Category: Nursing

NRNP 6552 Different Roles of the Nurse Practitioner Discussion essay

Discussion: Different Roles of the Nurse Practitioner

The term ‘history” is broad in meaning. Within that broad framework archeologists tend to focus their careers on various specialties and areas of interest, such as specific historical eras or geographical areas.

So it is with nurses. Within the broad framework of healthcare, nurse practitioners focus their careers on various roles. These roles may in part be based on narrower areas of interest such as women’s health. Careers also focus on selected technical nursing specialties NRNP 6552 Different Roles of the Nurse Practitioner Discussion essay.

Photo Credit: Getty Images/Blend Images

For this Discussion, you will explore your professional interests and those interests are addressed in specific guidelines and competencies. You also examine the different nurse practitioner roles related to women’s health and how these roles might impact the way you work.

To prepare:

Review the modular structure of this course and reflect on how each module defines the specific skills needed as an advanced Nurse Practitioner (NP).

Review the ANA guidelines, NP competencies, and the Ethic resources found in this week’s Learning Resources and consider how they impact the work of the NP.

By Day 3

Post a brief explanation about the differences in roles related to a CRNP, a CNM, and a PA and how each of these roles might impact the how you practice as a FNP. Be specific and provide examples.

Read
 a selection of your colleagues’ responses.

By Day 6

Respond to at least 
two
 of your colleagues’ posts on 
two different days 
and
 
provide additional insight to your colleagues related to issues and topics they may want to also consider. Use the Learning Resources and/or the best available evidence from current literature to support your explanation NRNP 6552 Different Roles of the Nurse Practitioner Discussion essay.

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!

Main Discussion

The role of the mid-level practitioner varies based on their scope of practice, and this can differ state by state. Certified Registered Nurse Practitioners (CRNP) and Certified Nurse Midwives (CNM) are recognized roles as Advanced Practice Registered Nurses (APRN) (ANA, 2021). Nurse Practitioners (NP) select a population focus, with specialty tracks guiding the type of care they will deliver within the community. In the United States, a CNM graduates from a nurse-midwifery program with a goal to promote health and provide care to all women throughout their lifespan (Zhou and Lu, 2018). A Physician Assistant’s education entails a comprehensive approach to general medicine, formed under a medical model that is designed to complement medical doctors (AAPA, 2021). When looking at the utilization of costs for complex patients, as a primary care provider (PCP), NPs and PAs were associated with lower healthcare costs and less use of acute care services; however, there can be different clinical approaches to management that may stem from their educational models (Morgan et al., 2019). Following evidence-based practice is imperative regardless of the approach to the treatment and plan of care NRNP 6552 Different Roles of the Nurse Practitioner Discussion essay.

Observing these different roles can provide insight and impact the practice of a Family Nurse Practitioner (FNP) student. Educational backgrounds and practical experience can provide an excellent learning platform. Nurse Practitioners are often primary care providers, and in states with independent practice, this is often promoted within the healthcare organization (Poghosyan et al., 2017). Specialties, such as a preceptorship with a CNM, can provide an excellent opportunity to hone women’s health skills, such as contraception counseling, preventative care including PAP smears, clinical breast exams, prenatal and postpartum care. Learning from a PA can provide greater insight into general medicine. Every encounter offers a learning opportunity, and each preceptor can teach you something if you keep an open mind and are willing to learn.

References

American Academy of Physician Assistants (AAPA). (2021). How are Pas different from nurse practitioners (NPs)? https://www.aapa.org/what-is-a-pa/

American Nurses Association (ANA) (2021). Recognition of a nursing specialty, approval of a specialty nursing scope of practice statement, acknowledgment of specialty nursing standards of practice, and affirmation of focused practice competencies. 
https://www.nursingworld.org/~49d755/globalassets/practiceandpolicy/scope-of-practice/3sc-booklet-2021-june.pdf

Morgan, P., Smith, V., Berkowitz, T., Edelman, D., VanHoutven, C., Woolson, S., Hendrix, C., Everett, C., White, B., Jackson, G. (2019). Primary care: impact of physicians, nurse practitioners, ad physician assistants on utilization and costs for complex patients. 
Health Affairs
, 
38
(6), 733–739. 
https://pubmed.ncbi.nlm.nih.gov/31866788/

Poghosyan, L., Liu, J., & Norful, A. A. (2017). Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study. 
International journal of nursing studies
, 
74
, 1–7. 
https://doi.org/10.1016/j.ijnurstu.2017.05.004

Zhou, N., & Lu, H. (2018). A review and comparison of midwifery management and education in five representative countries. 
International journal of nursing sciences
, 
5
(1), 10–14. 
https://doi.org/10.1016/j.ijnss.2017.12.007

 

sample 2

There are several specialized roles that an Advanced Practice Nurse (APRN) can select for clinical practice.  When it comes to women’s health, there are 3 roles to choose from which include Certified Professional Midwife/CPM, Certified Nurse Midwife/CNM, or a Certified Midwife. Each of these roles can provide women with holistic services (Winter et al., 2020).

The scope of practice for each discipline is designated in the APRN’s practicing state (Yang, 2020). The role of the Certified Professional Mid-Wife (CPM) is unique because the APRN must have experience in the field. In addition, the nurse is certified by a midwifery credentialing agency (Marzalik, Feltham, Jefferson, & Pekin, 2018). If you work as a CPM, you could be in a position of providing services to patients in their homes until her child is born NRNP 6552 Different Roles of the Nurse Practitioner Discussion essay.

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A Certified Nurse Midwife or CNM is also an APRN’s who graduates with at least with a master’s level degree from a school with an approved Nurse-Midwife nursing program (Marzalik, Feltham, Jefferson, & Pekin, 2018). The candidate must pass the national Certified Nurse Midwife Examination and maintain continuing education credits required by his/her State

Licensure Organization. As a CNM, you can work in various venues such as hospitals, birthcenters, OB/GYN practices and/or health clinics while providing care throughout a patient’s lifespan.

The credentials to become a Certified Midwives are somewhat different due to the fact that the certification can be achieved by a person who does not have a nursing background. Then the candidate will need a graduate level degree which is certified by the American Midwifery Certification Board. With this delegation, you could provide services to patients from adolescent to menopause in either a hospital, health clinics, OB/GYN office, homes and/or a birth center (Marzalik, Feltham, Jefferson, & Pekin, 2018).

Regardless of the medical specialty practice the Advanced Practice Registered Nurse achieves, the goal of care remains the same. The APRN must ensure that each patient is counseled on health promotion, and that health determinants to care are minimized, and make sure the patient receives quality of care by putting the patient first.  Additionally, it is important that the patient has an opportunity to ask sensitive questions during her examination.

References

American Nurses Association (ANA). (n.d.). View the code of ethics for nurses with interpretive statements. https://www.nursingworld.org/practice-policy/nursing-excellence/ethics/code-of ethics-for-nurses/ NRNP 6552 Different Roles of the Nurse Practitioner Discussion essay

Marzalik, P. R., Feltham, K. J., Jefferson, K., Pekin, K. (2018). Midwifery education in the U.S. Certified Nurse-Midwife, Certified Midwife and Certified Professional Midwife, 
Midwifery
, 
(60)
, 9-12. 
https://doi.org/10.1016/j.midw.2018.01.020

Winter, S., Chapman, S. A., Chan, G. K., Duderstadt, K., & Spetz, J. (2020). Nurse Practitioner role and practice environment in primary and in nonprimary care in California. 
Medical Care 
Research and Review
.  
https://doi.org/10.1177/1077558720942706

Yang, B. K., Johantgen, M. E., Trinkoff, A. M., Idzik, S. R., Wince, J., & Tomlinson, C. (2020). State Nurse Practitioner Practice Regulations and U.S. Health Care Delivery Outcomes: A Systematic Review. 
Medical Care Research and Review 
https://doi.org/10.1177/1077558719901216 NRNP 6552 Different Roles of the Nurse Practitioner Discussion essay

There are many mental health illnesses or disorders that play a part into choosing the right tool to use for that particular person. Therefore, the PMHNP needs to be knowledgeable about the different types that are provided. The assessment tool Endicott Work Productivity Scale (EWPS) is one of the many tools used in psychotherapy. The EWPS is a psychiatric assessment tool that measures a person’s sensitivity in work productivity. It measures how a person’s mental illness will or can affect their ability to function while working. It includes measuring performance ability, attendance and presenteeism, sickness and overall productivity at the workplace. The scale rates 0 (no difficulty) to 4 (always difficult) and consists of 25 questions at five points each, that is done by the person himself. It is based on a five point Linkert scale. The scale ranges from 0 at best to 100 being worst. Once completed the total score is based on the person’s subjective feelings, behaviors or attitudes they may have had before the questionnaire (Noben et al., 2014). It is best to use the EWPS tool when information is needed about the person’s effect of work activity and productivity, when they are not performing at their best. In regards to their behavior, performance, feelings and thought processes while working. It also helps to assess the progress of the psychopharm medications the person is taking and how it affects their illness and ability (Boezeman et al., 2016).

 

The development of EWPS was done in 1994 by Jean Endicott and research was conducted to show the psychometric properties of EWPS. There were two groups one with the community (66 people) and the other with patients with depressive disorder (42 people) and receiving treatment. Fifty percent of the depressed patients were female of an average age of 41 years old and 70 percent were nondepressed females in the community sample. The community’s age was not reported. There was not a manual reported. The samples were appropriate in composition for preliminary test validation but not inadequate in size. The total score is based on the degree to which behaviors and subjective feelings or attitudes that are likely to reduce productivity and efficiency in work activities characterize the subject during the week before evaluation. Although the study needed a bigger sample size for both the community and the depressed, the results had shown a significant mean difference. The EWPS scale has proven to be accurate but also biased with the results. But overall in most cases the study had shown that the EWPS was an appropriate tool to use for people to measure sensitivity of work productivity (Endicott, 1994).

 

 

References

Boezeman, E. J., Nieuwenhuijsen, K., & Sluiter, J. K. (2016). Predictive value and construct validity of the work functioning screener‐healthcare (WFS‐H). Journal of Occupational Health, 58(2), 163-169. 
https://doi.org/10.1539/joh.15-0056-oa

Endicott, J. (1994). Endicott Work Productivity Scale.

Noben, C. Y., Evers, S., Nijhuis, F. J., & De Rijk, A. E. (2014). Quality appraisal of generic self-reported instruments measuring health-related productivity changes: A systematic review. BMC Public Health, 14(1). 
https://doi.org/10.1186/1471-2458-14-115

response

Thank you for your informative post about the Endicott Work Productivity Scale (EWPS). This was an assessment tool that I was unfamiliar with so I really enjoyed reading your overview and thoughts on this particular tool. I like that the scale assesses efficiency as well as productivity; this is especially helpful as more and more companies move to a work from home model and use a productivity metric to assess employee’s work.  (Endicott, 1997).

As the mental health field moves forward in, what I believe to be, a positive direction, the understanding of the facets of life that a mental health diagnosis can have becomes clearer. For example, an individual suffering from depression can certainly work in a full time position however, their ability to focus or work at the same speed as others may be impaired. Since depression can include difficulty concentrating, remembering, or making decisions, it only makes sense that this could potentially include a patient’s work.

I also believe that utilizing an evidence based assessment tool would assist in providing the patient’s employee with data driven information as to why the employee may require some accommodations or a personalized productivity scale.

 

References

Endicott, J., & Nee, J. (1997). Endicott Work Productivity Scale (EWPS): a new measure to assess treatment effects. Psychopharmacology bulletin, 33(1), 13–16.

National Institute of Mental Health (2020). Depression Basics. Retrieved September 12, 2020 from 
https://www.nimh.nih.gov/health/publications/depression/index.shtml

NRNP 6552 Discussion: Different Roles of the Nurse Practitioner

The shortage of physicians allows non-physician professionals to practice to the full extent of their education and training which gives patients more options for types of services (ANA, n.d.). Many non-physician health care providers are trained and willing to help meet this need, but are not permitted to do so because of limitations in their scope of practice. Given the shortage of primary care physicians, allowing non-physician professionals to practice to the full extent of their education and training gives patients more options and more types of services (ANA, n.d.) NRNP 6552 Discussion: Different Roles of the Nurse Practitioner.

Advanced practice registered nurses (APRNs) can practice to the full extent of education, training, and certification with regard to individual State practice regulations concerning requirements such as clinical supervision or mandatory collaboration with physicians. A certified registered nurse practitioner (CRNP) competencies include functioning as an independent practitioner while demonstrating the highest level of accountability for professional practice. APRN’s provide the full spectrum of health care services including health promotion, disease prevention, health protection, anticipatory guidance, counseling, disease management, palliative, and end-of-life care (NONPF, 2017). Providers use advanced health assessment skills to differentiate between normal, variations of normal and abnormal findings. Diagnostic screening and strategies aide in the development of diagnosing disease. Medications are prescribed within scope of practice NRNP 6552 Discussion: Different Roles of the Nurse Practitioner. Patients with acute and chronic disease are managed while providing patient-centered care that recognizes cultural diversity (NONPF, 2017).

A physician’s assistant (PA) role is comprised of primary care and specialty care in the medical and surgical field. Professional competencies for physician assistants include effective and appropriate application of medical knowledge, interpersonal and communication skills, patient care, professionalism, practice-based learning and improvement, and systems-based practice (AAPA, 2013).

The scope of practice for certified nurse midwifes (CNMs) includes primary health care for women from adolescence through menopause, contraceptive care, prenatal and postnatal care, care of the newborn during the first month of life, gynecology, family planning services, health promotion, disease prevention, and individualized wellness education and counseling (Marzalik et al., 2018). Prescriptive authority varies from state to state (Marzalik et al., 2018)

Influence on my future practice as an APRN will come from clinical practicum and learning experiences. The PA profession is an emerging profession that provides substantial contribution to the healthcare workforce in all medical specialty areas (Kulo et al., 2021). PA’s practice under a physician giving them a broad knowledge base NRNP 6552 Discussion: Different Roles of the Nurse Practitioner. This background will challenge my thought process when it comes to diagnosing and treating patients. A surgical PA would be able to provide procedural techniques such as suturing that I may not have exposure to in a primary care office setting. Though similar to an advanced practice nursing degree, the PA’s role with provide a different view and approach to treatment through their diverse training and education. A CNM can provide specific training regarding women’s health, and neonatal health. Their specified education is targeted of women’s health and allows for the expertise that the specialized field requires. A CNM will help expand my role as a Family Nurse Practitioner (FNP) my bridging primary care with women’s health. Healthcare providers educated to provide primary healthcare services such as CNM’s are projected to play a key role in meeting the demand of access to affordable healthcare since the passing of the Affordable Care Act in 2010 (Hastings-Tolsma et al., 2015). A CNM can provide me with insight into caring for a pregnant woman and specific considerations for the high risk pregnant population. While working with an FNP during my first clinical rotation I quickly realized the vast amount of knowledge a primary care provider must possess in order to adequately manage patients of all populations. Initiating insulin treatment for a type 2 diabetic and starting statin treatment when lifestyle modifications have not improved cholesterol levels are examples of treatment plans I learned from my previous primary care preceptor. Gaining and applying knowledge from different mid-level providers can improve practice and clinical skills to create a well-rounded FNP NRNP 6552 Discussion: Different Roles of the Nurse Practitioner.

References

American Academy of Physician Assistants (AAPA) (2013). Competencies for the Physician Assistant Profession. https://www.aapa.org/wp-content/uploads/2017/02/PA-Competencies-updated.pdf

American Nurses Association (ANA). (n.d.). Scope of Practice. https://www.nursingworld.org/practice-policy/aprn/

Hastings-Tolsma, M., Tanner, T., Hensley, J. G., Anderson, J., Patterson, E., Dunemn, K. N., & Purcell, S. K. (2015). Trends in Practice Patterns and Perspectives of Colorado Certified Nurse-Midwives. 
Policy, Politics & Nursing Practice, 16
(3/4), 97–108. https://doi-org.ezp.waldenulibrary.org/10.1177/1527154415601477

Kulo, V., Fleming, S., Gordes, K. L., Jun, H.-J., Cawley, J. F., & Kayingo, G. (2021). A physician assistant entry-level doctoral degree: more harm than good? 
BMC Medical Education, 21
(1), 274. https://doi-org.ezp.waldenulibrary.org/10.1186/s12909-021-02725-5

Marzalik, P. R., Feltham, K. J., Jefferson, K., & Pekin, K. (2018). Midwifery education in the U.S. – Certified Nurse-Midwife, Certified Midwife and Certified Professional Midwife. 
Midwifery
, 60, 9–12. https://doi-org.ezp.waldenulibrary.org/10.1016/j.midw.2018.01.020

The National Organization of Nurse Practitioner Faculties (NONPF). (2017). 
Nurse Practitioner Core Competencies Content. 
https://cdn.ymaws.com/www.nonpf.org/resource/resmgr/competencies/2017_NPCoreComps_with_Curric.pdf NRNP 6552 Discussion: Different Roles of the Nurse Practitioner

response

So true the shortage of Physicians and non-physicians has allowed APRN to have more professional responsibilities. An Advanced Practice Nurse can work as either a FNP or Midwife with the appropriate training. Although both of these clinical positions are underutilized in some communities, each of these disciplines can facilitate cost saving and effective care when collaborating together (Casey et al., 2017). The FNP works in tandem with the Midwife, the symbiotic relationship can help reduce pregnancy related deaths in the United States (Krishnaswami & Del C Colon-Gonzalez, 2019). The collaboration should foster respect and communication (Smith, 2016).

Maternity patients must receive timely medical care from the perinatal point to the postnatal time frame. A FNP typically provides medical management, family planning and management of patients in the beginning months of their pregnancies (Van Hecke et al., 2019). For complicated cases and pregnancies beyond the first trimester, the FNP can refer the case to the Midwife’s practice or to an obstetrician.

References

Casey, M., O’Connor, L., Cashin, A., Smith, R., O’Brien, D., Nicholson, E., O’Leary, D., Fealy, G., McNamara, M., Glasgow, M. E., Stokes, D., & Egan, C. (2017). An overview of the outcomes and impact of specialist and advanced nursing and midwifery practice, on quality of care, cost and access to services: A narrative review. Nurse Education Today, 56, 35–40. 
https://doi-org.ezp.waldenulibrary.org/10.1016/j.nedt.2017.06.004

Krishnaswami, J., & Del C Colon-Gonzalez, M. (2019). Reforming Women’s Health Care: A Call to Action for Lifestyle Medicine Practitioners to Save Lives of Mothers and Infants. American journal of lifestyle medicine, 13(5), 495–504. 
https://doi.org/10.1177/1559827619838461

Smith, D. C. (2016). Interprofessional Collaboration in Perinatal Care. The Journal of Perinatal & Neonatal Nursing, 30(3), 167–173. doi:10.1097/JPN.0000000000000187.

Van Hecke, A., Goemaes, R., Verhaeghe, S., Beyers, W., Decoene, E., & Beeckman, D. (2019). Leadership in nursing and midwifery: Activities and associated competencies advanced practice nurses and midwives. Journal of Nursing Management NRNP 6552 Discussion: Different Roles of the Nurse Practitioner. 2019;27(6):1261-1274. doi:10.1111/jonm.12808

Discussion: Different Roles of the Nurse Practitioner

The term ‘history” is broad in meaning. Within that broad framework archeologists tend to focus their careers on various specialties and areas of interest, such as specific historical eras or geographical areas.

So it is with nurses. Within the broad framework of healthcare, nurse practitioners focus their careers on various roles. These roles may in part be based on narrower areas of interest such as women’s health. Careers also focus on selected technical nursing specialties.

Photo Credit: Getty Images/Blend Images

For this Discussion, you will explore your professional interests and those interests are addressed in specific guidelines and competencies. You also examine the different nurse practitioner roles related to women’s health and how these roles might impact the way you work.

To prepare:

Review the modular structure of this course and reflect on how each module defines the specific skills needed as an advanced Nurse Practitioner (NP).

Review the ANA guidelines, NP competencies, and the Ethic resources found in this week’s Learning Resources and consider how they impact the work of the NP NRNP 6552 Discussion: Different Roles of the Nurse Practitioner.

  ORDER A PLAGIARISM FREE PAPER NOW

By Day 3

Post a brief explanation about the differences in roles related to a CRNP, a CNM, and a PA and how each of these roles might impact the how you practice as a FNP. Be specific and provide examples.

Read
 a selection of your colleagues’ responses.

By Day 6

Respond to at least 
two
 of your colleagues’ posts on 
two different days 
and
 
provide additional insight to your colleagues related to issues and topics they may want to also consider. Use the Learning Resources and/or the best available evidence from current literature to support your explanation.

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!

Week 1 Discussion: Career Goals, Strength and Challenges

Certified Registered Nurse Practitioner (CRNP), Certified Nurse Midwifery (CNM), and Physician Assistant are all mid-level providers yet have different roles in the health care system. Mid-level providers have their position and specialty in providing care to other areas of health care. Also, every state has its unique scope on how they function and providing care to the individual. Manning et al. (2018) described that as paradigms of health care delivery evolve, mid-level providers such as nurse practitioners and physician assistants have become an essential consideration in the health care workforce planning and patient care. According to the AMA Journal of Ethics (2021), physician assistants are health care professionals licensed to practice medicine under physician supervision NRNP 6552 Discussion: Different Roles of the Nurse Practitioner. Their role is to conduct physical exams, diagnose and treat illnesses, order, and interpret tests, counsel on preventive health care, assist in surgery, and write prescriptions (AMA Journal of Ethics, 2021). AANP (2021) described that the Nurse Practitioner has autonomously and collaborates with health care professionals and other individuals; NPs provide a full range of primary, acute, and specialty health care services. A nurse-midwife is a licensed health care professional who specializes in women’s reproductive health and childbirth. In addition, attending births, perform annual exams, give counseling, and write prescriptions (Staff Writers, 2021). In a profession as dynamic as nursing, and with evolving health care demands, changes in the scope of practice and overlapping responsibilities are inevitable in our current and future health care system. Each of these roles will have a significant impact on my practice as a Nurse Practitioner. Mid-level providers working in different areas and specialties significantly impact each other by providing care to each area that the patient needs it.

For example, last semester, I did my clinical rotation for adults across the life span. I had a female patient came to the clinic with an annual pap smear. The result came in, and it was positive; my preceptor was able to refer the patient to Gynecology for further examination and treatment. Another example, when I have a patient who came in with non-compliance Type 2 diabetes with acute kidney injury. My preceptor and I are able to refer the patient to Endocrinologist, nutritionist, nephrologist, and community group for diabetes. The number of patients with multiple and chronic medical conditions is increasing globally, which causes functional and emotional impairment to increase in health care demands. Ang et al. (2021) explain that collaboration in health care has been shown to enhance patient outcomes, including reducing preventable adverse drug effects, lowering morbidity and mortality rates, and adjusting medication dosages, especially in medical-based departments in a hospital. Besides improving patient care, health care providers have also benefited from teamwork, including reduced overlapping tasks, reduced burnout, and increased job satisfaction (Ang et al., 2021) NRNP 6552 Discussion: Different Roles of the Nurse Practitioner.

References

AANP. (2021). What’s a nurse practitioner (NP).
https://www.aanp.org/about/all-about-nps/whats-a-nurse-practitioner

AMA Journal of Ethics. (2021). Illuminating the art of medicine.
https://journalofethics.ama-assn.org/article/physician-assistants-and-their-role-primary-care/2012-05

American Nurses Association (ANA). (n.d.). Scope of practice.
https://www.nursing-world.org/practice-policy/scope-of-practice/

Ang, W. C., Abd Rahim, S. N., Abd Rahman, N. F., Muhamad, S. N., Rokimi, W. R., & Ng, S.C. (2021). Healthcare Professionals’ Experiences on Interdisciplinary Collaboration in a Medical Department of a Malaysian General Hospital. 
Medicine & Health (Universiti Kebangsaan Malaysia), 16(
1), 246–255.
https://doi-org.ezp.waldenulibrary.org/10.17576/MH.2021.1601.20

 

Manning, B. T., Bohl, D. D., Hannon, C. P., Redondo, M. L., Christian, D. R., Forsythe, B., Nho, S. J., & Bach, B. R. (2018). Patient Perspectives of Midlevel Providers in Orthopaedic Sports Medicine. 
Orthopaedic Journal of Sports Medicine, 6
(4), 1–7.

 

Staff Writers. (2021). What is a certified nurse-midwife (CNM)?https://www.nursepractitionerschools.com/certified-nurse-midwife/ NRNP 6552 Discussion: Different Roles of the Nurse Practitioner

NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

Week 1: Health and Health Promotion

Much like archaeologists sift through sand to identify artifacts of interest, nurse practitioners must devote time and effort to interviewing patients, sifting through facts to identify relevant information that can be pieced together to create a relevant patient history. These efforts have their own unique challenges and approaches based on the characteristics of the patient, including sex, age, culture, and more.

Female patient interviews have their own unique characteristics. Sensitive matters related to sexual health, physical and/or emotional abuse, pregnancy, menstruation, and other topics may leave patients uncomfortable and create challenges to productive conversations NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

For this week, you will examine the role of the patient interview in health promotion. You also will practice approaches to building a patient history by interviewing a volunteer by creating a script which you use to conduct a mock patient interview with the volunteer.

Learning Objectives

Students will:

Analyze professional interests of study

Analyze the different roles related to the a CRNP (certified registered nurse practitioner), a CNM (certified nurse midwife), and a PA (Physician Assistant)

Create scripts for taking a health history to include difficult questions

Develop patient health histories related to difficult questions

*These Learning Objectives are introduced this week and assessed in Week 2 NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

Learning Resources

Required Readings
 (click to expand/reduce)

Required Media
 (click to expand/reduce)

Optional Resources
 (click to expand/reduce)

Discussion: Different Roles of the Nurse Practitioner

The term ‘history” is broad in meaning. Within that broad framework archeologists tend to focus their careers on various specialties and areas of interest, such as specific historical eras or geographical areas.

So it is with nurses. Within the broad framework of healthcare, nurse practitioners focus their careers on various roles. These roles may in part be based on narrower areas of interest such as women’s health. Careers also focus on selected technical nursing specialties NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

Photo Credit: Getty Images/Blend Images

For this Discussion, you will explore your professional interests and those interests are addressed in specific guidelines and competencies. You also examine the different nurse practitioner roles related to women’s health and how these roles might impact the way you work.

To prepare:

Review the modular structure of this course and reflect on how each module defines the specific skills needed as an advanced Nurse Practitioner (NP).

Review the ANA guidelines, NP competencies, and the Ethic resources found in this week’s Learning Resources and consider how they impact the work of the NP.

By Day 3

Post a brief explanation about the differences in roles related to a CRNP, a CNM, and a PA and how each of these roles might impact the how you practice as a FNP. Be specific and provide examples.

Read
 a selection of your colleagues’ responses.

  Providers present with many different education backgrounds. Some credentials one may see within a women’s health care setting include: certified registered nurse practitioner (CRNP) or advanced practice nurse practitioner (APNP), certified nurse midwife (CNM) and physician’s assistant (PA). This discussion will look at the different roles of an individual based on their educational background NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

When looking at providers one area to discuss includes scope of practice. For nurse practitioners (NPs) in the United States, state level practicing laws vary from state to state despite educational preparation for independent patient care, prescribing practices and diagnostic procedures (Poghosyan, Liu, & Norful, 2017, Kraus & DuBois, 2017). The scope of practice for an NP in Ohio falls under a reduced practice. APNPs, including a CNM, in the state of Ohio must collaborate with a licensed physician with a written agreement for prescribing practices per the Ohio Revised Code (NCSL, 2021, McCleery, et al., Freeman, 2019).  Limitations for CNM is also addressed in the state laws.  For example, a CNM in Ohio is unable to deliver breech babies or perform version (Legislative Service Commission, 2020). Prescribing practices and scope of practice for PAs also differs in the Ohio revised Code. A supervision agreement between the PA and an appropriate physician that addresses prescriptive authority for schedule II-V controlled substances along with a scope of practice agreed upon by both parties must be submitted to the State Medical Board (NCSL, 2021). As an advanced practice provider, it is important to know the scope of practice within the state, practicing guidelines within the facility, and the agreement with the supervising physician.

Another difference in these three provider roles includes their approach to care. An individual who takes the nursing path, such as a CNM or APNP, directs care with a patient-centered approach to disease prevention and education. An individual who takes the medical school approach, such as a PA, follows a disease-centered approach to health care. Clinical approaches to healthcare vary based on scope of practice, education, and practice influence (Freeman, 2019). These differences in approaches are important in team management planning NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

In conclusion, healthcare is changing rapidly in how care is provided with an emphasis on a team approach to management. As a practitioner, it is important to know the differences between the roles of different advanced practice providers. Knowing an individual’s own scope of practice within their state and surrounding states is an important aspect of providing safe care. As a provider it is also important to ensure safe care is provided to all individuals. Knowing roles of other providers is important when delegation is required.

References

Freeman, J. (2019). Family Physicians, Nurse Practitioners, Physician Assistants, and Scope of Practice: Who Will Decide? 
Family Medicine, 51
(4): 305-307. doi: 10.22454/FamMed.2019.356702

Kraus, E. & DuBois, J. (2017). Knowing your limits: A qualitative study of physician and nurse practitioner perspectives on NP independence in primary care. 
Journal of General Internal Medicine, 32
(3): 284-290. doi: 10.1007/s11606-016-3896-7

Legislative Service Commission. (2020). Section 4723.43 | Scope of specialized nursing services. Retrieved from 
https://codes.ohio.gov/ohio-revised-code/section-4723.43
.

NCSL. (2021). Scope of Practice Policy. Retrieved from https://scopeofpracticepolicy.org/states/oh/

Poghosyan, L. Liu, J. & Norful, A. (2017). Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study.
 International Journal of Nursing Studies, 74
: 1-7. doi: 10.1016/j.ijnurstu.2017.05.004 NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

By Day 6

Respond to at least 
two
 of your colleagues’ posts on 
two different days 
andprovide additional insight to your colleagues related to issues and topics they may want to also consider. Use the Learning Resources and/or the best available evidence from current literature to support your explanation.

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!

I enjoyed reading your post as it highlights the fact that the fundamental differences that exist between a CRNP, CNM, and a PA assistance, lies in their scope of practice. A Family nurse practitioner or APRN has a wide variety of specialties which in some cases, is conducive to the patients. Most patients believe that as an APRN, you can prescribe any medication as long as a diagnosis is established. The APRN profession encompasses a wide variety of advanced nursing specialties; hence a wide variety of scope of practices issues is associated with this profession (Citizen Advocacy Center). This is because sometimes patients believe that as a nurse practitioner you can provide any services they need. At my clinical site today we had a patient who came in for a  regular pap smear but while checking her vital signs and doing her labs, her blood pressure was so elevated and the urine dipstick indicated a glucose level of greater than 2000. The patient was referred to the ER and she started crying and requesting to know why they could not prescribe her blood pressure medications. The NP is WHNP and can not prescribe medications for blood pressure and diabetes but it was difficult for the patient to understand NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

The scope of practice for APRNs is also very dynamic as they can acquire new knowledge through education and take on new roles. “The scope of the advanced practices evolves through experience, acquisition of knowledge, evidence-based practices, technology development, and changes in the health care delivery system. Therefore, advanced practice registered nurses may need to practice in new settings, perform new procedures, and develop new skills during their professional careers” (Texas Board of Nursing).

Reference

Citizen Advocacy Center (CAC): Scope of Practice FAQs for Consumers. Advanced Practice Registered Nurse (APRNs). Retrieved from; www.ncsbn.org/APRNS_Scope_of_practice_FAQs_for_Consumers.pdf

Texas Board of Nursing: Practice-APRN scope of practice. Retrieved from; https://bon.texas.gov/practice_scope_of_practice_aprn.asp

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6

To Participate in this Discussion:

Week 1 Discussion NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

Module 1 Assignment: Taking a Health History: Building a Health History: Asking Difficult Questions

Much of an archeologist’s work is done under the mantra “proceed with caution.” Archeologists must dutifully secure permissions to access sites. They also must exercise extreme caution when excavating or analyzing in a lab to avoid potential damage to historical artifacts.

Likewise, nurse practitioners must proceed with caution when building a patient’s health history. Important questions can be difficult for both nurse and patient. Care must be taken to approach such questions with dignity, tact, and respect to create an environment conducive to productive conversations.

For this Assignment, you will develop a script to be used to interview a volunteer serving in the role of patient.

To prepare:

Review the Ewing (2004) questionnaire found in this week’s Learning Resources and consider the difficult questions you might have to ask when you take a patient’s health history.

Review the screening tools found in the Learning Resources and consider how you might use an app or tool to assist in screening.

Review the media programs related to a vaginal exam, pap test, and breast exam.

Review the health history guide presented in Chapter 7 of the Schuiling & Likis (2022) text and consider how you would create your own script for building a health history. (
Note:
 You will also find the Health History Form in Chapter 7)

Describe the components of a complete gynecologic health history.  Include  considerations for special populations such as  LGBTQ+ individuals NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

What health maintenance guidelines should be  included for initial and follow up  might be needed for follow-up assessments?  (i.e., bone density test, Gardasil vaccine, shingles, etc.)?

What questions would you consider in your patient’s assessment? For example

What is your patient’s living situation?

Do they have stairs?

Do they live by themselves?

Do they have a working refrigerator?

Create your own script for building a health history and use the Health History Template for guidance (consider the type of language you would use to help your patient be more comfortable). As you create your script, consider the difficult questions you want to include in your script.

Assignment: 
(1- to 2-page reflection)

In addition to your script for building a health history for this assignment, include a separate section called “Reflection” that includes the following:

A brief summary of your experiences in developing and implementing your script during your health history.

Explanations of what you might find difficult when asking these questions. What you found insightful and what would you say or do differently.

Reminder:
The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

No Assignment submission due this week.

By Day 7 of Week 2

Submit
 your Module 1 Assignment by 
Day 7 of Week 2.

What’s Coming Up in Week 2?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you continue to explore common health screening but more specifically, how technology tools can support your screening process when working with women and/or LGBTQ+ individuals. You also examine the elements of gynecologic history and the recommended screenings NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

Week 2: Knowledge Check

In Week 2, you will experience your first Knowledge Check which covers the topics from Weeks 1 and 2 of Module 1. Please refer to the Week 2 Knowledge Check Assignment for further details related to the topics covered. Plan your time accordingly.

Practicum – Upcoming Deadline

In the Nurse Practitioner programs of study (FNP, AGACNP, AGPCNP, and PMHNP) you are required to take several practicum courses. If you plan on taking a practicum course within the next two terms, 
you will need to submit your application via 
Meditrek
 .

For information on the practicum application process and deadlines, please visit the 
Field Experience: College of Nursing: Application Process – Graduate
 web page.

Please take the time to review the 
Appropriate Preceptors and Field Sites
 for your courses.

Please take the time to review the practicum manuals, FAQs, Webinars and any required forms on the 
Field Experience: College of Nursing: Student Resources and Manuals
 web page.

Field Experience: College of Nursing Quick Answers

Field Experience: MSN Nurse Practitioner Practicum Manual

Student Practicum Resources: NP Student Orientation

To go to the next week:

Week 2 NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

Week 2: Common Health Screenings

Archeologists do not begin their work by simply selecting a site and digging for historical finds. Their initial steps involve laying the groundwork through research to apply expertise in their historical areas of focus, combined with best practices for excavation and analysis.

Similarly, nurse practitioners do not simply develop a treatment plan for patients. They methodically construct a patient’s history and apply best practices to conduct health screenings that help inform treatment. For practitioners of women’s healthcare this means applying expertise in specialized areas such as gynecology and gynecologic history taking and screening.

For this week, you examine the elements that comprise a patient’s gynecologic history.  As part of your Module 1 assignment, you will describe elements of a complete gynecologic history.

Learning Objectives

Students will:

Analyze the elements of gynecologic history and recommended screenings for individuals (i.e., LGBTQ+)

Analyze health maintenance guidelines when conducting patient assessments

Create scripts for taking a health history to include difficult questions

Develop patient health histories related to difficult questions

Identify key terms, concepts, and principles related to the primary care of individuals, families, and communities NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

Learning Resources

Required Readings
 (click to expand/reduce)

Required Media
 (click to expand/reduce)

Optional Resource
(click to expand/reduce)

Module 1 Assignment: Taking a Health History: Building a Health History: Asking Difficult Questions

Much of an archeologist’s work is done under the mantra “proceed with caution.” Archeologists must dutifully secure permissions to access sites. They also must exercise extreme caution when excavating or analyzing in a lab to avoid potential damage to historical artifacts.

Likewise, nurse practitioners must proceed with caution when building a patient’s health history. Important questions can be difficult for both nurse and patient. Care must be taken to approach such questions with dignity, tact, and respect to create an environment conducive to productive conversations NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

For this Assignment, you will develop a script to be used to interview a volunteer serving in the role of patient.

To prepare:

Review the Ewing (2004) questionnaire found in the Week 1 Learning Resources and consider the difficult questions you might have to ask when you take a patient’s complete health history.

Review the screening tools found in the Learning Resources and consider how you might use an app or tool to assist in screening.

Review the media programs related to a vaginal exam, pap test, and breast exam.

Review the health history guide presented in Chapter 7 of the Schuiling & Likis (2022) text and consider how you would create your own script for building a complete health history. (
Note:
 You will also find the Health History Form in Chapter 7)

Include considerations for special populations such as LGBTQ+ individuals.

What health maintenance guidelines should be included for initial and follow up might be needed for follow-up assessments? (i.e., bone density test, Gardasil vaccine, shingles, etc.)?

Create your own script for building a health history and use the Health History Template for guidance (consider the type of language you would use to help your patient be more comfortable). As you create your script, consider the difficult questions you want to include in your script. There is no sample template to provide to you. You are the one to develop the script. Think of it as you are writing a movie and you need to write the script for the movie. What lines would you provide for the actor to utilize when sitting down with a patient to perform a COMPLETE Medical History which also entails those DIFFICULT GYN questions. You do not need to provide the answers to the questions however, if you find that beneficial, you may do so NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

Assignment: 
(1- to 2-page reflection)

In addition to your script for building a health history for this assignment, include a separate section called “Reflection” that includes the following:

A brief summary of your experiences in developing and implementing your script during your health history.

Explanations of what you might find difficult when asking these questions. What you found insightful and what would you say or do differently.

Reminder:
The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

By Day 7 of Week 2

Submit
 your Module 1 Assignment by 
Day 7 of Week 2.

Submission and Grading Information

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

Please save your Assignment using the naming convention “M1Assgn+last name+first initial.(extension)” as the name.

Click the 
Module 1 Assignment Rubric 
to review the Grading Criteria for the Assignment.

Click the 
Module 1 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 “M1Assignment+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.

Grading Criteria

To access your rubric:

Module 1 Assignment Rubric NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

Check Your Assignment Draft for Authenticity

To check your Assignment draft for authenticity:

Submit your Module 1 Assignment draft and review the originality report.

Submit Your Assignment by Day 7

To participate in this Assignment:

Module 1 Assignment

Knowledge Check: Module 1

In this exercise, you will complete a 20-question Knowledge Check to gauge your understanding of this module’s content.  You will have 1 attempt for each question. Each question is worth 1 point.

Possible topics to be covered from Weeks 1 and 2:

Adult Gerontology

Women’s Health and Health Promotion

Gynecologic Health care for Sexual and Gender Minorities

Using Evidence to Support Clinical Practice

Role of women’s health NP

Gynecologic Anatomy and Physiology

Gynecologic History and Physical Exam

Gynecologic Screening and Health Maintenance

Sexual Violence

Women’s Health Care Across the Life Span

Well-Woman Exam

Osteoporosis

Tobacco Cessation NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

Photo Credit: kyoshino / iStock / Getty Images Plus / Getty Images

By Day 7

Complete
 and 
submit
 your Knowledge Check.

Submission Information

Submit Your Knowledge Check by Day 7

To submit your Knowledge Check:

Module 1 Knowledge Check

What’s Coming Up in Module 2?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

In Module 2, you explore important aspects of gynecologic health. You will examine common gynecologic conditions through a variety of case studies. You also will complete a Knowledge Check covering the topics from Weeks 3 through 5, and you will complete a Midterm Exam to assess your understanding of the content examined in Weeks 1 – 6 of the course.

Week 5: Knowledge Check

In Week 5, you will complete your next Knowledge Check which covers the topics from Weeks 3, 4 and 5 of Module 2. Please refer to the Week 5 Knowledge Check Assignment for further details related to the topics covered. Plan your time accordingly NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

  ORDER A PLAGIARISM FREE PAPER NOW

To go to the next module:

Module 2

Week 3: Gynecologic Health

Western movies often portray dusty old towns with limited available resources that include a single general store, a single saloon, and a single sheriff. Within these settings, healthcare is revealed to be the responsibility of the single town doctor.

Unlike these theatrical towns of old, most modern developed communities enjoy the luxury of diverse choices in shopping, entertainment, and more. Thankfully, this includes healthcare options that extend the concept of the “old west” town doctor to diverse specialty areas of practice, including those focused on women’s health care and wellness, such as gynecology.

For this week, you will use a case study to analyze information obtained from well-woman examinations. You also will consider and propose treatment plans for diagnoses.

Learning Objectives

Students will:

Analyze pertinent patient information obtained from a comprehensive well-woman exam

Formulate differential diagnoses

Recommend diagnostics to support differential diagnoses

Develop treatment and management plans

Develop additional questions to support patient assessments NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

Learning Resources

Required Readings
 (click to expand/reduce)

Required Media
 (click to expand/reduce)

Optional Resources
(click to expand/reduce)

Case Study Discussion: Gynecologic Health

Case studies provide the opportunity to simulate realistic scenarios involving patients presenting with various health problems or symptoms. Such case studies enable nurse learners to apply concepts, lessons, and critical thinking to interviewing, screening, diagnostic approaches, as well as the development of treatment plans.

Photo Credit: Teodor Lazarev / Adobe Stock

For this Case Study Discussion, you will review a case study scenario to obtain information related to a comprehensive well-woman exam and determine differential diagnoses, diagnostics, and develop treatment and management plans.

To prepare:

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

Review the Learning Resources for this week and pay close attention to the media program related to the basic microscope skills. Also, consider re-reviewing the media programs found in Week 1 Learning Resources.

Carefully review the clinical guideline resources specific to your assigned case study.

Use the Focused SOAP Note Template found in the Learning Resources to support Discussion. Complete a SOAP note and critically analyze this and focus your attention on the diagnostic tests. You are NOT to post your SOAP note. This is for your information only to help you develop your differential diagnosis and additional questions NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

By Day 3

DO NOT POST A SOAP NOTE. Post
 your differential diagnosis. Include the additional questions you would ask the patient. Be sure to include an explanation of the tests you might recommend, ruling out any other issues or concerns and include your rationale. Be specific and provide examples. Use your Learning Resources and/or evidence from the literature to support your explanations.

Read
 a selection of your colleagues’ responses.

By Day 6

Respond to at least 
two
 of your colleagues’ posts on 
two different days 
and explain how you might think differently about the types of tests you might recommend and explain why. Use your Learning Resources and/or evidence from the literature to support your position.

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!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 3 Case Study Discussion Rubric

Post by Day 3 and Respond by Day 6

To Participate in this Discussion:

Week 3 Case Study Discussion NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

What’s Coming Up in Week 4?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will explore common gynecologic conditions as they relate to sexually transmitted infections (STIs), and contraceptive issues, as well as other conditions through a specific case study.

To go to the next week:

Week 4

Week 4: Common Gynecologic Conditions, Part 1

Patients can present a variety of symptoms including breast or vaginal discomfort that may indicate gynecologic conditions. These conditions may range from minor and easy- to-treat infections to more serious issues related to cancer or sexually transmitted diseases.

Nurse practitioners must apply expertise and best practices to early interventions to contribute to diagnoses of issues and plans for treatments. These activities typically begin with analysis of findings from interviews and screenings.

For this week, you will practice these approaches by considering circumstances of case study. You will analyze a patient history and symptoms presented and recommend tests and treatment options.

Learning Objectives

Students will:

Identify key symptoms consistent with a medical diagnosis

Analyze the health history and presentation of a patient

Analyze patient diagnoses

Apply case-specific clinical guidelines

Recommend diagnostic tests and treatment options NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

Learning Resources

Required Readings
 (click to expand/reduce)

Optional Resource
(click to expand/reduce)

Case Study Discussion: Common Gynecologic Conditions, Part 1

Case studies provide the opportunity to simulate realistic scenarios involving patients presenting with various health problems or symptoms. Such case studies enable nurse learners to apply concepts, lessons, and critical thinking to interviewing, screening, and diagnostic approaches, as well as to the development of treatment plans.

Photo Credit: Teodor Lazarev / Adobe Stock

For this Case Study Discussion, you will once again review a case study scenario to obtain information related to a comprehensive well-woman exam and determine differential diagnoses, diagnostics, and develop treatment and management plans NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

To prepare:

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

Review the Learning Resources for this week and specifically review the clinical guideline resources specific to your assigned case study.

Use the Focused SOAP Note Template found in the Learning Resources to support your Discussion. Complete a SOAP note and critically analyze this and focus your attention on the diagnostic tests. You are NOT to post your SOAP note. This is for your information only to help you develop your differential diagnosis and additional questions.

By Day 3

DO NOT POST A SOAP NOTE.
 
Post
 your primary diagnosis. Include the additional questions you would ask the patient and explain your reasons for asking the additional questions. Then, explain the types of symptoms you would ask. Be specific and provide examples. (
Note:
 When asking questions, consider sociocultural factors that might influence your question decisions.)

Based on the preemptive diagnosis, explain which treatment options and diagnostic tests you might recommend. Use your Learning Resources and/or evidence from the literature to support your recommendations.

Read
 a selection of your colleagues’ responses.

By Day 6

Respond to at least 
two
 of your colleagues’ posts on 
two different days 
and explain how you might think differently about the types of diagnostic tests you would recommend and explain your reasoning. Use your Learning Resources and/or evidence from the literature to support your position NRNP 6552: Advanced Nurse Practice in Reproductive Health Care.

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!

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 4 Case Study Discussion Rubric

Post by Day 3 and Respond by Day 6

To Participate in this Discussion:

Week 4 Case Study Discussion

What’s Coming Up in Week 5?

Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images

Next week, you will continue to explore common gynecologic conditions as they relate to reproductive health issues as well as other conditions.

Specifically, for next week’s Discussion, you will propose a case study scenario for instructor approval. Please review the Week 5 Discussion instructions and be ready to submit your proposed case study scenario by Day 1 of Week 5. Plan your time accordingly.

Week 5: Knowledge Check

In Week 5, you will complete your next Knowledge Check which covers the topics from Weeks 3, 4 and 5 of Module 2. Please refer to the Week 5 Knowledge Check Assignment for further details related to the topics covered. Plan your time accordingly. NRNP 6552: Advanced Nurse Practice in Reproductive Health Care

tina jones gastrointestinal shadow health subjective data

Subjective Data Collection: 29 of 31 (93.5%)

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.

Chief Complaint

Finding:

Established chief complaint tina jones gastrointestinal shadow health subjective data

Finding:

Reports frequently occurring stomach pain

(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:

How are you feeling? tina jones gastrointestinal shadow health subjective data

History of Present Illness

Finding:

Asked about onset of pain

Finding:

Reports noticing pain for “at least a month”

(Found)

Pro Tip: By establishing a timeline of Tina’s abdominal pain, you’re soliciting information that can help you to understand the nature and extent of her stomach pain.

Example Question:

How long have you had abdominal pain?

Finding:

Reports that pain increased gradually

(Found)

Pro Tip: By establishing a timeline of Tina’s abdominal pain, you’re soliciting information that can help you to understand the nature and extent of her stomach pain.

Example Question:

Did the abdominal pain start suddenly?

Finding:

Asked about frequency of pain

Finding:

Reports pain occurs every day

(Found)

Pro Tip: By establishing a timeline of Tina’s abdominal pain, you’re soliciting information that can help you to understand the nature and extent of her stomach pain.

Example Question:

Do you have abdominal pain every day?

Finding:

Reports 3 to 4 episodes a week that are more severe

(Found)

Pro Tip: By establishing a timeline of Tina’s abdominal pain, you’re soliciting information that can help you to understand the nature and extent of her stomach pain.

Example Question:

How many times a week do you have abdominal pain?

Finding:

Asked about duration of pain

Finding:

Pain begins right after finishing a meal

(Found)

Pro Tip: Soliciting information about what triggers Tina’s stomach pain can allow you to understand the nature of her symptoms and most effectively treat her.

Example Question:

How long after a meal does the pain start?

Finding:

Each episode lasts “a few hours”

(Found)

Pro Tip: Soliciting information about the duration of Tina’s stomach pain can allow you to understand the nature of her symptoms and most effectively treat her.

Example Question:

How many hours does the abdominal pain last?

Finding:

Asked about severity of pain on a scale

Finding:

Rates present pain as 1 or 2 out of 10

(Found)

Pro Tip: Pain severity might change over time for a variety of reasons. Asking Tina to rate the severity of her pain on a scale of 1-10 will provide a quantified and relative measurement of her condition.

Example Question:

Can you rate your current stomach pain on a scale of 0 to 10?

Finding:

Rates worst pain after eating as 5 out of 10

(Found)

Pro Tip: Pain severity might change for a variety of reasons. Asking Tina to rate the severity of her pain on a scale of 1-10 after she eats will provide a quantified and relative measurement of her condition tina jones gastrointestinal shadow health subjective data.

Example Question:

Can you rate the stomach pain after you eat on a scale of 0 to 10?

Finding:

Rates pain when supine as a 6 or 7 out of 10

(Available)

Pro Tip: Pain severity might change for a variety of reasons. Asking Tina to rate the severity of her pain when she’s lying down, on a scale of 1-10, will provide a quantified and relative measurement of her condition.

Example Question:

Can you rate the stomach pain when you’re lying down on a scale of 0 to 10?

Finding:

Asked about character of the pain

Finding:

Describes the pain as similar to heartburn

(Found)

Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, experience, or symptoms.

Example Question:

Does the pain feel like heartburn?

Finding:

Denies crushing pain

(Found)

Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, experience, or symptoms.

Example Question:

Is the pain crushing?

Finding:

Denies gnawing pain

(Found)

Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, experience, or symptoms.

Example Question:

Is the pain gnawing?

Finding:

Denies cramping pain

(Found)

Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, experience, or symptoms.

Example Question:

Does the stomach pain feel like cramps?

Finding:

Denies that abdomen is tender to the touch

(Found)

Pro Tip: Follow-up questions will enable Tina to more fully and specifically describe her condition, experience, or symptoms tina jones gastrointestinal shadow health subjective data.

Example Question:

Is your stomach tender to the touch?

Finding:

Asked location of the pain

Finding:

Pain is in center of upper stomach, below breastbone

(Found)

Pro Tip: Specifying the location of pain can narrow and define where Tina’s pain is occurring. Soliciting this information allows you to more accurately treat her symptoms.

Example Question:

Where is your stomach pain the worst?

Finding:

Pain does not radiate

(Available)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina to describe what her pain feels like specifies the way that her symptoms and pain manifest.

Example Question:

Does the stomach pain radiate?

Finding:

Denies shoulder pain

(Available)

Pro Tip: Determining where Tina’s pain is occurring will allow you to most effectively treat her symptoms. Asking Tina if she has shoulder pain will help you to determine precisely where her pain is located.

Example Question:

Do you have shoulder pain?

Finding:

Denies back pain

(Available)

Pro Tip: Determining where Tina’s pain is occurring will allow you to most effectively treat her symptoms. Asking Tina if she has back pain will help you to determine precisely where her pain is located.

Example Question:

Do you have back pain?

Finding:

Denies arm pain

(Available)

Pro Tip: Determining where Tina’s pain is occurring will allow you to most effectively treat her symptoms. Asking Tina if either arm hurts will help you to determine precisely where her pain is located.

Example Question:

Does either arm hurt?

Finding:

Denies flank pain

(Available)

Pro Tip: Determining where Tina’s pain is occurring will allow you to most effectively treat her symptoms. Asking Tina if she has flank pain will help you to determine precisely where her pain is located tina jones gastrointestinal shadow health subjective data.

Example Question:

Do you have flank pain?

Finding:

Denies pain on right side of abdomen

(Found)

Pro Tip: Determining where Tina’s pain is occurring will allow you to most effectively treat her symptoms. Asking Tina if she has pain on the right side of her stomach will help you to determine precisely where her pain is located.

Example Question:

Do you have pain on the right side of your stomach?

Finding:

Asked about aggravating factors

Finding:

Pain occurs after eating

(Found)

Pro Tip: By determining what factors aggravate Tina’s pain you can develop a treatment plan for her. Asking if her pain is worse after she eats will help you to most effectively treat Tina’s symptoms.

Example Question:

Do you feel the pain after you eat?

Finding:

Pain worsens with larger meals

(Found)

Pro Tip: By determining what factors aggravate Tina’s pain you can develop a treatment plan for her. Asking if her pain is worse after she eats larger meals will help you to most effectively treat Tina’s symptoms.

Example Question:

Is the pain worse with larger meals?

Finding:

Reports that spicy foods increase the pain

(Found)

Pro Tip: By determining what factors aggravate Tina’s pain you can develop a treatment plan for her. Asking if her pain is worse after she eats spicy food will help you to most effectively treat Tina’s symptoms.

Example Question:

Does spicy food make the pain worse?

Finding:

Denies high-fat foods as an aggravating factor

(Available)

Pro Tip: By determining what factors aggravate Tina’s pain you can develop a treatment plan for her. Asking if her pain is worse after she eats greasy food will help you to most effectively treat Tina’s symptoms.

Example Question:

Does greasy food make the pain worse?

Finding:

Pain worsens when supine

(Found)

Pro Tip: Pain severity might change for a variety of reasons. Asking Tina if her pain is worse when she is supine will provide a relative measurement of her condition.

Example Question:

Is the pain worse when you lay down?

Finding:

Pain worsens when bending over

(Found)

Pro Tip: Pain severity might change for a variety of reasons. Asking Tina if her pain is worse when she bends over will provide a relative measurement of her condition.

Example Question:

Is the pain worse when you bend over?

Finding:

Asked about relieving factors

Finding:

Pain improves between meals

(Found)

Pro Tip: Pain might change over time for a variety of reasons. Asking Tina if her pain improves between meals establishes a timeline of when her symptoms are most aggravated.

Example Question:

Does your pain improve between meals?

Finding:

Pain improves when upright

(Found)

Pro Tip: Pain might change for a variety of reasons. Asking Tina if her pain improves when she is standing will solicit information about which positions are least uncomfortable for Tina.

Example Question:

Does your pain improve when you sit up?

Finding:

Asked about effects of pain on diet and appetite

Finding:

Reports decreased appetite

(Found)

Pro Tip: Pain can have a substantial effect on diet and appetite. Asking Tina how her appetite has been will illustrate the ways in which her symptoms are manifesting.

Example Question:

How has your appetite been?

Finding:

Describes not wanting to eat out of anticipation of pain

(Found)

Pro Tip: Pain can have a substantial effect on diet and appetite. Asking Tina why she has been eating less will illustrate the ways in which her symptoms are manifesting.

Example Question:

Why have you been eating less?

Finding:

Reports eating smaller meals

(Found)

Pro Tip: Pain can have a substantial effect on diet and appetite. Asking Tina if she has been eating smaller meals will illustrate the ways in which her symptoms are manifesting.

Example Question:

Have you been eating smaller meals?

Finding:

Reports avoiding spicy foods

(Found)

Pro Tip: Pain can have a substantial effect on diet and appetite. Asking Tina if she still eats spicy foods will illustrate the ways in which her symptoms are manifesting.

Example Question:

Do you still eat spicy foods?

Finding:

Asked about increased burping

Finding:

Reports burping

(Found)

Pro Tip: Increased burping can be a result of heartburn, acid reflux, or indigestion. Asking Tina if she’s been burping more would indicate that Tina has been swallowing more air recently.

Example Question:

Have you been burping?

Finding:

Burping occurs after eating

(Found)

Pro Tip: Increased burping can be a result of heartburn, acid reflux, or indigestion. Asking Tina when she burps the most would indicate that Tina has been swallowing more air recently.

Example Question:

When do you burp the most? tina jones gastrointestinal shadow health subjective data

Finding:

Asked about changes in weight

Finding:

Denies recent weight loss

(Available)

Pro Tip: Foundational questions about general health and wellbeing can help you to determine how your patient perceives her health. Asking Tina if her weight changed recently can indicate whether Tina has concerns about recent weight loss.

Example Question:

Have you lost weight recently?

Medical History

Finding:

Confirmed use of medications

Finding:

Confirms medications (no new medications reported)

(Found)

Pro Tip: Determining what, if any, medications a patient is taking is a crucial element of a thorough health history and will help you avoid unwanted drug interactions.

Example Question:

What medications do you take?

Finding:

Reports occasional antacid use

(Found)

Pro Tip: Tina’s response to a question about pain management will reveal the severity of her pain, her health literacy, and the way she’s managing her symptoms.

Example Question:

Have you been taking antacids?

Finding:

Denies frequent Advil (ibuprofen) use

(Available)

Pro Tip: The medication that a patient takes reveals a current treatment plan and healthcare access. Asking Tina how frequently she is taking the Ibuprofen will illustrate the extent of her pain and how effectively OTC medication works for her injury.

Example Question:

How often do you take ibuprofen?

Finding:

Followed up on use of antacids and relieving factors

Finding:

Antacid brand is Tums

(Found)

Pro Tip: The medication that a patient takes reveals a current treatment plan and healthcare access. Asking Tina what kind of antacids she takes will illustrate the extent of her pain and how effectively OTC medication works for her pain.

Example Question:

What kind of antacids do you take?

Finding:

Takes antacids every few days

(Available)

Pro Tip: The medication that a patient takes reveals a current treatment plan and healthcare access. Asking Tina how often she takes an antacid will illustrate the extent of her pain and how effectively OTC medication works for her pain.

Example Question:

How often do you take an antacid?

Finding:

Takes between 2 and 4 antacid tablets at a time

(Found)

Pro Tip: The medication that a patient takes reveals a current treatment plan and healthcare access. Asking Tina how many antacids she takes at a time will illustrate the extent of her pain and how effectively OTC medication works for her pain.

Example Question:

How many antacids do you take at a time?

Finding:

Reports that antacids offer partial relief

(Found)

Pro Tip: The medication that a patient takes reveals a current treatment plan and healthcare access. Asking Tina if the antacids have been helping will illustrate the extent of her pain and how effectively OTC medication works for her injury.

Example Question:

Do the antacids help?

Finding:

Confirmed allergies

Finding:

Confirms allergies (no new allergies reported)

(Found)

Pro Tip: It’s best practice to ask a patient about her allergies each visit, even with an established patient, to uncover any new allergy triggers or symptoms.

Example Question:

Have you had any new allergies?

Finding:

Asked about past gastrointestinal history

Finding:

Denies past history of ulcers

(Found)

Pro Tip: Soliciting a relevant medical history from your patient will aid in effectively treating your patient’s symptoms. Asking Tina if she ever had any ulcers will allow her to describe any historical concerns or problems she’s had.

Example Question:

Have you ever had any ulcers?

Finding:

Denies gastrointestinal disease

(Found)

Pro Tip: Soliciting a relevant medical history from your patient will aid in effectively treating your patient’s symptoms. Asking Tina about her gastrointestinal history will allow her to describe any historical concerns or problems she’s had.

Example Question:

Do you have any gastrointestinal diseases?

Finding:

Denies past history of GERD

(Available)

Pro Tip: Soliciting a relevant medical history from your patient will aid in effectively treating your patient’s symptoms. Asking Tina if she’s ever been diagnosed with GERD will allow her to describe any historical concerns or problems she’s had.

Example Question:

Have you ever been diagnosed with GERD?

Finding:

Denies past gastrointestinal surgery

(Found)

Pro Tip: Soliciting a relevant medical history from your patient will aid in effectively treating your patient’s symptoms. Asking Tina if she’s had any gastrointestinal surgeries will allow her to describe any historical concerns or problems she’s had.

Example Question:

Have you had any gastrointestinal surgeries?

Finding:

Denies past history of appendicitis

(Found)

Pro Tip: Soliciting a relevant medical history from your patient will aid in effectively treating your patient’s symptoms. Asking Tina if she’s had appendicitis will allow her to describe any historical concerns or problems she’s had tina jones gastrointestinal shadow health subjective data.

Example Question:

Have you had appendicitis?

Finding:

Denies past history of cholecystitis

(Available)

Pro Tip: Soliciting a relevant medical history from your patient will aid in effectively treating your patient’s symptoms. Asking Tina if she ever had her gallbladder removed will allow her to describe any historical concerns or problems she’s had.

Example Question:

Have you ever had your gallbladder removed?

Finding:

Denies past history of stomach cancer

(Found)

Pro Tip: Soliciting a relevant medical history from your patient will aid in effectively treating your patient’s symptoms. Asking Tina if she ever had stomach cancer will allow her to describe any historical concerns or problems she’s had.

Example Question:

Have you ever had stomach cancer?

Finding:

Denies past history of liver disease

(Found)

Pro Tip: Soliciting a relevant medical history from your patient will aid in effectively treating your patient’s symptoms. Asking Tina if she’s ever been diagnosed with liver disease will allow her to describe any historical concerns or problems she’s had.

Example Question:

Have you ever been diagnosed with liver disease?

Finding:

Denies past history of kidney disease

(Available)

Pro Tip: Soliciting a relevant medical history from your patient will aid in effectively treating your patient’s symptoms. Asking Tina if she’s ever had any kidney diseases will allow her to describe any historical concerns or problems she’s had.

Example Question:

Have you ever had any kidney diseases?

Finding:

Denies past history of bladder disease

(Found)

Pro Tip: Soliciting a relevant medical history from your patient will aid in effectively treating your patient’s symptoms. Asking Tina if she’s ever had a bladder disease will allow her to describe any historical concerns or problems she’s had.

Example Question:

Have you ever had a bladder disease?

Finding:

Asked about typical bowel movements

Finding:

Reports bowel movement every 2 days

(Found)

Pro Tip: GERD and IBS often occur together. Asking Tina about her bowel movements is significant in understanding her gastrointestinal symptoms.

Example Question:

How often do you have a bowel movement?

Finding:

Denies pain during bowel movements

(Found)

Pro Tip: GERD and IBS often occur together. Asking Tina about her bowel movements is significant in understanding her gastrointestinal symptoms.

Example Question:

Do you have any pain with your bowel movements?

Finding:

Denies bloody or tarry stools

(Found)

Pro Tip: GERD and IBS often occur together. Asking Tina if there are any abnormalities in her stools is significant in understanding her gastrointestinal symptoms.

Example Question:

Do you have dark colored stools?

Finding:

Denies mucus in stool

(Found)

Pro Tip: GERD and IBS often occur together. Asking Tina if there are any abnormalities in her stools is significant in understanding her gastrointestinal symptoms tina jones gastrointestinal shadow health subjective data.

Example Question:

Do you notice mucus in your stools?

Finding:

Describes consistency of bowel movements

(Available)

Pro Tip: GERD and IBS often occur together. Asking Tina about her bowel movements is significant in understanding her gastrointestinal symptoms.

Example Question:

Are your bowel movements consistent?

Finding:

Asked about typical urination

Finding:

Reports increased urination

(Found)

Pro Tip: Bladder dysfunction can indicate a GI problem. Asking Tina if she has been urinating more than usual can help you to determine the cause of Tina’s symptoms.

Example Question:

Have you been urinating more than usual?

Finding:

Reports urine is a clear or light-yellow color

(Found)

Pro Tip: Bladder dysfunction can indicate a GI problem. Asking Tina what color her urine is can help you to determine the cause of Tina’s symptoms.

Example Question:

What color is your urine?

Finding:

Reports nocturia

(Found)

Pro Tip: Bladder dysfunction can indicate a GI problem. Asking Tina if she has to wake up to urinate can help you to determine the cause of Tina’s symptoms.

Example Question:

Have you had to wake up to urinate?

Finding:

Denies pain during urination

(Found)

Pro Tip: Bladder dysfunction can indicate a GI problem. Asking Tina if it is painful when she urinates can help you to determine the cause of Tina’s symptoms.

Example Question:

Is it painful when you urinate?

Finding:

Describes urine character as normal

(Found)

Pro Tip: Bladder dysfunction can indicate a GI problem. Asking Tina what her urine looks like can help you to determine the cause of Tina’s symptoms.

Example Question:

What does your urine look like?

Finding:

Denies pink or bloody urine

(Found)

Pro Tip: Bladder dysfunction can indicate a GI problem. Asking Tina if her urine is ever red can help you to determine the cause of Tina’s symptoms.

Example Question:

Is your urine ever red?

Finding:

Denies incontinence

(Available)

Pro Tip: Bladder dysfunction can indicate a GI problem. Asking Tina if she ever has trouble holding her urine in can help you to determine the cause of Tina’s symptoms.

Example Question:

Do you ever have trouble holding your urine in?

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Finding:

Asked about menstruation and sexual activity

Finding:

LMP was 3 weeks ago

(Found)

Pro Tip: Gynecologic disorders appear to be more common in people with IBS. Soliciting information about Tina’s menstrual patterns can indicate whether her menstrual patterns are normal tina jones gastrointestinal shadow health subjective data.

Example Question:

When was your last menstrual period?

Finding:

Denies sexual activity

(Found)

Pro Tip: Some sexually active people with IBD report pain and bloating during sex. Asking Tina if she is sexually active can help you to determine the extent of her gastrointestinal symptoms.

Example Question:

Are you currently sexually active?

Social History

Finding:

Asked about most recent meal

Finding:

Most recent meal was breakfast this morning

(Found)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina when she most recently ate will illustrate her dietary recent patterns.

Example Question:

When was your most recent meal?

Finding:

Most recent meal was toast with butter and honey and orange juice

(Found)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina what she ate for breakfast will indicate how she has been eating recently.

Example Question:

What did you eat for breakfast?

Finding:

Asked 24-hour diet recall

Finding:

Yesterday’s breakfast was cereal

(Found)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina what she had for breakfast yesterday will illustrate her recent dietary patterns tina jones gastrointestinal shadow health subjective data.

Example Question:

What did you have for breakfast yesterday?

Finding:

Yesterday’s lunch was pizza

(Found)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina what she had for lunch yesterday will illustrate her recent dietary patterns.

Example Question:

What did you have for lunch yesterday?

Finding:

Yesterday’s dinner was a baked potato

(Found)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina what she had for dinner yesterday will illustrate her recent dietary patterns.

Example Question:

What did you have for dinner yesterday?

Finding:

Asked about typical diet

Finding:

Reports typical intake is 3 meals a day plus snacks

(Found)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina how many means she typically eats in a day will illustrate her recent dietary patterns tina jones gastrointestinal shadow health subjective data.

Example Question:

How many meals do you eat in a typical day?

Finding:

Typical breakfast is cereal, bread, or a muffin

(Found)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina what she typically has for breakfast will illustrate her recent dietary patterns.

Example Question:

What is your typical breakfast?

Finding:

Typical lunch is a sandwich and chips

(Found)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina what she typically has for lunch will illustrate her recent dietary patterns.

Example Question:

What is your typical lunch?

Finding:

Typical dinner is chicken, a vegetable or potatoes, and bread

(Found)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina what she typically has for dinner will illustrate her recent dietary patterns.

Example Question:

What is your typical dinner?

Finding:

Reports fast food intake 3 times a week

(Available)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina how often she eats fast food will illustrate her recent dietary patterns.

Example Question:

How often do you eat fast food?

Finding:

Typical snack is pretzels, French fries, crackers or chips

(Available)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina what she typically has for a snack will illustrate her recent dietary patterns.

Example Question:

What is a typical snack for you?

Finding:

Asked about typical beverages

Finding:

Last alcoholic drink was 2 weeks ago

(Found)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina when she last had an alcoholic drink will illustrate her recent dietary patterns.

Example Question:

When did you last have an alcoholic drink?

Finding:

Typical alcohol frequency is 2 – 3 times a month tina jones gastrointestinal shadow health subjective data

(Available)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina how many drinks she typically has in a month will illustrate her recent dietary patterns.

Example Question:

How many times a month do you drink alcohol?

Finding:

Typical alcohol intake is 2 – 3 drinks at a time

(Found)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina how many alcoholic drinks she typically has at a time will illustrate her recent dietary patterns.

Example Question:

How many alcoholic drinks do you typically have at one time?

Finding:

Reports that alcohol intake bothered her stomach

(Available)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina if the alcohol makes her stomach pain worse will indicate whether alcohol is causing some of her GI symptoms.

Example Question:

Does alcohol make your stomach pain worse?

Finding:

Reports drinking soda

(Found)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina if she drinks soda will illustrate her recent dietary patterns.

Example Question:

Do you drink soda?

Finding:

Reports drinking 3 – 4 diet cokes a day

(Available)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina how many diet cokes she drinks a day will illustrate her recent dietary patterns.

Example Question:

How many diet cokes do you drink in a day?

Finding:

Reports that she hasn’t noticed a connection between soda intake and pain

(Available)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina if the diet coke makes her stomach pain worse will indicate whether diet coke is causing some of her GI symptoms.

Example Question:

Does the diet coke make your stomach pain worse?

Finding:

Reports drinking 6 – 8 glasses of water a day tina jones gastrointestinal shadow health subjective data.

(Found)

Pro Tip: Because diet is such a large part of the GI system, asking Tina questions about her diet can be particularly informative. Asking Tina how many glasses of water she has a day will indicate her current patterns of diet and consumption.

Example Question:

How many glasses of water do you drink each day?

Finding:

Asked about recent dietary and life experiences

Finding:

Denies recent travel

(Found)

Pro Tip: Recent dietary or new life experiences can result in digestive problems. Asking Tina if she’s traveled recently might point to something new that is triggering digestive problems for Tina.

Example Question:

Have you traveled recently?

Finding:

Denies food poisoning

(Found)

Pro Tip: Recent dietary or new life experiences can result in digestive problems. Asking Tina if she thinks she could have food poisoning might indicate what’s triggering Tina’s digestive problems.

Example Question:

Do you think you could have food poisoning?

Finding:

Asked about substance use

Finding:

Denies illicit drug use

(Found)

Pro Tip: Drug use can cause damage to the cells of the digestive tract and inhibit the secretion enzymes needed for digestion. Asking Tina if she currently uses and illicit drugs might indicate whether drug use is causing problems for her digestion.

Example Question:

Do you currently use any recreational drugs?

Finding:

Denies cigarette smoking

(Found)

Pro Tip: Smoking or inhaling substances can have adverse effects on the digestive system. Asking Tina if she currently smokes can help you to discern whether smoking was a factor in Tina’s recent digestive problems.

Example Question:

Do you smoke cigarettes?

Social Determinants of Health

Finding:

Asked about food access tina jones gastrointestinal shadow health subjective data.

Finding:

Reports living near grocery store

(Available)

Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.

Example Question:

How far away is the grocery store from where you live?

Finding:

Reports access to fresh foods

(Available)

Pro Tip: Asking a patient about Social Determinants of Health (SDOH) can unearth underlying social, political, or economic barriers to their health and wellbeing. Recognizing a patient’s SDOH can lead you to provide more informed and empathetic care for your patients, because you will have a greater understanding of the challenges they face.

Example Question:

Do you have access to fresh produce?

Review of Systems

Finding:

Asked about general symptoms

Finding:

Denies fever

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like fever, details the way her individual symptoms and pain manifest.

Example Question:

Have you had any fever recently?

Finding:

Denies chills

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like getting chills, details the way her individual symptoms and pain manifest tina jones gastrointestinal shadow health subjective data.

Example Question:

Have you been feeling chills?

Finding:

Denies fatigue

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like fatigue, details the way her individual symptoms and pain manifest.

Example Question:

Have you been fatigued?

Finding:

Denies night sweats

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her injury, like night sweats, details the way her individual symptoms and pain manifest.

Example Question:

Have you had night sweats?

Finding:

Asked about review of systems for mental health

Finding:

Reports occasional feelings of anxiety

(Found)

Pro Tip: Anxiety can manifest in symptoms like heartburn or acid reflux. Asking Tina if she’s experienced anxiety would suggest a cyclical relationship between her physical symptoms and anxiety.

Example Question:

Have you been experiencing anxiety?

Finding:

Reports feelings of stress

(Found)

Pro Tip: Anxiety can manifest in symptoms like heartburn or acid reflux. Asking Tina about her recent stress levels would suggest a cyclical relationship between her physical symptoms and anxiety.

Example Question:

How is your recent stress level? tina jones gastrointestinal shadow health subjective data.

Finding:

Asked about review of systems for gastrointestinal

Finding:

Denies nausea

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like nausea, details the way her individual symptoms and pain manifest.

Example Question:

Have you had any nausea?

Finding:

Denies vomiting

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like vomiting, details the way her individual symptoms and pain manifest.

Example Question:

Have you been vomitting?

Finding:

Denies diarrhea

(Available)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like diarrhea, details the way her individual symptoms and pain manifest.

Example Question:

Have you had any diarrhea?

Finding:

Denies constipation

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like constipation, details the way her individual symptoms and pain manifest.

Example Question:

Have you been constipated?

Finding:

Denies flatus

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like gas, details the way her individual symptoms and pain manifest.

Example Question:

Have you had gas?

Finding:

Denies bloating

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like feeling bloated, details the way her individual symptoms and pain manifest.

Example Question:

Have you felt bloated tina jones gastrointestinal shadow health subjective data?

Finding:

Asked about review of systems for respiratory

Finding:

Denies sore throat

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like throat pain, details the way her individual symptoms and pain manifest.

Example Question:

Do you have any throat pain?

Finding:

Denies coughing

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like coughing, details the way her individual symptoms and pain manifest.

Example Question:

Have you been coughing?

Finding:

Denies dysphagia

(Available)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like difficulty swallowing, details the way her individual symptoms and pain manifest.

Example Question:

Do you have difficulty swallowing?

Finding:

Denies difficulty breathing

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like difficulty breathing, details the way her individual symptoms and pain manifest.

Example Question:

Have you had difficulty breathing?

Finding:

Denies chest pain

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like chest pain, details the way her individual symptoms and pain manifest.

Example Question:

Have you had any chest pain?

Finding:

Denies palpitations

(Available)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like palpitations, details the way her individual symptoms and pain manifest tina jones gastrointestinal shadow health subjective data.

Example Question:

Have you had any palpitations?

Finding:

Denies change in sense of taste

(Found)

Pro Tip: Symptoms often vary from patient to patient. Asking Tina about the symptoms she is experiencing with her pain, like change in her sense of taste, details the way her individual symptoms and pain manifest.

Example Question:

Has there been any change to your sense of taste?

Family History

Finding:

Asked about relevant family history

Finding:

Reports family history of colon cancer

(Found)

Pro Tip: Family histories can suggest genetic predispositions to certain conditions. Asking if Tina has a family history of colon cancer might reveal a predisposition to gastrointestinal issues.

Example Question:

Do you have a family history of colon cancer?

Finding:

Denies family history of GERD

(Found)

Pro Tip: Family histories can suggest genetic predispositions to certain conditions. Asking if Tina has a family history of GERD might reveal a predisposition to gastrointestinal issues.

Example Question:

Do you have a family history of GERD?

Finding:

Denies family history of IBS

(Found)

Pro Tip: Family histories can suggest genetic predispositions to certain conditions. Asking if Tina has a family history of irritable bowel syndrome might reveal a predisposition to gastrointestinal issues.

Example Question:

Do you have a family history of irritable bowel syndrome?

Finding:

Denies family history of cholecystitis

(Found)

Pro Tip: Family histories can suggest genetic predispositions to certain conditions. Asking if Tina has a family history of cholecystitis might reveal a predisposition to gastrointestinal issues.

Example Question:

Do you have a family history of cholecystitis?

Finding:

Denies family history of liver disease

(Found)

Pro Tip: Family histories can suggest genetic predispositions to certain conditions. Asking if Tina has a family history of liver disease might reveal a predisposition to gastrointestinal issues.

Example Question:

Do you have a family history of liver disease?

Finding:

Denies family history of kidney disease

(Found)

Pro Tip: Family histories can suggest genetic predispositions to certain conditions. Asking if Tina has a family history of kidney disease might reveal a predisposition to gastrointestinal issues.

Example Question:

Do you have a family history of kidney disease?

Finding:

Denies family history of bladder disease tina jones gastrointestinal shadow health subjective data

tina jones gastrointestinal shadow health transcript

Hello. My name is xxxx. I will interview you and later do a physical exam.

Greet

07/05/20 10:03 PM CDT

Hey.

What is your name?

Question

07/05/20 10:03 PM CDT

Tina Jones.

What is you date of birth?

Question

07/05/20 10:04 PM CDT

February 17th.

How old are you?

Question

07/05/20 10:05 PM CDT

I’m 28.

What brings you to the clinic today?

Question

07/05/20 10:05 PM CDT

I’ve been having this stomach pain for awhile. It keeps coming back, and it really is starting to bother me.

Sorry to hear that you are feeling bad

Empathize

07/05/20 10:05 PM CDT

Thanks for understanding tina jones gastrointestinal shadow health transcript.

When did the pain start?

Question

07/05/20 10:06 PM CDT

Probably at least a month ago. Maybe longer. It started out really minor so it took me awhile to realize it was getting bad.

Where s the pain located?

Question

07/05/20 10:06 PM CDT

It’s like… my upper stomach. Like right below my breastbone, in the middle.

Describe how the pain feels

Question

07/05/20 10:06 PM CDT

Um, it feels like heartburn. But sometimes, if it’s bad, it’s sharper than that.

Does the pain increase?

Question

07/05/20 10:06 PM CDT

Yeah, it’s getting worse over time. I get these stomach pains every day.

How many times a week are you getting the pain? (Clarified to How many times a week have you been having issues with abdominal pain?.)

Question

07/05/20 10:07 PM CDT

Every time I eat it hurts a little, but 3 or 4 times a week, it’ll be a lot worse. (Clarified to how many times a week I have abdominal pain.)

Do you have the abdominal pain everyday?

Question

07/05/20 10:08 PM CDT

Yeah, I’ve had stomach pain for awhile now.

when did the abdominal pain begin?

Question

07/05/20 10:09 PM CDT

Probably at least a month ago. Maybe longer. It started out really minor so it took me awhile to realize it was getting bad.

How long does the pain last?

Question

07/05/20 10:09 PM CDT

For a few hours after I eat.

How do you rate the pain on a scale of 0 to 10? (Clarified to Can you rate your current pain level on a scale of 0 to 10?.)

Question

07/05/20 10:10 PM CDT

Right now, it’s like a 1 or 2. But after I eat, it’s like a. . . 5? (Clarified to how I would rate my pain on a scale.)

Is the pain crushing?

Question

07/05/20 10:10 PM CDT

No.

Is the pain gnawing ?

Question

07/05/20 10:11 PM CDT

No, it’s not like that.

Is the pain cramping tina jones gastrointestinal shadow health transcript?

Question

07/05/20 10:11 PM CDT

No, it’s not like stomach cramps.

where is the pain located?

Question

07/05/20 10:11 PM CDT

It’s like… my upper stomach. Like right below my breastbone, in the middle.

on what side of your stomach is the pain located?

Question

07/05/20 10:12 PM CDT

No, it’s right in the center of my stomach, like between my belly button and my ribs.

do you have sharp pain in your lower abdomen?

Question

07/05/20 10:13 PM CDT

No, it’s not at all like that. It’s in the middle of my stomach.

Am sorry you feel that

Empathize

07/05/20 10:14 PM CDT

I appreciate you saying that.

does your pain occur after eating?

Question

07/05/20 10:14 PM CDT

Yes. Every time I eat it hurts. I’ve been eating less because I don’t like being in pain.

Your pain is with larger meals?

Question

07/05/20 10:15 PM CDT

Yes, large meals make the pain worse. [AUDIO COMING SOON]

do you eat spicy foods?

Question

07/05/20 10:15 PM CDT

Well, I used to eat spicy food sometimes, but in the last few weeks I can’t. It makes my stomach pain too bad.

Do you eat a lot of fatty foods?

Question

07/05/20 10:16 PM CDT

Not too much. I mean, I like French fries and stuff, but I try not to eat them too often.

French fries are considered fatty foods, try cut down on them

Educate

07/05/20 10:17 PM CDT

Alright, thanks for letting me know.

Is your pain worse when you bend over?

Question

07/05/20 10:17 PM CDT

Yeah. It gets worse when I bend over — I noticed that at work.

sorry to hear that

Empathize

07/05/20 10:18 PM CDT

Thanks for saying that.

Does it hurt when you lie flat?

Question

07/05/20 10:18 PM CDT

Yeah.

Try not to bend over at work

Educate

07/05/20 10:18 PM CDT

Thanks for telling me tina jones gastrointestinal shadow health transcript.

Is the pain better when you sit up? (Clarified to Does the pain improve when you sit up?.)

Question

07/05/20 10:19 PM CDT

Usually, yeah. (Clarified to if my pain improves when I sit up.)

any decrease in appetite?

Question

07/05/20 10:20 PM CDT

Yeah, I haven’t been wanting to eat lately.

Its important you take 3 meals a day

Educate

07/05/20 10:20 PM CDT

OK, I understand.

Do you eat out?

Question

07/05/20 10:20 PM CDT

I try not to eat out too much, but with my schedule I end up having to.

have you been eating smaller meals than usual?

Question

07/05/20 10:21 PM CDT

Yeah, I’ve been trying to eat really little meals. I haven’t been that hungry, and I don’t want to have the pain of eating a big meal.

Any increase in burping? (Clarified to Have you been burping more than usual?.)

Question

07/05/20 10:22 PM CDT

Yeah, that’s been happening after I eat. (Clarified to if I have been burping more than usual lately.)

what makes your stomach pain relieve? (Clarified to What makes the abdominal pain better?.)

Question

07/05/20 10:23 PM CDT

I feel the best in-between meals. And sitting up on the couch seems to help. And sometimes I take an antacid. (Clarified to what makes the abdominal pain better.)

Sitting up position helps prevent stomach acid from coming up the esophagus.

Educate

07/05/20 10:25 PM CDT

Sure, I think I understand what you mean.

What is the name of the antacid?

Question

07/05/20 10:25 PM CDT

I take the chewable Tums.

How many chewable tums? (No matching questions found.)

Question

07/05/20 10:25 PM CDT

How many chew able tums do you take in a day?

Question

07/05/20 10:26 PM CDT

I start with two, and then I chew a couple more if I need to. The bottle says you can have up to four.

Do the tums help relieve your pain?

Question

07/05/20 10:27 PM CDT

Yeah, they help. I try to only take them when the pain seems worse than usual.

Does use of antacid help?

Question

07/05/20 10:27 PM CDT

Yeah, they help. I try to only take them when the pain seems worse than usual.

Does the pain change?

Question

07/05/20 10:28 PM CDT

Yeah, it’s getting worse over time. I get these stomach pains every day.

Does the stomach pain come with nausea and vomiting?

Question

07/05/20 10:28 PM CDT

No, I don’t feel nauseous.

does your pain cause vomiting? (No matching questions found.)

Question

07/05/20 10:29 PM CDT

does the pain cause vomiting? (No matching questions found.)

Question

07/05/20 10:29 PM CDT

is your abdomen tender?

Question

07/05/20 10:30 PM CDT

No. My stomach pain’s not tender like that.

any cramping?

Question

07/05/20 10:30 PM CDT

Yeah, I get cramps pretty bad.

Is your pain associated with gas?

Question

07/05/20 10:31 PM CDT

I don’t think so. I haven’t been gassy lately.

are you passing gas?

Question

07/05/20 10:31 PM CDT

No.

How is your bowel?

Question

07/05/20 10:31 PM CDT

I guess I normally go once a day, or sometimes every other day.

What the bowel colour? (No matching questions found.)

Question

07/05/20 10:32 PM CDT

What is your typical breakfast?

Question

07/05/20 10:33 PM CDT

I usually have either cereal or toast, or if I pick something up on my way to work, I’ll get a muffin or some pumpkin bread.

what is your usual lunch?

Question

07/05/20 10:33 PM CDT

I usually either make a sandwich and bring it with me, or I get a sandwich somewhere. And I have chips or pretzels with it. Or *maybe* French fries, but I try not to get them too often.

Try and avoid fatty foods such as chips and french fries, they are not healthy.

Educate

07/05/20 10:35 PM CDT

That makes sense.

any flatus after eating? (No matching questions found.)

Question

07/05/20 10:35 PM CDT

How often do you eat spicy foods?

Question

07/05/20 10:36 PM CDT

Well, I used to eat spicy food sometimes, but in the last few weeks I can’t. It makes my stomach pain too bad tina jones gastrointestinal shadow health transcript.

Spicy foods can irritate the stomach lining.

Educate

07/05/20 10:36 PM CDT

Alright, thanks for letting me know.

Are you having stomach pain now? (Clarified to Do you have stomach pain right now?.)

Question

07/05/20 10:37 PM CDT

Only a little. (Clarified to if I have stomach pain right now.)

what tome of the day is the pain the worst?

Question

07/05/20 10:37 PM CDT

I don’t think it’s a particular time of day. It just hurts the worst right after I eat.

Do you have allergies?

Question

07/05/20 10:39 PM CDT

Yeah, I’m allergic to cats.

Do you have gastrointestinal disease?

Question

07/05/20 10:39 PM CDT

I don’t have like, diseases. But I’ve had this stomach pain for like, a month.

have you ever had gastrointestinal surgery?

Question

07/05/20 10:40 PM CDT

No.

any past history of appendicitis?

Question

07/05/20 10:40 PM CDT

No.

have you ever had cholecystitis?

Question

07/05/20 10:41 PM CDT

Not that I’ve heard of.

Any history of stomach cancer?

Question

07/05/20 10:42 PM CDT

No.

what about liver disease? (No matching questions found.)

Question

07/05/20 10:42 PM CDT

Any history of liver disease?

Question

07/05/20 10:43 PM CDT

No, I’ve never had any problems with my liver.

any history of ulcers?

Question

07/05/20 10:43 PM CDT

No.

any history of bladder disease?

Question

07/05/20 10:43 PM CDT

No, I never have.

do you experience pain during bowel movements?

Question

07/05/20 10:44 PM CDT

No.

Any bloody or tarry stools?

Question

07/05/20 10:44 PM CDT

Um, no.

any mucus ins stool? (Clarified to Have you had mucus in your stool?.)

Question

07/05/20 10:44 PM CDT

Ew. No. (Clarified to if there has been mucus in my stool.)

Any changes in bowel movements pattern?

Question

07/05/20 10:45 PM CDT

No, everything’s been normal in that department.

Do you have increased urination?

Question

07/05/20 10:45 PM CDT

Yeah, but I’ve been drinking more water.

drinking water is good for you

Educate

07/05/20 10:46 PM CDT

That makes sense.

What is the colour of your urine?

Question

07/05/20 10:46 PM CDT

Um, light yellow or almost clear? The regular color.

Do you have pain during urination?

Question

07/05/20 10:47 PM CDT

No.

do you experience nocturia? (No matching questions found.)

Question

07/05/20 10:48 PM CDT

do you experience nocturia?do you urinate more than usual at night?

Question

07/05/20 10:49 PM CDT

Yeah, but I’ve been drinking more water.

does your urine have blood?

Question

07/05/20 10:50 PM CDT

I don’t think so… My pee hasn’t been red or anything.

when was your last period?

Question

07/05/20 10:51 PM CDT

I think it was just about a month ago tina jones gastrointestinal shadow health transcript.

do you have stomach pain during you periods?

Question

07/05/20 10:51 PM CDT

Yeah, I get cramps pretty bad.

are you sexually active?

Question

07/05/20 10:52 PM CDT

Um, not right now.

when was your last meal?

Question

07/05/20 10:52 PM CDT

This morning, I had breakfast at home.

what did you have for breakfast?

Question

07/05/20 10:53 PM CDT

This morning, I had toast with butter and honey, and some orange juice.

what did you have for dinner yesterday?

Question

07/05/20 10:53 PM CDT

Last night we had baked potatoes with broccoli and cheese soup on them.

what did you have for lunch yesterday?

Question

07/05/20 10:53 PM CDT

I had a piece of pizza. It was someone’s birthday at work, so they ordered pizza for all of us.

what was your breakfast yesterday?

Question

07/05/20 10:54 PM CDT

I had a small bowl of cereal.

What is your typical diet?

Question

07/05/20 10:55 PM CDT

It’s pretty good, I think. I’m not a huge health nut or anything.

what is your typical breakfast?

  ORDER A PLAGIARISM FREE PAPER NOW

Question

07/05/20 10:55 PM CDT

I usually have either cereal or toast, or if I pick something up on my way to work, I’ll get a muffin or some pumpkin bread.

what is your typical dinner?

Question

07/05/20 10:55 PM CDT

Oh, we try to make something easy. We eat a lot of frozen chicken breasts. We do hamburgers that we make at home every so often. We make sure we have a vegetable, and we eat a lot of potatoes. And we usually have rolls or something.

what is your typical lunch?

Question

07/05/20 10:56 PM CDT

I usually either make a sandwich and bring it with me, or I get a sandwich somewhere. And I have chips or pretzels with it. Or *maybe* French fries, but I try not to get them too often.

how many meals do you have in a day?

Question

07/05/20 10:56 PM CDT

I try to eat breakfast, lunch, and dinner. I usually have a snack somewhere in there.

Do you take alcohol? (No matching questions found.)

Question

07/05/20 10:56 PM CDT

Do you drink alcohol?

Question

07/05/20 10:57 PM CDT

Not lately, but I do every so often.

how often do you drink alcohol?

Question

07/05/20 10:57 PM CDT

Very rarely.

how many beers do drink per sitting?

Question

07/05/20 10:57 PM CDT

Never any more than 2 or 3.

That moderate drinking which is ok

Educate

07/05/20 10:58 PM CDT

Thanks for telling me.

Do you take soda? (No matching questions found.)

Question

07/05/20 10:58 PM CDT

Do you drink soda?

Question

07/05/20 10:58 PM CDT

Yeah, I drink diet Coke.

How many glasses of water do you take daily?

Question

07/05/20 10:59 PM CDT

Probably… 6 or 8 glasses? I drink a lot of water.

Have you had food poisoning?

Question

07/05/20 10:59 PM CDT

I’ve had food poisoning when I was a kid, and this isn’t anything like that.

Have you had recent travel?

Question

07/05/20 11:00 PM CDT

No. I’ve been here in Shadowville working my butt off!

Do you use illicit drugs tina jones gastrointestinal shadow health transcript?

Question

07/05/20 11:00 PM CDT

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

do you smoke cigarette

Question

07/05/20 11:00 PM CDT

No, I’ve never smoked a cigarette in my life.

Great! Smoking and drugs are not good for you

Educate

07/05/20 11:01 PM CDT

OK, I understand.

are you bloated?

Question

07/05/20 11:01 PM CDT

No, I don’t feel bloated.

Do you have sore throat?

Question

07/05/20 11:02 PM CDT

No, my throat doesn’t hurt.

Are you coughing?

Question

07/05/20 11:02 PM CDT

No, I haven’t been coughing.

do you have difficulty breathing?

Question

07/05/20 11:02 PM CDT

No, my breathing has been fine.

do you have chest pain?

Question

07/05/20 11:02 PM CDT

No, I’m not having chest pain. The pain I’m feeling is lower, like right in the middle of my torso. . . above my stomach, but below my ribs.

has you sense of taste changed?

Question

07/05/20 11:03 PM CDT

No, I can taste everything fine.

Any family history of colon cancer?

Question

07/05/20 11:03 PM CDT

Um, Grandpa Jones died of colon cancer.

am sorry to hear that

Empathize

07/05/20 11:05 PM CDT

Thanks.

do you have a family history of GERD?

Question

07/05/20 11:05 PM CDT

No.

Do you have a family history of ibs?

Question

07/05/20 11:06 PM CDT

No, I haven’t heard anything about that.

Do you have a family history of Cholecystitis?

Question

07/05/20 11:06 PM CDT

Not that I’ve heard of.

Any family history of liver disease?

Question

07/05/20 11:06 PM CDT

No, nobody’s had anything happen with their liver that I know of.

Any family history of bladder disease?

Question

07/05/20 11:07 PM CDT

Not that I’ve heard of.

Any family history of kidney disease?

Question

07/05/20 11:10 PM CDT

No, nobody’s had that.

What are your allergies?

Question

07/05/20 11:10 PM CDT

I’m allergic to cats.

what happens when you are around cats?

Question

07/05/20 11:11 PM CDT

Whenever I’m around cats, I start sneezing, my eyes get itchy. . . and my asthma starts to act up tina jones gastrointestinal shadow health transcript.

Are you allergic to dust?

Question

07/05/20 11:11 PM CDT

Well. . . I don’t know if it’s allergies, but sometimes my asthma acts up around dust.

are you allergic to penicillin?

Question

07/05/20 11:12 PM CDT

Yes.

what do you take for asthma?

Question

07/05/20 11:13 PM CDT

I have my Proventil inhaler, and then my daily Flovent inhaler, too.

what is the dosage of the proventil?

Question

07/05/20 11:13 PM CDT

I haven’t used my rescue inhaler in three months — not since I started the daily Flovent one.

when did you last use you flovent? (No matching questions found.)

Question

07/05/20 11:14 PM CDT

how consistent are your bowel movements? (Clarified to How often do you have a bowel movement?.)

Question

07/05/20 11:15 PM CDT

Usually every other day. (Clarified to how often I have a bowel movement.)

Do you get up in the middle of the night to urinate?

Question

07/05/20 11:16 PM CDT

Yeah, I definitely get up more than once during the night.

how many meals do you typically eat in a day?

Question

07/05/20 11:17 PM CDT

I try to eat breakfast, lunch, and dinner. I usually have a snack somewhere in there.

what did you have for dinner last night?

Question

07/05/20 11:17 PM CDT

Last night we had baked potatoes with broccoli and cheese soup on them.

ok. such a heavy meal may upset your stomach

Educate

07/05/20 11:18 PM CDT

Sure, I think I understand what you mean.

when did you last drink alcohol?

Question

07/05/20 11:19 PM CDT

At least 2 weeks ago. I have been staying at from it.

do you smoke pot?

Question

07/05/20 11:19 PM CDT

No, not since… not in like 6 or 7 years.

its good that you quit

Educate

07/05/20 11:20 PM CDT

That makes sense.

Any fever?

Question

07/05/20 11:20 PM CDT

No. No fever.

Any chills?

Question

07/05/20 11:20 PM CDT

No, no chills.

Any fatigue?

Question

07/05/20 11:20 PM CDT

No, I don’t feel tired tina jones gastrointestinal shadow health transcript.

any night sweats?

Question

07/05/20 11:20 PM CDT

No.

do you have anxiety?

Question

07/05/20 11:20 PM CDT

Not too much — I can get a little anxious and stressed because I’m busy and I work hard. I might have some anxiety lately. Especially since I’d like to get this heartburn fixed.

am sorry to hear that

Empathize

07/05/20 11:21 PM CDT

I appreciate you telling me that.

any feelings of stress?

Question

07/05/20 11:21 PM CDT

Ha. Yeah, I do feel stressed out. I’m almost done with school in a few months, and so I’m job-hunting. Plus I work. It’s a lot right now. And I’d like to figure out what’s going on with my stomach, too.

How do you cope with your stress?

Question

07/05/20 11:21 PM CDT

I just keep my head down and work on one thing at a time. I try to get a lot of sleep, too, if I’m especially stressed. And my mom is really supportive, so just talking with her always makes me feel better.

we should help you get off stress and anxiety

Educate

07/05/20 11:22 PM CDT

Thanks for telling me.

Any nausea?

Question

07/05/20 11:22 PM CDT

No, I’m fine.

Any vomiting?

Question

07/05/20 11:22 PM CDT

No.

Any constipation?

Question

07/05/20 11:23 PM CDT

I don’t have that problem.

any medications that you use?

Question

07/05/20 11:24 PM CDT

I have a daily inhaler. And I’ve been taking antacid chews sometimes for my stomach, too.

what is your highest level of education?

Question

07/05/20 11:24 PM CDT

Well, I’m finishing up my Bachelor’s degree right now.

what course are you pursuing? (No matching questions found.)

Question

07/05/20 11:24 PM CDT

what is your major?

Question

07/05/20 11:25 PM CDT

I’m going to get my bachelor’s in accounting tina jones gastrointestinal shadow health transcript.

Are you working?

Question

07/05/20 11:25 PM CDT

I’m a supervisor at Mid-American Copy & Ship. I’ve been working there since high school, and I’ve just kept moving up.

great, how is the work environment? (Clarified to How is work going?.)

Question

07/05/20 11:25 PM CDT

I like my job now, but once I graduate I’d really like to get a job at an accounting firm. I want my job to teach me new things and allow for real advancement. (Clarified to how work is.)

who do you live with?

Question

07/05/20 11:26 PM CDT

Right now I live back at home with my mom and my sister.

Tested skin turgor on forearm

Exam Action

07/05/20 11:27 PM CDT

Inspected right side of abdomen

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07/05/20 11:29 PM CDT

Inspected front of abdomen

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07/05/20 11:29 PM CDT

Inspected left side of abdomen

Exam Action

07/05/20 11:29 PM CDT

Auscultated breath sounds in anterior right middle lobe

Exam Action

07/05/20 11:30 PM CDT

Auscultated breath sounds in anterior right upper lobe

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07/05/20 11:30 PM CDT

Auscultated breath sounds in anterior right lower lobe

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07/05/20 11:30 PM CDT

Auscultated breath sounds in anterior left mid-chest (upper lobe)

Exam Action

07/05/20 11:30 PM CDT

Auscultated breath sounds in anterior left upper lobe

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07/05/20 11:30 PM CDT

Auscultated breath sounds in anterior left lower lobe

Exam Action

07/05/20 11:30 PM CDT

Auscultated breath sounds in posterior left lower lobe on side

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07/05/20 11:30 PM CDT

Auscultated breath sounds in posterior left lower lobe near spine

Exam Action

07/05/20 11:30 PM CDT

Auscultated breath sounds in posterior left lower lobe

Exam Action

07/05/20 11:30 PM CDT

Auscultated breath sounds in posterior left mid-back (lower lobe)

Exam Action

07/05/20 11:30 PM CDT

Auscultated breath sounds in posterior left lower lobe near spine

Exam Action

07/05/20 11:30 PM CDT

Auscultated breath sounds in posterior right mid-back (lower lobe)

Exam Action

07/05/20 11:30 PM CDT

Auscultated breath sounds in posterior right lower lobe near spine

Exam Action

07/05/20 11:30 PM CDT

Auscultated breath sounds in posterior right lower lobe on side

Exam Action

07/05/20 11:31 PM CDT

Auscultated breath sounds in posterior right upper lobe

Exam Action

07/05/20 11:31 PM CDT

Auscultated breath sounds in posterior left upper lobe

Exam Action

07/05/20 11:31 PM CDT

Auscultated breath sounds in posterior right lower lobe

Exam Action

07/05/20 11:31 PM CDT

Auscultated aortic area with the bell

Exam Action

07/05/20 11:31 PM CDT

Auscultated tricuspid area with the bell

Exam Action

07/05/20 11:31 PM CDT

Auscultated mitral area with the bell tina jones gastrointestinal shadow health transcript

Exam Action

07/05/20 11:31 PM CDT

Auscultated Erb’s point with the bell

Exam Action

07/05/20 11:31 PM CDT

Auscultated pulmonic area with the bell

Exam Action

07/05/20 11:32 PM CDT

Auscultated right upper quadrant

Exam Action

07/05/20 11:32 PM CDT

Auscultated left lower quadrant

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07/05/20 11:32 PM CDT

Auscultated left upper quadrant

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07/05/20 11:32 PM CDT

Auscultated right lower quadrant

Exam Action

07/05/20 11:32 PM CDT

Auscultated aorta in abdomen

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07/05/20 11:32 PM CDT

Auscultated right lower quadrant

Exam Action

07/05/20 11:35 PM CDT

Auscultated right upper quadrant

Exam Action

07/05/20 11:35 PM CDT

Auscultated left upper quadrant

Exam Action

07/05/20 11:35 PM CDT

Auscultated aorta in abdomen

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07/05/20 11:35 PM CDT

Auscultated left renal artery

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07/05/20 11:36 PM CDT

Auscultated right renal artery

Exam Action

07/05/20 11:36 PM CDT

Auscultated left iliac artery

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07/05/20 11:36 PM CDT

Auscultated right iliac artery

Exam Action

07/05/20 11:36 PM CDT

Auscultated right femoral artery

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07/05/20 11:36 PM CDT

Auscultated left femoral artery

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07/05/20 11:37 PM CDT

Auscultated right femoral artery

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07/05/20 11:37 PM CDT

Percussed right upper quadrant

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07/05/20 11:38 PM CDT

Percussed left upper quadrant

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07/05/20 11:38 PM CDT

Percussed right lower quadrant

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07/05/20 11:38 PM CDT

Percussed left flank for CVA tenderness

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Percussed right flank for CVA tenderness

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Percussed spleen

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Percussed for liver span: 7 cm in the mid-clavicular line

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Palpated right lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

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Palpated left lower quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

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Palpated right upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

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Palpated left upper quadrant with light pressure: No tenderness reported; no masses, guarding, or distension

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Palpated right upper quadrant with deep pressure: No masses

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Palpated left lower quadrant with deep pressure: No masses

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Palpated right upper quadrant with deep pressure: No masses

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Palpated left upper quadrant with deep pressure: No masses

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Palpated right lower quadrant: with deep pressure: No masses

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Palpated liver: Palpable 1 cm below right costal margin

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Palpated for spleen: Not palpable

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Palpated for right kidney: Not palpable

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Palpated for left kidney: Not palpable

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07/05/20 11:43 PM CDTtina jones gastrointestinal shadow health transcript

NURS 6512 Episodic/ Focused SOAP note Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat

Case Study 2: Focused Thyroid Exam

Patient Information:

Initials: C.M

Age: 32 years

Sex: F

Race: African American

S.

CC:
“I am feeling tired and my hair is falling out.”

HPI
: C.M is a 32-year-old African American female patient presenting with chief complaints of feeling tired and her hair falling out. She first noticed her hair falling out from her scalp 12 weeks ago, which occurred in patches when brushing her hair. The symptom of fatigue started after hair loss, about eight weeks ago. C.M. also mentions that she has gained weight, about 30 pounds, in the past year, even though she has experienced a significant decrease in appetite. She states that fatigue occurs when performing light tasks, climbing stairs, and when walking short distances. Her hair falls out when shampooing or brushing. Fatigue is exacerbated by activity and relieved by rest, while any friction on the scalp triggers hair fall. She reports trying to use hair treatments to stop the hair fall out, but they have had no impact NURS 6512 Episodic/ Focused SOAP note Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat.

Current Medications
: Vitamin C supplements, 1 tablet per day, long-term use.

Allergies:
No known food or drug allergies.

PMHx
: Immunization is up-to-date. Last Tetanus- 16 months ago. No history of chronic illnesses.  Had an Incision & Drainage in 2012 due to Abscess on the left thigh.

Social Hx
: C.M is a paralegal working in a law firm. She lives in Baltimore, Maryland, with her husband and daughter aged seven years. Her hobbies include writing articles, reading novels, and skiing. She admits taking alcohol, vodka 3-4 glasses on weekends, but denies smoking or using illicit drugs. Her physical exercise routine includes taking brisk walks for about 20 minutes when going to work and swimming on weekends. She sleeps for approximately 7 hours a day and takes three balanced meals. C.M. reports attending annual well-exams, putting on safety belts while driving, and having smoke detectors.

Family Hx
: The maternal grandmother has colorectal cancer, diagnosed at the age of 57 years. The paternal grandfather had renal failure. Mother had breast cancer that was successfully treated four years. Siblings are alive and well.  Her daughter has eczema.

ROS
:

GENERAL:  Reports weight gain, and fatigue with low energy levels. Denies chills, malaise, or fever.

HEENT: Head: Reports hair loss. Denies headache. Eyes:  Denies visual changes, or excessive lacrimation. Ears: Denies hearing loss, ear discharge, or tinnitus. Nose: Denies sneezing, congestion, runny nose, or epistaxis. Throat: Denies sore throat.

SKIN: Denies skin color changes, rashes, lesions, or itching.

CARDIOVASCULAR:  Reports fatigue on exertion.  Denies chest pain, pressure, or discomfort. No edema, SOB, or palpitations.

RESPIRATORY:  Denies cough, sputum production, or shortness of breath.

GASTROINTESTINAL:  Reports decreased appetite. Denies nausea, vomiting, abdominal discomfort, bowel changes, or blood in the stool NURS 6512 Episodic/ Focused SOAP note Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat.

GENITOURINARY:  Denies pelvic pain, abnormal vaginal discharge, painful urination, urinary frequency/urgency, or blood in the urine. Last menstrual period, 06/18/2020.

NEUROLOGICAL:  Denies headache, syncope, dizziness, muscle weakness, tingling sensations in the extremities, or loss of smell/taste sensation.

MUSCULOSKELETAL:  Denies muscle pain, limitations in movement, joint pain, or stiffness.

HEMATOLOGIC:  No history anemia, easy bleeding or bruising, or blood transfusion.

LYMPHATICS:  No history of inflamed lymph nodes or splenectomy.

PSYCHIATRIC:  Reports sleeping disturbances. Denies history of mental disorders and the presence of suicidal ideations.

ENDOCRINOLOGIC:  Reports cold intolerance. Denies excessive thirst or hunger, increased sweating, or increased urine production.

ALLERGIES:  No history of allergies.

O.

Physical exam
:

Vital signs
: BP- 110/68, PR- 68, RR- 20, Temp-97.3 F

Ht. – 5’4, Wt. – 167 pounds

HEENT:
Head: Normocephalic and atraumatic. Hair black with patches of hair loss. Coarse and straw-like hair. Eyes: Sclera is white; PERRLA. Ears: T.M.s intact. Sinuses: Non-palpable. Nose: Nasal septum well-aligned. Throat: Tonsillar glands non-inflamed.

Neck:
Lymph nodes non-palpable; Trachea is midline. On palpation, the Thyroid gland is nodular.

Respiratory:
Rhythmic and smooth respirations. Lungs clear on auscultation bilaterally.

Cardiovascular:
Capillary refill- 2 secs. No neck vein distensions or edema. RRR and S1and S2 present. No gallop sounds of systolic murmurs.

Integumentary:
Skin is dry. No hypo/hyperpigmentation, skin rashes, or lesions.

Diagnostic results
:

Complete Blood Count- To establish the Hemoglobin and hematocrit level, red blood cell count, and white blood cell count. Low hemoglobin, hematocrit, and red blood cell count may cause fatigue and cold intolerance (Turner, Parsi & Badireddy, 2020).  The white blood cell count will establish the presence of infection.

Thyroid-stimulating hormone (TSH) Test. A TSH test will establish TSH levels. An increase in TSH is associated with Hypothyroidism, while a decrease in TSH is usually present in hyperthyroidism (Chaker, Bianco, Jonklaas & Peeters, 2017).

A
.

Differential Diagnoses

Hypothyroidism

Hypothyroidism is an endocrine condition that results from low levels of thyroid hormone (Chaker
et
al., 2017). It develops when the thyroid gland is not able to produce adequate amounts of thyroid hormone. Symptoms common in Hypothyroidism include dry skin, hair loss, voice changes, fatigue, constipation, cold intolerance, muscle cramps, sleep disturbances, menstrual cycle abnormalities, weight gain, and galactorrhea (Chaker
et
al., 2017). Physical findings that may be present in Hypothyroidism include Enlarged thyroid gland, weight gain, slowness of speech and movements, dry skin, coarse and brittle hair, pallor and jaundice (Chaker
et
al., 2017). Other physical findings include dull facial expressions, bradycardia, pericardial effusion, and prolonged ankle reflex relaxation time.

Hypothyroidism is the priority diagnosis based on pertinent positive findings of weight gain, hair loss, fatigue, cold intolerance, sleeping difficulties, dry skin, and coarse straw-like hair NURS 6512 Episodic/ Focused SOAP note Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat.

The Assignment

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

Anemia

Anemia refers to the reduction in the proportion of the red blood cells (Turner, Parsi & Badireddy, 2020). Symptoms of Anemia include weakness, tiredness, cold intolerance, lethargy, restless legs, shortness of breath on exertion, chest pain, reduced exercise tolerance, and Pica (Turner, Parsi & Badireddy, 2020). Physical findings common in Anemia include cool skin, tachypnea, hypotension, conjunctiva pallor, glossitis, tachycardia, and a systolic murmur.

Anemia is a likely diagnosis based on a positive history of fatigue, tiredness, and cold intolerance. However, there are no findings of Anemia symptoms such as pallor, shortness of breath, systolic murmur, or tachypnea, which rules out Anemia as the priority diagnosis.

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Non-toxic Goiter

Goiter is defined as the enlargement of the thyroid gland. Non-toxic goiter is characterized by thyroid gland enlargement with no disturbance in the thyroid function (Alkabban & Patel, 2020). The enlargement may be diffuse or localized growth. The goiter can compress the upper trachea, laryngeal nerves, and esophagus (Alkabban & Patel, 2020). This results in symptoms such as dysphagia, shortness of breath, and voice hoarseness caused by mechanical compression of laryngeal nerves. Physical examination findings include central neck swelling that is either smooth or nodular, and the mass moves with swallowing (Alkabban & Patel, 2020). The goiter can deviate the trachea or extend retrosternal.

Non-toxic goiter is a likely diagnosis based on positive findings of the palpable nodular thyroid gland. However, the patient has no other findings of non-toxic goiter, making it an unlikely diagnosis NURS 6512 Episodic/ Focused SOAP note Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat.

Hashimoto’s Thyroiditis

Thyroiditis is described as an inflammation of the thyroid gland (Pyzik
et al
., 2015). It results in either unusually high or low levels of thyroid hormones in the blood. Hashimoto’s Thyroiditis occurs due to the immune system attacking the thyroid gland, making it inflamed and damaged (Pyzik
et al
., 2015). As the thyroid gland is destroyed over time, it becomes unable to produce enough thyroid hormone. Hashimoto’s Thyroiditis causes symptoms of an underactive thyroid gland such as tiredness, weight gain, and dry skin (Pyzik
et al
., 2015). Specific symptoms of Hashimoto thyroiditis include perceiving fullness in the throat, painless thyroid enlargement, fatigue, sore throat, and temporary neck pain (Pyzik
et al
., 2015). On physical exam, a firm, rubbery thyroid gland is usually palpated.

Hashimoto’s Thyroiditis is a differential diagnosis based on pertinent positive findings of fatigue, weight gain, dry skin, and a palpable nodular thyroid gland. However, the patient dies not present with specific symptoms of Hashimoto’s Thyroiditis, which makes it an unlikely diagnosis.

Addison Disease

Addison disease is characterized by primary adrenal insufficiency. It is caused by bilateral adrenal cortex destruction resulting in decreased production of adrenocortical hormones, including aldosterone, cortisol, and androgens (Bornstein
et al
., 2016). Symptoms of Addison include fatigue, weight loss, generalized weakness, dizziness, anorexia, nausea, vomiting, abdominal pain, tachycardia, and postural hypotension (Bornstein
et al
., 2016). Diffuse hyperpigmentation of the skin and mucous membranes often occurs in sun-exposed areas as well as decreased body hair (Bornstein
et al
., 2016). Other physical findings include dehydration and refractory hypotension.

Pertinent positive findings of Addison disease include fatigue, decreased appetite, and hair loss. Nonetheless, the patient has weight gain, which rules our Addison as the primary diagnosis NURS 6512 Episodic/ Focused SOAP note Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat.

References

Alkabban, F. M., & Patel, B. C. (2020). Non-toxic Goiter. In
StatPearls [Internet]
. StatPearls Publishing.

Bornstein, S. R., Allolio, B., Arlt, W., Barthel, A., Don-Wauchope, A., Hammer, G. D., Husebye, E. S., Merke, D. P., Murad, M. H., Stratakis, C. A., & Torpy, D. J. (2016). Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. 
The Journal of clinical endocrinology and metabolism
, 
101
(2), 364–389.
https://doi.org/10.1210/jc.2015-1710

Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P. (2017). Hypothyroidism. 
Lancet (London, England)
, 
390
(10101), 1550–1562. https://doi.org/10.1016/S0140-6736 (17)30703-1

Pyzik, A., Grywalska, E., Matyjaszek-Matuszek, B., & Roliński, J. (2015). Immune disorders in Hashimoto’s thyroiditis: what do we know so far? 
Journal of immunology research
, 
2015
, 979167. https://doi.org/10.1155/2015/979167

Turner, J., Parsi, M., & Badireddy, M. (2020). Anemia. In 
StatPearls [Internet]
. StatPearls Publishing NURS 6512 Episodic/ Focused SOAP note Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat.

Comprehensive SOAP Lab Assignment: Differential Diagnosis for Skin Conditions

Comprehensive SOAP Template
 

Patient Initials: J.R                  Age: 8 years                Gender: Male

SUBJECTIVE DATA:

Chief Complaint (CC):
 Rash on the face, arms, and trunk accompanied by itching. (Fig 9.80 Ball
et al
., 2019).

History of Present Illness (HPI):
J.R is an 8-year-old Caucasian patient presented with complaints of a pruritic rash. The patient’s caregiver reports that the rash appeared two days ago when the child was in school. The rash first appeared on the scalp and the face and progressed to upper limbs and the trunk on the same day. The mother states that the rash started as small red spots, which rapidly progressed to small clear pimples with a surrounding reddish area within 12 hours. The caregiver reports that this is the first episode that the child developed the characteristic rash. She states that the child has had a mild increase in body temperature, is inactive, and has a decreased appetite. The patient states that scratching the rash triggers pruritus in his entire body. The caregiver reports that she had administered the child with Chlortrimeton syrup to lower the fever and reduce the itchiness, which had a moderate impact on the pruritus but did not control the spread and appearance of the rash. The patient denies any history of insect bite. However, the child reports that a classmate had developed a similar rash two weeks ago Comprehensive SOAP Lab Assignment: Differential Diagnosis for Skin Conditions.

Medications:
OTC Chlortrimeton syrup 10 mL three times a day.

Allergies:
No known food, drug, or environmental allergies.

Past Medical History (PMH):
J.R. had a history of hospitalization at the age of 3 years due to severe pneumonia, which was managed with IV antibiotics and oxygen therapy.  No history of chronic illnesses.

Past Surgical History (PSH):
The patient had a minor surgery, Incision, and Drainage, in Sep-2019 due to an abscess on his right thigh.

Sexual/Reproductive History:
The patient is sexually inactive.

Personal/Social History:
J.R. lives with his parents and two siblings in Salt Lake City, Utah. He is in 3
rd
grade and has a great academic performance. He states that his favorite subjects are science and art. He enjoys drawing and painting and is part of the Art club in school. The patient also states that he enjoys watching animation movies and playing video games when indoors. The mother reports that the child has no difficulties in performing ADL’s. The patient has an active lifestyle and enjoys playing soccer and swimming. He plays soccer in school and is part of the junior soccer team. He takes three meals a day with snacks between meals. The mother reports that he provides the child with a balanced diet with plenty of fruits, real fruit juices, and milk. The patient reports no eating difficulties. He sleeps approximately 10 hours a day and denies having sleeping difficulties Comprehensive SOAP Lab Assignment: Differential Diagnosis for Skin Conditions.

Immunization History:
The patient’s vaccination history is up-to-date. The last Influenza shot was 4 months ago.

Significant Family History:
Maternal grandmother died at the age of 79 due to Lung cancer. The paternal grandfather has Hypertension and Type 2 Diabetes. Parents are alive and well. The elder sibling, 13-year-old, has Eczema.

Lifestyle:

J.R.’s mother denies engaging in any cultural practices or using herbs. The patient is economically supported by his father and mother. The father is an accountant while the mother is a high school teacher. The mother reports that she controls TV-time and supervises what the child watches on T.V. J.R. reports that he puts on protective gear when swimming and playing soccer. He also states that he has several friends, both from school and the neighborhood.

Review of Systems:

General:
Genera body malaise and low-grade fever. Denies recent weight changes

HEENT:
Head: Denies a history of headache. Eyes: Denies changes in vision, eye reddening, photophobia, or excessive lacrimation. The last eye-checkup 2 years ago, no abnormalities detected. Ear: Denies hearing loss, ear discharge, or pain behind the ear. Nose: Denies nasal discharge, epistaxis, facial tenderness, or history of allergic rhinitis. Reports an intact sense of smell.  Throat: Denies dental pain, bleeding gums, or tongue soreness. Denies difficulties in swallowing, sore throat, or hoarseness Comprehensive SOAP Lab Assignment: Differential Diagnosis for Skin Conditions.

Neck:
Denies neck pain or stiffness.

Breasts:
Denies breast mass or tenderness.

Respiratory:
Denies cough, sputum production, shortness of breath, exertional dyspnea, or wheezing. History of Severe pneumonia 2015.

Cardiovascular/Peripheral Vascular:
Denies edema, chest pain, palpitations, shortness of breath, exertional dyspnea, or bluish discoloration of lips or fingers.

Gastrointestinal:
Denies experiencing nausea, vomiting, abdominal discomfort, or changes in elimination pattern.

Genitourinary:
Denies urinary frequency, urgency, dysuria, or blood in the urine. Denies penile discharge.

Musculoskeletal:
Denies difficulties in movement, muscle pain, joint pain, or joint stiffness.

Psychiatric:
No history of anxiety, depression, or child conduct disorders.

Neurological:
Denies history of headache, dizziness, syncope, seizures, tingling sensations, muscle weakness, or gait/posture abnormalities.

Skin:
Pruritic red rash (refer to HPI).

Hematologic:
No history of blood transfusion.

Endocrine:
Denies cold/heat intolerance, acute thirst, increased hunger, or excessive sweating Comprehensive SOAP Lab Assignment: Differential Diagnosis for Skin Conditions.

Allergic/Immunologic:
No history of allergic reactions.

OBJECTIVE DATA:

Physical Exam:

Vital signs:
Ht.- 2’6, Wt.- 52.9 pounds RR- 18, HR-94, BP-104/65, and Temp- 99.86F

General:
Patient is sick-looking with no acute distress. Maintains and upright posture. Neat and well-groomed. Patient is Alert and maintains eye-contact.

HEENT:
Head is Normocephalic and symmetrical. The sclera is white and conjunctiva pink.

PERRLA, Tympanic membranes intact. Nasal septum well-aligned. Mucous membranes pink and moist. The tongue is midline; 2 missing teeth. Tonsillar glands non-inflamed.

Neck:
Trachea midline, No Thyroid gland enlargement.

Chest/Lungs:
Chest rise and falls uniformly on breathing in and out. Respirations smooth with no use of accessory muscles. Chest clear on auscultation.

Heart/Peripheral Vascular:
No JVD or edema. RRR with no murmurs, friction rubs or

S gallop.  Pulses+2 bilateral pedal and +2 radial

Abdomen:
Flat and smooth. BS-normoactive in all quadrants. No tenderness, masses, or organomegaly on palpation.

Genital/Rectal:
Normal male genitalia. No anal fissures or tears present.

Musculoskeletal:
Muscle strength 5/5

Neurological:
CNs-intact, DTRs-intact

Skin:
Papular and vesicular lesions present on the scalp, face, upper extremities, and trunk. The lesions are elevated and circumscribed on the superficial layer of the skin. The skin around the vesicles is erythematous. The erythematous Lesions are filled with clear fluid and are < 1 cm in diameter and appear in clusters (Fig 9.80 Ball et al ., 2019) Comprehensive SOAP Lab Assignment: Differential Diagnosis for Skin Conditions. ASSESSMENT:   Priority Diagnosis Chickenpox: Chickenpox, also known as Varicella, is an acute and highly communicable disease common in children and young adults. It is caused by the varicella-zoster virus (VZV) (Ball et al ., 2019). The VZV is spread by droplets from the upper respiratory tract or discharges of ruptured lesions on the skin (Kennedy & Gershon, 2018). It has an incubation period of 14 – 21 days. It has a communicability period of 1 to 2 days before the onset of the rash and until lesions have crusted over. Varicella results in a skin rash that forms small, itchy blisters, which scabs over. It typically starts on the scalp and then spreads to the face, chest, back, and upper extremities (Ball et al ., 2019). It begins with small, erythematous macules that rapidly progress over 12-14 hours to papules and then clear vesicles (Gershon et al ., 2015). The vesicular stage is often accompanied by intense pruritus. The skin rash is accompanied by low-grade fever, fatigue, pharyngitis, and headaches, lasting five to seven days (Gershon et al ., 2015).  However, childhood varicella does not begin with a prodromal phase but starts with the onset of exanthema. Chickenpox is the priority diagnosis based on pertinent positive findings of red spots that progressed into erythematous vesicles and pruritus. Besides,  a history of rash on the scalp and face and spread to upper extremities and trunk. Other positive findings include a low-grade fever, general malaise, and loss of appetite Comprehensive SOAP Lab Assignment: Differential Diagnosis for Skin Conditions.   ORDER A PLAGIARISM FREE PAPER NOW Differential Diagnoses Nun-bullous Impetigo: Impetigo is a common and highly contagious, superficial skin infection that manifests with either a bullous or non-bullous appearance (Hartman-Adams, Banvard & Juckett, 2014). Non-bullous impetigo on children begins as a single lesion typically presenting as a red macule or papule. This quickly progresses into a vesicle. The vesicle ruptures, causing erosion and the vesicular contents dry to form a characteristic honey-colored crust (Ball et al ., 2019). The non-bullous impetigo commonly occurs on the face or extremities. Individuals often have mild regional lymphadenopathy, but pharyngitis is absent (Hartman-Adams, Banvard & Juckett, 2014). Nun-bullous impetigo is a differential diagnosis based on a positive history of the appearance of small red spots, which quickly progressed to vesicles within 12 hours. However, the presence of fever, erythematous vesicles, and absence of crusts rules out non-bullous impetigo s the priority diagnosis. Erythema Multiforme: Erythema Multiforme (E.M.) is an acute and self-limited skin condition considered a type IV hypersensitivity reaction. It is associated with certain infections, medications, and other triggers (Hafsi & Badri, 2019). It present with pink macules with purple central papules. E.M. is categorized into E.M. minor and major. E.M. minor is characterized by a localized eruption of the skin with minimal or no mucosal involvement (Hafsi & Badri, 2019). The papules evolve into iris lesions that appear within 72-hours and begin on the extremities. The lesions remain fixed for at least 7 days and then start to heal. E.M. major manifests with localized eruptions that involve one or more mucous membranes (Hafsi & Badri, 2019). E.M. is a differential diagnosis based on the presence of red spots in the patient. However, the history of the spread of lesions makes E.M. an unlikely diagnosis Comprehensive SOAP Lab Assignment: Differential Diagnosis for Skin Conditions. Dermatitis herpetiformis: Dermatitis herpetiformis manifest with clustered excoriations, erythematous, urticarial plaques, and papules with vesicles (Antiga & Caproni, 2015). The dermatitis herpetiformis lesions are typically located on the extensor surfaces of the elbows, knees, buttocks, and trunk (Antiga & Caproni, 2015). It is extremely pruritic, and the vesicles are get excoriated to erosions. (Antiga & Caproni, 2015) This is a differential diagnosis based on positive findings of pruritic erythematous papular and vesicular lesions on the trunk. Pertinent negative findings include clustered excoriations and the presence of lesions on the scalp, face, and upper extremities. Besides, the presence of fever, malaise, and loss of appetite rules out dermatitis herpetiformis as a primary diagnosis.   References Antiga, E., & Caproni, M. (2015). The diagnosis and treatment of dermatitis herpetiformis.  Clinical, cosmetic and investigational dermatology ,  8 , 257–265. https://doi.org/10.2147/CCID.S69127 Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th Ed.). St. Louis, MO: Elsevier Mosby. Gershon, A. A., Breuer, J., Cohen, J. I., Cohrs, R. J., Gershon, M. D., Gilden, D., Grose, C., Hambleton, S., Kennedy, P. G., Oxman, M. N., Seward, J. F., & Yamanishi, K. (2015). Varicella-zoster virus infection. Nature reviews. Disease primers ,  1 , 15016. https://doi.org/10.1038/nrdp.2015.16 Hafsi, W., & Badri, T. (2019). Erythema Multiforme. In  StatPearls [Internet] . StatPearls Publishing. Hartman-Adams, H., Banvard, C., & Juckett, G. (2014). Impetigo: diagnosis and treatment.  American family physician ,  90 (4), 229-235. Kennedy, P., & Gershon, A. A. (2018). Clinical Features of Varicella-Zoster Virus Infection.  Viruses ,  10 (11), 609. https://doi.org/10.3390/v10110609 Comprehensive SOAP Lab Assignment: Differential Diagnosis for Skin Conditions. The Lab Assignment Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case. Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of  three to five  possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources Comprehensive SOAP Lab Assignment: Differential Diagnosis for Skin Conditions.

NURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children

Case Study Assignment: Assessment Tools and Diagnostic Tests in  Children

The health and wellbeing of children are critical milestones in the growth and development of children. The Centers for Disease Control and prevention (CDC) and the Health Resources and Services Administration (HRSA) have reported that one in six or 17% of children aged between three and seventeen years had a developmental disability in the 2009-2017 period (Zablotsky et al., 2019). According to Zablotsky et al. (2019), the number of affected children increased from 16.2% in 2009–2011 to 17.8% in 2015–2017. On the other hand, Ford et al. (2017) have found that developmental and behavioral disorders are now among the top-five chronic conditions in the pediatric population. The main concern is that minority children and those living in rural areas carry a disproportionate burden of developmental disabilities. A combination of these issues highlights the critical role that Nurse Practitioners (NPs) play in screening and care management of children. As such, the purpose of this assignment is to explore a case involving a severely underweight 12-year-old Hispanic girl with underweight parents who has been bullied in school just recentlyNURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children.

Health Issues and Risks

The patient presented in the case is underweight, which is one of the four broad sub-categories of undernutrition. Nutrition plays a critical role in the adolescence stage of growth and development. According to Burns et al. (2017), adolescence is a unique and crucial stage of development characterized by intense cognitive, physical, and psychosocial development. Burns et al. (2017) has identified malnutrition as a key miscellaneous causes of delayed growth and puberty. Undernutrition particularly causes a short stature with a delayed pattern of growth. The patient has an increased risk of delayed puberty considering that the stage begins early in girls compared to boys. Research findings have shown that severe states of undernutrition impair the normal activity of the reproductive process (Zablotsky et al., 2019). Zablotsky et al. (2019) have found that undernutrition that occurs in late childhood can delay the onset of puberty. Nutrition is vital for the patient since the growth spurt triggered by puberty increases the demand for nutritional needs, including micro and macronutrients NURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children.

Moreover, macro and micronutrients are also crucial for normal health and wellbeing. Therefore, being underweight has significantly increased the risk of the 12-year-old girl to multiple health issues. Specifically, the girl’s underweight status means that she is not getting enough nutrients to achieve developmental milestones. As such, she has a higher risk of nutritional deficiencies, impaired immunity, and hormonal imbalances. The three expose the patient to a myriad of health problems and complications. For example, lack of calcium and vitamin D increase the risk of fragile bones and osteoporosis while iron, vitamin B12, and foliate deficiencies cause anemia (Ball et al., 2019). On the other hand, underweight increases the risk of infection because of decreased or compromised immune function. A notable example is where underweight individuals often take long to heal wounds compared to the general population. Furthermore, underweight persons have poor general health, including problems related to skin, hair and teeth; general body weakness; and frequent infections (Burns et al., 2017).

The current information show that the patient is underweight. However, it is crucial to gather additional information about the underlying causes of the patient’s underweight. First, the patient’s parents are also underweight, which highlights the need of assessing any underlying genetic factors. A person’s genetic background has been shown to influence the risk of underweight, overweight, and obesity (Ball et al., 2019). Thus, it is critical to assess the plausibility of this theory through a focused patient history. The second issue to consider is whether the patient has an underlying disease condition. Co-existing diseases, including thyroid disease, digestive problems, and cancer contribute to cases of underweight (Burns et al., 2017). Therefore, examining the patient’s medical history is useful to confirm or rule out co-occurring medical concerns. Third, a comprehensive assessment of the patient’s socioeconomic status could provide valuable clues about the cause of underweight in the family. The assessment will focus on social determinants of health and how they influence the family’s nutritional status. Poverty is a powerful social determinant of health associated with the growing burden of undernutrition in the US (Ball et al., 2019).

Assessment tools will play a fundamental role in gleaning additional information from the case. The Sexual Maturity Rating (SMR) or Tanner Staging is the first screening to consider to find out if the child’s undernutrition is affecting her sexual development. Tanner Staging will allow the NP to assess whether the patient is achieving her sexual developmental milestones to inform referral decisions. The 24-hour diet recall is another tool that will help the NP to have a general overview of the patient’s diet. The tool provides “list all the food, beverages, and snacks eaten during the past 24 hours” (Ball et al, 2019). The second test is necessary to find out if the patient’s underweight is a consequence of poor nutrition and deprivation. Furthermore, the NP will also measure the patient’s weight and BMI as part of the differential diagnosis for undernutrition. The four broad sub-types of undernutrition include underweight stunting, wasting, and severe weight loss. Thus, assessment/screening tools specific to the child will allow the NP to make the right diagnosis and develop an individualized care plan for the patient NURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children.

Depression and anxiety are two additional risks to consider for further information. Screening for depression and anxiety is crucial since the patient has been bullied in school most recently. Underweight brings forward concerns about body image and self-esteem, which then exposes the child to the risk of bullying. Research findings have shown that a combination of bullying and weight status are strong predictors of depression and anxiety among children (Ford et al., 2017). The child is also at a high risk of internalizing disorders because she is currently in the adolescence stage of development. A major concern is that an underlying mental health problem is the main cause of suicide in more than 90% of children and teenagers (Burns et al., 2017). Thus, it is of the essence to screen and evaluate the risk of depression, including the presence of comorbid conditions and differential diagnosis. The HEEADSSS psychosocial assessment tool will help the NP to gather comprehensive information about the case. The HEEADSSS will specifically support the collection of comprehensive information on social economic status of the family, including the patient’s risk profile and developmental milestones (Smith & McGuinness, 2017).

Specific Assessment Questions

Malnutrition and the risk of depression are the primary concerns for the patient. A detailed patient and medical history is necessary to establish the underlying etiology of malnutrition. Issues of body image and self-esteem underpin the risk of depression and anxiety. However, it is critical to find be sensitive when exploring these issues. The following questions will guide the assessment process.

Could you describe your eating habits on a normal day, including the food choices?

Has your daughter been underweight since childhood or it is a recent phenomenon?

Has your daughter been diagnosed or receiving treatment for a medical condition in the past six months?

Has your family experienced food insecurity recently?

Have you sought food assistance from welfare agencies over the past three months?

Has your family experienced any changes in economic status in the recent past?

Proactive Strategies

Patient education will form the hallmark of the care management plan for the family. Patient education will focus on creating awareness about the role that nutrition plays in promoting optimal growth and development NURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children. Both the patient and her parents will verbalize meals and food choices that will terminate the underweight status. The family members will also verbalize the health risks and implications of inadequate nutrition. The second strategy will entail assessing the needs of the family and connecting them to community-based resources. Social and welfare support at the community level is particularly important if the family lives in a deprived community. The best approach is to assess the level of support that the family is getting, including accessibility to available resources. The NP will then identify gaps and areas where support is needed the most. The third strategy is to sustain the family within the healthcare system. Patient follow-up is necessary to access progress in clinical outcomes.

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References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019).
Seidel’s guide to physical examination: An interprofessional approach
(9th ed.). Elsevier Mosby

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (Eds.). (2017).
Pediatric primary care
(6th ed.). Elsevier.

Ford, S. H., Choi, H., Brunssen, S., & Van Riper, M. (2017). Delays and disabilities: NP screening and care management.
Journal for Nurse Practitioners, 13
(2), e67-e73. https://doi.org/10.1016/j.nurpra.2016.11.005

Smith, G. L, & McGuinness, T. M. (2017). Adolescent psychosocial assessment: The HEEADSSS.
Journal of Psychosocial Nursing and Mental Health Services, 55
(5), 24-27. https://doi.org/10.3928/02793695-20170420-03 NURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children

Zablotsky, B., Black, L. I., Maenner, M. J., Schieve, L. A., Danielson, M. L., Bitsko, R. H., Blumberg, S. J., Kogan, M. D., & Boyle, C. A. (2019). Prevalence and trends of developmental disabilities among children in the US: 2009–2017.
Pediatrics, 144
(4), e20190811. https://doi.org/10.1542/peds.2019-0811

The Assignment

Assignment
 (3–4 pages, not including title and reference pages)
:

Assignment Option 1: Adult Assessment Tools or Diagnostic Tests:

Include the following:

A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.

What is its purpose?

How is it conducted?

What information does it gather?

Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

Assignment Option 2: Child Health Case:

Include the following:

An explanation of the health issues and risks that are relevant to the child you were assigned.

Describe additional information you would need in order to further assess his or her weight-related health.

Identify and describe any risks and consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.

Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information.

Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight NURS 6512 Assignment 1: Case Study Assignment: Assessment Tools and Diagnostic Tests in Adults and Children.

AG is a 54-year-old Caucasian male – NURS 6512 discussion post

Post
 an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

WK 2 Health Assmt.   Discussion.

AG is a 54-year-old Caucasian male who was referred to your clinic to establish care after a recent hospitalization after having a seizure related to alcohol withdrawal. He has hypertension and a history of alcohol and cocaine abuse. He is homeless and is currently living at a local homeless shelter. He reports that he is out of his amlodipine 10 mg which he takes for hypertension. He reports he is abstaining from alcohol and cocaine but needs to smoke cigarettes to calm down since he is not drinking anymore AG is a 54-year-old Caucasian male – NURS 6512 discussion post.

Socio-Economic, Spiritual, Lifestyle and Cultural Factors

Ball et al. (2019), explain that patients age differently and their knowledge, cognitive abilities, personality, and experience will influence how the interview is conducted by a provider.  There could be a multitude of reasons as to why an older adult can become homeless.  This includes unemployment due to corporate age discrimination as told by Murphy and Eghaneyan (2018).  AG’s drug and alcohol use could be a reason as to why he lost his employment and due to financial constrains, was unable to pay rent or mortgage.  It is the responsibility of the nurse practitioner to gather information from the patient and not make assumptions about situations.  The socioeconomic factors we are looking at are employment, education, and income per Coogle and Owens (2015).

An individual’s income plays an important role in the determinant of health according to Mullen (2015). Having a higher income enables better nutrition, housing, health care, and recreation per Tsai (2018). On the other hand,  poverty has a strong detrimental effect on health and is normally associated with unhealthy or risky behaviors as reported by Tsai (2018).  People with low income have been observed to have more association with the consumption of unhealthy goods, like tobacco, alcohol and illicit drug use according to Tsai (2018). AG has no income and therefore has fewer chances of seeking healthcare resources or preventative services.  These services could mean the difference between having a manageable health condition versus late stage multiple diagnosis and treatment.   AG smokes, uses drugs and alcohol which shows his lack of health promoting behaviors AG is a 54-year-old Caucasian male – NURS 6512 discussion post.

Education is one of the focal determinants of health and is an indicator of a person’s socio-economic status per Mullen (2015).  People who are better educated have fewer morbidities than their counterparts according to Hook and Markus (2020).  We do not know AG’s level of education and therefore we cannot draw any conclusions.  AG’s lifestyle is contributing to his present status which is having a negative effect on his health.   From his chosen lifestyle, AG can end up having a heart attack or death from uncontrolled hypertension and the use of illicit drugs.  Cigarette smoking can also increase cardiovascular problems as well as cause cancer.

AG needs support and education in the management of his illness.  Due to the socioeconomic factors unfolding in his life, he may become depressed and without help, may contemplate suicide.  Inquiring about AG’s mood like depression or anxiety can allow the NP to analyze what resources are appropriate.  There is no mention of any religious preferences and this could be a question that the NP can ask during patient interviews.

Drug users and homeless individuals experience severe health inequalities and barriers to accessing healthcare.   It is the duty of the healthcare workers to change their perception of others and be receptive to other people’s cultures as O’Donnell et al. (2019) explain.

Sensitive Issues while Interacting with Patient

AG may have reservations about speaking about his adversities with a new provider for fear of being judged or prejudice.   As a nurse practitioner, one should be cautious about how questions are posed to the patient as Coogle and Owens (2015) explain.  A tone that is accusatory will not yield pertinent information.   The NP should make sure that they are not passing judgement or being prejudice against any patient that they encounter per Ball et al. (2019).  The nurse practitioner should listen carefully to AG during the information gathering process AG is a 54-year-old Caucasian male – NURS 6512 discussion post.  The nurse practitioner should also be careful of the non-verbal cues they present.  How a clinician controls their emotions is also a strong communication skill that is very important during the interview process.

AG did not choose a healthy lifestyle and therefore the nurse practitioner can offer AG resources that can aid him in his health quest.  Smoking cessation resources should also be offered when AG is ready to give up the unhealthy habit.  At this time, it is imperative that the clinician offers full support and not force AG to give up any behaviors unwillingly.   The nurse practitioner does not know anything about AG and therefore must use the RESPECT model as adviced by Ball et al. (2019).

Questions pertaining to why he chose to use drugs and alcohol should be asked respectfully without any preformed notions from the NP per Ball et al. (2019).   A trusting relationship must be formed with AG who may probably be embarrassed about the life choices he has made.  AG is in his early fifties and mid-life crisis is also a concern at this time and therefore the NP must not make him feel like he is a  failure.  Instead AG needs reassurance, support, guidance and with the help of the NP, he can set a goal that is attainable per Coogle and Owens (2015).

Questions to ask AG

Part of the information gathering involves asking the patient his allergies and the reactions experienced, the patient’s family history of illnesses, any previous surgeries to name a few.

Have you had any  other previous hospitalizations including any mental health stay

Can you please tell me how you ended up staying at the shelter or being homeless

When did you start using cocaine, alcohol and tobacco substances

What were your last employment and the duration

What is your highest level of education

Do you have any religious or cultural preferences, that we need to put in place AG is a 54-year-old Caucasian male – NURS 6512 discussion post

Do you ever experience feelings of hopelessness, depression, sadness

Are there are resources that you would like to have access to

Is there anything else you think we might be able to assist you with

AG should have an opportunity to ask any questions or clarify information.  Resources should be offered by the nurse practitioner who can also put AG in contact with a social worker for further commendations.

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). 
Seidel’s guide to physical examination: An interprofessional approach
 (9th ed.). St. Louis, MO: Elsevier.

Coogle, C., & Owens, M. (2015). Screening and Brief Intervention for Alcohol Misuse in Older Adults: Training Outcomes Among Physicians and Other Healthcare Practitioners in Community-Based Settings. 
Community Mental Health Journal
, 
51
(5), 546–553. https://doi-org.ezp.waldenulibrary.org/10.1007/s10597-014-9804-x

Hook, C. J., & Rose Markus, H. (2020). Health in the United States: Are Appeals to Choice and Personal Responsibility Making Americans Sick? 
Perspectives on Psychological Science
, 
15
(3), 643–664. 
https://doi-org.ezp.waldenulibrary.org/10.1177/1745691619896252

Mullen, J. (2015). Living Longer Better: A Call to Action to Promote the Health of Older Adults and Their Communities. 
Journal of Public Health Management & Practice
, 
21
(4), 410–412. https://doi-org.ezp.waldenulibrary.org/10.1097/PHH.0000000000000280

Murphy, E. R., & Eghaneyan, B. H. (2018). Understanding the Phenomenon of Older Adult Homelessness in North America: A Qualitative Interpretive Meta-Synthesis. 
British Journal of Social Work
, 
48
(8), 2361–2380. https://doi-org.ezp.waldenulibrary.org/10.1093/bjsw/bcx163

O’Donnell, P., Tierney, E., O’Carroll, A., Nurse, D., & MacFarlane, A. (2016). Exploring levers and barriers to accessing primary care for marginalised groups and identifying their priorities for primary care provision: a participatory learning and action research study. 
International Journal for Equity in Health
, 
15
(1), 197.

Tsai, J. (2018). Lifetime and 1-year prevalence of homelessness in the US population: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. 
Journal of Public Health
, 
40
(1), 65–74. https://doi-org.ezp.waldenulibrary.org/10.1093/pubmed/fdx034 AG is a 54-year-old Caucasian male – NURS 6512 discussion post

By Day 6 of Week 2

Respond on or before Day 6
 
on 2 different days
 to at least
 two
 of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

response

Great post! I thought that you addressed a situation that had several layers of difficulty extremely well. It’s clear that you were very aware of the cultural and socioeconomic factors at play. Treating a patient with a history of ETOH abuse is difficult in itself, but given that fact that the patient is currently homeless adds another hurdle for the patient as well as the practitioner. I especially enjoyed your acknowledgment of the sensitivity of the patient’s situation and that you used that knowledge to form well thought out and pointed questions.

Given the prevalence of mental health and substance abuse in the homeless population, I do think that establishing a timeline will be extremely important in the treatment of this patient. Did the patient begin drinking heavily before or after he was homeless? Had he been diagnosed with any mental health disorder and at what age?

Research estimates that 38 percent of homeless people are alcohol dependent and that their living conditions made it more difficult to remain sober and achieve stability. That makes appropriate treatment and follow up an important part of ensuring this patient is successful with their sobriety.  Effective communication is always key, but maybe more so in complex and difficult situations. Establishing a positive patient relationship depends on communication built on courtesy, comfort, connection, and confirmation. Building a history is important, of course, but building trust from the start will help to ensure that the patient is open and honest and in turn, or treatment will be more effective.

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Murray, K. (2019). Homeless Alcoholism. Retrieved June 13, 2020 from https://www.alcoholrehabguide.org/resources/homeless-alcoholism/#sources AG is a 54-year-old Caucasian male – NURS 6512 discussion post

Discussion: Diversity and Health Assessments

May 2012, Alice Randall wrote an article for 
The New York Times
 on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Photo Credit: Getty Images

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the healthcare field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and healthcare professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds. Your Instructor will assign a case study to you for this Discussion.

To prepare:

Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.

By Day 1 of this week, you will be assigned a case study by your Instructor. 
Note
: Please see the “Course Announcements” section of the classroom for your case study assignment.

Reflect on the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient assigned to you.

Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?AG is a 54-year-old Caucasian male – NURS 6512 discussion post

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By Day 3 of Week 2

Post
 an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

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!

Read
 a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond on or before Day 6
 
on 2 different days
 to at least
 two
of your colleagues who were assigned a different patient than you. Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why AG is a 54-year-old Caucasian male – NURS 6512 discussion post.

Week 2 Discussion: Diversity

Case Study 2:

AG is a 54-year-old Caucasian male who was referred to the clinic to establish care after a recent hospitalization after having a seizure related to alcohol withdrawal. He has hypertension and a history of alcohol and cocaine abuse. He is homeless and is currently living at a local homeless shelter. He reports that he is out of his amlodipine 10 mg which he takes for hypertension. He reports he is abstaining from alcohol and cocaine but needs to smoke cigarettes to calm down since he is not drinking anymore.

 

The socioeconomic issues affecting AG is homelessness, finances, and lack of adequate health care. During the initial interview, I would assess for financial income and the ability to secure stable long term housing. Establish if any family or friends are involved in his life, ask the patient if he has been to rehab in the past and if he is willing to go to inpatient rehab to stabilize and receive counseling and coping strategies (Cuevas & Whitiney, 2019). Ask the patient what are his plans, and how long he plans to stay at the shelter because accommodation is only temporary and safe housing is to be included in planning (Manning & Greenwood, 2019).

The patient’s perceived quality of life is based on his current lifestyle which includes substance abuse, lack of stable housing. AG is a 54-year-old caucasian male and sensitivity to cultural differences to avoid miscommunication is to be considered in cultural factors, and history of substance abuse and seizures he should be assessed for cognitive function. Issues I need to be sensitive about are his finances, be sensitive in the questioning line of income, does he have an income from unemployment, SSI, or disability, does he he have health insurance or the ability to pay for medications and food. Family relations can be a source of anxiety to some individuals, I will be sensitive to line of questioning on family, friends, and community relations if he has any support or in contact with any members. Religion and faith-based beliefs can create a barrier to communication and the ability to accept some interventions. As far as his substance abuse I would ask about when last he used, how long he has been using, identify his triggers to reduce relapse. I will be sensitive to his personal space and mode of communication, ask what is his preferred mode of communication, language, what name he wants to be called (Ball, Dains, Flynn, Solomon, & Stewart, 2019) AG is a 54-year-old Caucasian male – NURS 6512 discussion post.

Targeted questions to the patient to build his health history and to assess his health risks include

1. Medical and familial history, when was he first diagnosed with hypertension, and family history of cardiac disease. What medications he currently take and when was his last dose. Where did he last seek medical attention?

2. Level of education and any work skills, this is to assess his level of comprehension and processing of information to be exchanged.

3. Depression screening tool to assess for level of anxiety, what does he mean he needs a cigarette to calm down, how many does he smoke daily, what are his triggers?

4. History of substance abuse, what are his substances of choice, did he ever attempt to quit before, did he ever have the professional help to quit. How much money does he usually spend on his habit?

5. Well- maintenance evaluation, when last did he have physical, including prostrate screening, colorectal screening, diabetes risk assessment, cardiovascular disease risk assessment, and STD risk assessment screening?

6. Any history of abuse or trauma, any history military service to rule out PTSD

7. Vaccination history for immunity against community-acquired infections because of his housing disposition.

 

References

Ball, J. W., Daines, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Cuevas, R., & Whitney, G. (2019). Better Together: An Early Head Start Partnership Supporting Families in Recovery Experiencing Homelessness. 
ZERO TO THREE
, 
39
(4), 29–34.

Manning, R. M., & Greenwood, R. M. (2019). Recovery in Homelessness: The Influence of Choice and Mastery on Physical Health, Psychiatric Symptoms, Alcohol and Drug Use, and Community Integration. 
Psychiatric Rehabilitation Journal
, 
42
(2), 147–157. https://doi-org.ezp.waldenulibrary.org/10.1037/prj0000350

response

Your post categorically addresses the socioeconomic factors that affect this patient. According to 
Health People
(2020), race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual’s ability to achieve good health(“Disparities,” n.d.). The targeted questions are structured to provide detailed information that will assist in the patient’s care plan. Numerous studies have shown that the homeless seek treatment late in their disease process; fall out of disease management plan including non-adherence to prescribed medications,  and have a frequent  habit of visiting the Emergency Room and Inpatient services AG is a 54-year-old Caucasian male – NURS 6512 discussion post. It is important for clinicians to inquire about readiness to change and the resources available for this patient. Examples of questions that bring forth the need for change are: What are the benefits of staying sober?; Have you ever thought of committing suicide?”; If you did want to make a change, how would you go about it?” (Cooper, 2016). Such inquiry elicits the individual’s commitment to making change.

Cooper, D. B. (2016). 
Intervention in mental health-substance use
. CRC Press.

Disparities
. (n.d.). Healthy People 2020 |. https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities AG is a 54-year-old Caucasian male – NURS 6512 discussion post