 puffs 88 mcg/spray BID Albuterol 90 mcg/spray MDI 2 puffs Q4H Drospirenone PO QD

• Fluticasone propionate, 110 mcg 2 puffs BID (last use: this morning) • Metformin, 850 mg PO BID (last use: this morning) • Drospirenone and ethinyl estradiol PO QD (last use: this morning) • Albuterol 90 mcg/spray MDI 2 puffs Q4H prn (last use: three months ago) • Acetaminophen 500-1000 mg PO prn (headaches) • Ibuprofen 600 mg PO TID prn (menstrual cramps: last taken 6 weeks ago)

Allergies

Allergic to cats and dust Allergiic to penicillin Denies any food or latex allergy

• Penicillin: rash • Denies food and latex allergies • Allergic to cats and dust. When she is exposed to allergens she states that she has runny nose, itchy and swollen eyes, and increased asthma symptoms.

Medical History

Diagnosed with asthma at 2 1/2 years DIagnosed with diabetes at age 24 years Last asthma exacerbation 3 months ago Diagnosed with PCOS four months ago and take Yaz Has a history of hypertension Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation

Asthma diagnosed at age 2 1/2. She uses her albuterol inhaler when she is around cats. Her last asthma exacerbation was three months ago, which she resolved with her inhaler. She was last hospitalized for asthma in high school. Never intubated. Type 2 diabetes, diagnosed at age 24. She began metformin 5 months ago and initially had some gastrointestinal side effects which have since dissipated. She monitors her blood sugar once daily in the morning with average readings being around 90. She has a history of hypertension which normalized when she initiated diet and exercise. No surgeries. OB/GYN: Menarche, age 11. First sexual encounter at age 18, sex with men, identifies as heterosexual. Never pregnant. Last menstrual period 2 weeks ago. Diagnosed with PCOS four months ago. For the past four months (after initiating Yaz) cycles regular (every 4 weeks) with moderate bleeding lasting 5 days. Has new male relationship, sexual contact not initiated. She plans to use condoms with sexual activity. Tested negative for HIV/AIDS and STIs four months ago.

 

 

 

 

Neurological

Student Documentation

Model Documentation

Subjective

Denies any dizinness, ligh-headedness, loss of sensation, tingling, numbness Denies any seizures or sense of disequilibrium

Reports no dizziness, light-headedness, tingling, loss of coordination or sensation, seizures, or sense of disequilibrium.

Objective

Normal graphesthesia, stereognosis and rapid alternating movements bilaterallly Tests of cerebellar function normal DRTs and equal bilaterally in upper and lower extremities Reduced sensation to monofilament in bilateral plantar surfaces

Normal graphesthesia, stereognosis, and rapid alternating movements bilaterally. Tests of cerebellar function normal. DTRs 2+ and equal bilaterally in upper and lower extremities. Decreased sensation to monofilament in bilateral plantar surfaces.

Skin, Hair & Nails

Student Documentation

Model Documentation

Subjective

Reports imporved acne due to use of oral contraceptives Facial and body hair imporved Denies any nail or hair changes

Reports improved acne due to oral contraceptives. Skin on neck has stopped darkening and facial and body hair has improved. She reports a few moles but no other hair or nail changes.

Objective

Scattered pustules on face Facial hair on upper lip Acanthos nigricans on posterior neck Nails free of any abnormalities or ridges

Scattered pustules on face and facial hair on upper lip, acanthosis nigricans on posterior neck. Nails free of ridges or abnormalities. Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation

Knowledge Check: Cardiovascular and Respiratory Disorders

Knowledge Check: Cardiovascular and Respiratory Disorders

In this exercise, you will complete a 10- to 20-question Knowledge Check to gauge your understanding of this module’s content. This Knowledge Check will give you an opportunity to review a given scenario or situation to help you to determine cause and effect of a given disorder from a pathophysiology perspective. Please note that this is a formative practice for you to help you better prepare for your Midterm and Final Exam.

Possible topics covered in this Knowledge Check include:

myocardial infarction

endocarditis

myocarditis

valvular disorders

lipid panels

coagulation

clotting cascade

deep vein thrombosis

hypertension

heart failure

COPD

asthma

pneumonias

BUY PLAGIARISM-FREE PAPER HERE

To prepare:

To access your Knowledge Check for this Module, click on the
Module Knowledge Checks
link below. You will be redirected to the Blackboard classroom Knowledge Checks page.

Click on this
Module’s Knowledge Check
from the Blackboard classroom Knowledge Checks page.

The Module Knowledge Check will open in a new browser window. Ensure that your browser is allowing pop-ups.

Complete the questions for each scenario. Knowledge Check: Cardiovascular and Respiratory Disorders

Note
: You may exit and resume the Knowledge Check at any time.

To
exit
the Knowledge Check without completing the activity, close the browser window.

To
resume
the Knowledge Check, click on the Knowledge Checks link from the Blackboard navigation bar or click on the Module Knowledge Checks link below. Knowledge Check: Cardiovascular and Respiratory Disorders

Once you finalize your Knowledge Check and you are satisfied with your responses, 
print your results
from the last slide in your Knowledge Check.

You will see specific
directions
for 
creating a PDF
 file to submit for scoring in the
Submission Information
area below.

Note: 
You may submit your Knowledge Check results file at any time during this week. However, it must be submitted by 
Day 7 of Week 3
. Knowledge Check: Cardiovascular and Respiratory Disorders

NURS-6052 Assignment: Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Assignment: Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?

In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.

BUY PLAGIARISM-FREE PAPER HERE

To Prepare:

Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.

Develop a PICO(T) question to address the clinical issue of interest for the Assignment.

Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.

Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment
 (Evidence-Based Project)

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

Identify and briefly describe your chosen clinical issue of interest.

Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.

Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.

Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.

Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples. NURS-6052 Assignment: Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

By Day 7 of Week 5

Submit
 Part 3 of your Evidence-Based Project.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the naming convention “WK5Assgn+last name+first initial.(extension)” as the name.

Click the 
Week 5 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Week 5 Assignment 
link. You will also be able to “View Rubric” for grading criteria from this area.

Next, from the Attach File area, click on the 
Browse My Computer
 button. Find the document you saved as “WK5Assgn+last name+first initial.(extension)” and click 
Open
.

If applicable: From the Plagiarism Tools area, click the checkbox for 
I agree to submit my paper(s) to the Global Reference Database
.

Click on the 
Submit
button to complete your submission. NURS-6052 Assignment: Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Due to the nature of this assignment, your instructor may require more than 5 days to provide you with quality feedback.

NURS_6052_Module03_Week05_Assignment_Rubric

Grid View

List View

Excellent

Good

Fair

Poor

Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

·   Identify and briefly describe your chosen clinical issue of interest.

·   Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.

·   Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.

·   Provide APA citations of the four peer-reviewed articles you selected.

·   Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

81 
(81%)
 – 90 
(90%)

The presentation clearly and accurately identifies and describes in detail the chosen clinical issue of interest.

The presentation clearly and accurately describes in detail the developed PICO(T) question.

The presentation clearly and accurately identifies four or more research databases used to conduct a search for the peer-reviewed articles selected.

The presentation clearly and accurately provides full APA citations for at least four peer-reviewed articles selected, including a thorough and detailed explanation of the strengths of using systematic reviews for clinical research.

The presentation includes specific and relevant examples that fully support the research.

The presentation provides a complete, detailed, and accurate synthesis of two outside resources related to the peer-reviewed articles selected, and fully integrates at least two outside resources and two or three course-specific resources that fully support the presentation.

72 
(72%)
 – 80 
(80%)

The presentation accurately identifies and describes the chosen clinical issue of interest.

The presentation accurately describes the developed PICO(T) question focused on the chosen clinical issue of interest.

The presentation accurately identifies at least four research databases used to conduct a search for the peer-reviewed articles selected.

The presentation accurately provides APA citations for at least four peer-reviewed articles selected, including an adequate explanation of the strengths of using systematic reviews for clinical research.

The presentation includes relevant examples that support the research presented.

NURS-6052 Assignment: Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

The presentation provides an accurate synthesis of at least one outside resource related to the peer-reviewed articles selected. The response integrates at least one outside resource and two or three course-specific resources that may support the presentation.

63 
(63%)
 – 71 
(71%)

The presentation inaccurately or vaguely identifies and describes the chosen clinical issue of interest.

The presentation inaccurately or vaguely describes the developed PICO(T) question focused on the chosen clinical issue of interest.

The presentation inaccurately or vaguely identifies at least four research databases used to conduct a search for the peer-reviewed articles selected.

The presentation inaccurately or vaguely provides APA citations for at least four peer-reviewed articles selected, including an inaccurate or vague explanation of the strengths of using systematic reviews for clinical research.

The presentation includes inaccurate or vague examples to support the research presented.

The presentation provides a vague or inaccurate synthesis or outside resources related to the peer-reviewed articles selected. The response minimally integrates resources that may support the presentation.

0 
(0%)
 – 62 
(62%)

The presentation inaccurately and vaguely identifies and describes the chosen clinical issue of interest or is missing.

The presentation inaccurately and vaguely describes the developed PICO(T) question, or is missing.

The presentation inaccurately and vaguely identifies less than four research databases used to conduct a search for the peer-reviewed articles selected or is missing.

The presentation inaccurately and vaguely provides APA citations for at least four peer-reviewed articles selected, including an inaccurate and vague explanation of the strengths of using systematic reviews for clinical research, or is missing.

The presentation includes inaccurate and vague examples to support the research presented or is missing.

The presentation provides a vague and inaccurate synthesis of no outside resources related to the articles selected and fails to integrate any resources to support the presentation or is missing.

Written Expression and Formatting—Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided, which delineates all required criteria.

5 
(5%)
 – 5 
(5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided, which delineates all required criteria.

4 
(4%)
 – 4 
(4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

Purpose, introduction, and conclusion of the assignment is stated yet is brief and not descriptive.

3.5 
(3.5%)
 – 3.5 
(3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60–79% of the time.

Purpose, introduction, and conclusion of the assignment is vague or off topic. NURS-6052 Assignment: Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews

0 
(0%)
 – 3 
(3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion are provided. Written Expression and Formatting—English Writing Standards: Correct grammar, mechanics, and proper punctuation. 5  (5%)  – 5  (5%) Uses correct grammar, spelling, and punctuation with no errors. 4  (4%)  – 4  (4%) Contains a few (one or two) grammar, spelling, and punctuation errors. NURS-6052 Assignment: Evidence-Based Project, Part 3: Advanced Levels of Clinical Inquiry and Systematic Reviews 3.5  (3.5%)  – 3.5  (3.5%) Contains several (three or four) grammar, spelling, and punctuation errors. 0  (0%)  – 3  (3%) Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. Total Points: 100