Category: Nursing

Denise is a 30-year-old Black female G0 with a history of seizure disorder who presents to clinic for her annual well visit.

Case #1. Teresa.

History of Present Illness (HPI):
Teresa is a 34-year-old Hispanic G2P2002. She presents to your office today at 10-weeks post-partum (PP) for her 6-week PP check.
She underwent a C-section for failure to progress following a 20-hour labor with Pitocin augmentation. She was discharged from the hospital on

day 2 post-partum without complications. Teresa has had difficulty with breast feeding due to discomfort in her suture line and terrible pain in her right breast since her discharge from the hospital. She reports occasional chills- she has not measured her temperature at home. Teresa was seen by the lactation consultant while in the hospital but “nothing is working” and her son “cries all the time”. She is afraid to feed her son formula as her mother-in-law wants her to “keep trying to breastfeed”. Teresa tells you she feels as if she has failed her son- “it was so easy with my first baby, I know my husband thinks I am a bad mother”.

Prior medical history: None. Prior surgical history: Appendectomy (2000)

Current medications: Prenatal vitamins, stool softener. Allergies: None

OB- GYN History: NSVD (2019) healthy female 7lb 10oz; C-section healthy male 8 lbs. 8 oz as per HPI.

Menarche age 12, cycle length- 5 days- frequency every 28 days- 4-5 tampons per day. No history of sexually transmitted infections (STDs). History of abnormal pap smear in 2019 which was followed by a normal colposcopy. Last pap (during recent prenatal care) reported normal. HIV negative.

LMP: First PP menstrual cycle last week. Has not resumed sexual activity PP. Contraception history: Oral contraceptives, condoms.

Social history: Lives with husband, mother- in- law, and children. Stay at home mom. Denies EtOH or recreational drug use, never smoker. Her family speaks Spanish at home; she is fluent in English.

Family history: Unremarkable.

Review of Systems (ROS): Negative except as noted in HPI.

Physical Exam (PE)

VS: BP: 110/70, P: 90, RR: 18, T: 38.4, Weight: 132 lbs.

Teresa’s C-section suture line is healing well without erythema or tenderness. No vaginal discharge or lesions, no cervical motion tenderness (CMT), uterus normal size firm and non-tender. On breast exam, you do note an erythematous, swollen, and painful area to the right breast. Her physical exam is otherwise unremarkable.

Case #2. Joanna.

History of Present Illness (HPI): Joanna is a 28-year-old Caucasian G4P1021. She is single, living with her father and 2-year-old daughter. She has a part-time job as a server at the local restaurant; she does not have health insurance. Joanna presents to your office at the community health center today stating she is pregnant and wants to receive OB care. She tells you that she has not yet been evaluated for this pregnancy as she was afraid to take time off from work and did not have enough money to pay for the visit.

Prior medical history: None. Prior surgical history: None

Current medications: None. Allergies: Penicillin

OB- GYN History: NSVD (2021) healthy female 6lb 8oz. Menarche age 10, cycle length- 3 days- irregular cycles since menarche- frequency every 20-30 days- 2-3 tampons per day. No history of sexually transmitted infections (STDs). Joanna’s OB history includes two first trimester elective terminations of pregnancy, and 1 term female infant delivered vaginally at 37 weeks. Denies any complications during her prior pregnancy however, she notes that her daughter experienced hypoglycemia and respiratory distress, spending 2 weeks in the Neonatal Intensive Care Unit (NICU).

LMP: Approximately 5 months ago. Contraception history: Condoms “sometimes”.

Social history: Lives with her retired father and daughter. Restaurant server. Denies EtOH or

recreational drug use. Currently smoking 1 pack of cigarettes/ day (15 pack-year history). She and her

mother are still paying for her daughter’s NICU stay. The child’s father is not involved in any way.

Family history: Mother (deceased age 55)- Type 2 diabetes.

Review of Systems (ROS): Unremarkable with exception of dysuria (“it burns when I pee”) over the past

1-week. Denies fever, chills, abdominal or flank pain. Thick white vaginal discharge and “itching” for the

past month.

Physical Exam (PE)

VS: BP: 108/68, P: 72, RR: 18, T: 37.3, Weight 144lbs

On physical exam you palpate a fundal height of approximately 20cm with an audible fetal heart tone (FHT) of 160. On speculum exam you visualize a multiparous cervix without lesions; bluish discoloration of the cervix, vagina, and vulva is noted with a thick, white discharge. There is no cervical motion tenderness (CMT) on exam. The uterus is anteverted, non- tender, with fundus palpable at the umbilicus. Joanna’s physical exam is otherwise unremarkable. Wet mount reveals budding yeast. Urine dipstick with 1+ leukocytes, trace blood and 2+ glucose.

Case #3. Monica.

History of Present Illness (HPI): Monica is a 43-year-old African- American G3P2102. She is currently separated from her husband of 20 years and is working full-time as a legal secretary. About 8 months ago, Monica started having irregular periods with heavier than usual flow until she stopped having periods or any vaginal bleeding about 3 months ago. She is currently recovering from a “stomach flu”; however, she reports daily nausea, vomiting, bloating and decreased appetite over the past 3 weeks. She is worried because she has gained 12 pounds over the last 3 months “due to menopause”. She comes to the clinic today to discuss menopause symptoms and hormone replacement therapy.

Prior medical history: Hypertension (2010)- well controlled on current antihypertensive

Prior surgical history: Cholecystectomy (2015)

Current medications: Lisinopril 10mg daily. Allergies: None

OB- GYN History: NSVD x 2 (2015, 2019) healthy female 6lb 8oz; healthy female 7lbs 6oz. First trimester

miscarriage (9 weeks) in 2014. Menarche age 15, cycle length-7 days- frequency every 28 days- 5-6 pads

per day. No history of sexually transmitted infections (STDs). No history of abnormal pap (last pap 2

years ago).

LMP: Approximately 3 months ago. Contraception history: Condoms; past use of oral contraceptives.

Social history: Lives with her elderly father, 2 daughters. Separated from her husband for 6 months.

Family history: Mother deceased (age 60)- breast cancer. Father alive (age 70)- hypertension.

Review of Systems (ROS): Unremarkable with exception of as noted in HPI.

Physical Exam (PE)

VS: BP: 130/78, P: 78, RR: 18, T: 36.1 Weight: 152 lbs.

Physical exam is unremarkable with exception of a palpable 12- 14 weeks size uterus on bimanual. You

check a for a fetal heartbeat and obtain a heart tone of 145 via doppler. The intake nurse reports that a

urine pregnancy test came back positive.

Monica is in disbelief.

Case #4. Laura.

History of Present Illness (HPI): Laura is a 16-year-old Caucasian G1P0. She presents to your office after missing her second period. She is “worried” as she “always gets her period on time”. She is in high school- about to enter the 11th grade. She lives with her grandmother and 2 older siblings. Her urine

pregnancy test in clinic today is positive.

Laura is sexually active with her boyfriend; they do not use condoms. He “pulls out” as birth control. She reports being treated at the health department for chlamydia and gonorrhea earlier this year. She thinks her boyfriend was treated but he is not answering her calls since she told him about the missed

periods a few weeks ago. She reports daily nausea, vomiting and dysuria for the past 2 weeks.

Prior medical history: None. Prior surgical history: None

Current medications: None. Allergies: None

OB- GYN History: Menarche age 12, cycle length-7 days- frequency every 30 days- 2 tampons per day.

History of chlamydia and gonorrhea (GC) in the past year. Last pap reported normal at the time of

chlamydia/ GC diagnosis. Has not received Human Papillomavirus (HPV) vaccine.

LMP: Approximately 2 months ago. Contraception history: Withdrawal

Social history: Lives with her grandmother, siblings. Denies EtOH or recreational drug use. Currently

smoking 1 pack of cigarettes/ day

Family history: Mother deceased at age 42- drug overdose. Father unknown.

Review of Systems (ROS): Unremarkable with exception of as noted in HPI.

Physical Exam (PE)

VS: BP: 110/68, P: 80, RR: 18, T: 37.1 Weight: 110 lbs. (states usual weight 120 lbs.).

Physical exam is unremarkable with exception of a cloudy, yellow mucoid cervical discharge on speculum

exam; friable appearance of the cervix with cervical motion tenderness (CMT). You palpate an 8-week

size uterus on bimanual.

Laura’s urine reveals 2+ ketones, 2+ nitrates, and 3+ leukocytes.

Case 5: Denise.

Denise is a 30-year-old Black female G0 with a history of seizure disorder who presents to clinic for her annual well visit. She is excited to tell you that she is getting married in 2 months and they are planning to start a family “right away”. Denise went to see her gynecologist last month who told her she was “young and healthy- not to worry, everything will work out fine”. No labs were done at the gyn visit; she hasn’t started prenatal vitamins. She comes to see you today as she “wants to be sure that she is up to date on everything she needs” before the wedding.

Prior medical history: Seizure disorder (diagnosed at age 18). Prior surgical history: None

Current medications: Levetiracetam 500mg 2 times a day. Allergies: None

Reports she believes she has had all childhood vaccinations. Has not received COVID or influenza vaccines. She is not sure about Hepatitis B or Tdap.

OB- GYN History: G0. Menarche age 14, cycle length-5 days- frequency every 28 days- 2-3 pads per day. No history of sexually transmitted infection. Last PAP 2020, no history of abnormal PAP. Has not received Human Papillomavirus (HPV) vaccine. Her only sexual partner is her current fiancé (male). LMP was approximately 2 weeks ago. Contraception history: Condoms.

Social history: Sixth grade teacher. Lives with her fiancé. Denies EtOH or recreational drug use. Has never smoked cigarettes or vaped.

Family history: Mother (age 56) alive and well. Father deceased at age 50 from lung cancer (smoker). Sister aged 21- healthy. Maternal grandmother alive age 88 (hysterectomy for fibroid uterus). Maternal grandfather deceased age 78 (unknown cause). Paternal grandparents- unknown.

Review of Systems (ROS).

Constitutional: No Weight Change, No Fever, No Chills, No Night Sweats, No Fatigue, No Malaise

ENT/Mouth: No Hearing Changes, No Ear Pain, No Nasal Congestion, No Sinus Pain, No Hoarseness, No sore throat, No Rhinorrhea, No Swallowing Difficulty

Eyes: No Eye Pain, No Swelling, No Redness, No Foreign Body, No Discharge, No Vision Changes

Cardiovascular: No Chest Pain, No SOB, No Dyspnea on Exertion, No Orthopnea, No Claudication, No Edema, No Palpitations

Respiratory: No Cough, No Sputum, No Wheezing, No Smoke Exposure, No Dyspnea

Gastrointestinal: No Nausea, No Vomiting, No Diarrhea, Occasional Constipation (managed with diet), No Pain, No Heartburn, No Anorexia, No Dysphagia, No Hematochezia, No Melena, No Flatulence, No Jaundice

Genitourinary: No Dysmenorrhea, No Abnormal Vaginal Bleeding, No Dyspareunia, No Dysuria, No Urinary Frequency, No Hematuria, No Urinary Incontinence, No Urgency, No Flank Pain, No Urinary Flow Changes, No Hesitancy

Musculoskeletal: No Arthralgias, No Myalgias, No Joint Swelling, No Joint Stiffness, No Back Pain, No Neck Pain, No Injury History

Skin: No Skin Lesions, No Pruritis, No Hair Changes, No Breast/Skin Changes, No Nipple Discharge

Neuro: No Weakness, No Numbness, No Paresthesia, No Loss of Consciousness, No Syncope, No Dizziness, No Headache, No Coordination Changes. Last reported seizure was 10 years ago. Followed by neurologist- last seen in 2023.

Psych: No Anxiety/Panic, No Depression, No Insomnia. No Memory Changes. Denies Violence/Abuse, No Eating Concerns

Heme/Lymph: No Bruising, No Bleeding, No Transfusion History, No Lymphadenopathy

Endocrine: No Polyuria, No Polydipsia, No Temperature Intolerance

Physical Exam (PE).

VS: BP: 130/84, P: 80, RR: 18, T: 37.1, Weight: 118 lbs. BMI 19.0

General: Awake, alert, and oriented. No acute distress. Well developed, hydrated, and nourished. Appears stated age.

Skin: Skin in warm, dry, and intact without rashes or lesions. Appropriate color for ethnicity. Nailbeds pink with no cyanosis or clubbing.

Head: The head is normocephalic and atraumatic without tenderness, visible or palpable masses, depressions, or scarring. Hair is of normal texture and evenly distributed.

Eyes: Conjunctivae are clear without exudates or hemorrhage. Sclera is non-icteric. No signs of nystagmus. Eyelids are normal in appearance without swelling or lesions.

Ears: The external ear and ear canal are non-tender and without swelling.

Nose: Nasal mucosa is pink and moist. Nares are patent bilaterally.

Throat: Oral mucosa is pink and moist with good dentition. Tongue normal in appearance without lesions and with good symmetrical movement. The pharynx is normal in appearance without tonsillar swelling or exudates.

Neck: The neck is supple without adenopathy. Trachea is midline. Thyroid gland is normal without masses.

Cardiac: The external chest is normal in appearance. Heart rate and rhythm are normal. No murmurs, gallops, or rubs are auscultated.

Respiratory: The chest wall is symmetric and without deformity. Lung sounds are clear in all lobes bilaterally without rales, rhonchi, or wheezes.

Breasts: Symmetrical. No Masses, Dimpling or Nipple Discharge. No Axillary Adenopathy.

Abdominal: Abdomen is soft, symmetric, and non-tender without distention. There are no visible lesions or scars. Umbilicus is midline without herniation. Bowel sounds are present and normoactive in all four quadrants. No masses, hepatomegaly, or splenomegaly are noted.

Genital: External genitalia is normal in appearance without lesions, swelling, masses or tenderness. Vagina is pink and moist without lesions or discharge. Cervix is non-tender without lesions. Uterus is anteflexed, non-tender and normal in size. Ovaries are non-tender without palpable masses or enlargement.

Extremities: Upper and lower extremities are atraumatic in appearance without tenderness or deformity. No swelling or erythema.

Neurological: The patient is awake, alert, and oriented to person, place, and time with normal speech. Motor function is normal with muscle strength 5/5 bilaterally to upper and lower extremities. Sensation is intact bilaterally. Reflexes 2+ bilaterally. No gait abnormalities are appreciated.

Psychiatric: Appropriate mood and affect. Good judgement and insight. No suicidal or homicidal ideation.

What is your pre conceptual plan for Denise? What are her risks?

Keep in mind that the goal of pre-conceptual care is to reduce the risk of adverse health effects for the woman, fetus, and neonate- optimize health and prevention; address modifiable risk factors, chronic illnesses, and medication safety.

Monica is a 43-year-old African- American G3P2102. She is currently separated from her husband of 20 years and is working full-time as a legal secretary. About 8 months ago, Monica started having irregular periods with heavier than usual flow until she stopped having periods or any vaginal bleeding about 3 months ago

Case #1. Teresa.

History of Present Illness (HPI):
Teresa is a 34-year-old Hispanic G2P2002. She presents to your office today at 10-weeks post-partum (PP)

for her 6-week PP check. She underwent a C-section for failure to progress following a 20-hour labor with Pitocin augmentation. She was discharged from the hospital on

day 2 post-partum without complications. Teresa has had difficulty with breast feeding due to discomfort in her suture line and terrible pain in her right breast since her discharge from the hospital. She reports occasional chills- she has not measured her temperature at home. Teresa was seen by the lactation consultant while in the hospital but “nothing is working” and her son “cries all the time”. She is afraid to feed her son formula as her mother-in-law wants her to “keep trying to breastfeed”. Teresa tells you she feels as if she has failed her son- “it was so easy with my first baby, I know my husband thinks I am a bad mother”.

Prior medical history: None. Prior surgical history: Appendectomy (2000)

Current medications: Prenatal vitamins, stool softener. Allergies: None

OB- GYN History: NSVD (2019) healthy female 7lb 10oz; C-section healthy male 8 lbs. 8 oz as per HPI.

Menarche age 12, cycle length- 5 days- frequency every 28 days- 4-5 tampons per day. No history of sexually transmitted infections (STDs). History of abnormal pap smear in 2019 which was followed by a normal colposcopy. Last pap (during recent prenatal care) reported normal. HIV negative.

LMP: First PP menstrual cycle last week. Has not resumed sexual activity PP. Contraception history: Oral contraceptives, condoms.

Social history: Lives with husband, mother- in- law, and children. Stay at home mom. Denies EtOH or recreational drug use, never smoker. Her family speaks Spanish at home; she is fluent in English.

Family history: Unremarkable.

Review of Systems (ROS): Negative except as noted in HPI.

Physical Exam (PE)

VS: BP: 110/70, P: 90, RR: 18, T: 38.4, Weight: 132 lbs.

Teresa’s C-section suture line is healing well without erythema or tenderness. No vaginal discharge or lesions, no cervical motion tenderness (CMT), uterus normal size firm and non-tender. On breast exam, you do note an erythematous, swollen, and painful area to the right breast. Her physical exam is otherwise unremarkable.

Case #3. Monica.

History of Present Illness (HPI): Monica is a 43-year-old African- American G3P2102. She is currently separated from her husband of 20 years and is working full-time as a legal secretary. About 8 months ago, Monica started having irregular periods with heavier than usual flow until she stopped having periods or any vaginal bleeding about 3 months ago. She is currently recovering from a “stomach flu”; however, she reports daily nausea, vomiting, bloating and decreased appetite over the past 3 weeks. She is worried because she has gained 12 pounds over the last 3 months “due to menopause”. She comes to the clinic today to discuss menopause symptoms and hormone replacement therapy.

Prior medical history: Hypertension (2010)- well controlled on current antihypertensive

Prior surgical history: Cholecystectomy (2015)

Current medications: Lisinopril 10mg daily. Allergies: None

OB- GYN History: NSVD x 2 (2015, 2019) healthy female 6lb 8oz; healthy female 7lbs 6oz. First trimester

miscarriage (9 weeks) in 2014. Menarche age 15, cycle length-7 days- frequency every 28 days- 5-6 pads

per day. No history of sexually transmitted infections (STDs). No history of abnormal pap (last pap 2

years ago).

LMP: Approximately 3 months ago. Contraception history: Condoms; past use of oral contraceptives.

Social history: Lives with her elderly father, 2 daughters. Separated from her husband for 6 months.

Family history: Mother deceased (age 60)- breast cancer. Father alive (age 70)- hypertension.

Review of Systems (ROS): Unremarkable with exception of as noted in HPI.

Physical Exam (PE)

VS: BP: 130/78, P: 78, RR: 18, T: 36.1 Weight: 152 lbs.

Physical exam is unremarkable with exception of a palpable 12- 14 weeks size uterus on bimanual. You

check a for a fetal heartbeat and obtain a heart tone of 145 via doppler. The intake nurse reports that a

urine pregnancy test came back positive.

Monica is in disbelief.

Case #4. Laura.

History of Present Illness (HPI): Laura is a 16-year-old Caucasian G1P0. She presents to your office after missing her second period. She is “worried” as she “always gets her period on time”. She is in high school- about to enter the 11th grade. She lives with her grandmother and 2 older siblings. Her urine

pregnancy test in clinic today is positive.

Laura is sexually active with her boyfriend; they do not use condoms. He “pulls out” as birth control. She reports being treated at the health department for chlamydia and gonorrhea earlier this year. She thinks her boyfriend was treated but he is not answering her calls since she told him about the missed

periods a few weeks ago. She reports daily nausea, vomiting and dysuria for the past 2 weeks.

Prior medical history: None. Prior surgical history: None

Current medications: None. Allergies: None

OB- GYN History: Menarche age 12, cycle length-7 days- frequency every 30 days- 2 tampons per day.

History of chlamydia and gonorrhea (GC) in the past year. Last pap reported normal at the time of

chlamydia/ GC diagnosis. Has not received Human Papillomavirus (HPV) vaccine.

LMP: Approximately 2 months ago. Contraception history: Withdrawal

Social history: Lives with her grandmother, siblings. Denies EtOH or recreational drug use. Currently

smoking 1 pack of cigarettes/ day

Family history: Mother deceased at age 42- drug overdose. Father unknown.

Review of Systems (ROS): Unremarkable with exception of as noted in HPI.

Physical Exam (PE)

VS: BP: 110/68, P: 80, RR: 18, T: 37.1 Weight: 110 lbs. (states usual weight 120 lbs.).

Physical exam is unremarkable with exception of a cloudy, yellow mucoid cervical discharge on speculum

exam; friable appearance of the cervix with cervical motion tenderness (CMT). You palpate an 8-week

size uterus on bimanual.

Laura’s urine reveals 2+ ketones, 2+ nitrates, and 3+ leukocytes.

Monica is a 43-year-old African- American G3P2102. She is currently separated from her husband of 20 years and is working full-time as a legal secretary. About 8 months ago, Monica started having irregular periods with heavier than usual flow until she stopped having periods or any vaginal bleeding about 3 months ago

History of Present Illness (HPI): Joanna is a 28-year-old Caucasian G4P1021. She is single, living with her father and 2-year-old daughter

Case #1. Teresa.

History of Present Illness (HPI):

(SOLVED)Teresa is a 34-year-old Hispanic G2P2002
. She presents to your office today at 10-weeks post-partum (PP) for her 6-week PP check. She underwent a C-section for failure to progress following a 20-hour labor with Pitocin augmentation. She was discharged from the hospital on

day 2 post-partum without complications. Teresa has had difficulty with breast feeding due to discomfort in her suture line and terrible pain in her right breast since her discharge from the hospital. She reports occasional chills- she has not measured her temperature at home. Teresa was seen by the lactation consultant while in the hospital but “nothing is working” and her son “cries all the time”. She is afraid to feed her son formula as her mother-in-law wants her to “keep trying to breastfeed”. Teresa tells you she feels as if she has failed her son- “it was so easy with my first baby, I know my husband thinks I am a bad mother”.

Prior medical history: None. Prior surgical history: Appendectomy (2000)

Current medications: Prenatal vitamins, stool softener. Allergies: None

OB- GYN History: NSVD (2019) healthy female 7lb 10oz; C-section healthy male 8 lbs. 8 oz as per HPI.

Menarche age 12, cycle length- 5 days- frequency every 28 days- 4-5 tampons per day. No history of sexually transmitted infections (STDs). History of abnormal pap smear in 2019 which was followed by a normal colposcopy. Last pap (during recent prenatal care) reported normal. HIV negative.

LMP: First PP menstrual cycle last week. Has not resumed sexual activity PP. Contraception history: Oral contraceptives, condoms.

Social history: Lives with husband, mother- in- law, and children. Stay at home mom. Denies EtOH or recreational drug use, never smoker. Her family speaks Spanish at home; she is fluent in English.

Family history: Unremarkable.

Review of Systems (ROS): Negative except as noted in HPI.

Physical Exam (PE)

VS: BP: 110/70, P: 90, RR: 18, T: 38.4, Weight: 132 lbs.

Teresa’s C-section suture line is healing well without erythema or tenderness. No vaginal discharge or lesions, no cervical motion tenderness (CMT), uterus normal size firm and non-tender. On breast exam, you do note an erythematous, swollen, and painful area to the right breast. Her physical exam is otherwise unremarkable.

Case #2. Joanna.

History of Present Illness (HPI): Joanna is a 28-year-old Caucasian G4P1021. She is single, living with her father and 2-year-old daughter. She has a part-time job as a server at the local restaurant; she does not have health insurance. Joanna presents to your office at the community health center today stating she is pregnant and wants to receive OB care. She tells you that she has not yet been evaluated for this pregnancy as she was afraid to take time off from work and did not have enough money to pay for the visit.

Prior medical history: None. Prior surgical history: None

Current medications: None. Allergies: Penicillin

OB- GYN History: NSVD (2021) healthy female 6lb 8oz. Menarche age 10, cycle length- 3 days- irregular cycles since menarche- frequency every 20-30 days- 2-3 tampons per day. No history of sexually transmitted infections (STDs). Joanna’s OB history includes two first trimester elective terminations of pregnancy, and 1 term female infant delivered vaginally at 37 weeks. Denies any complications during her prior pregnancy however, she notes that her daughter experienced hypoglycemia and respiratory distress, spending 2 weeks in the Neonatal Intensive Care Unit (NICU).

LMP: Approximately 5 months ago. Contraception history: Condoms “sometimes”.

Social history: Lives with her retired father and daughter. Restaurant server. Denies EtOH or

recreational drug use. Currently smoking 1 pack of cigarettes/ day (15 pack-year history). She and her

mother are still paying for her daughter’s NICU stay. The child’s father is not involved in any way.

Family history: Mother (deceased age 55)- Type 2 diabetes.

Review of Systems (ROS): Unremarkable with exception of dysuria (“it burns when I pee”) over the past

1-week. Denies fever, chills, abdominal or flank pain. Thick white vaginal discharge and “itching” for the

past month.

Physical Exam (PE)

VS: BP: 108/68, P: 72, RR: 18, T: 37.3, Weight 144lbs

On physical exam you palpate a fundal height of approximately 20cm with an audible fetal heart tone (FHT) of 160. On speculum exam you visualize a multiparous cervix without lesions; bluish discoloration of the cervix, vagina, and vulva is noted with a thick, white discharge. There is no cervical motion tenderness (CMT) on exam. The uterus is anteverted, non- tender, with fundus palpable at the umbilicus. Joanna’s physical exam is otherwise unremarkable. Wet mount reveals budding yeast. Urine dipstick with 1+ leukocytes, trace blood and 2+ glucose.

Case #3. Monica.

History of Present Illness (HPI): Monica is a 43-year-old African- American G3P2102. She is currently separated from her husband of 20 years and is working full-time as a legal secretary. About 8 months ago, Monica started having irregular periods with heavier than usual flow until she stopped having periods or any vaginal bleeding about 3 months ago. She is currently recovering from a “stomach flu”; however, she reports daily nausea, vomiting, bloating and decreased appetite over the past 3 weeks. She is worried because she has gained 12 pounds over the last 3 months “due to menopause”. She comes to the clinic today to discuss menopause symptoms and hormone replacement therapy.

Prior medical history: Hypertension (2010)- well controlled on current antihypertensive

Prior surgical history: Cholecystectomy (2015)

Current medications: Lisinopril 10mg daily. Allergies: None

OB- GYN History: NSVD x 2 (2015, 2019) healthy female 6lb 8oz; healthy female 7lbs 6oz. First trimester

miscarriage (9 weeks) in 2014. Menarche age 15, cycle length-7 days- frequency every 28 days- 5-6 pads

per day. No history of sexually transmitted infections (STDs). No history of abnormal pap (last pap 2

years ago).

LMP: Approximately 3 months ago. Contraception history: Condoms; past use of oral contraceptives.

Social history: Lives with her elderly father, 2 daughters. Separated from her husband for 6 months.

Family history: Mother deceased (age 60)- breast cancer. Father alive (age 70)- hypertension.

Review of Systems (ROS): Unremarkable with exception of as noted in HPI.

Physical Exam (PE)

VS: BP: 130/78, P: 78, RR: 18, T: 36.1 Weight: 152 lbs.

Physical exam is unremarkable with exception of a palpable 12- 14 weeks size uterus on bimanual. You

check a for a fetal heartbeat and obtain a heart tone of 145 via doppler. The intake nurse reports that a

urine pregnancy test came back positive.

Monica is in disbelief.

History of Present Illness (HPI): Joanna is a 28-year-old Caucasian G4P1021. She is single, living with her

father and 2-year-old daughter

Case 2:  Maxine

Case Write-Up

Maxine, a 31-year-old nulligravida, is seen for a routine well-woman examination. She notices a recent pattern of missed periods, and over the last three months, she has had an episode of heavy bleeding and has required an hourly tampon change. Her last period was two weeks ago, and she is not on any form of contraception as her husband wants to get her pregnant. Maxine has an unremarkable past medical and surgical history and is taking prenatal vitamins. Examination shows of concern includes weight loss of 21 pounds within one year, BMI of 17.3, withdrawn, poor eye contact, and a bruise on the inner thigh. Other than that, the vag and breast examinations are normal. She has a social history of recent marriage, loss of job as per her husband, and alcohol use during the day. Breast cancer is noted in her family history under her maternal grandmother. All these together, with the history of menstrual changes and weight loss, elicit behavioral and psychosocial issues related to the possible reproductive endocrine system and to warrant further evaluation.

GET ASSIGNMENT HELP HERE

 

Outline Subjective data.

 

Identify data provided in your chosen case and any additional data needed.

Outline

Objective findings.

 

Identify findings provided in your chosen case and any additional data needed.

Identify diagnostic tests, procedures, laboratory work indicated.

 

Describe the rationale for each test or intervention with supporting references.

Distinguish at least three differential diagnoses.

 

Describe the rationales for your choice of each diagnosis with supporting references.

Identify appropriate medications, treatments or other interventions associated with each differential diagnosis.

 

Describe rationales and supporting references for each.

 

Explain key

Social Determinants of Heath (SDoH) for your chosen case.

Describe collaborative care referrals and patient education needs for your chosen case.

 

Subjective information is Maxine’s description of her last period which was heavy, and menstrual irregularity over the last three months which includes skipped periods. She does not have any gynecologic pain, she denies infections, and she has no other systemic complaints.

Her plans for pregnancy have led her to discontinue contraceptive use. Menarche for this patient was at age ten, and she has no record of pregnancies, sexually transmitted infections, or reports of complications. Her gynecological cycles have been normal and average five days. Three years ago, she was due for a Pap smear and her results came back normal. Maxine described her wine consumption as one to two glasses and that she drinks while her husband is at work. Since her husband requested her to leave, she has been socially isolated. Though she is without complaints, her withdrawn demeanor and poor eye contact are distressing and suggest the need for further evaluation to determine the presence of psychological distress or safety issues and to assess for intimate partner violence, stress, eating disorders and reproductive coercion.

 The
objective data
shows vital signs are stable. Blood pressure, pulse, temperature, and respiratory rate are within normal limits. She is underweight, with a BMI of 17.3. Last year, she weighed 122 lbs and now weighs 101 lbs. Her appearance is withdrawn, disheveled, and she avoids eye contact. A bruise is present on her right inner thigh which raises concerns for trauma or potential interpersonal violence. No abdominal tenderness or masses were found in the normal examination of her abdomen.

On pelvic exam, no lesions were seen on external genitalia, there’s no cervical motion tenderness, and the uterus is normal-sized with no adnexal masses. While the reproductive exam is mostly unremarkable, weight loss, the bruising, and the behavioral changes stand out. Other objective information required includes:  pregnancy status, lab evaluation of the hormonal balance, screens for sexually transmitted infections, nutritional evaluation, and formal screening for partner violence.

In case of potential early pregnancy complications such as heavy bleeding or missed periods, a pregnancy test should be part of the primary evaluation. To determine the cause of heavy menstrual bleeding, a complete blood count (CBC) test is required to assess potential anemia. A thyroid function test (including TSH and free T4) is also required, as thyroid disorders are often associated with menstrual irregularities (Javed et al., 2025). To assess ovulatory dysfunction and STIs such as chlamydia, gonorrhea, HIV, and syphilis, a pelvic ultrasound should be done to check if there are structural issues such as fibroids or polyps causing the bleeding. Some metabolic and nutritional lab tests may be warranted considering the weight and BMI. Due to the bruising, behavioral changes, or social history, screening for partner violence is recommended (Javed et al., 2025).

One potential diagnosis is abnormal uterine bleeding due to dysfunctional ovulation, which could be attributed to considerable stress or significant weight loss. That is because hypothalamic-pituitary-ovarian axis function can be disrupted leading to cycle irregularities (Zhang et al., 2023). Another differential is thyroid disease, hyper or hypothyroidism, which presents frequent concomitant factors (Javed et al., 2025). Intimate partner violence with reproductive coercion is also a strong consideration evidenced by bruises and withdrawal attributed to the husband’s control over employment and reproductive decisions (Grace et al., 2020). Pregnancy-related bleeding, early loss, or implantation bleeding must be excluded and is imperative concerning the age of the female. Finally, bleeding disorders and uterine structural abnormalities like fibroids may account for the heavy bleeding (Zhang et al., 2023). All these conditions can be better evaluated and explained through laboratory tests and imaging to ascertain the cause and treatment.

Maxine’s condition management will depend on the confirmed diagnosis. That is because for patients with ovulatory dysfunction due to low body weight or stress, treatment is centered on nutritional rehabilitation, stress management, and possibly hormonal therapy to regulate cycles (Zhang et al., 2023). On the same, for those with diagnosed complications of pregnancy, care may involve obstetric monitoring, expectant management or treatment of the identified miscarriage. Also, in patients with thyroid disease, management of hypothyroidism may involve the use of the drug levothyroxine and hyperthyroidism may involve antithyroid medications. Javed et al. (2025) state that heavy menstrual bleeding may be treated with nonsteroidal anti-inflammatory drugs or tranexamic acid to reduce the bleeding. Where intimate partner violence is suspected like in Maxine’s case, first priority is given to the safety of the patient, followed by emergency counseling and referral to assistance while in the presence of anemia, iron supplements may be necessary. Hence, Maxine’s case must be developed and adopt personalized management that is in line with the recognized gynecology and primary healthcare guidelines (Zhang et al., 2023).

Maxine’s health is influenced by several social determinants. First, relationship power dynamics may affect her autonomy in employment and reproductive decisions because her husband demands that she stop working and become pregnant (Grace et al., 2020). This is further compounded by the financial reliance on a partner, which increases one’s exposure to domestic violence, abuse, and the financial and geographical barriers that compromise one’s ability to access healthcare. Second, social isolation is a real possibility since she is now a housewife and appeared withdrawn during the visit. This is because isolation is a known precursor for domestic violence and mental health issues (Grace et al., 2020). She may also be utilizing coping strategies or experiencing some stress, which may be evidenced by her health behaviors such as alcohol abuse during the day and her possible nutritional deficiencies as indicated by her weight (Javed et al., 2025). The absence of strong social support networks that integrate health care also limits her ability to access health care. This explains the need for trauma-informed care, partner violence screening, and community and counseling referrals to address the social determinants at play.

Maxine would benefit from a multidisciplinary care approach and a referral for evaluation of abnormal uterine bleeding and fertility planning may be warranted for obstetrician-gynecologist (Kerns et al., 2022). Furthermore, assessing mental health may be necessary to evaluate stress, possible depression, or concerns regarding relationships. Also, if there is suspected intimate partner violence, referrals to social work and community advocacy are critical to creating a safe plan and assisting with resources while if low BMI or disordered eating is a concern, a nutritionist or dietitian may be of assistance. Javed et al. (2025) state that patient education includes information regarding what is normal for menstrual cycles, what is considered excessive or concerning bleeding, and planning for future pregnancies. Additionally, counseling around the use of alcohol and healthy coping strategies is advised. However, it is important that education is provided in a private setting to ensure that Maxine has a safe way to speak about issues that are sensitive and may not be able to be talked about with a partner to achieve better outcomes.

 

References

Grace, K. T., Decker, M. R., Alexander, K. A., Campbell, J., Miller, E., Perrin, N., & Glass, N. (2020). Reproductive coercion, intimate partner violence, and unintended pregnancy among Latina women.
Journal of Interpersonal Violence
,
37
(3-4), 886260520922363. https://doi.org/10.1177/0886260520922363

Javed, N., Shakoor, H., Khattak, S., Mustafa, Y., Maghar, M. M., & Jabeen, S. (2025). Exploring the Relationship Between Thyroid Dysfunction and Menstrual Irregularities in Women.
Indus Journal of Bioscience Research
,
3
(10), 317–324. https://doi.org/10.70749/ijbr.v3i10.2563

Kerns, J., Itriyeva, K., & Fisher, M. (2022). Etiology and management of amenorrhea in adolescent and young adult women.
Current Problems in Pediatric and Adolescent Health Care
,
52
(5), 101184. https://doi.org/10.1016/j.cppeds.2022.101184

Zhang, Y., Luo, Z., Jia, Y., Zhao, Y., Huang, Y., Ruan, F., Ying, Q., Ma, L., Luo, J., & Zhou, J. (2023). Development and validation of a predictive model of abnormal uterine bleeding associated with ovulatory dysfunction: a case-control study.
BMC Women’s Health
,
23
(1). https://doi.org/10.1186/s12905-023-02589-5 Maxine, a 31-year-old nulligravida, is seen for a routine well-woman examination. She notices a recent pattern of missed periods

NRNP 6552 Week 9 case study answers – History of Present Illness (HPI): Teresa is a 34-year-old Hispanic G2P2002. She presents to your office today at 10-weeks post-partum (PP) for her 6-week PP check

 

College of Nursing, Walden University

Advanced Nurse Practice in Reproductive Health Care – 6552-C

Gynecologic Health – Week 9 Case Study

Case 1:  Teresa

Case Write-Up

Teresa is a 34-year-old Hispanic female of G2P2002 who has come to visit at 10 weeks postpartum with a delay of 6 weeks of postpartum care following a cesarean section as a result of failure to progress after prolonged labor. She reports having serious problems with breastfeeding since discharge, and she reports pain in the right breast, localized swelling, and pain at the incision site. She also complains of chills, though no recorded fever at home. Teresa reports a psychosocial concern of inadequacy, guilt, and being judged by her husband and mother-in-law over breastfeeding. Physical examination shows fever (38.4°C) and an erythematous, swollen, and tender field of the right breast, which is indicative of an infectious process. Her cesarean wound is healing well, and her pelvic examination is normal. The case raises concerns of postpartum complications such as lactational mastitis and potential postpartum mood disorder, which have to be further examined and treated.

PLACE YOUR ORDER HERE

Outline Subjective data.

 

Identify the data provided in your chosen case and any additional data needed.

Outline

Objective findings.

 

Identify findings provided in your chosen case and any additional data needed.

Identify diagnostic tests, procedures, and laboratory work indicated.

 

Describe the rationale for each test or intervention with supporting references.

Distinguish at least three differential diagnoses.

 

Describe the rationales for your choice of each diagnosis with supporting references.

Identify appropriate medications, treatments, or other interventions associated with each differential diagnosis.

 

Describe rationales and supporting references for each.

 

Explain key

Social Determinants of Health (SDoH) for your chosen case.

Describe collaborative care referrals and patient education needs for your chosen case.

 

Subjective Data Provided

Teresa presents with severe pain in her right breast, inability to breastfeed, and emotional instability with a sense of failure and perceived judgment. She also complains of chills, failure to breastfeed despite lactation consultation, and fear of using formula because of family pressure. She denies substance use and has no notable past medical history.

 

Additional Subjective Data Needed

Additional subjective data required will involve severity and duration of breast symptoms, nipple cracking or discharge, frequency of breastfeeding or pumping, sleep pattern, appetite alteration, and formal postpartum depression screening using questionnaires like the Edinburgh Postnatal Depression Scale (EPDS). Additional investigations on support mechanisms, cultural beliefs about breastfeeding, and marital relations are also necessary.

Objective Data

Vital signs reveal that the patient has a fever (38.4°C) with otherwise stable hemodynamics. Physical examination reveals a localized erythematous, swollen, and tender locality of the right breast, which is indicative of inflammation or infection. The cesarean section is healing without any indication of infection. Pelvic examination is normal.

 

Additional Objective Data Needed

Other objective information that should be obtained includes laboratory confirmation of infection (CBC), a potential breast ultrasound to evaluate the establishment of an abscess, and mental health screening outcomes. Observation of breastfeeding technique may also provide useful clinical information.

To determine infection, a complete blood count (CBC) is recommended to investigate the presence of leukocytosis (Mank & Brown, 2024).

In case of a suspected abscess, a breast ultrasound is advised, especially when no response is obtained to the initial treatment (Toomey & Le, 2023).

Where the recurrent or severe cases are involved, milk culture can be taken to determine the causative organisms (Blackmon et al., 2024).

Postpartum depression screening with EPDS is necessary due to her emotional distress (ACOG, 2025) NRNP 6552 Week 9 case study answers – History of Present Illness (HPI): Teresa is a 34-year-old Hispanic G2P2002. She presents to your office today at 10-weeks post-partum (PP) for her 6-week PP check

The primary diagnosis is lactational mastitis, and it is supplemented by local pain, erythema, swelling, and fever. This disorder is prevalent among breastfeeding women because of milk stasis and the introduction of bacteria by nipple trauma (Blackmon et al., 2024).

Breast abscess is a second differential that can occur as a complication of untreated mastitis and is characterized by persistent pain, fever, and a palpable, fluctuating mass (Toomey & Le, 2023).

A third differential is postpartum depression, evidenced by Teresa’s feelings of failure, guilt, and perceived inadequacy. It is more likely to occur in cases of hormonal changes, lack of sleep, and psychosocial stressors (ACOG, 2025).

In the case of mastitis, antibiotics like dicloxacillin or cephalexin against the Staphylococcus aureus and ongoing breastfeeding or pumping to clear the milk stasis should be used as the first-line treatment (Blackmon et al., 2024). Ibuprofen and other analgesics are advised to be used for pain and inflammation.

In case a breast abscess has been confirmed, it must be treated with incision and drainage or ultrasound-guided aspiration along with antibiotics.

In the case of postpartum depression, treatment can involve psychotherapy, including cognitive behavioral therapy, and in more severe cases, pharmacologic therapy using selective serotonin reuptake inhibitors (SSRI) like sertraline, which is safe in breastfeeding (ACOG, 2025).

Lactation support, reassurance, and education are among the supportive interventions that can be used to decrease anxiety and enhance the success of breastfeeding.

The cultural and family demands on breastfeeding, especially the pressure of her mother-in-law, are a major factor in her health. This can add to emotional distress and unwillingness to use formula supplementation.

Also, her status as a stay-at-home mother might be a contributing factor to social isolation and poor access to external support networks (Bord et al., 2025). The influence of language in the house and cultural practices can also affect healthcare communications and decision-making. She is also emotionally stressed and feels that she is not supported by her partner, which further worsens her condition.

It is necessary to refer to a lactation consultant to resolve the problems with breastfeeding and avoid complications. Referral to a mental health professional is required to assess and treat postpartum depression.

In case of aggravation of the infection or in case of an abscess, a referral to a breast specialist or surgeon could be necessary. Referral to social work can be used to intervene in family situations and offer support.

Education of patients should cover correct breastfeeding, the need for continued milk expression during infection, the signs of worsening infection, and an explanation that formula supplementation is not wrong when necessary (Wilde, 2021).

Postpartum mental health education and promotion of health-seeking behavior due to emotional symptoms are essential to enhance the outcomes (ACOG, 2023).

 

References

ACOG. (2025).
Patient screening
. Www.acog.org.
https://www.acog.org/programs/perinatal-mental-health/patient-screening

Blackmon, M. M., Nguyen, H., & Mukherji, P. (2024, December 11).
Acute mastitis
. PubMed; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK557782/

Bord, S., Inchi, L., Paldi, Y., Baruch, R., Schwartz Shpiro, M., Ronen, S., Eizenberg, L., Gens, I., & Yaari, M. (2025). The pivotal role of social support, self-compassion, and self-care in predicting physical and mental health among mothers of young children.
Healthcare
,
13
(15), 1889.
https://doi.org/10.3390/healthcare13151889

Mank, V., & Brown, K. (2024, April 21).
Leukocytosis
. PubMed; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK560882/

Pileri, P., Sartani, A., Mazzocco, M. I., Giani, S., Rimoldi, S., Pietropaolo, G., Pertusati, A., Vella, A., Bazzi, L., & Cetin, I. (2022). Management of breast abscess during breastfeeding.
International Journal of Environmental Research and Public Health
,
19
(9), 5762.
https://doi.org/10.3390/ijerph19095762

Toomey, A., & Le, J. K. (2023, January 11).
Abscess, breast
. Nih.gov; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK459122/

Wilde, V. K. (2021). Breastfeeding insufficiencies: Common and preventable harm to neonates.
Cureus
,
13
(10).
https://doi.org/10.7759/cureus.18478

Case #1. Teresa.

History of Present Illness (HPI): Teresa is a 34-year-old Hispanic G2P2002. She presents to your office today at 10-weeks post-partum (PP) for her 6-week PP check. She underwent a C-section for failure to progress following a 20-hour labor with Pitocin augmentation. She was discharged from the hospital on day 2 post-partum without complications. Teresa has had difficulty with breast feeding due to discomfort in her suture line and terrible pain in her right breast since her discharge from the hospital. She reports occasional chills- she has not measured her temperature at home. Teresa was seen by the lactation consultant while in the hospital but “nothing is working” and her son “cries all the time”. She is afraid to feed her son formula as her mother-in-law wants her to “keep trying to breastfeed”. Teresa

tells you she feels as if she has failed her son- “it was so easy with my first baby, I know my husband thinks I am a bad mother”.

Prior medical history: None. Prior surgical history: Appendectomy (2000)

Current medications: Prenatal vitamins, stool softener. Allergies: None

OB- GYN History: NSVD (2019) healthy female 7lb 10oz; C-section healthy male 8 lbs. 8 oz as per HPI.

Menarche age 12, cycle length- 5 days- frequency every 28 days- 4-5 tampons per day. No history of

sexually transmitted infections (STDs). History of abnormal pap smear in 2019 which was followed by a

normal colposcopy. Last pap (during recent prenatal care) reported normal. HIV negative.

LMP: First PP menstrual cycle last week. Has not resumed sexual activity PP. Contraception history:

Oral contraceptives, condoms.

Social history: Lives with husband, mother- in- law, and children. Stay at home mom. Denies EtOH or

recreational drug use, never smoker. Her family speaks Spanish at home; she is fluent in English.

Family history: Unremarkable.

Review of Systems (ROS): Negative except as noted in HPI.

Physical Exam (PE)

VS: BP: 110/70, P: 90, RR: 18, T: 38.4, Weight: 132 lbs.

Teresa’s C-section suture line is healing well without erythema or tenderness. No vaginal discharge or

lesions, no cervical motion tenderness (CMT), uterus normal size firm and non-tender. On breast exam,

you do note an erythematous, swollen, and painful area to the right breast. Her physical exam is

otherwise unremarkable.

 

NRNP 6552 Week 9 case study answers – History of Present Illness (HPI): Teresa is a 34-year-old Hispanic G2P2002. She presents to your office today at 10-weeks post-partum (PP) for her 6-week PP check

Allowed Attempts
 2

Back to Week at a Glance

Working Through COMMON Pregnancy Case Studies and Other Issues in Advanced Nursing Practice

The Assignment for this week is to provide you an opportunity to analyze one of five case studies provided.  These case studies involve common pregnancy and psychosocial issues encountered in advanced nursing primary care practice. You will use the case study template under weekly resources to develop your assignment.

Resources

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare:

Review the 5 case studies in this week’s Learning Resources. Select one of the cases to prepare your written assignment.

Review the Learning Resources for this week.

Assignment Instructions:

Use the Case Study Template from the Learning Resources to complete the assignment. Your submission must include a brief case write-up, followed by the fully completed template, which must be integrated into the document rather than submitted separately.

Include a title page, a case summary in your own words, the completed template, and a reference page formatted in APA style.

Ensure your submission meets all criteria outlined in the template and rubric for completeness and accuracy.

By Day 7 of Week 9

Submit
 your case study assignment by 
Day 7 of Week 9
.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the 
Turnitin Drafts
 from the 
Start Here
 area.

To submit your completed assignment, save your Assignment as 
Wk9Assgn_LastName_Firstinitial

Then, click on 
Start Assignment
 near the top of the page.

Next, click on 
Upload File
 and select 
Submit Assignment
 for review.

Rubric

NRNP_6552_Week9_Case_Study_Assignment_Rubric

NRNP_6552_Week9_Case_Study_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeAnalyzes subjective and objective data and outlines applicable diagnostic tests related to case studies.

30 to >26.7 ptsExcellent
The response provides clear, complete, and comprehensive descriptions of subjective and objective case data, appropriately outlining all diagnostic tests, clinical procedures and pharmacological interventions.

26.7 to >23.7 ptsGood
The response provides clear, complete partial descriptions of the components of the subjective and objective case data, appropriately outlining most of the diagnostic tests, clinical procedures and pharmacological interventions.

23.7 to >20.7 ptsFair
The response provides some components of the subjective and objective case data, but they are incomplete, vague or inaccurate, outlining some of the diagnostic tests, clinical procedures and pharmacological interventions.

20.7 to >0 ptsPoor
The response provides unclear or incomplete components of subjective and objective case data. The diagnostic tests, clinical procedures and pharmacological interventions are missing, incorrect, or inappropriately applied.

30 pts

This criterion is linked to a Learning OutcomeIdentifies differential diagnoses related to case studies.

30 to >26.76 ptsExcellent
The response contains at least 3 differential diagnoses relevant and applicable to the case.

26.76 to >23.7 ptsGood
The response contains at least 2 differential diagnoses relevant and applicable to the case.

23.7 to >20.7 ptsFair
The response contains at least 1 differential diagnosis relevant and applicable to the case.

20.7 to >0 ptsPoor
The response contains few or no differential diagnoses and/or diagnoses are not relevant and applicable to the case.

30 pts

This criterion is linked to a Learning OutcomeFormulates a treatment plan related to case studies based on scientific rationale, evidence- based standards of care, and practice guidelines. Integrates ethical, psychological, physical, financial issues and Social Determinants of Health in plan.

30 to >26.76 ptsExcellent
Formulates a thorough treatment plan including explanations of appropriate diagnostic tests and treatment options. Fully incorporates syntheses representative of knowledge gained from the resources for the module and current credible sources, with no less than 75% of the treatment plan having exceptional depth and breadth. Supported by at least 3 current peer- reviewed, references or professional practice guidelines.

26.76 to >23.7 ptsGood
Formulates a partially complete treatment plan including partial explanations of appropriate diagnostic tests and treatment options. Somewhat incorporates syntheses representative of knowledge gained from the resources for the module and current credible sources with no less than 50% of the treatment plan having exceptional depth and breadth. Supported by at least 3 current peer- reviewed, references or professional practice guidelines.

23.7 to >20.7 ptsFair
Formulates a minimally complete treatment plan including incomplete or vague explanations of appropriate diagnostic tests and treatment options. Lacking in synthesis of knowledge gained from the resources for the module and current credible sources. Supported by at least 2 current peer- reviewed, references or professional practice guidelines.

20.7 to >0 ptsPoor
Formulates a treatment plan that contains incomplete explanations of appropriate diagnostic tests and treatment options and/ or explanations are missing. Lacks synthesis gained from the resources for the module and current credible sources. Supported by 1 or no current peer- reviewed, references or professional practice guidelines.

30 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

5 to >4.45 ptsExcellent
Uses correct grammar, spelling, and punctuation with no errors.

4.45 to >3.95 ptsGood
Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3.95 to >3.45 ptsFair
Contains several (3 or 4) grammar, spelling, and punctuation errors.

3.45 to >0 ptsPoor
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5 to >4.45 ptsExcellent
Uses correct APA format with no errors.

4.45 to >3.95 ptsGood
Contains a few (1 or 2) APA format errors.

3.95 to >3.45 ptsFair
Contains several (3 or 4) APA format errors.

3.45 to >0 ptsPoor
Contains many (≥ 5) APA format errors.

5 pts

Total Points: 100 NRNP 6552 Week 9 case study answers – History of Present Illness (HPI): Teresa is a 34-year-old Hispanic G2P2002. She presents to your office today at 10-weeks post-partum (PP) for her 6-week PP check

NURS FPX 4025 Assessment 1 Analyzing a Research Paper

Jose Sanchez:

Stabilize VS and BG levels. Get interpreter.

Guidance: The patient’s laboratory findings indicate diabetic ketoacidosis which is life-threatening. The patient requires continuous monitoring of cardiac, respiratory, and neurological status. Frequent monitoring of BG levels, ABGs and adjustments to IV fluids and medications. In addition, the patient is non-English speaking and requires a trained interpreter for communicating.

NURS FPX 4025 Assessment 1 Analyzing a Research Paper

Analyzing a Research Paper: Diabetic Ketoacidosis (DKA)

The diagnosis of interest for this Sentinel U simulation is diabetic ketoacidosis (DKA) as seen in Jose Sanchez’s case. DKA symptoms include hyperglycemia, acidosis, ketosis, and confusion. Evidence-based practice (EBP) is essential in the care of high-acuity patients to inform practice with the best available evidence to improve patient outcomes. The article by Elendu et al. (2023) provides a review of DKA, and this paper assesses its validity and clinical relevance.

Evaluation of Credibility

Fig. 1: Abstract

Table for Article Evaluation

Criteria

Analysis

Type of Study & Level of Evidence

This is a comprehensive review (secondary research study). It’s a Level I evidence on the Johns Hopkins Evidence-Based Practice (JHEBP) model, high in the evidence hierarchy due to multiple studies. The research method is a literature analysis of DKA.

Credibility Factors

The article is peer-reviewed, published in a credible journal, is up-to-date (2023), has multiple expert authors, and includes a DOI. It refers to evidence-based sources and adheres to a scholarly writing format.

Importance of Diagnosis (DKA)

The article describes the key factors of DKA (hyperglycemia, ketosis, and metabolic acidosis), which are present in Jose Sanchez. It discusses common precipitating factors, including infection and diabetes, and the need for rapid treatment, which fits the patient’s symptoms.

Application to Practice/Patient Population

The findings apply to acute care settings, including emergency and critical care units. For example, interventions such as IV fluids, insulin therapy, and electrolyte monitoring can be directly applied to Jose Sanchez. The article also supports patient education and prevention strategies, including culturally appropriate care (e.g., interpreter use).

 

Summary of Findings and Relevance to Diagnosis

DKA is the most common hyperglycemic crisis and a common cause of death in people with diabetes, according to the article. It notes some of the classic signs and symptoms, such as hyperglycemia, metabolic acidosis, and ketosis, all of which are evident in Jose Sanchez. It also describes the usual precipitating factors, which include infection and insulin deficiency, both of which are present in the patient’s case. Crucially, it stresses the need for prompt hospitalization, administration of intravenous fluid, insulin, and electrolyte replacement, which are all part of the patient’s management. In addition, the article cites altered mental status, which is associated with serum osmolality, as related to the patient’s confusion. The results also confirm that DKA is potentially life-threatening if incorrectly diagnosed or improperly managed, and the need for continuous monitoring. This information is important as it supports the care being delivered to Jose Sanchez and emphasizes the need to identify and rapidly treat DKA.

GET ASSIGNMENT WRITING HELP HERE

Generalizability to Practice and Patient Population

This article is very generalizable for clinical practice, acute care, and emergency departments. The protocols for management, including fluid replacement, insulin administration, and electrolyte monitoring, can be applied to many patients presenting with DKA, regardless of where they live. This is particularly important in a variety of health care settings, including resource-poor settings where mortality from DKA remains high. The article also highlights the importance of education and the prevention of recurrent DKA. In the Sentinel U scenario, Jose Sanchez needs an education translation into Spanish to understand the management of diabetes and the importance of insulin. This article justifies culturally sensitive discharge and follow-up arrangements. It also emphasizes the need to identify triggers, such as infection, which can help nurses to prevent such triggers in other patients. Therefore, the results of the article can be readily applied to improve patient care and reduce hospital readmissions NURS FPX 4025 Assessment 1 Analyzing a Research Paper.

Conclusion

The article discussed is credible, has a high level of evidence, and is relevant to a diagnosis of diabetic ketoacidosis. The article’s conclusions align with the diagnosis and treatment of Jose Sanchez and highlight the need for evidence-based care, including fluid replacement, insulin administration, and monitoring. Additionally, the article offers valuable insights that can be applied across the spectrum of health care and is a useful resource for nursing. NURS FPX 4025 Assessment 1 Analyzing a Research Paper Using credible evidence to guide patient care supports sound clinical practice, patient safety, and positive outcomes.

References

Elendu, C., David, J. A., Udoyen, A.-O., Egbunu, E. O., Ogbuiyi-Chima, I. C., Unakalamba, L. O., Temitope, A. I., Ibhiedu, J. O., Ibhiedu, A. O., Nwosu, P. U., Koroyin, M. O., Eze, C., Boluwatife, A. I., Alabi, O., Okabekwa, O. S., Fatoye, J. O., & Ramon-Yusuf, H. I. (2023). Comprehensive review of diabetic ketoacidosis: An update.
Annals of Medicine and Surgery
,
85
(6), 2802–2807.
https://doi.org/10.1097/ms9.0000000000000894

 

 

Instructions: NURS FPX 4025 Assessment 1 Analyzing a Research Paper

Identify and write a summary of the various factors that contribute to the credibility of a research article related to a diagnosis of interest that you identified from the Sentinel U simulation on Patient Management & Delegation. In the module, there are 10 patients listed with various diagnosis. Select one diagnosis of interest to you from the simulation.

Collapse All

Introduction

Evidence-based practice (EBP) integrates the best evidence available to guide optimal nursing care, with a goal to enhance safety and quality. EBP is crucial to nursing practice because it incorporates the best evidence from current literature, along with the expertise of the practicing nurse. The concern for quality care that flows from EBP generates a desired outcome. Without these factors, a nurse cannot be an effective leader. It is important to lead not only from this position but from knowledge and expertise. To gain the knowledge, you require a good understanding of how to search for scholarly resources, as well as make decisions regarding the content of the scholarly resources.

Professional Context

As a baccalaureate-prepared nurse, you will be responsible for providing patient-centered, competent care based on current evidence-based best practices. You will be required to do research, analysis, and dissemination of best evidence to stay abreast of these best practices. Understanding where to go to find credible evidence, determining the type of evidence and being able to make decisions based on the findings of credible evidence is the foundation of evidence-based care.

Preparation

Review the 
What Is Scholarly?
 Campus page. Specifically, look at the following two items on the page:

What Are Peer-Reviewed Articles?

Anatomy of a Scholarly Article.

These will give you the factors that contribute to credibility, which you will need to identify in the article you choose for this assessment NURS FPX 4025 Assessment 1 Analyzing a Research Paper.

Also, look at the “Find EPB Articles” section of the 
Evidence-Based Practice in Nursing & Health Sciences
 library guide (found in the guide’s left-hand menu). This may help you locate an article to use for this assessment.

Instructions

Write a 2-page analysis of a scholarly research article, demonstrating your ability to locate credible, useful evidence related to a diagnosis of interest selected from the Sentinel U simulation on Patient Management & Delegation. There are 10 patients, each with a different medical diagnosis. Select one patient with a diagnosis of interest to you NURS FPX 4025 Assessment 1 Analyzing a Research Paper.

Once you have chosen your diagnosis of interest from the Sentinel U simulation, complete the following:

Use a credible search engine to locate a research article on your topic.

Review the article for the following criteria:

Type of study (quantitative or qualitative, the level on the pyramid of evidence, methodology).

Credibility factors.

Importance of content to selected diagnosis.

The ability to apply the content in your current workplace or patient population.

Take a screenshot of the abstract and paste it into a Word document (see the 
Example of Screenshot [PDF]
document). You can refer to the instructions in the 
Taking Screenshots [PDF]

Create a table or series of text boxes next to or below the screenshot and use that to label each criterion.

Also take a screenshot of the patient and the diagnosis from Sentinel U simulation you used.

Write up a summary of your findings on the second page. Note what information is important to your specified diagnosis. How credible is the article you’ve found and how useful is it related to your specified diagnosis and your ability to apply it?

Include a link to your article.

Include a reference to your article in APA format.

Review the Analyzing a Research Paper scoring guide for specific details of grading prior to submission.

Competencies Measured

By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:

Competency 1: Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.

Determine the type of study and the level of evidence according to the pyramid of evidence.

Identify the credibility factors of an article.

Summarize the findings of an article, noting what information is important to a specified diagnosis.

Competency 2: Analyze the relevance and potential effectiveness of evidence when making a decision.

Summarize the ability to generalize article findings in a specified work space and patient population.

Competency 5: Apply professional, scholarly communication strategies to lead practice changes based on evidence.

Provide an APA-formatted reference and link to an article.

Scoring Guide

Use the NURS FPX 4025 Assessment 1 Analyzing a Research Paper scoring guide to understand how your assessment will be evaluated.

 

Criterion 1

Determine the type of study and the level of evidence according to the pyramid of evidence.

Distinguished

Determines the type of study and the level of evidence according to the pyramid of evidence, providing reasons for the determinations.

 

Criterion 2

Identify the credibility factors of an article.

Distinguished

Identifies the credibility factors of an article, including if the article is peer-reviewed.

 

Criterion 3

Summarize the findings of an article, noting what information is important to a specified diagnosis.

Distinguished

Summarizes the findings of an article, noting what information is important to a specified diagnosis, and the information’s implications.

 

Criterion 4

Summarize the ability to generalize article findings in a specified work space and patient population.

Distinguished

Summarizes the ability to generalize article findings in a specified work space and patient population, providing examples.

 

Criterion 5

Provide an APA-formatted reference and link to an article.

Distinguished

Provides a flawless APA-formatted reference and link to an article.

 

 

NURS FPX 4025 Assessment 1 Analyzing a Research Paper

What is Scholarly?

It’s important to know how to differentiate between scholarly and popular sources. While popular sources such as blogs, websites, Twitter, and magazine articles may be credible, they might not have the level of rigor expected by your program. Scholarly journals continue to be the preferred vehicle for research information. Most scholars publish their works as articles in peer-reviewed journals.

What are peer-reviewed articles?

Peer-reviewed articles are considered the gold standard in academic publishing. The phrase “peer-review” has several synonyms you may hear, such as scholarly, refereed, or juried.

What are peer-reviewed articles

What are peer-reviewed articles?

Learn more about the peer-review process and how to identify peer-reviewed articles. 
View media.

Peer-review is a process many academic journals require before publishing an article to ensure they are publishing the best content. Each research article considered for a peer-reviewed journal must go through critical evaluation by subject experts (usually faculty member peers or other researchers in the field). The article is evaluated on its research methodology, literature review, discussion, results, and conclusions before it is published. If an article does not meet the standards of scholarship in the discipline, it will not be published by the journal.

Launch video player in a new window
 2:03

Basics of Peer Review

The publisher CREDO shows the characteristics of peer review resources.

Hallmarks of a scholarly article

When searching for peer-reviewed articles, many databases allow you to limit your search to peer-reviewed journals. However, you should know the these characteristics of scholarly articles:

Always includes references, footnotes or a bibliography of works cited

Uses the language of the discipline

Reports new academic research studies, including methodology and data analysis

Gives author’s title, affiliation, and usually contact information

Has a long, descriptive title

Is longer than 5 pages

Has very few advertisements or images in its print or PDF version

NURS FPX 4025 Assessment 1 Analyzing a Research Paper

Anatomy of a scholarly article

Anatomy of a scholarly article

See the different parts of a scholarly article, including how to recognize them on the fly.
View media.

Scholarly databases

Scholarly journals are not widely available for free online. You may be able to get to the first page, but these articles are tightly controlled by the publishers and you usually have to pay to read them. Online articles from subscription journals can cost $20-30 each.

Libraries, however, buy journal collections in the form of electronic databases. These databases are large collections of publications that are built to research complex academic topics through precise searching. The Capella Library purchases its databases and journal collections exclusively to match the research needs of students in Capella’s many programs. The databases can be accessed from the 
library’s homepage
.

Not everything within the library databases is “scholarly.” In fact, most of the library databases contain a mixture of peer-reviewed and non-peer-reviewed content, such as trade publications and magazine articles. NURS FPX 4025 Assessment 1 Analyzing a Research Paper Many of our academic databases allow you to remove non-scholarly content from your search results by marking a checkbox labeled “Scholarly or Peer-Reviewed Journals.”

Locating scholarly sources

Locating scholarly sources

Learn more about the world of scholarly information and how it will contribute to your assignments. 
View media.

Resources

Evaluating Source Quality

Get the criteria for differentiating between scholarly and popular sources.

 

NURS-FPX4025 Reading List – NURS FPX 4025 Assessment 1 Analyzing a Research Paper

https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/lists/3452314540006731?auth=SAML

Assessment 1: EBP, Databases, and Nursing Practice

https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/lists/3452314540006731?auth=SAML&section=3452314550006731

American Nurses Association, . (2023).
What is evidence-based practice in nursing?
https://www.nursingworld.org/content-hub/resources/workplace/evidence-based-practice-in-nursing/

https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/citation/4230439960006731?auth=SAML

Cleary‐Holdforth, J., & O’Mathúna, D. (2022). How nursing stakeholders in the Republic of Ireland define evidence‐based practice and why it matters.
Worldviews on Evidence-Based Nursing
,
19
(5), 396–404. https://doi.org/10.1111/wvn.12593

https://capella.alma.exlibrisgroup.com/leganto/public/01CAPELLA_INST/citation/4230440210006731?auth=SAML

References for Assessement 1:

eBook

Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals: Model & Guidelines, Fifth Edition

Tools for Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals: Model & Guidelines, Fifth Edition

By:

Kim Bissett
;

Judy Ascenzi
;

Madeleine Whalen

In:

2025

eBook Collection (EBSCOhost)

NURS FPX 4025 Assessment 1 Analyzing a Research Paper

NURS-6630 Week 7: Discussion/Assignment: Patient Medication Guide Loxapine

Introduction

Loxapine is a tricyclic antipsychotic medication used in the treatment of schizophrenia. As a conventional antipsychotic, this drug helps to treat schizophrenia by decreasing the level of excitement in the brain (Lebel et al., 2023). Excitement in this case means excessive brain activity that are involved in emotion, perception, and thought processing. Overactivity in the brain in schizophrenia is caused by excess dopamine in the brain. It is a first-generation drug that can be taken orally and nasally through inhalation.

Brand names: Adasuve, Loxitane

Off-label use: Psychosis in Parkinson’s, mania in bipolar, treatment-resistant depression.

FDA Approved use: Acute agitation in schizophrenia and bipolar I, schizophrenia.

 

 

Classification

Loxapine is a first-generation antipsychotic. This means that it is an older medication that was developed in the 1950s for the treatment of psychosis.

Sub-classification: Loxapine is a dibenzoxazepine derivative. Dibenzoxazepine is a class of compounds which is used as an incapacitating agent. Loxapine is a molecule derived from this compound and is targeted for psychosis therapy NURS-6630 Week 7: Discussion/Assignment: Patient Medication Guide Loxapine

 

 

 

III.
         Mechanism of Action

Loxapine is a dopamine antagonist and a serotonin 5-HT2 blocker.

It blocks the effects of dopamine in the brain by blocking the D2 receptors, which reduces brain activity in dopaminergic pathways. These pathways are involved in psychotic symptoms such as hallucinations and delusions.

It also blocks serotonin 5-HT2 receptors, which brings about a therapeutic effect on the patient.

 

Pharmacokinetics

After oral administration, sedation begins in 30 minutes, with peak concentration of the drug in 1.5 to 3hours. The duration of sedation lasts about 12 hours after administration. Rate of drug metabolism is contingent on route of administration. It is more rapidly absorbed orally through the GI tract and completely absorbed through IV.

Loxapine is metabolized in the liver through aromatic hydroxylation and N-oxidation to a variety of metabolites.

It is excreted through the urine and feces.

Its half-life is 5 hours at initial phase and 19 hours at terminal phase.

 

Dosing and Administration

Typical adult doses are about 10mg taken twice daily and can be increased gradually. The total daily dosage is about 60mg to 100mg per day based on response to the drug and tolerance (Im et al., 2023).

The drug is often taken by mouth and in capsules. There is also the inhalation form by Adasuve for incidents of acute agitation in the patient. Inhalation delivers the medication faster than the oral route through the lungs.

For patients with liver or kidney complications, the dosing can be adjusted. This may also be adjusted for older adults, who then require lower doses to avoid toxicity and side effects.

Loxapine should be taken at the same time daily to ensure the body has steady levels of the drug (Nuss et al., 2022). Inconsistent timing or missing doses may lead to a relapse of symptoms or an increase in the side effects of the drug.

 

 

VII. Special Populations

Older adults- Loxapine should be cautiously administered to older adults because of their increased risk of falls, sedation, and confusion.

Children and adolescents – The drug is typically not recommended for this age group as safety is yet to be established (Im et al., 2023).

Pregnant women- There is a risk of neonatal complications, such as withdrawal symptoms in the newborn, and therefore loxapine must be cautiously administered (Merino et al., 2022).

Suicidal patients- Those with active suicidal ideation should receive loxapine cautiously. Loxapine can increase impulsivity and cause mood changes, leading to heightened suicidal ideation.

 

VIII. Half-Life

The half-life of a medication is the amount of time it takes for half of the drug to be eliminated from the body. This helps determine how often a drug needs to be taken and how long it stays effective in the system (Im et al., 2023).

It is crucial for the clinician to understand the half-life concept as this determines the dosage of the drug administered. A longer half-life means smaller and less frequent dosage because the drug is in the system for longer.

Loxapine’s half-life is between 4 and 8 hours, with 7-hydroxyloxapine, a metabolite that has a longer effect and contributes to the 12 to 24-hour duration of antipsychotic dynamics NURS-6630 Week 7: Discussion/Assignment: Patient Medication Guide Loxapine

 

 

 

 

IX:
Side Effects and Adverse Reactions

Drowsiness or sedation – feeling sleepy or sluggish.

Dry mouth – decreased saliva production

Constipation – due to slowed gastrointestinal movement (Merino et al., 2022).

Blurred vision – usually temporary

Dizziness or lightheadedness, especially when standing up quic

Seizures – especially at high doses or in those with seizure disorders.

Severe hypotension – low blood pressure that can lead to fainting.

 

 

Clinical Concerns with Extrapyramidal Symptoms (EPS) and Tardive Dyskinesia (TD)

EPS

Acute dystonia: painful muscle stiffness, especially in the neck and face.

Akathisia: feeling restless or unable to sit still

Parkinsonism: tremors, slow movement, and stiffness like Parkinson’s disease (Fadem & Citrome, 2019).

Bradykinesia: slowness in movement.

Tardive Dyskinesia (TD)

Repetitive, involuntary movements—especially of the mouth, tongue, face, or limbs (Im et al., 2023).

Movements may look like lip-smacking, blinking, or twitching

Can occur after months or years of treatment

Risk Factors:

Long-term use of antipsychotics

Higher doses

Older adults

Female patients

History of mood disorders

Screening Tools to Detect EPS and TD

AIMS (Abnormal Involuntary Movement Scale) – helps detect TD.

SAS (Simpson-Angus Scale) – for Parkinsonian symptoms.

BARS (Barnes Akathisia Rating Scale) – for restlessness and akathisia.

NURS-6630 Week 7: Discussion/Assignment: Patient Medication Guide Loxapine

Contraindications and Significant Drug Interactions:

Hypersensitivity

Respiratory issues for the inhaled version.

History of seizures (Fadem & Citrome, 2019).

Drug to Drug interactions

Alcohol, opioids, benzodiazepines

Anticholinergics

Macrolides, citalopram (Fadem & Citrome, 2019).

Patient must:

Avoid alcohol

Monitor ECG if combining with other QT-prolonging medications (Fadem & Citrome, 2019).

Use extra caution in polypharmacy, especially in older adults.

 

 

 

References

Faden, J., & Citrome, L. (2019). Examining the safety, efficacy, and patient acceptability of inhaled loxapine for the acute treatment of agitation associated with schizophrenia or bipolar I disorder in adults. Neuropsychiatric disease and treatment, 15, 2273–2283.
https://doi.org/10.2147/NDT.S173567

Im, D. S., Capitanov, M., & VandenBerg, A. M. (2023). Loxapine in the treatment of manic and psychotic symptoms in an individual intolerant to multiple Mood-Stabilizing and antipsychotic medications. Case Reports in Psychiatry, 2023, 1–11.
https://doi.org/10.1155/2023/8887553

Lebel, C., Endomba, F. T., Chabridon, G., & Chauvet-Gélinier, J. (2023). Efficacy and safety of loxapine in acute agitation. The Primary Care Companion for CNS Disorders, 25(6).
https://doi.org/10.4088/pcc.23r03552

Merino, D., Fernandez, A., Gérard, A. O., Ben Othman, N., Rocher, F., Askenazy, F., Verstuyft, C., Drici, M.-D., & Thümmler, S. (2022). Adverse Drug Reactions of Olanzapine, Clozapine and Loxapine in Children and Youth: A Systematic Pharmacogenetic Review. Pharmaceuticals, 15(6), 749.
https://doi.org/10.3390/ph15060749

Nuss, P., Corruble, E., Baloche, E., Garay, R. P., & Llorca, P. (2022). Fifty years of experience with loxapine for the rapid non-coercive tranquilization of acute behavioral disturbances in schizophrenia patients, and beyond. Expert Review of Neurotherapeutics, 22(8), 639–653.
https://doi.org/10.1080/14737175.2022.2108706
  NURS-6630 Week 7: Discussion/Assignment: Patient Medication Guide Loxapine

RUA – Capstone Evidence-Based Paper: Communication Concept

 

RUA – Capstone Evidence-Based Paper: Communication Concept

Introduction

This paper aims to evaluate performance on the Clinical Judgment Exam (CJE) Readiness assessment and to examine strategies for effective communication in nursing practice. The NCLEX-RN
®
blueprint highlights effective communication as a crucial skill, particularly in promoting and maintaining health, as it supports efforts to foster patient-centered care, improve clinical judgment, and facilitate a safer transition into professional nursing practice. This discussion emphasizes the importance of enhancing communication skills to boost readiness for NCLEX-RN
®
success and overall clinical competence.

Health promotion and maintenance rely on effective communication to help nurses establish therapeutic relationships, encourage behavioral change, and educate patients. In this NCLEX-RN® category, nurses must work with interdisciplinary teams to promote wellbeing, give clear instructions, and assess patient understanding. Poor communication can lead to adverse health outcomes, reduce treatment adherence, and cause misunderstandings (Samir et al., 2025). Therefore, improving communication skills directly boosts the quality of patient care and health promotion efforts.

Importance

Effective communication is essential in professional nursing because it guarantees accurate information exchange, fosters teamwork, and enhances patient safety. Nurses depend on concise, clear, and culturally sensitive communication to advocate successfully for patients, minimize errors, and coordinate care. Poor communication can compromise clinical judgment and lead to adverse outcomes, such as misdiagnoses or medication errors (Watson, 2024).

Clear communication is vital for ensuring treatment adherence, engaging patients, and improving health literacy. Patients with limited health literacy or language barriers are at greater risk of miscommunication, which can lead to higher readmission rates and poor disease management. Ignoring communication barriers can damage healthcare quality by disrupting effective teamwork and increasing the likelihood of errors. Persistent communication problems may also cause patients to disregard treatment instructions, resulting in worse health outcomes (Kwame & Petrucka, 2021).

Healthcare Disparities, Inequalities, and Interventions

Ineffective communication affects many patients, particularly those with limited English proficiency (LEP). These patients often find it difficult to understand medical information, which can cause disparities in quality of care and health outcomes. Tackling this issue necessitates the use of healthcare resources, such as culturally competent care and professional medical interpreter services, to support evidence-based communication practices (Wehbe-Alamah & McFarland, 2026).

Communication-related healthcare disparities include misinterpretation of instructions, unequal access to information, and lower patient satisfaction among diverse populations. These disparities are amplified by limited health literacy, language barriers, and cultural differences (Nisar et al., 2026). For example, patients who have difficulty understanding discharge instructions are at higher risk of complications or hospital readmission.

Communication gaps can be reduced by adopting evidence-based strategies that utilize standardized tools, such as the Teach-Back Method, which ensures patients understand by asking them to restate what they have understood in their own words. Trained interpreters can replace family members to improve confidentiality and accuracy in communication. Additionally, culturally competent communication training can be incorporated into nursing education and practice as part of a proven strategy (Samir et al., 2025).

Patient education should use materials appropriate to the patient’s health literacy level, language, and cultural background. This requires nurses to adapt their communication style to each individual patient, promoting active participation and understanding. Such an approach helps improve patient outcomes and encourages health equity (Wehbe-Alamah & McFarland, 2026).

Legal & Ethical Considerations and Intervention Challenges

The principle of autonomy is an ethical aspect of communication in nursing, requiring that information given to patients be accurate and understandable to enable them to make informed decisions. Poor communication can violate this principle by limiting patients’ understanding. A legal consequence of inadequate communication might involve informed consent: failure to clearly explain the benefits and risks can lead to legal repercussions for healthcare providers (Yoder-Wise & Sportsman, 2023).

A strategy to prevent the described ethical dilemma is to adopt patient-centered communication methods that convey information to patients in a manner that respects their preferences and values. Ethical standards are maintained through active listening and confirming understanding. To avoid legal issues, nurses should accurately record all communication and utilize interpreter services when needed to ensure proper informed consent (Yoder-Wise & Sportsman, 2023).

An anticipated challenge is managing time constraints that may limit the depth of interactions with patients, especially in busy clinical settings. Another expected issue is the lack of training in effective communication techniques and resistance to change among healthcare professionals. Overcoming these challenges requires leadership commitment to communication excellence, ongoing education, and organizational support (Yoder-Wise & Sportsman, 2023).

Participants and Interdisciplinary Approach

Effective communication interventions require collaboration among members of an interdisciplinary team. Three key participants include medical interpreters, physicians, and nurses. Medical interpreters address language barriers by facilitating accurate communication between healthcare providers and patients. Physicians contribute by providing medical information and working with nurses to ensure consistent messaging. Nurses coordinate care, deliver education, and assess patient understanding (Wehbe-Alamah & McFarland, 2026).

Including interdisciplinary members improves communication by bringing together diverse perspectives and expertise. For example, physicians offer clinical clarity, while interpreters guarantee linguistic accuracy. This collaborative approach encourages evidence-based practice by ensuring patient-centered and comprehensive communication strategies (Kwame & Petrucka, 2021). Interdisciplinary teamwork boosts care quality, minimizes errors, and enhances patient safety.

Quality Improvement

Addressing communication gaps is an essential strategy for improving patient outcomes, including boosting patient satisfaction, lowering hospital readmissions, and increasing treatment adherence. Effective communication improves health outcomes by helping patients better understand their conditions and actively participate in their care (Nasir et al., 2026).

Enhancing communication is essential in the nursing profession, as it helps minimize workplace errors, strengthen professional relationships, and improve clinical judgment. Additionally, it increases nurses’ confidence and supports their successful transition into practice. Resources such as standardized communication tools (e.g., SBAR) contribute to better patient outcomes by ensuring structured, clear information exchange (Wehbe-Alamah & McFarland, 2026).

Furthermore, continuing education programs and simulation-based training are valuable resources for enhancing nurses’ knowledge and competence in communication. These resources enable nurses to practice their communication skills in realistic scenarios, helping them to improve their readiness for clinical practice (Samir et al., 2025). Implementing these strategies helps to foster a culture of safety and supports quality improvement initiatives.

Conclusion

This paper examines the importance of communication in the Clinical Judgment Exam Readiness assessment, which is part of the NCLEX-RN® health promotion and maintenance category. Effective communication is vital for providing patient-centered, safe care, reducing healthcare disparities, and improving health outcomes. By addressing communication challenges through continuous education, fostering interdisciplinary teamwork, and using evidence-based strategies, we can improve patient care and support professional growth.

Resources such as training programs, standardized communication tools, and interpreter services improve communication and support evidence-based practice. Addressing communication challenges is essential because they impact care quality, health equity, and patient safety. Developing strong communication skills is vital for success on the NCLEX-RN® exam and for transitioning into a competent, professional nursing career.

Reference

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: barriers, facilitators, and the way forward.
BMC nursing, 20
(1), 158.
https://doi.org/10.1186/s12912-021-00684-2

Nisar, S., Khan, S., Rehman, A., Gobis, R. A., Shaikhomer, M., Alshanberi, A. M., Hariri, N. H., Alshareef, M. H., & Alsanosi, S. M. (2026). The impact of language barriers on patients’ perception of their physician’s involvement in shared decision-making.
Frontiers in public health, 13
, 1728046.
https://doi.org/10.3389/fpubh.2025.1728046

Samir, M. M., Eisa, N. M., Khaled, H., Syed, W., Al-Rawi, M. B. A., Warda, A. E. A., Kamal, N. M., Mahmoud, R. S., & Refaee, A. S. (2025). The impact of communication skills training on patient-centered attitude and patient satisfaction: A longitudinal study of Egyptian physicians.
Preventive medicine reports, 55
, 103117.
https://doi.org/10.1016/j.pmedr.2025.103117

Watson, N. A. (2024). 
Effective Communication for Nursing Practice
. SAGE Publications.

Wehbe-Alamah, H. B., & McFarland, M. R. (2026). 
Leininger’s Transcultural Healthcare: Concepts, Theories, Research & Practices
. McGraw Hill LLC.

Yoder-Wise, P. S., & Sportsman, S. (2023). 
Leading and Managing in Nursing
(8th ed.). Mosby RUA-Capstone Evidence-Based Paper.

 

 

Capstone Course

RUA-Capstone Evidence-Based Paper Guidelines

© 2023 Chamberlain University. All Rights Reserved

RUA- Capstone Evidence-Based Guidelines September 2023

Purpose

The student will analyze their performance on the Clinical Judgment Exam (CJE) Readiness and reflect on areas of

opportunity and strategies to promote NCLEX-RN® success and transition into practice. The student will apply

the priority concept (topic) to evidence-based professional practice upon which nurses have the ability to resolve

or have a positive impact. There is a focus on the healthcare disparities of the individual, as well as ethical and

legal implications to professional practice. The student will discuss how an interdisciplinary approach promotes

quality improvement for the patient and evidence-based professional practice, driving positive outcomes.

Course outcomes: This assignment enables the student to meet the following course outcomes:

CO 1: Synthesize knowledge from sciences, humanities, and nursing in managing the needs of humans as

consumers of healthcare in a patient-centered environment.(PO 1)

CO 2: Integrate communication and relationship skills in teamwork and collaboration functioning effectively with

health team members and consumers of care.(PO 3)

CO 3: Utilize information technology to manage knowledge, mitigate error, andsupport decision making with

health team members and consumers of care. (PO8)

CO4: Integrate criticalthinking, clinicalreasoning skills, best current evidence, clinical expertise, and patient/family

preferences/values in the implementation of the nursing process. (PO 4)

CO 5: Explore the impact of professional standards, legislative issues, ethical principles, and values on professional

nursing, using data to monitor outcomes and improve quality and safety. (POs 5 and 6)

Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy

applies to this assignment.

Total points possible: 120 points

Preparing the assignment: Follow these guidelines when completing this assignment. Speak with your faculty

member if you have questions.

In this paper, the student will provide a detailed description of the relationship between the category from the

NCLEX-RN® examination blueprint, the priority concept (topic) selected based on assessment performance, and

professional practice.

1) Write a 4–6-page paper (not including the title page or reference page) using APA format.

2) Include the following sections:

a. Introduction – 12 points/10%.

• Offer a detailed description of the purpose statement for thepaper.

• Identify the priority concept (topic) from the Clinical Judgment Readiness Exam and align to one of the

four (4) main categories of the NCLEX-RN® examination blueprint:

a. Assurance of a safe and effective care environment

b. Health promotion and maintenance of health

c. Preservation of the patient population’s psychosocial integrity

d. Preservation of the patient population’s physiological integrity

• Provide a detailed description of the relationship between the category from the NCLEX-RN®

examination blueprint and the priority concept (topic).

• This section should not exceed two (2) paragraphs. A paragraph is 3-5 sentences.

b. Importance – 12 points/10%

• Describe the primary importance of the priority concept (topic) to professional practice.

• Describe the importance of the priority concept (topic) to the health status of a patient population.

2

Capstone Course

RUA-Capstone Evidence-Based Paper Guidelines

© 2023 Chamberlain University. All Rights Reserved

RUA- Capstone Evidence-Based Guidelines September 2023

• Include 2 potential negative effect(s) to professional practice if the priority concept (topic) is

unresolved.

• Include 2 potential negative effect(s) to the patient population if the priority concept (topic) is

unresolved.

• Provide appropriate, adequate, and relevant scholarly support for this section.

c. Healthcare Disparities, Inequalities, and Interventions – 30 points/ 25%

• Identify a primary patient population that may be negatively influenced by the priority concept (topic)

if unresolved.

• Identify a healthcare resource to support evidence-based professional practice related to the priority

concept (topic).

• Summarize potential priority concept (topic) healthcare disparities and inequalities related to diverse

populations.

• Propose an evidence-based solution for the priority concept (topic) related to healthcare disparities.

• Identify an evidence-based practice intervention.

• Discuss patient education considerations related to the priority concept (topic).

• Provide appropriate, adequate, and relevant scholarly support for this section.

d. Legal & Ethical Considerations and Intervention Challenges – 18 points/ 15%

• Identify one (1) ethical and one (1) legal implication for addressing the priority concept (topic) in

professional practice.

• Discuss one (1) strategy in prevention of an ethical dilemma related to the priority concept (topic) in

professional practice.

• Discuss one (1) strategy in prevention of legal consequences related to the priority concept (topic) in

professional practice.

• Identify one (1) anticipated challenge to the success of preventing the priority concept (topic) in

professional practice.

• Identify one (1) anticipated challenge to the success of resolving the priority concept (topic) in

professional practice.

• Provide appropriate, adequate, and relevant scholarly support for this section.

e. Participants and Interdisciplinary Approach – 12 points/10%

• Identify three (3) parties (identify two (2) members of a discipline outside of nursing) who will be

involved in the implementation of the priority concept (topic) interventions.

• Discuss the role of these member in the intervention implementation for the priority concept (topic).

• Discuss the benefit of including the identified interdisciplinary members from disciplines outside

nursing to promote evidence-based professional practice.

• Provide appropriate, adequate, and relevant scholarly support for this section.

f. Quality Improvement – 12 points/10%

• Provide at least one (1) benefit in patient outcomes from addressing the priority concept (topic) within

the clinical environment.

• Provide at least one (1) benefit to the nursing profession that will result from addressing this priority

concept (topic) in clinical professional practice.

• Discuss at least one (1) resource utilized to promote improved patient outcomes in the clinical

environment.

• Discuss at least one (1) resource utilized to increase professional nurse knowledge promoting

improved clinical professional practice.

• Provide appropriate, adequate, and relevant scholarly support for this section.

g. Conclusion – 12 points/10%

• Provide a thorough recap of the purpose to promote increased evidence-based professional practice

knowledge related to the priority concept (topic) deficiency.

• Summarize resources identified to support improved evidence-based professional practice related to

the priority concept (topic).

3

Capstone Course

RUA-Capstone Evidence-Based Paper Guidelines

© 2023 Chamberlain University. All Rights Reserved

RUA- Capstone Evidence-Based Guidelines September 2023

• Include a complete statement describing why addressing the priority concept (topic) matters for

patient outcomes and evidence-based professional practice.

• This section should provide no new information and should be limited to 1-2 paragraphs.

h. APA Style and Organization 12 points/10%

• References are submitted with paper.

• Uses current APA format and is free of errors.

• Grammar and mechanics are free of errors.

• Paper is 4-6 pages, excluding title and reference pages.

• A minimum of three (3) scholarly, peer reviewed, primary sources from the last 5 years, excluding the

textbook, are provided.

• Each section should have a cited source to support information provided.

For writing assistance, visit the Writing Center.

Capstone Course

RUA-Capstone Evidence-Based Paper Guidelines

© 2023 Chamberlain University. All Rights Reserved

RUA- Capstone Evidence-Based Guidelines September 2023

Grading Rubric

Criteria are met when the student’s application of knowledge within the paper demonstrates achievement of the outcomes for this assignment.

Assignment Section and

Required Criteria

(Points possible/% of total points available)

Highest Level of

Performance

High Level of

Performance

Satisfactory

Level of

Performance

Unsatisfactory

Level of

Performance

Section not

present

Introduction

(12 points/10%) 12 points 10 points 9 points 7 points 0 points

Required criteria

1. A detailed description of the purpose statement for the

paper.

2. Identify the priority concept (topic) from the Clinical

Judgment Exam and align to one (1) of the four (4) main

categories of theNCLEX-RN® examination blueprint:

a. Assurance of a safe and effective careenvironment

b. Health promotion and maintenance of health

c. Preservation of the patient population’s psychosocial

integrity

d. Preservation of the patient population’s physiological

integrity

3. Provide a detailed description of the relationship between

the category from the NCLEX-RN® examination blueprint

and the priority concept (topic) identified on the Clinical

Judgment Exam.

4. This section should not exceed two (2) paragraphs. A

paragraph is 3-5 sentences.

Includes 4

requirements for

section.

Includes 3

requirements for

section.

Includes 2

requirements for

section.

Includes 1

requirements for

section.

No requirements

for this section

presented.

Importance

(12 points/10%) 12 points 10 points 9 points 7 points 0 points

Required criteria

1. Describe the primary importance of the priority concept

(topic) to professional practice.

2. Describe the importance of the priority concept (topic) to

the health status of a patient population.

3. Include two (2) potential negative effects to professional

practice if the priority concept (topic) is unresolved.

Includes 5

requirements for

section.

Includes 4

requirements for

section.

Includes 3

requirements for

section.

Includes 2 or fewer

requirements for

section.

No requirements

for this section

presented.

Capstone Course

RUA-Capstone Evidence-Based Paper Guidelines

© 2023 Chamberlain University. All Rights Reserved

RUA- Capstone Evidence-Based Guidelines September 2023

4. Include two (2) potential negative effects to the patient

population if the priority concept (topic) is unresolved.

5. Provide appropriate, adequate, and relevant scholarly

support for this section.

Healthcare Disparities, Inequalities, and Interventions

(30 points/25%) 30 points 25 points 23 points 21 points 0 points

Required criteria

1. Identify a primary patient population that may be negatively

influenced by the priority concept (topic) if unresolved.

2. Identify a healthcare resource to support evidence-based

practice related to the priority concept (topic).

3. Summarize potential priority concept (topic) healthcare

disparities and inequalities related to diverse populations.

4. Propose an evidence-based solution for the priority concept

(topic) related to healthcare disparities.

5. Identify an evidence-based practice intervention.

6. Discuss patient education related to the priority concept

(topic).

7. Provide appropriate, adequate, and relevant scholarly

support for this section.

Includes 7

requirements for

section.

Includes 6

requirements for

section.

Includes 5

requirements for

section.

Includes 4 or fewer

requirements for

section.

No requirements

for this section

presented.

Legal & Ethical Considerations and Intervention

Challenges

(18 points/15%)

18 points 16 points 14 points 12 points 0 points

Required criteria

1. Identify at least one (1) ethical and one (1) legal implication

for addressing the priority concept (topic) in professional

practice RUA-Capstone Evidence-Based Paper.

2. Discuss at least one (1) strategy in prevention of an ethical

dilemma related to the priority concept (topic) in

professional practice.

3. Discuss at least one (1) strategy in prevention of legal

consequences related to the priority concept (topic) in

professional practice.

4. Identify one (1) anticipated challenge to the success of

preventing the priority concept (topic) in professional

practice.

Includes 6

requirements for

section.

Includes 5

requirements for

section.

Includes 4

requirements for

section.

Includes 3 or fewer

requirements for

section.

No requirements

for this section

presented.

Capstone Course

RUA-Capstone Evidence-Based Paper Guidelines

© 2023 Chamberlain University. All Rights Reserved

RUA- Capstone Evidence-Based Guidelines September 2023

5. Identify one (1) anticipated challenge to the success of

resolving the priority concept (topic) in professional practice.

6. Provide appropriate, adequate, and relevant scholarly

support for this section.

Participants and Interdisciplinary Approach

(12 points/10%) 12 points 10 points 9 points 7 points 0 points

Required criteria

1. Identify three (3) primary parties (two members outside of

the nursing discipline) who will be involved in the

implementation of the priority concept (topic)

interventions.

2. Discuss the role of these members in the intervention

implementation for the priority concept (topic).

3. Discuss the benefit of including the identified

interdisciplinary members from disciplines outside nursing

to promote evidence-based professional practice.

4. Provide appropriate, adequate, and relevant scholarly

support for this section.

Includes 4

requirements for

section.

Includes 3

requirements for

section.

Includes 2

requirements for

section.

Includes 1

requirement for

section.

No requirements

for this section

presented.

Quality Improvement

(12 points/10%) 12 points 10 points 9 points 7 points 0 points

Required criteria

1. Provide at least one (1) benefit in patient outcomes from

addressing the priority concept (topic) within the clinical

environment.

2. Provide at least one (1) benefit to the nursing profession

that will result from addressing this priority concept (topic)

in clinical professional practice.

3. Discuss at least one (1) resource utilized to promote

improved patient outcomes in the clinical environment.

4. Discuss at least one (1) resource utilized to increase

professional nurse knowledge promoting improved clinical

professional practice.

5. Provide appropriate, adequate, and relevant scholarly

support for this section.

Includes 5

requirements for

section.

Includes 4

requirements for

section.

Includes 3

requirements for

section.

Includes 2 or fewer

requirements for

section.

No requirements

for this section

presented.

Capstone Course

RUA-Capstone Evidence-Based Paper Guidelines

© 2023 Chamberlain University. All Rights Reserved

RUA- Capstone Evidence-Based Guidelines September 2023

Conclusion

(12 points/10%) 12 points 10 points 9 points 7 points 0 points

Required criteria

1. Provide a thorough recap of the purpose to promote

increased evidence-based professional practice knowledge

related to the priority concept (topic) deficiency.

2. Summarize resources identified to support improved

evidence-based professional practice related to the

priority concept (topic). This section should not include

new information.

3. Include a complete statement describing why addressing

the priority concept (topic) matters for patient outcomes

and evidence-based professional practice. RUA-Capstone Evidence-Based Paper

4. This section should be a limited to 1-2 paragraphs.

Includes 4

requirements for

section.

Includes 3

requirements for

section.

Includes 2

requirements for

section.

Includes 1

requirement for

section.

No requirements

for this section

presented.

APA Format, Grammar, and Punctuation

(12 points/10%) 12 points 10 points 9 points 7 points 0 points

Required criteria

1. References are submitted with paper.

2. Uses current APA format and is free of errors.

3. Grammar and mechanics are free of errors.

4. Paper is 4-6 pages, excluding title and reference pages.

5. A minimum of three (3) scholarly, peer reviewed, primary

sources from the last 5 years, excluding the textbook, are

provided.

6. Each section should have a cited source to support

information provided.

Includes 6

requirements for

section.

Includes 5

requirements for

section.

Includes 4

requirements for

section.

Includes 3 or fewer

requirements for

section.

No requirements for

this section

presented.

Total Points Possible = 120 points

RUA-Capstone Evidence-Based Paper

Our Struggle for Freedom, Civil Liberties and Political Equality Essay

Option 1: This week, you have reflected on liberties and freedom. Describe one environmental risk to public health. What role should the government play within this context? Based on the Bill of Rights, how can citizens regulate environmental health risks?

The more research I do into toxins, the more risks I find in the environment that could and is causing public health concerns. In my opinion, one of the largest issues I see in our country right now is water quality. While we certainly have cleaner drinking water than some other countries to be a first-world country with the knowledge and resources we have I would have to say our drinking water does not live up to that. Studies have been done that have shown our drinking water contains multiple contaminants such as arsenic and fluoride, both have the potential to cause many health issues (Fawell et al,. 2003). I have also seen many studies that have shown high levels of heavy metals in the drinking water and when one’s body begins to build up with heavy metals it can cause everything from chronic fatigue to autoimmune disorders. In 1974 the Safe Drinking Water Act was passed by Congress which laid out the standards for safe and good quality drinking water and also helped monitor states, local authorities, and water suppliers enforcing those standards (Centers for Disease Control and Prevention, 2022). Unfortunately, these standards were researched and put into place 40 years ago. Based on new research and ongoing research we have gained light years of knowledge since then.

The government should be taking steps to update what is considered safe drinking water and work on finding larger-scale ways to put that into place. As an individual, I do have access to purchase whole-home health filtration systems, individual sink and shower filters, and smaller-scale filtration devices. While I believe I am fortunate to have access to these things they are also expensive and I believe with the water quality being what it is and causing a health risk to all citizens that the government should own that and take responsibility to fix it.

As a citizen based on the Bill of Rights, I have options to bring this issue to light in the hopes of changing it. we can use our protected rights under the Bill of Rights to advocate for reform. One of the protected rights under the Bill of Rights I could utilize includes things such as the right to assemble peacefully through such things as protests and make the government aware of concerns protected by our First Amendment (Greenburg et al,. 2018). The First Amendment allows the citizens the right to help in influencing many things including environmental health regulations

 

Response – Our Struggle for Freedom, Civil Liberties and Political Equality Essay

Hi,

Your post presents an informative discussion on an environmental risk for public health, the role that the government plays in the context, and the position of citizens in regulating environmental health risks. I like that you identify toxins in drinking water sources as an environmental risk that presents public health concerns, citing studies on how USA drinking water sources contain contaminants like arsenic and fluoride. In addition, I like that you identify the position of the legislature in addressing concerns about safe drinking water through legislation that sets out standards for what constitutes safe and good quality drinking water. Besides that, I like that you identify the government’s laxity in enforcing the legislation. Additionally, I like that you identify the citizens role in regulating the environment, noting that each individual has a responsibility of ensuring intake of safe drinking water by using small-scale filtration devices. Furthermore, I like that you identify advocacy as an option that citizens can explore to bring attention to the issue of contaminated drinking water, and ensure adequate measures are taken to address and reverse the situation. While your discussion post is well presented, I feel that it can be improved by identifying the position of citizens in regulating the environmental health risk through environmental citizenship. This involve undertaking responsible pro-environmental behavior by participating in society as change agents. They can participate in the public and private sphere through individual and collective actions to develop healthy relationships with the environment, achieve sustainability, prevent creation of new contaminants, ensure proper disposal of contaminants, and decontaminate water sources (Stoett & Lamalle, 2023). Overall, the discussion post is well presented, but can be improved by mentioning the need for individual and collective action to bring attention to the issue, reverse the situation, and prevent future occurrence.

Reference

Stoett, P., & Lamalle, S. (2023).
Representations and Rights of the Environment
. Cambridge University Press. Our Struggle for Freedom, Civil Liberties and Political Equality Essay

Our Struggle for Freedom, Civil Liberties and Political Equality

Option 1: This week, you have reflected on liberties and freedom. Describe one environmental risk to public health. What role should the government play within this context? Based on the Bill of Rights, how can citizens regulate environmental health risks?

Or

Option 2: The Bill of Rights is not only included with the United States Constitution but also state constitutions. All states have provisions in their constitutions that protect individual rights. Go online and look up your state constitution concerning amendments that are included in the Bill of Rights. How does your state constitution protect your individual rights?

Be sure to make connections between your ideas and conclusions and the research, concepts, terms, and theory we are discussing this week. Equality, Americans w/ Disabilities Act, Women’s rights

Our Struggle for Freedom, Civil Liberties and Political Equality

Option 1: This week, you have reflected on liberties and freedom. Describe one environmental risk to public health.

Pollution, particularly dumping, is an environmental risk to public health. By definition, a dumping site is a location in which toxic waste is disposed of. It creates an environmental health disparity as people living close to dumping sites are exposed to a combination of social inequities and poor environmental quality that result in greater incidences of disease and sickness compared to those living in less polluted environments. The polluted environment in dumping exposes the community to environmental pollutants that cause health problems like heart disease, respiratory diseases, and cancer (Kury, 2021).

What role should the government play within this context?

The government plays a role in regulating dumping sites. It develops and enforces waste management regulations, oversees waste collection and disposal, promotes initiatives to recycle and reduce waste, educates the public about waste management, and raises awareness about waste management issues (Stoett & Lamalle, 2023).
Our Struggle for Freedom
, Civil Liberties And Political Equality

Based on the Bill of Rights, how can citizens regulate environmental health risks?

A sustainable, healthy, clean, and interdependent environment is necessary for citizens to fully enjoy, as indicated in the Bill of Rights. In this case, citizens can regulate the environmental health risks through environmental citizenship that may involve undertaking responsible pro-environmental behavior. For that matter, citizens would participate in society as agents of change in the public and private sphere on a global, national, and local scale through collective and individual actions, in the direction of developing a healthy relationship with the environment, achieving sustainability, preventing the creation of new environmental problems, and solving contemporary environmental problems. Some of the specific actions citizens may undertake include encouraging wise management of natural resources, protecting and conserving natural resources and diversity, and preventing, reducing, and eliminating the use, generation, and release of pollutants (Stoett & Lamalle, 2023).

References

Kury, F. L. (2021). 
The Constitutional Question to Save the Planet: The Peoples’ Right to a Healthy Environment
. Environmental Law Institute.

Stoett, P., & Lamalle, S. (2023).
Representations and Rights of the Environment
. Cambridge University Press Our Struggle for Freedom, Civil Liberties And Political Equality