Category: Nursing

Lower back pain soap note examples

CC:
lower back pain x 1 week

 

HPI:
42-year-old obese female presents with complaints of lower back pain for the past week that feels worse today. The pain is constant and intermittently radiates down her left leg. It is not improved with ibuprofen. She works as a grocery store clerk.

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Review of systems:

General:
No fever, chills, or weight changes or sweating or general weakness.

Eyes:
No blurred or double vision or pain or redness.

Ears:
No pain or decrease in hearing.

Nose:
No runny nose or blockage or bleeding.

Throat:
No sore throat.

Head:
No headache.

Chest:
No chest pain or cough or shortness of breath or wheezing.

Breasts:
No pain or tenderness or noticeable lump.

Heart:
No irregular heart beat or palpitations or chest pain.

Gastrointestinal:
No nausea or vomiting or constipation or difficulty swallowing or rectal bleeding or bloating or distension or hemorrhoids or diarrhea or abdominal discomfort.

Genitourinary:
No vaginal discharge or bleeding or dysuria or vaginal problems.

Musculoskeletal:
No muscle problems or weakness.
Lower back pain that radiates down left leg.

Skin:
No rashes or bruises or skin masses or other skin complaints.

Neurologic:
No weakness or headache or seizures or numbness or tingling.

Psychiatric:
No anxiety or depression or suicidal/homicidal thoughts.

Endocrine:
No excessive thirst or excessive urination or excessive heat or cold.

Immunologic:
No tuberculosis or hepatitis or HIV or recurrent infections.

Hematologic:
No anemia or easy bruising or bleeding.

Lower back pain soap note examples

 

PMHx
: none

FamilyHx
: none

SocialHx
: Pt works as a grocery store clerk

Allergies
: NKA

Objective:

66 in

275 lb

44.4

122/75 mmHg

78 bpm

14 bpm

97.6 °F

99 %

 

General:
Normotensive, in no acute distress.

Head:
Normocephalic, no lesions.

Eyes:
PERRLA, EOM’s full, conjunctivae clear, fundi grossly normal.

Ears:
EAC’s clear, TM’s normal.

Nose:
Mucosa normal, no obstruction.

Throat:
Clear, no exudates, no lesions.

Neck:
Supple, no masses, no thyromegaly, no bruits.

Chest:
Lungs clear, no rales, no rhonchi, no wheezes.

Heart:
RR, no murmurs, no rubs, no gallops.

Abdomen:
Soft, no tenderness, no masses, BS normal.

Back:
Normal curvature, no tenderness.

Extremities:
FROM, no deformities, no edema, no erythema.

Neuro:
Physiological, no localizing findings.

Skin:
Normal, no rashes, no lesions noted.

Lower back pain soap note examples

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Assessment:

Actual Dx:

(E66.0) Obesity, body mass index (bmi 40-44.9).

(M54.5) Dorsalgia, acute low back pain.

ICD-10-CM Codes. (2019). Retrieved from https://www.icd10data.com/ICD10CM/Codes/

Plan:

– begin medications listed below as needed.

– pt educated on importance of weight loss and dietary modification to reduce back strain

– RTC for follow up in 30 days if symptoms persist

Ultram (tramadol) 100 MG Oral Tablet Sig: Take 1 tablet (100 mg) by mouth every 6 hours as needed for pain. #40, no refills.

Flexeril (cyclobenzaprine) 10 MG Oral Tablet Sig: Take 1 tablet (10 mg) by mouth every 8 hours as needed. Take at bedtime if drowsiness occurs. #30, no refills.

Ultram, Flexeril: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing. (2019). Retrieved from https://www.webmd.com/drugs

Education:

Provide education to pt on importance of dietary modification and exercise in order to lose weight and reduce strain on her back. Stress importance of establishing goals and the health benefits associated with a healthy BMI. If necessary and pt continues to struggle in 30 days will refer to dietician for additional support on nutrition and increasing her level of physical activity (UpToDate, 2019).

 

History & Physical Examination

 

Patient Demographics
:

Name: T.H.

Age/race/sex: 26 Hispanic Female

Clinical site: Primary Care clinic; Presents for sick visit.

 

 

SUBJECTIVE DATA

 

Chief Complaints
:
    “My lower back has been hurting for about 2 weeks now”.

 

History of Present Illness
:  

Mrs. H is a 26 y/o Hispanic female with a six year history of depression-controlled on Sertraline, who presents to the clinic today complaining of spontaneous occurring acute low back pain to lumber region that started about 2 weeks ago after wearing heels to a party. Reports it has been very difficult to dress lower body and to bend. She reports the pain is constant but has intermittent intensities of aching and soreness throughout the day. The pain is localized to the lumber area, described as aching and soreness with no radiation, rated a 5/10 in office today with 3/10 being the lowest amount of pain experienced and 8/10 being the worst pain she has experienced. Reports the pain is worse in the mornings when getting out of bed after lying down all night. She hasn’t tried any pharmacological or non-pharmacological therapies. She reports no heavy lifting, strenuous exercise, current injuries, nor feelings of anxiety or depression. However, about 5 years ago she was riding her bike, went down a ramp and flipped head first over the handle bars of the bike. At which time she experienced this same low back pain, went to the ER and had X-rays that showed some inflammation and swelling. She was then prescribed a muscle relaxant, Ibuprofen, and physical therapy for 8 weeks, which helped tremendously. At today’s visit, she hopes to find out where the pain is coming from and what she can do to prevent it from returning. Lower back pain soap note examples

 

Past Medical History:

Depression-active- diagnosed 6 years ago after mom passed in a MVA

Low back pain-active-diagnosed about 5 years ago after previous back injury.

 

 

Past Surgical History:

No surgeries to date

 

Allergies:

NKA to food, dust, mold, environment, or medications.

 

Medications:

Sertraline 150 mg by mouth daily for depression

 

Health Maintenance:

Influenza Vaccine-October 2017 at CVS.

All other immunizations are up-to-date including TDaP, MMR, and Varicella.

Last Pap smear- June 2016-normal

Performs MSBE

Depression screen positive for PHQ2; on meds and see Psychologists regularly.

CAGE 0/4

 

Personal & Social History:

Lives alone in a one bedroom apartment.

Works at a nursing home as a Certified Nursing Assistant 4 days/week. She loves her job and has a dependable car.

Denies any smoking, illicit drug abuse, or alcohol misuse.

Previously did cross fit in high school. However, do to work she hasn’t had much time to get the amount of exercise she needs.

Patient is sexually active with only one sex partner, her boyfriend.

24 hour diet recall: B- one bowl of Chex cereal; L- a turkey sandwich, chips, and a diet coke; S-about 1-2 cups of cheese-it crackers and a diet coke; D- Meatloaf, veggies, mashed potatoes from Boston Market, and a bottled water. Lower back pain soap note examples

 

Family History:

Grandparents

Paternal:      Paternal grandfather 81, HTN, DM; Paternal grandmother 76 history of DM

and MI.

Maternal:     Maternal grandfather died at 82 from MI, maternal grandmother 79, history

of diabetes and arthritis.

 

Parents

Father:         Father 59, history of HTN, Diabetes, Depression, and Stroke.

Mother:        Mother 52, died in a MVA.

 

Siblings

Siblings:      Only child.

 

Children

Children:     No children.

 

Review of Systems:
 

General

Denies any fever, chills, night sweats, weight loss or weight gain in the past year.

Skin

Denies dry skin and itching. Denies abnormal lesions or new nevi/moles

Head

Previous head injury, denies any masses, lesions and headache

Eyes

Denies any discharge, itchy, blurred vision, vision loss or vision changes, eye pain or injection.

Ears

Denies any itching, fullness, vertigo, ear pain or drainage, hearing loss or changes in quality of hearing.

Nose/Sinuses

Denies epistaxis, PND, maxillary or frontal sinus pain, or changes in smell

Mouth/Throat

Denies sore throat and dysphagia. Denies gum disease, has all original teeth, last dental exam was in July of this year, sees the dentist annually.

Neck/Lymph Nodes

Denies swollen /painful lymph nodes, denies any neck pain or stiffness. Lower back pain soap note examples

Breasts

Denies masses, pain, or nipple discharge. Does perform regular SBE.

Thorax/Respiratory

Denies any SOB, DOE, or wheezing.

CVS

Denies CP, palpitations, denies peripheral edema, Orthopnea

GI/Abdomen

Denies dyspepsia, nausea, vomiting, diarrhea, constipation, bloating, hematemesis, hematochezia, or abdominal pain. No recent changes in bowel habits. Last bowel movement was this morning, which is consistent with her regular bowel habits and was normal.

GU

Denies any pain on urination, frequency, urgency, or vaginal discharge.

Musculoskeletal

See HPI.

Neurologic

Denies memory loss, numbness, tingling, or burning pains or weakness.

Endocrine

Denies known glucose abnormalities, heat or cold intolerance

Psychiatric

Reports a history of depression but denies any anxiety.

 

 

OBJECTIVE

Physical Examination:

Vital Signs/HT/WT

T: 98.2F, P: 72 readily palpable, RR: 16, BP 110/64 on right, 110/68 on the left SaO2 on RA: 100% HT: 5’8”, WT: 128lbs (toned-physique, stable with no gains or losses within the last 6 months), BMI: 19.46, normal for ht. and wt.

General

26 y/o Hispanic female, pleasant appears her stated age sitting on the examination table in moderate distress as evidenced by arms tensed on elbows as she’s guarding pain. Well groomed, well developed, AAOx3

Skin

Warm, moist, no rashes or suspicious moles, +turgor

Head/Scalp

ATNC, thick black hair, no dandruff, no lesions/masses.

Eyes

External examination without ptosis, strabismus or exophthalmos. Conjunctiva pink. Rest of exam deferred.

Ears

Auricles symmetrical, no lesions or tophi; Rest of exam deferred.

Nose

Bilateral nasal turbinates’ pink, moist. Rest of exam deferred.

Sinuses

Deferred

Mouth

Lips pink, moist mucous membrane, tongue protrudes in midline.

Pharynx/Throat

Deferred. Lower back pain soap note examples

Neck/Lymph nodes

Trachea midline with full AROM without pain.

CVS

RRR, normal S1, S2, no murmurs, rubs, or extra systole, JVD 3cm at 30 degrees, no carotid bruits, no cyanosis or vascular lesions. No chest wall deformity. PMI at 5
th
ICM MCL. Non-tender without heaves or thrill. Auscultation of the abdomen without bruit. Palpation without pulsatile masses

Lungs/Thorax

Chest symmetrical without deformity, respirations even and unlabored throughout anterior and posterior lung fields. Palpation without tenderness.  Tactile fremitus present. Resonance heard on percussion throughout anterior and posterior lung fields. Vesicular breath sounds auscultated throughout anterior and posterior peripheral lung fields.

Breasts

Deferred

Abdomen

Deferred

GU

Deferred

Musculoskeletal

Mandible moves in midline TMJ palpation without clicks or tenderness. Neck and cervical spine have no noted deformities or signs of inflammation. Curvature of cervical, thoracic and lumbar spine within normal limits. Bony features of shoulders and hips are of equal height bilaterally and non-tender. Posture is slumped and gait is smooth but guarded. Palpation of spinous processes of C7-L5 are palpable, midline, and tender to deep palpation right below L5. Discomfort noted with lying flat on exam table. Patient can bend to touch toes but experiences discomfort at about 90 degrees from the upright position. Although patient can actively perform such maneuvers as bending her knees to her chest while lying flat, flex, extend, and rotate the spine there is some mild discomfort and pain noted throughout the maneuvers.

Extremities/Pulses

No edema, erythema or cyanosis to upper or lower extremities. Pulses 2/4 to bilateral femoral, popliteal, posterior tibial, and dorsalis pedis pulses.

Neurologic

AA O X3. Slumped posture while sitting and walking. Gait steady and intact. Sensation intact to light, deep, and sharp touch. gait and balance intact. CN II- XII intact.  Memory and cognition intact for present and past medical history.

Psych

Appropriate mood and affect

 

Evidence Based Assessment/Plan

Clinical Decision Making:
 26 y/o Hispanic female presents to the primary care clinic with a two week history of constant low back pain worse when ambulating and dressing. The pain is non-radiating and has intermittent intensities of aching and soreness consistent with acute non-specific low back pain. She has experienced these symptoms before after a biking accident 5 years ago. Given Mrs. H’s presenting signs and symptoms there is a need to differentiate between the diagnosis of acute non-specific low back pain and low back pain with radiculopathy. Mrs. H is an otherwise healthy young female with a history of depression controlled on antidepressant. She has no other co-morbidities or health issues.

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Differential Diagnosis:

CHARACTERISTICS OF DIFFERENTIAL DIAGNOSIS

SIGNS AND SYMPTOMS

PHYSICAL EXAM FINDINGS

Non-specific Acute Low Back Pain

Nonspecific or nonradicular low back pain is not associated with neurologic symptoms or signs. In general, the pain is localized to the spine or paraspinal regions (or both) and does not radiate into the leg. In general, nonspecific low back pain is not associated with spinal nerve root compression. Nonspecific low back pain might or might not be associated with significant pathology on magnetic resonance imaging (MRI) and is often a result of simple soft tissue disorders such as strain, but it can also be caused by serious medical disorders arising in the bony spine, parameningeal, or retroperitoneal regions.

 

Risk factors:

Smoking, obesity, older age, female gender, physically strenuous work, sedentary work, a stressful job, job dissatisfaction and psychological factors such as anxiety or depression.

 

Diagnosis:

Diagnosis is based on physical exam findings. Routine spine radiographs are of limited value because they visualize only bony structures. Guidelines from the U.S. Agency for Health Care Policy and Research (AHCPR) indicated value of routine spine radiographs for acute low back pain in the following settings: acute major trauma, minor trauma associated with risk of osteoporosis, risk of spinal infection, pain that does not respond to rest or recumbency, and history of cancer, fever, or unexplained weight loss. They may also be of value in assessing spinal alignment and rheumatologic disorders of bone. The American Academy of Neurology guideline recommends nonsurgical therapy before CT and MRI are used in patients with uncomplicated acute low back pain of less than 7 weeks’ duration.

www.aafp.org

 

Pain areas: in the low back, muscles and bones, hip, or leg.

 

Sensory: leg numbness or pins and needles.

 

Back joint dysfunction or muscle spasms.

 

Slumped gait due to pain on standing upright.

 

 

 

 

 

 

 

 

Some physical exam findings of low back pain may include the following;

 

Superficial tenderness over the lumbar region to light touch

 

Nonanatomic tenderness

 

Exacerbation of pain by applying a few pounds of pressure with the hands to the top of the head

 

Exacerbation of pain by simulated rotation or flexion of the spine

 

Ability to sit up straight from a supine position, but intolerance of the straight-leg-raising test

 

Nonanatomic distribution of sensory changes

 

http://www.clevelandclinicmeded.com

 

Acute lumbosacral radiculopathy

Low back pain accompanied by spinal nerve root damage is usually associated with neurologic signs or symptoms and is described as 
radiculopathy.
 There is usually pathologic evidence of spinal nerve root compression by disk or arthritic spur, but other intraspinal pathologies may be present and are often apparent on an MRI scan of the lumbosacral spine.

Risk factors:

Traumatic injury

Lumbar sprain or strain

Postural strain

sitting, standing or walking >2hrs per day

frequent moving or lifting >25 lbs.

strength <50% depression obesity poor health prior LBP poor back endurance Osteoarthritis Rheumatoid Arthritis www.aafp.org Diagnosis: After the initial examination, the diagnosis of lumbar radiculopathy can be supported by electrodiagnosis, MRI, CT scans, and/or contrast myelography. Treatment of lumbar radiculopathy will vary depending on the actual cause of the radiculopathy. These treatments can include the use of back supports, medication, physical therapy, steroid injection in the spine, and even surgery. http://www.aanem.org   Radiculopathy  — A common feature of low back pain is radiculopathy, which occurs when a nerve root is irritated by a protruding disc or arthritis of the spine. Radiculopathies usually cause radiating pain, numbness, tingling, or muscle weakness in the specific areas related to the affected nerve root, usually the lower leg. Most people with these conditions improve with limited or no treatment, described below. Lower back pain soap note examples Sciatica  — Sciatica refers to the most common symptom of radiculopathy. It is a pain that occurs when one of the five spinal nerve roots, which are branches of the sciatic nerve, is irritated, causing a sharp or burning pain that extends down the back or side of the thigh, usually to the foot or ankle. You may also feel numbness or tingling. Occasionally, the sciatica may also be associated with muscle weakness in the leg or the foot. If a disc is herniated, sciatic pain often increases with coughing, sneezing, or bearing down. Neurogenic claudication  — Neurogenic claudication is a type of pain that can occur when the spinal cord is compressed due to narrowing of the spinal canal from arthritis or other causes. The pain runs down the back to the buttocks, thighs, and lower legs, often involving both sides of the body. This may cause limping and weakness in the legs. Pain usually gets worse when extending the lower spine (e.g., when standing or walking), and gets better when flexing the spine by sitting, stooping, or leaning forward.   The onset of symptoms in patients with lumbosacral radiculopathy is often sudden and includes LBP. Some patients state the preexisting back pain disappears when the leg pain begins. Sitting, coughing, or sneezing may exacerbate the pain, which travels from the buttock down to the posterior or posterolateral leg to the ankle or foot. Radiculopathy in roots L1-L3 refers pain to the anterior aspect of the thigh and typically does not radiate below the knee, but these levels are affected in only 5% of all disc herniations. When obtaining a patient’s history, be alert for any red flags (i.e., indicators of medical conditions that usually do not resolve on their own without management). Such red flags may imply a more complicated condition that requires further workup (e.g., tumor, infection).   The presence of fever, weight loss, or chills requires a thorough evaluation. Patient age is also a factor when looking for other possible causes of the patient’s symptoms. Individuals younger than 20 years and those older than 50 years are at increased risk for more malignant causes of pain (e.g., tumor, infection).   POC LABS to Review No POC labs to review   Diagnosis 1-Guidelines for Treatment for Non-Specific Acute Low Back Pain (most likely dx): There is general agreement that patients with acute nonspecific spine pain or nonlocalizable lumbosacral radiculopathy (without neurologic signs or significant neurologic symptoms) require only conservative medical management. Patients should abstain from heavy lifting or other activities that aggravate the pain. Bed rest is not helpful and has been shown to delay recovery. Bed rest may be recommended for the first few days for patients with severe pain with movement. Recommended medications include nonsteroidal anti-inflammatory drugs such as ibuprofen or aspirin. If there are complaints of muscle spasm, muscle relaxants such as cyclobenzaprine may be used in the acute phase of pain. Narcotic analgesia should be avoided, in general, but it can be prescribed in cases of severe acute pain. A study by Cherkin and coworkers compared standard physical therapy maneuvers and chiropractic spinal manipulation for the treatment of acute low back pain and found that both provide small short-term benefits and improve patient satisfaction. Nonpharmacologic treatment, including superficial heat, massage, acupuncture, or spinal manipulation, should be used initially for most patients with acute or sub-acute low back pain, as they will improve over time regardless of treatment. When pharmacologic treatment is desired, nonsteroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxants should be used. Avoid imaging in cases of uncomplicated low back pain (unless there are specific clinical indications). Medications prescribed today;   Diclofenac Sodium 50 mg 1 by mouth twice daily for pain for 2 weeks. Flexeril (Cyclobenzaprine) 10 mg 1 tab by mouth three times a day as needed for muscle spasms for 2 weeks. www.aafp.org   Diagnostic test needed: No further diagnostic test needed at this time. Diagnosis was based on clinical presentation, history, and physical exam.   Referrals/Consults: Referral for physical therapy to evaluate and treat for low back pain and spasms.   Patient Education : Remaining active  — many people are afraid that they will hurt their backs further or delay recovery by remaining active. However, remaining active is one of the best things you can do for your back. In fact, prolonged bed rest is not recommended. Studies have shown that people with low back pain recover faster when they remain active. Movement helps to relieve muscle spasms and prevents loss of muscle strength. Although high-impact activities should be avoided, it is fine to continue doing regular day-to-day activities and light exercises, such as walking. If certain activities cause the back to hurt too much, it is fine to stop that activity and try another. If back pain is severe, bedrest may be necessary for a short period of time, generally no more than one day. When in bed, the most comfortable position may be to lie on the back with a pillow behind the knees and the head and shoulders elevated, or to lie on the side with the upper knee bent and a pillow between the knees.   Heat  — using a heating pad can help with low back pain during the first few weeks. It is not clear if cold packs help as well.   Work  — most experts recommend that people with low back pain continue to work so long as it is possible to avoid prolonged standing or sitting, heavy lifting, and twisting. Some people need to stay home from work if their occupation does not allow them to sit or stand comfortably. While standing at work, stepping on a block of wood with one foot (and periodically alternating the foot on the block) may be helpful. Pain medications  — Take medications on a regular basis for two weeks for it to be effective, rather than using the medication only when the pain becomes unbearable. If needed, take muscle relaxant before bedtime. Do not take this medication while driving or operating machinery.   Exercise — a program of exercises can help to increase back flexibility and strengthen the muscles that support the back. Although starting back exercises or stretching immediately after a new episode of low back pain might temporarily increase the pain, the exercise may reduce the total duration of pain and prevent recurrent episodes. Lower back pain soap note examples Recommended activities include those that involve strengthening and stretching, such as walking, swimming, use of a stationary bicycle, and low-impact aerobics. Avoid activities that involve twisting, bending, are high-impact, or make the back hurt more. Some specific exercises may help strengthen the muscles of the lower back. People with frequent episodes of low back pain should continue these exercises indefinitely to prevent new episodes.   Mattress choice – The benefit of a firm mattress in preventing or treating low back pain has not been proven. In one study, medium-firm mattresses were more likely to improve chronic back pain compared with firm mattresses https://www.uptodate.com/contents/low-back-pain-in-adults   Diagnosis 2-Guidelines for Treatment for Acute Lumbosacral Radiculopathy: The initial treatment of the patient with lumbosacral radiculopathy presenting with sensory symptoms and pain without significant neurologic deficits is not different from the approach for the patient with uncomplicated low back pain. However, such patients require observation for possible worsening of their neurologic status. For patients with acute lumbosacral radiculopathy, the objectives of treatment are to ameliorate pain (symptomatic treatment) and to address the specific underlying process (mechanism-specific treatment) if necessary http://www.clevelandclinicmeded.com   Diagnostic test needed: If signs and symptoms of radiculopathy, sciatica, or neurogenic claudication exists the patient may require one or more of test including Spinal Radiography, CT scan, MRI, contrast myelography, or electrodiagnosis. http://www.aanem.org   Referrals/Consults: Referral to an orthopedic surgeon or neurosurgeon is recommended under the following circumstances: Increasing neurologic problems (measurable weakness) Loss of sensation (e.g., numbness) or bladder and bowel symptoms Failure to improve after four to six weeks of nonsurgical management, with persistent and severe sciatica and evidence of nerve root involvement https://www.uptodate.com/contents/low-back-pain-in-adults   Patient Education : Most people with radiculopathy improve with conservative treatment such as medication and PT. Surgery is recommended for some people with radiculopathy. They, too, usually improve after a recovery period. Following treatment, most people are able to work and take part in other daily activities. Patient education would include education to prevent acute non-specific low back pain in addition to reducing chances of developing radiculopathy by maintaining good posture and a healthy weight. Using safe techniques when lifting heavy objects to prevent injuries to your back. Remembering to lift with your knees. That means you should bend your knees, not your back. Also asking for help when moving heavy or bulky objects and when doing repetitive tasks, take frequent breaks. https://www.healthline.com   Prevention : There are a number of ways to prevent low back pain from returning. Perhaps the most important are exercise and staying active. Regular exercise that improves cardiovascular fitness can be combined with specific exercises to strengthen the muscles of the hips and torso. The abdominal muscles are particularly important in supporting the lower back and preventing back pain. It is also important to avoid activities that involve repetitive bending or twisting and high-impact activities that increase stress in the spine.   Bend and lift correctly  — People with low back pain should learn the right way to bend and lift. As an example, lifting should always be done with the knees bent and the abdominal muscles tightened to avoid straining the weaker muscles in the lower back (p   Take a break  — People who sit or stand for long periods should change positions often and use a chair with appropriate support for the back. An office chair should be readjusted several times throughout the day to avoid sitting in the same position. Taking brief but frequent breaks to walk around will also prevent pain due to prolonged sitting or standing. People who stand in place for long periods can try placing a block of wood on the floor, stepping up and down every few minutes. https://www.uptodate.com/contents/low-back-pain-in-adults   Healthcare Maintenance/Recommendations :   Annual Influenza vaccine education provided-Received in October of 2017 Depression screen-positive- Recommended to continue Sertraline and visits to Psychologists as scheduled. CAGE-0/4 STI and STD education Sex behavioral counseling Reinforced recommendations for MSBE Cervical Cancer screen and HPV education-Recommended continuing routine Pap testing every 3 years. Diet and exercise education- Recommended to exercise at least 3 days/week; with exercises to help strengthen the core muscles. Continue eating a healthy diet and stay hydrated during workouts. Recommended using a back brace while at work to help with support with lifting and to call for lifting help instead of trying lift alone.   The USPSTF also recommends high blood pressure, depression, and alcohol misuse screening in this age group. Screening for HIV, Syphilis, HBV, HCV, and STI screening and behavioral counseling is also recommended in all sexually active females in this age group. Although, Mrs. H has a toned physique I think it’s important to counsel her on the importance of daily exercise and physical activity to help reduce pain and on healthful diet practices such as the DASH diet, which is high in grains, fruits, vegetables, and low in fat to help prevent future co-morbidities especially since her family history is so significant for such severe co-morbidities and mortalities.   Follow-up: Follow up in 2 weeks for evaluation of pain management or as needed if pain becomes worse or changes in presentation.     References American Academy of Family Physicians. (2017). Diagnosis and Treatment of Low Back Pain; Clinical Practice Guidelines. Retrieved from: http://www.aafp.org/patient-care/clinical-recommendations/all/back-pain.html American Association of Neuromuscular & Electrodiagnostic Medicine. (2017). Lumbar Radiculopathy. Retrieved from: http:www.aanem.org/Patients/Disorders/Lumbar-Radiculopathy Cleveland Clinic Center for Center for Continuing Education. Published by; Levin, Kerry. M.D. (2010). Low Back Pain. Retrieved from: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/neurology/low-back-pain/#top Healthline. (2017). Radiculopathy (Pinched Nerve). Retrieved from: https://www.healthline.com/health/radiculopathy#overview1 Lower back pain soap note examples Scientific Electronic Library Online by Ladeira, Carlos (2011). Evidence based practice guidelines for management of low back pain: physical therapy implications. Retrieved from: http://www.scielo.br/pdf/rbfis/v15n3/04.pdf U.S. Preventive Services Task Force. (2017). Grade A and B Recommendations. https://www.uspreventiveservicestaskforce.org/Search UpToDate. (2017). Patient Education. Low Back Pain in Adults (Beyond the Basics). Retrieved from: https://www.uptodate.com/contents/low-back-pain-in-adults-beyond-the-basics Lower back pain soap note examples

Healthcare Budget Request and Workbook Template

1 PAGE ESSAY AND SECOND EXCEL SPREADSHEET

Throughout this course, you will develop a comprehensive Healthcare Budget Request to promote commitment from leadership to your idea for a healthcare product or service to address gaps or provide opportunities to your organization. For this Healthcare Budget Request and Workbook Template Assignment, you will begin this effort by developing an executive summary for the proposal. You will also begin work on a spreadsheet workbook that you will utilize to calculate and present financial analysis in support of your idea.

Photo Credit: Getty Images/Vetta

To Prepare

Reflect on current gaps or opportunities for enhanced services within your healthcare organization.

Select one of these gaps or opportunities that you would like to analyze and for which you would like to propose a healthcare product or service solution.

Reflect on the impact this issue/opportunity and product/service solution have (or could have) on various stakeholders and systems across your healthcare organization Healthcare Budget Request and Workbook Template.

Identify one or more individuals within your healthcare organization to act as “finance counselor” with whom you can consult on financial and budget items such as costing, estimating, and budget request processes.

Reflect on the current costs associated with the selected issue or opportunity, including direct financial costs to the organization and financial costs to patients, healthcare providers, and other stakeholders. Also consider non-financial costs, including opportunity costs.

Consider how you would communicate a proposal to leadership that addresses the selected issue/opportunity within your organization. Healthcare Budget Request and Workbook Template.

The Assignment: Healthcare Budget Request – Executive Summary:

Develop an executive summary and structure for a healthcare budget request for your new product or service idea by completing the following:

Part 1: Executive Summary

Using the Healthcare Budget Request Template, develop a 1- to 2-page executive summary that describes the issue or opportunity that you are analyzing. In your executive summary, you should:

Describe the healthcare issue or opportunity you selected.

Describe the stakeholder groups impacted by this issue/opportunity.

Explain which stakeholder groups would most likely be responsible for helping you address the healthcare issue or opportunity you selected and why. Be specific and provide examples. Healthcare Budget Request and Workbook Template

Describe the healthcare product or service that you propose to address the identified gaps/opportunities and explain why.

Part 2: Workbook Template

As you progress through this course on the development of a Healthcare Budget Request, you will apply financial ratios and other calculations to make the business case for your idea. In this component of the assignment, you will customize a spreadsheet workbook and prepare it for use in your analysis. To do this, you will:

Review the Healthcare Budget Request Workbook Step-by-Step Guide found in the Resources.Follow the instructions in the guide, which will help you:

Create a workbook tab for each analysis you will conduct in subsequent parts of your Healthcare Budget Request.

Format your spreadsheet and presentation of results.

Save and close the spreadsheet file.

Assignment 2: Healthcare Budget Request and Workbook Template

This assignment has two parts. Part 1 is the development of an executive summary. Part 2 is the development of an Excel workbook template to be used throughout the course and you analyze data related to your proposed healthcare product or service. Be sure to read the details and directions as presented in the Blackboard classroom for this week.

Part 1: Executive Summary

Your executive summary will be a critical first component of your formal healthcare budget request. It will be your first real opportunity to sell leadership and other stakeholders on the value of your proposed product or service. Hence it should be persuasive. It should also be informative without explaining every facet in more detail that anyone cares to read up front. It should outline why the organization should invest resources in your idea. It should be specific and focus on results. Healthcare Budget Request and Workbook Template.

For the purposes of this Assignment, your executive summary should be 1-2 pages in length. Be sure to review the Learning Resources and conduct your own research to review samples of executive summaries (many examples can be found online).

Be sure to save your Executive Summary and submit it to the appropriate Assignment 2 Part 1 submission link by the due date specified in the classroom.

Part 2: Workbook Template

As you progress through this course on the development of your Healthcare Budget Request, you will apply financial ratios and other calculations to make the business case for your idea. In this Part 2 of this Assignment, you will develop a workbook that will be used in subsequent Assignments for use in your analysis. To do this:

1) Open a blank Excel workbook. Name this “lastname_firstname_assn2part2.xlsx” (where “lastname_firstname” is your last and first name).

2) Create a worksheet for each analysis you will conduct in subsequent parts of your Health Budget Request. Name each worksheet as follows:

• A3 Estimated Expenses

• A4 Budget Development

• A5 Ratio Analysis

• A6 Financial Statement Analysis

3) On each worksheet, include a title/header that reads similar to the following:

You may format these however you see fit, but you should make each worksheet presentable as these will be used by stakeholders considering your budget request.

4) Save and submit the workbook to the appropriate Assignment 2 Part B submission link by the due date specified in the classroom. Healthcare Budget Request and Workbook Template

Note: You have completed Assignment 2. Return to the Healthcare Budget Request Step-by-Step Guide Section 4 when it is time to begin the next Assignment.

 

Addressing the Healthcare Issue of the Need for Continuous Weight Monitoring of Patients Already on a Telehealth Platform: An Executive Summary

Executive Summary

The Healthcare Issue or Opportunity

This opportunity concerns the recognized need for effective and efficient continuous weight monitoring and reporting remotely for patients who are at home but treated on a telehealth platform. Without leaving the comfort of their homes to go to the health facility, these patients need to take their weight hand have that information together with the accompanying body mass index (BMI) value reach the clinician. This proposal seeks to address this issue by proposing a technological solution. Healthcare Budget Request and Workbook Template

Stakeholder Groups Impacted by the Issue

Two major stakeholder groups are impacted by this healthcare issue. These are the clinicians who include nurse practitioners and physicians on the one hand, and patients suffering from overweight, obesity, diabetes, renal failure, hyperlipidemia, and heart disease on the other. These two stakeholder groups are already connected together in a therapeutic relationship on an existing telehealth platform. The patients already consult and receive healthcare directions and interventions remotely by telemedicine. However, their weights and BMIs need constant monitoring and a way has to be found to facilitate this on the telehealth platform.

The Stakeholder Groups Most Likely to Help Address the Healthcare Issue Identified

Two stakeholder groups are most likely to help address this healthcare issue identified. The first one comprises of the companies that come up with the novel healthcare technologies that are currently transforming healthcare. These will help address this issue by availing the technology needed in terms of a digital weighing scale that can take weight, calculate the BMI, and relay the information automatically through the telehealth platform to the clinician. The other stakeholder group are the targeted patientsHealthcare Budget Request and Workbook Template. They will help address this healthcare issue if they will embrace this innovation and use it well and effectively for the benefit and convenience of themselves and their clinicians.

The Healthcare Product Proposed to Address this Issue

This will be a smart digital weighing scale which is Bluetooth-enabled and with the capability to calculate the BMI from the patient weight taken in kilograms. It will be able to do this through installed application software to which has been fed the patient’s height in meters. It relays this information by Bluetooth to the patient’s smartphone which then automatically sends it to the clinician on the telehealth platform Healthcare Budget Request and Workbook Template.

Financing Sought

The financing sought for this project is for the start-up expenses and the operating and maintenance costs of the smart digital scales over the next five years. It comes to a total of USD 18,000. This includes USD 6,000 for the purchase of 80 smart digital scales (start-up cost) and USD 12,000 for the operating and maintenance costs. The reason why the start-up costs are not high is because this project is being mounted on an existing and functional telehealth platform. It is thus devoid of the need to set up an entire telehealth platform whose start-up costs are astronomical. One smart scale will be bought at USD 75 and the total number of patients starting to use the innovation in 2020 is 40 patients. It is projected that patient numbers will increase by 10 every year up to 2024 (the fifth year). By 2024 there will be 80 patients on the platform using the smart scales. This explains the purchase of 80 smart digital scales. Healthcare Budget Request and Workbook Template

References

Davenport, T. & Kalakota, R. (2019). The potential for artificial intelligence in healthcare.
Future Healthcare Journal, 6
(2), 94-98. Doi:
https://dx.doi.org/10.7861/futurehosp.6-2-94

Masson, D.J. (2018).
6 steps to an effective financial statement analysis
. Retrieved 9 March 2020 from
https://www.afponline.org/ideas-inspiration/topics/articles/Details/6-steps-to-an-effective-financial-statement-analysis

Medicoreach (2019).
5 healthcare wearable devices and gadgets promising improved healthcare in 2019
. Retrieved 9 March 2020 from
https://www.medicoreach.com/healthcare-wearable-devices-gadgets-in-2019/ 
 Healthcare Budget Request and Workbook Template

AANP Exam tips

3 month old infant with down syndrome, due to milk intolerance, mom started on goats milk; now has pale conjunctiva but otherwise healthy. Low HCT. What additional test would you order? Iron, TIBC

3 months of synthroid, TSH increased, T4 normal, what do you do? Increase Medication

3 ways to assess cognitive function in patient with signs/symptoms of memory loss…. Mini mental exam

4 month old with strabismus, mom is worried…… tell her it is normal.

4 month old wont keep anything down, what is the main thing you look at? Growth chart

6 month old closed anterior fontanel. XRAY

Abnormal cells on PAP, what do you do next? Refer for Colposcopy

CAGE ACRONYM

Causes of tachycardia

Cranial nerves responsible for extraocular eye movements… 3,4,6

Definition of metabolic syndrome- cluster of conditions that increase risk of heart disease, stroke, diabetes.

Definitive diagnosis of acute bacterial prostatitis: urinalysis and culture!

Diagnose Trich: wet prep

Elederly presents with atrophic vaginitis, small uterus, palpable 4×5 ovary, what do you do next? Pelvic US

Elder presents with atrophic vaginitis-add estrogen cream

Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located? Anterior septum

ORDER A PLAGIARISM-FREE PAPER HERE

Fingernail hematoma treatment… drill hole, drain blood

GERD treatment: H2 is first line

Grade 3 cells on pap, treatment? Excision

Growth Plate fracture/Salter Harris Fx

Increased risk of ectopic pregnancy…. Salpingitis

Koplick Spots… Measles

Legg-Calve Perthes disease: avascular necrosis of the proximal femoral head

Lipid level of 1500, increased risk for? Pancreatitis

Low HGB, Low HCT, High MCV indicates what? Macrocytic anemia, B12 Def

Man with high BPH, prostate feels on digital exam? Enlarged, symmetrical, smooth

Man with HTN, CAD, present femoral pulses but absent pedal…. Arterial Insufficiency

McMurrays Sign- Meniscus tears

Lachmans- ACL

Know heart murmors!!!! MrPASS MVP MsARD

Newborn with foot turned in, what do you do? Refer to orthopedist

Osgood Schlatter disease- Knee pain

Patient forgot to start Thanksgiving dinner and husband states she has trouble remembering tasks and trouble with organization. What is this indicative of? Alzheimers

Pt has Barretts Esophagus, insurance no longer covers GI who was treating condition. Pt at FNP office wanting refill prescriptions. What do you do? Refer to oncologist

Know labs for diagnosing Hepatitis

Pt presents with rash on shoulder, erythematous maculopapular rash with center clearing and scaling? Tinea Corporis

Pt presents with “bag of worms:, indicates? Varicocele

Pt with atopic dermatitis, look for what other diseases? Asthma

Pt with bleeding after menopause- endometrial biopsy

Pt with hx of PID, increased rick for? Infertility

Bacterial vaginosis does not cause PID- trich, gonorrhea, and chlamidia can cause it

Pt with HIV took high potency anti viral treatments and CD4 is >400, what does this indicate? This is good. Want higher than 350

Pt with hx of htn and stroke, now having memory loss. What does this indicate? Vascular dementia

Pregnant teacher with exposure to 5ths disease, what risk is there to the fetus? Fetal death and birth defects

Quick assessment of patients fall risk? Timed Get up and Go

Red beefy tongue? Pernicious anemia

Rotator cuff injury presentation: disturbs sleep, arm weakness, dull ache

Shingles near eye- immediate referral to ophthalmology

Signs and symptoms of Roseola? High fever, pink flat or raised rash

Treatment for chronic alcoholism: 12 step program

Treatment for Gonorrhea? Rocpehin IM and Zithromax PO

Young female want birth control, forgets to take pills, does not want to get pregnant for at least 5 years: IUD

Questions:

few questions about T2DM and appropriate treatment, including insulin.

Know the reason for doing a PSA

When to give a pregnant woman with negative rubella titer the rubella vaccine

Treatment for gonorrhea, and syphilis, including during pregnancy

What meds you can’t take while ingesting grapefruit juice

Bells palsy s/S

S/s of serotonin syndrome

Kawasaki disease presentation

Lab test for “slapped face”

Treatment for shin splints

What to do with thyroid meds based on lab values

What heart sound would be expected in CHF

What antihypertensive meds to avoid in GERD

Who gets hep C screening

Definition of AIDS

No hepatitis a or b on mine

The cheapest treatment of shingles -acyclovir

T2DM has foot laceration, what would u monitor them for- osteomylitis

Acute GAD treatment-ssri

Know which murmurs are diastolic and where they’re located

What pts would need to go to ED with pneumonia… CURB65

Presentation of allergic conjunctivitis- bilateral eye symptoms

Treatment of mild persistent asthma

Parents have heterozygous disorder, what % of children are homozygous-25%

Weber and Rinne

No CN questions for me

Darcosytosis s/s

Cotton wool on fundoscopic exam means??

Chronic use of afrin causes…medicamentosa

Vascular dementia most commonly occurs with people who had stroke and htn

S/s of strep a pharyngitis

 

Questions:

 

Some of the questions I still remember from this morning exam:

Signs and symptoms of definitive HF

Description of Molluscum contagiosum

Management of fall with extended arm but no fracture seen on the xray

2 questions about Hepatitis

Dacryocystitis

Evaluation of fall for the elderly

Know your labs for anemia, hypo & hyperthyroidism, hyperparathyroidism

Systolic murmurs

Carotid bruits

Primary amenorrhea

Acquired hypothyroidism

Drugs for OM and alternatives

Drugs for gono and chlamydia and alternatives

Autosomal recessive and dominant

AV nicking

Pediatric asthma management

Infant dehydration assessment

Trichomonas

Grades of HF, bruits and thrills

A lot of questions about Weber and Rinnes test

Erysipelas

12 weeks just above SP

Intussuception

Wilms tumor

Antipsychotic drug that causes hyperglycemia

Management of TG if niacin does not work

When to prescribe insulin… that’s all I remember. And I’m sure all of you know these stuff?

but some variations like titration of levothyxine based on labs as well as coumadi at least 4 or 5 questions . Grapefruit affects what meds? On the review class from Barkley, some comments about the least expensive treatment for severe shingles. His questions are not the same format as AANP. TB diagnosis and PPD readings. No cranial nerves. Xray interpretation of knee fx. No pictures. What kind of pain on MI, ekg interpretation. Read in detail about the 3 recent posts about the new test, they helped me a lot . Good luck

 

Questions:

genetics, a few on sexually transmitted disease and the medications (mostly gonorrhea), I had several questions about the elderly and medications that were safe and meds that were not. I had several questions on Derm, Basal cell carcinoma and seborrheic keratosis, I had a lot of questions of what labs to order, and they gave the situation of the patient. I had several questions on monon, anemia ,and sinusitis. I had PNA when to send to ER, Glaucoma, Hep B, 2 murmurs, one asthma, One on Marijuana s/s, 2 on BV, one on Alzheimer’s, one on hypothyroidism, one on symptoms of a person with Myasthenia Gravis, menopause, woman had bleeding what to do, Glaucoma, also shingles around the eyes, treatment of Bells Palsy, also how to diagnose Temperal arthritis, OA and RA.

 

Questions:

anemias and RA vs OA, two murmurs, 2-3 Hepatitis serological, picking which Abx is appropriate for a named infection, PTSD, lots of frail elderly, STIs, PUD, GERD, Adolescents, who’s at risk for suicide, Myesthenia Gravis, Parkinson’s, appropriate tests for poss diagnoses, HTN meds, proteinuria, gastroenteritis dx, tests for appendicitis, expected labs changes in cholecystitis, dx hepatitis from pt symptoms.

Questions:

hep b and C, hypercalcemia, fibromyalgia, Alzheimer’s, fifth disease, MCL, Pagets.

Questions:

I had a couple of questions on genetics, a few on sexually transmitted disease and the medications (mostly gonorrhea), I had several questions about the elderly and medications that were safe and meds that were not. I had several questions on Rocky Mountain spotted fever. I had a lot of questions of what labs to order, and they gave the situation of the patient. I had several questions on mononucleosis, anemia ,and sinusitis. I want to thank everyone for all the questions that were posted, they helped a lot.

Questions:

Here’s some additional details on my AANP FNP exam from Jan 12, 2018. I suspect my exam was the “new version” (it was expected to be updated this January).

[Edit: I have no idea if/when the test is updated – lots of people posted conflicting information about it; you can search the group for posts on the subject to see the whole gamut.]

NOTE: I will not give out any questions or any specifics. This is just a vague description of some of the topics covered. ?

I feel like I had multiple musculoskeletal questions – from RA to pediatric conditions to tendonitis to grade 3 muscle strains.

I had a lot of endocrine on my exam too – particularly hypothyroid, hyperthyroid, Hypoparathyroidism vs hyperparathyroidism – the type of questions ranged from from s/s, to meds, to scan, test and lab results.

Quite a few derm questions, from lichen planus to tinea to BCC to shingles. One question about what in-office procedure is best for a specified derm finding.

Only 1-2 questions were right off the PSI predictor. Only a few were like the questions from this group or from Leik. Difficulty level of the AANP exam felt more in line with the difficulty of the APEA practice exam.

2 murmurs. One hepatitis serology. 2 asthma. 1 or 2 anemia questions.

Also:

EKG finding description for bradyarrythmia

Otitis externa and media

Varus vs. valgus in knee exam

Presentation of HTN 2* to renal dx

Tendonitis progressing into tear s/s

Palpable ovary in elderly female

Palpable abdominal mass in a child

Headaches

Hyperlipidemia

Calcium dosage

Meds that may worsen GERD s/s

Diltiazem

Acute renal conditions

Concussion

Pain meds for geriatric pt

Venous and arterial insufficiency

Top cause of mortality in a specific population group

Post menopausal abnormal gyne findings and how to respond

Antibiotics

Newborn/infant GI disorders

 

Questions:

Fair amount of derm and Peds derm dx and treatment, Peds ortho dx and reg ortho dx and tests, elderly women’s health issues, some pregnancy. 2 murmurs, one asthma, one asked about prolonged PR on EKG strip what kind of block!!, UAs, thyroid and parathyroid, one anemia, one hep serology, one asthma tx, infant emergent conditions.

passed AANP yesterday!! yayy! This group was so much help! Thank you for everyone posting tips and questions! I strongly recommend going through the tips that people have been giving in the past few weeks. My test had many of the topics they gave! Some of the questions I had no clue at all, but most of them I could come down to two answers and choose from there. It was very nerve wracking and I am so happy to be done! One thing that really helped me every day for a couple weeks for my test was I reread this bible verse over and over and told myself it was okay if I failed! It put less pressure on me 🙂 Here are some of the topics I specifically remember! (also read the old psi test because I had a couple from there on the test)

I started studying hard about 3-4 weeks before the test and I studied most week days at least 5-8 hrs because I felt very behind and like I needed it. I went to a fitzgerald live review a couple of months ago, I watched and took notes on all of the hollier videos (which really helped me get an initial knowledge for the topics) then I read the leik book (which had almost every topic that was on my exam!) then I made note cards and spent the last week reviewing those and the topics that were given by the people in this group. Probably overkill but I’m glad I did it! On my scratch paper I wrote: Deuteronomy 31:6, heart murmurs, cranial nerve picture, S/S of anticholinergics (SAD CUB) and SSRI (BAD SSRI), weber and Rinne and hepatitis panel.

– Dacrocytsis

-ruptured tympanic membrane

-Rosacea

-thyroid and parathyroid

-Treatment for gonorrhea and chlamydia while pregnant

-I had about 3 cranial nerves which I wasn’t expecting

-2-3 Rinne and Weber

-aquired hypothyroidism

-know what fundoscopic exam will look like from HTN and DM-I got one about AV nicking

-Fundal height at 12 weeks

-Wilms tumor

-Carotid bruits

-Primary amenorrhea

-Apthous stomatitis- a little kid with sores in his mouth

-Hypertension medications – like which one you would give or not give for specific patient- which one causes GERD CCB.

-Fibromyalgia diagnosis-11/18

-Gold standard for temporal lobe arthritis- biopsy, give sterids, associated with Temporal arteritis

-I had one hepatitis question- IGm was positive

-Cause for ectopic pregnancy

That’s all I can remember specifically! Good luck everyone!

Question that I  was able to remember

•       Basal Cell Cancer: Question description and the fact that it doesn’t have any tx  (Hints: Waxy, pearly, telangiectasia, ulcer center lesion

•       Actinic Keratosis: Question about description (Scaly red to yellow located in sun exposed area

•       Melanoma question: Know ABCDE

•       Subungal Hematoma tx: Make a hole and drain the blood

•       Tx for moderate acne- I got one about Retin A

•       Know Systolic and Diastolic Murmur (MR. ASS & MS. ARD). Mr. ASS question was asked about heart murmur with high pitch holosystolic and the other one is mid systolic.  Got one about a low rumbling diastolic murmur

•       Question about Grade III/VI Murmur: (Loud murmur easily heard)

•       Coarctation of Aorta: Know that systolic BP on lower extremities is supposed to be higher compare to upper extremities. In COA case its vise versa. Look for weak radial and bounding femoral pulse

•       Know the difference between Peripheral Arterial Disease and Chronic Venous Insufficiency. There was question about PAD and the answer was exercise by walking (Tx)- chronic venous insufficiency you elevate it

•       Question about JVD causes? HF right side to be specific

•       Know Bacterial endocarditis (There was a pt. with gradual onset of fever, hemorrhages on nail beds, painful raised red nodules) Osler’s nodes

•       RML CXR

•       Chronic bronchitis description and treatment

•       Hiv pt. PPD + (5mm)

•       Croup/Epiglottitis: Question about what condition would make you order Lateral X-ray of the neck. Options include: Drooling, Unable to do ROM of the neck / stiff neck.

•       Hyper and Hypothyroidism

•       Question about AV nicking (Arterioles pressing on vein of the eye): Its HTN retinopathy

•       Question causes of IOP-Papilledema

•       Rovsing sign

Mcmurray sign

•       Pt. with GERD and Barrett’s esophagus: Refer to Oncologist

•       Question about pencil like stool: Options include problem with ascending colon, descending colon. Descending colon

Question about  a thin narrow stool and possible causes include colon cancer, diarrhea, IBS. Refer for GI colonoscopy

•       Question about Hepatitis B active Immunology.

•       Know your urinalysis result

•       Question about Pt. complaining of headache after trauma: (Options include post concussion headache, subarachnoid hemorrhage and Subdural hemorrhage). I think the answer is subdural hemorrhage

•       Question about Migraine headache: Know the description and duration of headaches as well- nausea vomitting

•       Question about CN 3,4,6 (EOM)

•       Anemia question, Vitamin B12 deficiency-beefy red tongue, tingling

•       A lot of Musculoskeletal questions: (Anteriorly ligament which is for ACL; Apprehension test positive, lateral epicondylitis Tx, Morton’s Neuroma description as someone with high heels and has a mass or nodule on the 4th/5th toe)

•       Osgood Schlatter Disease: Hint tibia tuberosity

•       Question about an 88/yr. old patient in for follow up secondary. She’s been treated with Tylenol for Joint arthritis. Her SED rate was checked after 6 weeks of treatment and it was 28. Normal range is from something to 25. How would you treat the pt. (Do nothing, Increase Tylenol, change to NSAID, and pt. is expected to have a high SED rate due to age). I think it should be changed to NSAID cuz SED rate is a sign of inflammation,

•       Question about medial Tibia Stress

•       ADHD is a behavior disease

•       Which medication causes low sperm count for a patient (SSRI)

•       Question about grandiosity (Bipolar)

•       Question about contraceptive pills

•       Question about, Trichomonas test wet mount was mentioned on the exam

•       Question about a pt. pap’s smear noted with Low Grade Squamous Intraepithelial Lesions and High Grade Squamous Epithelia Lesion noted on the report, what should NP do? (Options are referring for colposcopy, repeat in 12 month and can’t remember other options. My review book stated to order HPV test if not done. Refer for colposcopy.

•       Question about NP palpating right ovaries on a 1-year postmenopausal woman. Options include (To refer for endocerviacal test, for ovarian cancer something, couldn’t remember other options). Answer is to r/o ovarian cancer

•       Another question about who is at high risk for ovarian cancer (Options include Family history, previous abortion and cant remember the rest)

•       High risk for ectopic pregnancy: (Options include: Infertile, and cant remember the rest of the options)

•       Question about chlamydia

•       Question about CURBS: Which of the options does not require hospitalization for pneumonia (Options are all except 1; all include one that’s not part of it) Review CURBS: It’s a criteria for pneumonia hospital admission

•       Question about genital wart tx

•       Question about treating HIV pt. with antiviral and CD4 count still less than 200. What should NP tell the pt. (Different option but the best option is to tell the pt. that he is qualified to be diagnosed with AIDS according to CDC

•       Most common cause of death in children (Options are poisoning, Motor vehicle accident, drowning, and cant remember the fourth one)

•       Tanner stage questions

•       Sensorineural (Presbyacus)

•       Know types of Alzheimer’s: Question about a pt. expericieng memory loss, and increase in confusion and she has a history of stroke, HTN, What type of Alzheimer. Options include (Dementia with lewy bodies, Vascular dementia, frontotemporal dementia). I think the answer is vascular dementia.

•       Question about Romberg test and how its done

•       Question about sensitivity

•       Question about Coombs test r/o bilirubin

•       Hyperbiliribubin question risk

     Preeclampsia tx  (bed rest, laying on her side and

•       Question about a pregnant female at slightly above symphysis pubic   and Fundal height is 32cm (above the umbilical. What should be done (I picked to have Ultrasound done to)

•       Question about molloscum contagiosum- umbilicated,

•       Question about pyloric stenosis (Hint is non bilious vomiting, olive like firm mass palpated on right upper quadrant)

•       Review your skin issues for adult and kids.

Question about Rubeola (Koplick)- measles

•       Question about horizontal nystagmus that stops when eye is close to midline in a college student (options include messinere, BBPV, normal and cant remember the forth one)

•       Question about someone eating, painful lump noted on the jaw that comes and go. Options include (Cancer of Wharton, sialolithiasis). The answer is sialolithiasis

•       Question about ADHD (options include are solely a behavior disorder, panic, personality disorder)

•       Question about a pt. complaining about upper arm tremor that seems to be hereditary. What’s the treatment? options include (Xanax, lorazepam, metoprolol and cant rember the last one)

•       Which among the list can cause increase in respiration. Options include (low oxygen, high oxygen, hypercapnia, hypocapnia)

•       Question about osteoporosis risk factors. Options include (low estrogen level, obesity, sedimentary lifestyle, cant remember the last one)

Osteoporosis exercise- walking (weight bearing exercise)

•       Tx to prevent fracture in a pt. with low vitamin d hydroxyl, high TSH and low Hct (Option include Calcium carbonate 600mg, vitamin d 800 IU, cant remember the remaining 2 options)

•       Questions about carotid bruit signs can signifies what. Options include (Pulmonary HTN, carotid problem, cant remember the remaining two options0

•       Ovarian CA risk. options are (multipara, family history and cant remember the rest).

•       Question about ectopic risk factor. Options include (abnormality, exposure to some chemicals, previous abortion)

•       Common causes of GERD. Options are (Histamine blocker, BB, CCB, cant remember the last one)

•       Zeprexa (What lab and intervention to put in place) such as weigh check, DM,)

•       Question about what’s the common bug in children with diarrhea.

•       What test needed to differentiate lesion/cyst found on a breast (Options include Screening mammogram, Ultrasound, Need aspiration)

•       Increase in triglyceride can cause pancreatitis

•       Weber/Rinne Test know this by heart multiple questions about it –WUS and WAC

Lung sound on a pt with emphysema- I put hyperresonance?

 

2/15/18:

Things I remembered that I marked:

– Assessment for dullness on patient with ascites

-INR goal on patient with DVT less than a month ago 2-3

If INR not therapeutic increase the dose

-know pneumoconiosis (so you know which one you can eliminate)

-Varus/Valgus test

-know the difference of measles (Rubeola)vs german measles(Rubella)

-patient with IOP of 32mmHg, what do you expect during fundoscopic exam-Cupping

-1st line tx for Chronic bronchitis

-significant risk factor for ovarian CA

-meds for patient with BPH and urge incontinence-flomax

-causes of hyperbilirubinemia in newborn

-treatment for genital herpes-cheapest option acyclovir oral

-mild persitent asthma meds

-CN responsible for EOM (3,4&6)

-metabolic syndrome criteria

-seasonal disorder definition

-intussusception symptoms

-fundal heights and what to do if there is discrepancy with the expected measurement

-glucagon counteracts hypoglycemia

-Janeway lesions and Osler’s nodes for bacterial endocarditis

-causes of carotid bruit

-III/VI murmur presentation

-organism responsible for IBS

-otitis externa treatment

-meds for patients with osteoporosis (know your Ca and Vit D dosage)

-Psych med that causes high glucose

-Meds for GAD-ssri

Know presentation of PTSD

-hallmark finding in retinoblastoma

-molloscum contagiosum description

-signs of dehydration in infants (post fontanel)

-meds for staph aureus infection (skin) with pus

-hyperparathyroidism=high calcium level

-tx for hyperthyroidism

-breast changes in elderly

-antihypertensive med that causes GERD

-difference of RA vs OA based on symptoms

-systolic vs diastolic murmurs

-recent guidelines on screening mammography

-symptoms of serotonin syndrome

-causes of arrhythmia in elderly-hyperthyroidism

-Weber/Rinne test

-How to diagnose fibromyalgia

-lab test for fifth disease-B19

-one anemia screening question

-pt has AOM but has hives on Amoxicillin and N/V with erythromycin, what meds to give? (Process of elimination..) azithromycin

 

2/14/18:

-treatment for chylamdia in pregnant women

-know CURB 65criteria.

-sensorineural hearing loss  what is it called in elderly-presbycusus

– basal cell description

– squamous cell description

-Signs in strep throat

-when do you see av nicking

– what does IOP look like of fundascope

-treatment for allergic rhinitis

-treatment for pt who comes in with “something in my eye”. What would NP do first? Check visual acuity

-papilledema what it looks like on fundascope .

-TB in duration for Immuno compromised pt.

-what does melanoma look like

-what would np do when pt. comes in with rash on palms .

-what test would you order to evaluate breast cyst

-know treatment for COPD

-know tx. For mild persistent asthma

-what is first approach for pt. With high lipids

-causes of GERD

-know how to treat thyroid  disease. They give you labs and you decide what to do  with meds

-jvd what does it indicate

-treatment for subungal  hematoma

-pyloric stenosis

-causes of Peptic ulcer disease and presentation

-when you give pregnant woman MMR- postpartum

-H/A. Know signs, duration I had 2 questions on  different type and 1 question  of treatment

-sensitivity def.

-tx for gonorrhea

-anemia’s. Know s/s and labs – ex what would pt present w/ an elevated MCV MCH

-know test you perform for knee injuries. Lachman Test and anterior drawer.

-neuro:Romberg tear, post  concussion

-breast changed in elderly

-know thx for calcium and vit. D

-Know murmurs where they Are located, radiate ,

-know murmur grades

-labs you would consider for pt w/5th disease

-tx. for GAD

-contraindications for taking ACEI

Ace inhibitor can cause renal stenosis- stop the ACE

-when you administer live vaccines-12months

-tx for mild acne

-when would you see Kolpik

-s/s of otitis externa

– cataracts – how would pt describe s/s

– Kawasaki disease.  How does pt present desquamation

– Know ABCDE of melanoma

– Lyme disease

– RMSF-presentations in hands and feet

– Coaction of  aorta. What would pt exam look like

– JVD when do you see it and what does it mean

– Description of MI  how would patient describe feeling-persistnat does let up

– Addison’s. What would pt.    presentation look like – needs steroids, HINT pt craving salt

– Romberg  Test. How do you do it

– Dx of essential tremors.  What would you prescribe for pt to relieve or decrease tremors

– HIV know DC4 count

– Tx of pt with urge incontinence what med would you prescribe

– Tx for allergic rhinitis-flonase

– Osteoarthritis how joints present (on hand) bochard and herberden

– Exercise that would help osteoporosis-walking

– Dx of fibromyalgia

– serotonin syndrome what are s/s

– Tx for veriocele

– Coombs Test

– Know Fundus Checks

– Morton’s. Neuroma

– Korsakoff wernicke

-Mastitis tx

2/11/18:

I had breast-feeding, Child growth stages, STD, hyper and hypo thyroidism, skin types and treatments, screening for breast cancer, colon cancer, birth control, hepatitis, heart murmur, several questions on medications for BP and DM type 1 and 2, temporal arteritis, anemia, and skin treatments for adolescents.

2/6/18

lot of geriatrics- HF, COPD meds, kidney issues & meds to avoid, DM- the question about DM pt with foot laceration – what is he at risk for was on there. Thyroid & parathyroid question, HTN, hyperlipidemia, neuro – Parkinson’s , LUTS, (bph, prostatitis) women/pregnancy- AFP testing, fundus height, mastitis treatment- obvious answer of dicloxacillin was not listed as an option, so I used Hollier’s trick- which bug are you treating then the answer became obvious- more than 5. One eye thing.  Lots of pedi – resp, msk, rash – viral exanthems, one murmur question.  Lots of adolescents- Early & late adolescents questions. STD male & female – HIV/AIDS, gonorrhea, syphillis. One anemia- pernicious, cluster & migraine h/a.  Reason for JVDistention.

 

2/2/18:

heart murmurs, cranial nerve picture, S/S of anticholinergics (SAD CUB) and SSRI (BAD SSRI), weber and Rinne and hepatitis panel.

– Dacrocytsis

-ruptured tympanic membrane

-Rosacea

-thyroid and parathyroid

-Treatment for gonorrhea and chlamydia while pregnant

-I had about 3 cranial nerves which I wasn’t expecting

-2-3 Rinne and Weber

-aquired hypothyroidism

-know what fundoscopic exam will look like from HTN and DM

-Fundal height at 12 weeks

-Wilms tumor

-Carotid bruits

-Primary amenorrhea

-Apthous stomatitis

-Hypertension medications – like which one you would give or not give for specific patient

-Fibromyalgia diagnosis

-Gold standard for temporal lobe arthritis

-I had one hepatitis question

-Cause for ectopic pregnancy

GOOD LUCK EVERYONE!!! HAPPY STUDYING!!!

 

 

 

 

 

 

 

 

 

Board Review Combined

Skin:

 

RMSF-
Inc. fever, chills, N/v, photophobia, myalgia, arthralgias THEN 2-5 days later you develop a petechial rash on forearms, ankles, wrists, that spreads towards trunk and becomes generalized. Think rocky NC/OK/AK/TN/MO. DX: PCR essay with Rickessetti Antigen TREATMENT- doxycycline. 
EXAM

 

Erythema Migraines-
(stage 1 Lyme) Target bulls-eye, usually appears in 7-14 days POST being bitten by a deer tick. Rash is hot to touch with rough texture, flu like symptoms. DX: B. Burgdorferi via ELISA, then confirm with western blot. Increased ESR.
TREATMENT
: Less than 7 Amoxicillin or cefuroxime axetil. Older than 7 Doxycycline.
EXAM

 

Melanoma-
Dark Moles, uneven texture, different colors, irregular, >6mm, could be itchy.

EXAM

 

Stevens Johnson Syndrome-
Classic is target or bulls-eye. Abruptly, hives, blisters, petechiae, purpura, necrosis, sloughing of tissues. Extensive mucosal involvement. Prodrome of fevers with flu like symptoms. Triggers: Allopurinol, anticonvulsants, pcn, sulfonamides, NSAIDS. HIV ppl have higher risk for this syndrome.

 

Psoriasis
–
Inherited. Pruritic erythematous plaques, fine silvery-white scales with pitted fingernails. Scalp, elbows, knees, sacrum, intergluteal folds.

(Koebner phenomenon- new psoriatic plaques form over skin trauma)

(Auspitz sign- pinpoint bleeding when plaques are removed).

TREATMENT: Topical steroids, Tar preps (mild). For (severe) do anti-TNF, or immunologic.

 

Acanthros Nigricans- velvet hyperpigmented patches most common on back of neck or skin folds- DM resistance.

 

Scabies- itching bedtime. Primethrin cream treat everyone wash sheets and everything else in hot water.

 

Atopic Dermatitis (eczema)-
Inherited. Extremely itchy. On flexural folds, neck, hands. Inc. IgE. “small vesicles that rupture leaving painful, bright-red, weepy lesions” they become lichenified from itching. First line: Topical steroids. Avoid hot water/soaps. PO antihistamines.
EXAM

 

Tinea Corporis-
“ring like itchy rash, slowly enlarge central clearing”-Treatment: most respond to topical antifungals, if severe do oral Lamisil. 
EXAM AZOLE ending

 

Actinic Keratosis-
Precursor to squamous cell carcinoma. “numerous dry round and pink to red lesions” with a rough and scaly texture. Does not heal. Slow growing in sun exposed areas. Diagnosis: BIOPSY Golden Standard. Treatment: Sm. (cryotherapy), Lrg. (5-FU cream)- which causes ur skin to ooze, crust, scab, redness.
EXAM

 

Seborrheic Keratosis-
soft round wart light tan to black pasted on. Asymptomatic and benign.

 

Cellulitis-
Deep dermis poor demarcated low legs. 
EXAM/ MULTIPLE QUESTIONS. DVT RISK, DM WITH CELLULITIS WATCH FOR OSTEOMYLITIS.

Erysipelas-
Group A strep, Upper dermis, clear demarcated, cheeks, shins.

TREATMENT- Dicloxacillin QID x10d. Cephalexin, Clinda. PCN ALLERGY? Do Azithro x5d.

MRSA TREATMENT: Bactrim, doxy, mino, clinda. If sulfa allergy do not use Bactrim.

 

Basal Cell Carcinoma- pearly, waxy, skin lesions, atrophic, ulcerated center that does not heal.

 

Molloscum Contagiosum- white plug, dome shaped. Highly contagious.
EXAM

 

Varicella Zoster Virus-
“contagious 48 h. before, until all lesions crusted over” low grade fever, generalized lymphadenopathy, intense itching, erythematous macules, papules develop over macules, then vesicles erupt. “initially on trunk, then scalp and face” TREATMENT supportive, antihistamines, acyclovir 20mg/kg 5xd. If given first 24 hours works best. 
EXAM

 

Acne Vulgaris (common acne)-
ON EXAM

mild (topicals only)
*open/closed comedone w/ or w/o sm. papules. Retin-A, acne worsens 4-6 weeks if no improvement in 8-12 weeks increase dose or add erythromycin, benzoyl peroxide.

Moderate (topicals plus antibiotics)-
papules, pustules w/ comedones. Continue with topicals combined with topical antibiotics. Then add ORAL antibiotics tetra, mino, doxy.

Severe-
with painful indurated nodule, cysts, abscesses, pustules. Accutane- check LFTs, 2 forms of contraceptives, monthly prego testing, only prescribe 1 month supply.

 

Acne Rosacea-
chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline.
EXAM

 

Impetigo-
Gram positive. Itchy pink-red lesions, evolve into vesiculopustules that rupture. If bullous-large blisters. Severe- Keflex, dicloxacillin. PCN Allergic-Azithro, clinda. If NO BULLAE- Bactroban. EXAM

 

Scarlet fever (Scarlantina)- “sandpaper textured-pink rash with sore throat” strawberry tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates.
EXAM

 

LICHEN PLANUS:
SMALL FLAT TOPPED, RED TO PURPLE BUMPS THAT MAY HAVE WHITE SCALES/FLAKES.. WHISPY GREY WHITE STREAKS CALLED WICHHAMS STRIAE. INNER WRISTS FOREARMS, AND ANKLES. IF ON SCALP CAUSE HAIR LOSS. Causes hep C, medications, contact with chemicals.
EXAM

 

Spider bite: fever chills, n/v, located arms, upper legs, or the trunk. Biten area becomes swollen, red, and tender, and blisters appear within 24-48 hours. Necrotic in center, which kills the tissue. Ice packs to wound and cold inactivates the toxin, tx like cellulitis of the skin, abx ointment at first, watch etc.
Exam

Pityoris rosea itchy, herald patch, xmas tree pattern, rash hands soles/feet think to test for secondary syphilis RPR then VDRL are screening, then dx FTA-ABS. EXAM AANP Exam tips

HEAD/EARS/EYES/NOSE/THROAT

 

Herpes keratitis-
fluorescein dye “fern like” CN V.  Abrupt onset of pain.

 

Corneal Abrasions- Round/Irregular.
Was on EXAM.

 

Acute Angle-closure
glaucoma
– acute/severe halos, cupping optic nerve, cloudy cornea, mid-dilated oval pupil. ER STAT.
EXAM

 

Primary
Open
Angle Glaucoma- CN2 gradual changes in peripheral vision LOST FIRST, then second central vision.

 

Cataracts is on EXAM in elderly night vision issues. Opaque
EXAM

 

Age-Related Macular Degeneration – Painless loss of “central vision” reports straight lines appear curved. Periphery is preserved. Give asmler grid.

 

Retinal Detachment- Floaters, curtain, flashes of light. Painless.
EXAM

 

Cholesteatoma- cauliflower, foul-smell, hearing loss. If erodes bones in face affects CN VII. SURGERY

 

Canker sores- Aphthous stomatitis: painful shallow ulcers heal 7-10 days. Magic mouthwash.

 

Papilledema-
optic disc swollen w/ blurred edges due to increased ICP.
EXAM

 

Hypertensive Retinopathy- Copper/silver wire arterioles. AV nicking(mild retinopathy). Retinal Hemorrhages.
EXAM

 

Diabetic Retinopathy-Cotton wool spots (moderate retinopathy), micro-aneurysms. ALSO RETINAL HEMORRHAGES ON CENTER OF EYE APPEAR ORANGE RED

 

Koplik Spots- “clusters sm. Size red papules w/ white centers in the buccal mucosa by lower molars”. Rubeolla. Fever, conjunctivitis, coryza, cough (3c). Morbiliform rash.
EXAM

 

Sensorineural:
 Lateralization to good ear.  Rinne- AC > BC.

Conductive: Lateralization to bad ear. Rinne- BC > AC.

Rinne (1
st
mastoid, 2 front of ear, time each area).

Weber: Tunning fork midline. CN 8 (acoustic).
EXAM

 

Hordeolum-
painful
swollen red warm abscess TREAT hot compress erythromycin, dicloxacillin.

 

Acute Otitis Media- middle ear. Usually S. pneumo. (others: h influ, mor catarrhalis).  Popping, muffled, afebrile or low-grade, TM can rupture blood and pus on pillow on awakening with relief of ear pain. “erythematous TM” bulging or retracting. Decreased mobility. TREATMENT: Amoxicillin (first line), then Augmentin, Omnicef, Ceftin, Levaquin. Weber- Lateralization to bad ear. Rhinne- BC>AC. If your patient is only PCN allergic do azithromycin or clarithromycin. 
EXAM MULTIPLE QUESTIONS AANP Exam tips

 

Otitis Media
with Effusion
– Ear pressure, popping, muffled hearing, chronic allergic rhinitis, sterile serious fluid is trapped in the middle ear. TM should
NOT BED RED
. TM may bulge or retract. TREATMENT: Oral decongestants, steroid nasal spray, treat like allergies. Usually Painless. Weber- Lateralization to affected ear. Rhinne- BC > AC. PRECEDES OR USUALLY FOLLOWS AOM. THIS ONE U CAN DO SUPPORTIVE CARE AND WAIT 3 MOS SOMEX.
EXAM

 

Otitis Externa (swimmers ear)- Pseudomonas aeruginosa. (other- S. aureus). External ear pain- d/c itching, hearing loss, tragus, green d/c. TREATMENT: Corticosporin,  Cipro
EXAM

 

Presbycusis- sensorineural loss without lateralization. Involves the inner ear.
Symmetrical progressive
. Human speech lost first. AGING ADULT
EXAM

 

Allergic Conjunctivitis- “stringy; increased tearing” PO antihistamines. Type I sensitivity. Typically bilateral. Rhinitis and allergic shiner.

 

Anthrax- animals/hides/hair/wool. Lesions begin as papule that enlarges quick 24-48h develops necrosis and ulceration (sort of like a spider bite recluse)- Treatment: Doxy, Cipro, Levaquin. If you suspect BIOTERRORISM treat 60 d. Prophylaxis – Cipro, doxy. If BIOTERRORISM 60 d.

 

Sialolithiaisis- painful lump hurts more with eating (by jaw) aka calculi or salvary stones. Usually in sub mandibular gland aka whartons; duct.

 

Meinier’s disease- VERTIGO TINNITUS, HEARING LOSS.

 

BBPV DIX HALLPIKE MANEUVAR
EXAM

SINUSITIS ON EXAM: TX AMOXICILLIN OR AUGMENTIN ALLERGY MACROLIDE

MONO know the name of test. Its
heterophile
antibody test. ON EXAM

 

CARDIOVASCULAR

MI- atypical SOB, dyspnea, weakness, n/v, fatigue, syncope. Back pain.
EXAM or typical signs

Medication causing heart burn- BB
, CCB,
alpha agonists. (HTN meds).
EXAM

 

ASS (Systolic Murmur)
Only systolic murmurs will radiate to a location on the exam.

Mitral Regurg (Holo/pansystolic)- radiates to axilla. Think Mitral area 5
th
ics MCL.

Aortic Stenosis (mid systolic ejection) radiates to neck. Think 2ics rsb.

MS ARD (Diastolic Murmur)

Mitral Stenosis – soft low rumbling best apex / mitral 5ics mcl. Opening snap. Use bell. (MID/LATE DIASTOLIC)

Aortic regurgitation- loud high pitched, blowing murmur. (EARLY DIASTOLIC)

 

All diastolic murmurs are pathological. Murmurs I-barely II-audible III- clearly audible
. IV- first time thrill
V-Steth edge VI-entire steth.
EXAM AANP Exam tips

 

Benign split s2- pulmonic best. Normal during inspiration disappears with expiration.

 

MVP- S2 click, followed by systolic murmur. Asymptomatic. MVP with palpitations is treated with BB. LATE SYSTOLIC.

 

S3- HF, Kentucky, early diastole. Abn >35. Bell
EXAM

S4-LVH stiffening, Tennesse, late diastole. “Atrial kick/gallop”
EXAM

S1- Closure of AV

S2- Closure of SL

 

EXAM:
1
ST
DEGREE OR A 2
ND
DEGREE DESCRIPTION OF HEART BLOCK

 

BBS AFTER MI IS ON EXAM

 

Isolated systolic hypertension- do CCB.
EXAM

Stable Angina? – do stress test.

PAD/ PVD (same)- Nocturnal pain relieved by lowering legs, poor pulses, dependent rubor, intermittent claudication, atrophy, shiny, hairless, cold feet. Initial do a pulse check, ABI 0.9 or less is PAD. Ateriography is the most DEFINITIVE test. Try to develop collateral circulation. Otherwise- Trental, Pletal.
EXAM

 

CVI- Impaired venous return. Achy legs relieved by elevation, edema after prolonged standing, night cramps, brownish discoloration, cold, ulcers. Etc. do support stockings. 
EXAM

 

BP – ST 1 (140-159/ 90-99), if you know this you will get the rest!! Normal is <120/80.  ELERGLY OVER 60 150/90 IS OK. ISH WILL INCREASE SYSTOLIC NOT DIASTOLIC. ON EXAM.   Thiazides- no sulfa allergies, hyperuricemia, hypokalemia, hypomagnesia, hyponatremia, hyperglycemia, hypertriglycerides. ON EXAM   Infective Endocarditis- Fever, chills, malaise, new onset murmur. Oslers nodes- painful petechiae, violet colored nodes on the fingers or feet. Janeway lesions- non tender red spots on the palms/soles. Fundoscopic exam may show roth spots or retinal hemorrhages. Blood culture x3 (first 24 hours). Antibiotic prophylaxis is NOT recommended. Except if there is existing infection. 1 h. b4 Amoxicillin 2g po or 50mg/kg.   Must check LFT before starting Statin. Know when to start statins and what to check for to decide mod-high dose statins. ON EXAM   Pulsus paradox Apical pulse can still be heard even though the radial pulse is no longer palpable. Certain issues cause impairment with diastolic filling, 10 or greater drop in the SYSTOLIC pressure. I think her patient had asthma and their pressure dropped by 10 etc. ON EXAM COA ON EXAM   ORDER A PLAGIARISM-FREE PAPER HERE PULM COPD- Gold 1-2- SABA or SAMA ON EXAM.. BASCIALLY ANTICHOLINERGIC FIRST LINE FOR COPD ON EXAM Gold 1-2 that are poor controlled- LAMA or LABA. May use SABA for rescue. Gold 3-4 LAMA first line. If poor use LAMA plus LABA. Alternative is LABA + ICS. Gold 3-4- refer SABA- Albuterol, levoalbuterol (terol) LABA- Formeterol, salmeterol (Terol) SAMA- Atrovent Ipatropium (tropium) LAMA- Spiriva Tiotroium (tropium) COPD long term is OXYGEN   Asthma Intermittent  ON EXAM. BASCIALLY IF LOW DOSE ICS, NEXT IS MEDIUM DOSE ICS ON EXAM (<2d, <2)- SABA Mild persistent (>2d, 3-4N)- SABA, Low dose ICS *Altern. Cromolyn, leukotriene, theophylline.

Mod Persistent

(DAILY, NOT NIGHTLY)- SABA,  Low dose ICS plus LABA or Medium dose ICS.

Severe- (Throughout the day, nightly)- SABA, Med ICS plus LABA.

 

Always think first line treatment for asthma is some type of SABA, and ICS.

 

CURB-65 (criteria for hospital admission) If >1pt. hospitalize. Confusion, Blood urea >19.6, Respiration >30, BP <90/60, 65 years of age or older. ON EXAM   Hypercapnia- causes greatest INC in respiration.   Emphysema Lungs- Percussion-HYPERENNOSANCE tactile frem + egophony- dec. CXR- flattened diaphragms with hyperinflation. Inc. AP diameter, accessory muscles, pursed-lip breathing, weight loss. ON EXAM   Acute Bacterial Pneumonia- CXR middle lobe. ON EXAM   OSA-does not include Microglossia which is an absent tongue congenital. EXAM   Tuberculosis- fatigue, fever, cough. Never do fewer than 3-4 drugs initially if positive, then u can narrow it down. Latent TB usually treated with INH. If u suspect ACTIVE TB order, NAAT, C&S, AFB. The AFB is not diagnostic. SPUTUM FOR C & S if gold standard. Deep morning cough collected for three “consecutive days”. TB is usually upper lobes. AANP Exam tips >5mm-think immunocompromised or person in close contacts
. EXAM

>10 think Immigrants, working status, drug users, home life.

>15 Think no risks

CXR- shows big black holes

 

Endocrine

Anything with hyper/hypo SUBCLINICAL-always think of their TSH being off but their Free T4/T3 are normal. Could recheck in 1 year if not having symptoms.

 

TPO- this lab is off MEANING ELEVATED in BOTH hyper/hypo thyroidism. TPO is GOLD stand for diagnosis in Hashimotos. But you always want to order a TSH first, THEN ur thyroid panel do not get ahead of yourself. Check ur TSH lab on both in 6-8 weeks but never sooner than 6 weeks that is how long these meds take to work.
TOPIC ON EXAM

 

Normal TSH 0.5-5

 

Complications of Cellulitis with a diabetic patient = OSTEOMYLITIS.
EXAM

 

Hyperthyroid- Low TSH, high “FREE” T4/T3. ALWAYS DO FREEs. Graves disease-autoimmune. Lid lag, exophthalmos, everything is hyper (body wise). Treatment: PTU/Tapazole.
PTU PREFER IN PREGNANCY

RAIU-no w/ prego. Destroys thyroid, lifelong treatment for hypo then.

 

Hypoglycemia- Pancrease releases glucagon which stimulates ur liver to convert stored glycogen to glucose. EXAM or if asks what pancreas secretes besides this its digestive enzymes

 

Hypothyroidism- High TSH LOW Free T4/T3, However, Free T4 is much more specific to this disease. Hashimotos (autoimmune) think of everything in ur body is slowing down. Synthroid.

 

Parathyroid gland- PTH is responsible for calcium loss or gain from bones, kidneys, and GI tract. EXAM

 

If you are already on TWO oral drugs for diabetes and A1c is 9 or higher,
start BASAL insulin. If you cannot tolerate metformin and your A1c is 9 or higher start BASAL insulin. ON EXAM

 

Cushings syndrome-Central obesity, moon face, purple striae, hairy, hypertension, elevated plasma CORTISOL in AM. “INC BS, SODIUM” Dec K. You must draw cortisol levels in the morning. AANP Exam tips

 

Addison’s- deficient in cortisol (think low sodium, bloodsugar, but INC K. You must give cortisol. (Diagnosis Plasma Cortisol <5 mcg/dl @ 0800.) EXAM   For parathyroid- dx blood test. You will have elevated calcium because your parathyroid is releasing too much from bones and shit and this will just cause it to float around and not help ur bones. TX: BIPHOSPHANATES FOR SECONDARY HYPERPARATHY. EXAM   Fructosesamine test- checks sugar for past 2-4 weeks. MAYBE EXAM   Gastrointestinal   High Triglycerides- causes pancreatitis >500. If >500 treat with Niacin or Fibrate or Niaspan. If your patient is already on NIACIN you can add a fibrate like (LOPID/TRICOR). Apparently an insulin infusion works also.
ON EXAM

 

Pancreatitis-  diagnosed with amylase / lipase draw. Amylase beings 2-12 h. Lipase 4-8 hours. Lipase however is MORE specific and sensitive to alcoholic pancreatitis. ACUTE: Grey Turner/ Cullen sign. Abd pain that rates to
midback “boring”
epigastric pain. Fever, n/v.
EXAM TOPICS

 

Gerd- Barrotts “pre ca” chronic cough, acid sour breath, sore throat, thinning tooth enamel. First line for mild/intermittent lifestyle. BB, CCB, HTN meds increase GERD. FIRST LINE: H2, only 6-8 weeks, if not effective do a PPI. Never d/c PPI abruptly. If you still got cho GERD post 6-8 weeks of treatment just PUNT this shit to GI. (PPI-prilosec, protonix, prevacid) (H2-Zantac, Pepcid). Barretts tx- PPI daily and H2 bedtime. ALWAYS GIVE h2 at BEDTIME.
EXAM

 

Pyloric stenosis- 4-6 weeks, nonbilious vomiting olive like mass immediately after vomiting. Diagnosis by ultrasound will see a string. Differential include: GERD, milk protein intol. Intestinal

obstruction. PUNT for surgical correction.
ON EXAM

 

Intussecption- sausage shaped mass in upper right quad. Currant jelly stool. Ur bowels prolapse into another part of ur intestine. Barium enema can help to reduce this. Previously healthy then they get sick. Usually before 2 years.
PROB ON EXAM

 

Pencil like stool think colon cancer: Descending colon- tenesmus incomplete sensation of defecation. ON EXAM

 

Encopresis-involuntary soiling of stool in kids <4 y. Caused by constipation. Treat behavior cuz they don’t want to shit in public and laxatives to relieve the current constipation. ON EXAM   Hep A: IgG Anti-HAV (GONE = G). IgM Anti-HAV (M= MEOW). Hep B: HBsAg = (HAS the word in it). Anti-HBs- (Anti= not now)                    IM GUESSING ONE ON EXAM HbeAg(E=Everyday/chronic). Hep C: Anti-HCV- order HCV RNA. Biopsy of liver to check stage. HEP D: Gotta have boobs before you can get dick. B before D.   Chronic hep C: just elevations in ALT.   Positive psoas/obturator/ rvosing – acute appendix. EXAM   Zolinger-Ellison Syndrome- gastrioma causes multiple ulcers. First line is PPI. Screening done by serum fasting gastrin level. Pancrease secretes enzymes lipase, amylase, proteases. Digest protein, fat, and carbs. EXAM   Hpylori negative ulcers: h2 first bedtime, may combine them with PPI. Do 6-8 weeks. PUNT after. PROB ON EXAM   Positive H. Pylori: (Always do ABX for 14 days). Triple therapy: Biaxin, Flagyl OR Amoxicillin. With a PPI. Quad: Pepto Bism, PPI, tetra, Flagyl   Genitourinary Diagnosis of a kidney stone- Ultrasound. Old lady with new onset of incontinence – UA/CULTURE UA results: >10 WBC NitrItes=Ecoli WBC casts (infection UTI,
pyelonephritis
)

RBC
case (
glomerulonephritis).
EXAM TOPICS

 

Any baby 2-24 months with UTI- do renal and bladder ultrasound for first febrile UTI.
EXAM

 

Signs of dehydration in baby: sunken fontanels, decreased urine, no tears when crying (normal in babies), dry/sticky mucous membranes, lethargy, irritability.

 

A sample with large amounts of epithelial cells and multiple bacteria = contaminated sample.

 

3+ protein in urine- do 24 hour urine for protein and creat clear. EXAM Cholesterol, serum creatin and albumin, blood sugar.

 

Stress incontinence- do kegals 100x day. So 10x a day and 10 each time.

 

KNOW THAT UTI IS 100,000 CFU’S TO BE DIAGNOSED.
EXAM

PSA WHAT DOES IT MEAN TO PATIENT
EXAM

 

Neurological

CN V- Trigeminal Herpes. CORNEAL ABRASION. EXAM

EOM- CN III, IV, VI. EXAM

IV- superior oblique muscles

VI- lateral muscles.

CN I- Nose

CN IX- Shoulder shrug/ ROMBERG test EXAM

CN VIII –ears 8 EXAM

CN VII- Facial BELLS EXAM

Old lady taking digoxin- if her creatinine level increases you have to decrease digoxin dose.

 

Migraine- Triptains for abortive. Prophylaxis (propranolol) TCA (Amitriptyline) Anticonvulsants (gabapentin, topiramate). EXAM TOPIC

Cluster headaches- High dose O2 via Mask 12L 100%, imitrex (abort) and a CCB for prophylaxis. VERAPAMIL  EXAM TOPIC

 

BPPH- Dix Hallpike maneuver- Primidone, or propranolol. AANP Exam tips

 

Fibro- 11/18 points. Widespread pain for at least three months. EXAM

 

Worst headache of my life- SAH- may experience sentinel headache few weeks prior. S/sx of meningitis. Falls in elderly or MVA younger.

 

SDH- skateboarding concussion. Diagnosed with CT (Never do Contrast if you suspect a bleed
). EXAM

 

MMSE- <24 dimentia. The lower your score the more retarded you are. EXAM   Trigeminal Neuralgia- compression of nerve root possibly. Unliateral facial pain close to nose/cheeks. Sharp shooting pains by eating etc. TREATMENT: high doses of anticonvulsants. MRI / CT.  AKA TIC DOULOUREUX   Temporal arteritis- one temple indurated cord like gold stand. Biopsy. Abrupt visual changes blindness, inc. ESR. CPR. Most have POLYMYALGIA RHEUMATICA. Treat high dose steroids. POLY- bilateral joint stiffness aching, shoulders neck hips and torso problems with dressing. 50 or older females.   Carpal- MEDIAN NERVE, tinnels sign t=tapping. Phalens sign- putting phingers together.   ABSENCE SEIZURE AKA PETIT MAL SEIZURE: SUDDEN BRIEF LAPSES OF IN ATTENTION. SEEN ON EXAM FEVER DECREASES SEIZURE THRESHOLD.. SEEN ON EXAM HEMATOLOGY ONE OF THESE IS ON EXAM AT LEAST FOR EACH MACRO OR MICRO TYPE. ALSO LEAD APPEARED ON AN EXAM. USUALLY IRON DEF..ABNORMAL LEAD LEVELS ARE >80 POISONING, TX >40 WITH SYMPTOMS TX. OVER 5 IS ELEVATED BUT PREVIOUS LABS MENTIONED ARE WHEN TO TREAT IT.

s/s n/v, fatigue, loss of appetite, abdomen and joint pain, slowed growth, mental disability.

Thalassemia- gold standard for sickle cell also. Only BETA THALASSEMIA will be abnormal with this NOT alpha. (Alpha-asians, BETA- by sea). MICROCYTIC HYPOCHROMIC. Check Ferritin this will be either normal or slightly elevated. HEMOGLOBIN ELECTROPHORESIS GOLD STANDARD TO DX. AANP Exam tips

 

Iron deficient- microcytic hypochromic. TIBC Inc. Ferritin/iron Dec. Angular cheilitis, glossitis, spoon-shaped nails, pica. Check reticulocyte wk post starting iron to make sure u don’t have bone marrow suppression. Must do 3-6 months. 150-250 elementary iron. Ferrous sulfate 325 mg po TID. Take with calcium helps to absorb. SE constipation black colored stools.

 

Macrocytic normochromic anemias (Folate/B12 CHECK THEM BOTH). B12 will be the ONLY one with neuro findings or pernicious. Pernicious (autoimmune destruction of parietal cells in fundus) think ppl that get their stomach taken out w/ pernicious must do b12 injections life long. With b12 only temporary.

PERNICIOUS- ANTI IF Antibody or 24 h urine test for MMA increase.

 

B12 foods- ALL MEAT PRODUCTS OF ANIMAL ORIGIN

Think of a BIG BEEFY TONGUE.

Folate- doesn’t cause neuro s/sx. Folic acid 1-5 mg/d. Prego need 400 mcg 1 mo. Prior to prego. Dec. neuro deficits. Eat things green.

Sickle cell- CBC is
SCREENING
, HGB electro is
GOLD STAND
diagnosis (don’t get a screening test and a gold standard test mixed up on the boards). Could do 8-10 prego a CVS or Amnio to check to sickle. Give sickle cell patients their vaccines to protect from illnesses such as pneumonia/flu
. EXAM

 

Musculoskeletal

 

Bicep Tendon Rupture- HOOK TEST (description of the test and say what it is trying to diagnose) bicep will roll into a giant ball
EXAM

 

Rotator cuff description- apprehension test rules it in or out. Positive means pain is reduce on relocation test and positive use. Rotator cuff injury-disturbed sleep, arm weakness, dull ache.
EXAM

 

Navicular fracture- falling with outstretched arm hyperextension. Thumb spica splint and PUNT 2 weeks to see on xray.

 

Drawers sign- “knee stability” Anterior checks ACL, posterior checks PCL. EXAM

McMurrays test- “CLICK” medial meniscus (valgus) EXAM.
LateRal
meniscus (va
R
us). (BOTH HAVE R’S)

Lachman’s- “LAXITY” VERY SENSITIVE for ACL. EXAM

 

OA- Large weight bearing joints. Early morning stiffness with inactivity. Has both nodes. FIRST LINE Acetaminophen. EXERCISE: Isometric exercises for knee OA. Non-weight bearing, like biking, swimming, stationary bike.
EXAM

 

OSTEOPOROSIS = WEIGHT BEARING- walking, lifting weights etc. bones are forced against gravity.
EXAM

 

RA- Early morning stiffness, sausage joints. Symmetrical involvement. Longer stiffness than OA. Joint space narrowing. Pain, warm, tender, swollen, things. TREAT: NSAIDS, steroids, DMARDS, TNF. Only has
BOUCHARDS,

SWAN NECK IS DESCRIPTION ON EXAM

 

Medial Tibial Stress Syndrome of Fracture: OVERUSE, “inner border” painful on palpation. DO bone scan or MRI cuz a plain X-ray wont show a stress fracture. FOLLOW RICE. EXAM

 

Lateral epicondylitis- (TENNIS) pain in outside elbow, worse with twisting or grasping.

Medial Epicondylitis- (GOLFER) inner elbow pain by funny bone. Baseball, bowlers.

 

Morton’s Neuroma- do mulder test. “pebble, burning, numbness” ¾ metatarsals. PUNT TO pod.
EXAM

 

Scoliosis- Adams Forward Bend Test= both arms hanging freely, knees straight, look for asymmetry of spine, scapular, thoracic, lumbar curvature, inspect shoulders and hip for asymmetry.

 

Treatment to prevent fracture in patient with low vitamin D high TSH low HCT-
VITAMIN D 600-800, CALCIUM 1000-1200. EXAM

 

Low back pain- MRI (herniated disk) So sciatica is a form of radiculopathy and one of the most common causes is a herniated disc. So both are aggravated by long periods of sitting.  And feel better with WALKING. Lumbar stenosis is aggravated by long periods of standing and walking. Releived by sitting and rest.
EXAM

 

PSYCHIATRIC

ELDERLY CANT SLEEP INSOMNIA ETC. SCREEN FOR DEPRESSION

Acute Serotonin Syndrome- Dilated pupils,
high fever
, muscular rigidity, mental status changes, hyperreflexes, clonus, uncontrolled shivery. You get this from SSRI, MAOIs, TCA. Could be potentially life threatening.
EXAM

 

Anorexia- lanugo, osteoporosis, BMI <18.5, peripheral edema, heart problems.   Atypical Antipsych- Zyprexa, Seroquel, Risperdal- OBESITY, DM2, check BMI Q3M. CAUSES WEIGHT GAIN. EXAM SSRI- Paxil (sex dysfunc causes this). Zoloft, Celexa (Good for older few drug interactions) Lexapro. Gradually wean paxil. SSRI are ALWAYS first choice FOR MAJOR AND MINOR DEPRESSION AND PTSD. Causes low sperm count also. EXAM   Kava Kava- used for anxiety and insomnia, don’t mix with other sedating medications, such as benzos.   Bipolar- Type I- class manic- severe anxiety, rage, chronic relationship difficulties, euphoria, talkativeness, flight of ideas. Type II- Hypomanic. TREATMENT: Lithium salts (affect TSH, Kidney), anticonvulsants, Antipsychotic.   MMSE- Used to evaluate confusion and dementia. Orientation, Immediate recall, Attention and Calculation, Writing and copying. 0 bad 30 good. <24 dimentia highly suggestive.   Anxiety Attack- Treat Benzo SHORT PERIOD OF TIME EXAM   Zyprexa- (atypical antipsychotic)   TCA- easy to overdose on don’t give to patients with suicidal.   Seasonal affective disorder- depression occurring during winter months, causative factors include circadian rhythm, drop in serotonin syndrome, change in melatonin level. Treatment light therapy, antidepressants, psychotherapy/talk therapy.   Generalized Anxiety Disorder- SSRI , SNIR, Wellbutrin. May do benzo for short time.  EXAM   WEAN BENZOS EXAM   Wellbutrin can help with sexual dysfunction from SSRI/Paxil. Do not give it to people with seizures or anorexics.   Alcoholics- CAGE questionnaire, 12 step program. Al-Alonon for family, Al-teen for teenagers and shit.   ADHD BEHAVIORAL, SO THERAPY FIRST THEN MEDS. ADDERAL, RITALI, VYVANSE, SETERRA.  EXAM   MENS HEALTH REVIEW   Acute Bacterial prostatitis- UA/ Culture is definitive. CBC shift to left (band cells) UA, pyuria, hematuria. High fever, chills, suprapubic, perineal pain, radiates to back or rectum, s/sx of uti. Prostate is warm and boggy. Older than 35= cipro, levaquin 4-6 wk. other Bactrim. AANP Exam tips <35-Rocephin 250mg IM and doxy 100 mg BIDx10d. EXAM   BPH- Symmetrical rubbery and enlarged. Proscar must times PSA X2. All of BPH meds, take at bedtime. Hytrin is good for ppl with HTN and BPH. EXAM   Testicular Torsion- extremely painful, swollen red scrotum, affected teste is higher/closer to the body, cremasteric reflex is missing. Dx- Doppler ultrasound with color flow study.   Women’s Health Review   Ectopic Pregnancy- Light to scant bleeding in 6-7 weeks/lower abd pain/pelvic pain. Intermittent cramping, if radiating to right shoulder think rupture. Pain is worsen with SUPINE or with JARRING. Previous ectopic pregnancy, tubal ligation, PID. Anything that is causing scaring. EXAM   Natural estrogen- Isoflavones. SOY BEANS EXAM   Ovarian CA- Family history. Should not ever be able to palpate an ovary, r/o US ovarian CA. Risks: >50, early menarche, late menopause, obesity, family history, 1
st
prego after 35, or not ever prego.  EXAM

 

Breast cancer- Do Ultrasound to differentiate between lesion vs cyst. EXAM OR AT LEAST MASS AND WHAT IS NEXT STEP MAMMO OR US.

 

LSIL- 21-24y.o. (Repeat in 12 mo) 25-29 (refer for colpososcopy/biopsy). >30 if HPV (-) repeat in 12 mo. If HPV (+) then refer to colp / biopsy.
EXAM

 

HSIL-  21-24y.o (colp), >25y.o surgical excision.

 

Bacterial Vaginosis- Wet smear. Squamous epithelial cells with a large amount of bacterial coating, just milky and fishy, no redness or irritation. KOH to cotton swab for whiff test. TREATMENT: FLAGYL BID x7d. Altern- Cleocin or flagyl cream
. EXAM TOPICS

 

Candidia Vaginitis- wet smear= pseudohyphae / spores w/ lrg wbc. Cheese curd like pruritis, itching, swelling, redness. TREAT: Diflucan 100 mgx1. Or OTC= Monistat, clotrimazole. Exam

 

Trich- Microscopic – mobile unicellular organisms with flagella and large amount of wbc. TREAT : FLAGYL 2 g PO x1, or 500 mg BID x7d. “
strawberry cervic,
red, itchy, grayish-green bubbly vaginal dc. Burning with urination. Wet prep.
EXAM TOPICS

 

WET PREP : BV, YEAST, TRICH. Exam

 

Atrophic vaginitis- lack a estrogen, apply topical estrogens.
exam

 

Pap smear- Begin 21 q 3y until 29. Age 30 pap / HPV repeat q 5 y. May stop at 65, if negative x10 y. Must have squamous epithelial cells and endocervical cells are present.

 

Mammogram- baseline 50 then q 2y. age 75 older =don’t do. Begin at 40 for high risk patients.

 

Postmenopausal bleeding- ENDOMETRIAL BX. EXAM. US to rule out OV CA

 

STD

AIDS <200. CD4. EXAM You want higher than 350   Gonorrhea Tx: Rocephin 250 mg IM and Azithromycin 1 gm po x1, or doxy 100 mg BID x7d. Green colored vaginal discharge, friable cervix. EXAM   Chlamydia- Azithromycin 1 gm PO x1 or Amoxicillin 500 mg PO TID x7d. Test of cure 3 weeks after completion of treatment (PREGO). EXAM If not prego do the Azithro 1 mg PO x1 or Doxy 100 mg BID x7d. AANP Exam tips Clap is usually asymptomatic.   Untreated Gonorrhea: leads to PID, abscess, ectopic prego, infertility, can pass to baby during delivery. In men: epidydimitis, infertility. Both people: can lead to disseminated, petechial pustule lesions, lesions of hands/soles, swollen, red, tender joints in one large joint. Green throat. Occasionally Fitz-Hugh-Curtis syndrome. Liver PID- Infertility, cervical motion tenderness indicates PID. Treat symptomatic PID even if GC and Clap are negative. Follow up with bimanual exam in 2-3 days . EXAM topic PID   Syphillis- PAINLESS GENITAL CHANCRE- Condyloma lata. First test do RPR, VDRL SCREENING if reactive then confirm with FTA ABS. EXAM…   Condyloma Acuminata (genital warts)- types 16/18 HPV. Treatment: trichloracetic acid….Condylox, aldara, veregne. EXAM   Genital herpes on exam: Dx RPR assay for 1 &2. Itching, burning, and tingling. Primary more severe lasts 2-4 weeks etc. recurrent outbreaks. First outbreak Acyclovir 400mg 3x/d for 7-10days. CHEAPEST medication Episodic, try to start within 1 day of lesion (pt may fee start of prodromal sx) Acyclovir BID or TID x 5 days. WOMENS HEALTH PREGNANCY / CHILDBIRTH   Pregnant (5 th disease)- Teratogenic on baby.   Positive signs of pregnancy: things done by health care provider, FHR HEARD, US SEE BABY. Probable: Signs, enlargement of uterus, prego test. Presumptive: She is just PRESUMING that she is prego.        EXAM TOPICS   Goodell’s sign: cervical softening. Chadwicks sign Blue cervix and vagina. Hegars sign- softening uterine isthmus.   1 st 1-12 weeks. 2 nd 13-26 weeks. 3 rd 27-end.   Appointment schedule: 0-28 q4w. 28-36 q2w. 36 till end q1w.   Naegele’s Rule- add 9 months and 7 days! BOOM OR SUBTRACT 3 MONTHS ADD 7 DAYS.   Fundal Height 12 weeks above symphysis pubis.      EXAM TOPICS Fundus 16 weeks between symphysis pubis and umbilicus. Fundus at 20 weeks is at umbilicus. 2 cm more of less from # of wk gestation is normal if more or less order US.   Placental Previa- 2 nd -3 rd trimester new PAINLESS vaginal bleeding worsened by interCourse. Blood is bright red. Uterus soft non-tender. If cervix is not dilated, treatment is strict bed rest. Administer IV MAG IF THERE IS UTERINE CRAMPING. Do not insert anything into the vag/rectal. If dilated cervix then deliver via c- section (according to leik).   Placental Abruption- Late third trimester, sudden vaginal bleeding PAINFUL. Uterus feels hard. Dark red bleeding. In severe cases deliver.   Can always do an ABD ultrasound with vaginal bleeding but NOT A VAGINAL ULTRASOUND.   Preeclampsia- late third trimester >34 wk. sudden onset of h/e, visual abnormalities, pitting edema. Edema easily seen on face eyes fingers, sudden rapid weight gain within 1-2d (>2-4lb/wk). RUQ pain. BP >140/90. Protein 1+, dec. urine. IF SEIZURES THEN ECLAMPSIA. Earliest is at 20 weeks that they can have this. Lay on left side.

 

1300 for calcium and pregnancy.

 

AT 16 WEEKS TEST FOR AFP
(EXAM) – Low- Downs

High-Neural tube deficits.

 

TRIPLE SCREEN- AFP, BETA HCG, ESTRIOL.

QUAD SCREEN- The triple screen PLUS INHIBIN A

 

GBS- 35-37 weeks swab.

 

GiVe rhogam at 28 weeks. The coombs test detects rh antibodies in the mother (indirect) and the infant (direct). 2
nd
dose is 72 hours or sooner post delivery. IF RH NEG MOM.

 

UTI- 10 (3) wbc is considered positive in prego with symptoms. Normal people its 10 (5). MEDS: Macrobid (not for 3 trimester) Augmentin, Amoxicillin, Cephalexin, Fosfomycin. EXAM

 

Mastitis- red firm tender area fever chills, flu like symptoms. Basically this is cellulitis on ur tit. Dicloxacillin, or Keflex. If you suspect MRSA, do Bactrim or clinda.
EXAM AANP Exam tips

 

CHILDREN

ADHD- hyperactive, impulsive, inattentive. Present prior to 12 years. Symptoms last > 6 months, should be evident in at least 2 different settings. Treated with schedule II – Ritalin, Adderal, vyvanse, streterra etc.
EXAM

 

Anterior fontanel- closes 15-18 mo. Posterior 2-3 mo.

 

Erythema infectiosum (5
th
disease)- “slapped cheeks” 5-14 y.o. LACY, spreads to upper arms lgs trunks dorsum of hands and feet. Rash can last up to 40 days. Fever, rash, runny nose, headache. EXAM humanparovirus19, no labs for it.

 

Milia 1-2mm papules. Resolves spontaneously.
EXAM

 

RETINOBLASTOMA- leukocoria: Hallmark sign white spots in eye. Cancer. Red light reflex.
EXAM

 

Cephalohematoma- swelling does not cross midline.

Caput succedaneum- crosses midline. Cone shaped head. HAHA.

 

Fragile X- Large head, mental retard. Delayed milestones, crawling, walking. Autism is common. Long face with prominent forehead, jaw, and large ears, large body.

 

Do not give varicella/MMR <12 mo. EXAM QUESTION Tdap, HPV, MCV4 (11-12y). HPV youngest age 9 years. Do not give TDAP <7years   Influenza youngest 6 month.   HBsAG + mom give baby Hep B and immunoglobulin.   Neuroblastoma- painful abd mass fixed first irregular, crosses midline. Most common side is adrenal glands. Weight loss fever horners syndrome. Raccoon eyes, bone pain, hypertension. 1-4 year olds. Dx ultrasound PUNT to nephro. NEURO think brain in middle crosses midline. **Urine catecholamines and anemia. EXAM   Wilms tumor (Nephroblastoma)- Not painful. Asymptomatic abd mass does NOT cross the midline. 2-3 y. o.d. do not palpate. Do ABD US. PUNT. Think Nephro doesn’t cross. Stays where kidney is. EXAM   Epiglottis- Acute/rapid onset of high fever, chills, toxicity. Severe sore throat, drooling saliva. Will not eat or drink muffled hot potato voice, anxiety, tachycardia, tachypnea. 2-6 y. old. Prophylaxis w/ rifampin. Report this disease.  EXAM   Autism- may be as early as 18 mo. 18-24 mo do screening. Most apparent in 2-6 y. old. “extremely sensitive to noises, touch smells, textures” poor language, repeated body movements. Five behaviors to look for: doesn’t point/wave/grasp by 12 mo. No babbling or cooing (by 12 mo) dose not say single words (by 16 mo) Does not say two – word phrases on his own ( by 24 months) Any loss of language or social skills ( by 24 months) Does not gesture by 24 months. Think about kids who do not act normal especially with interactions.   Kawasaki disease- acute high fever, enlarged lymph. BRIGHT RED RASH, conjunctivitis, dry cracked lips, strawberry tongue , Swollen hands, feet , AFTER the fever resides the rash PEELS on hands/feet . Treated with high dose aspirin and gamma globulin. This is TOXIC and VASCULAR, think blood clots, heart problems etc. Treat: high dose aspirin. EXAM   Hand-foot-mouth disease: Viral, acute fever, sore throat, headache, multiple blisters on hands, feet, diapher area. Ulcers are in the mouth throat tonsils and the tongue. Treat SYMPTOMS.   Encoporesis- Kid doesn’t like to poop. Do plain X-ray.   Bronchiolitis: Don’t give abx, cool mist breathing txs. Basically bronchitis in kids. EXAM topics   Croup: No antibiotics. Stridor barking cough. Dexamethasone x1 dose. Darcryotosis  lacrimal sac, rub down towards mouth. If think secondary AANP Exam tips   infection abx. EXAM how it presents. OLDER KIDS   Teste torsion- Doppler, unilateral teste pain, absent cremaster reflex. Scrotal edema, redness.   Precocious puberty before 8 / delayed if no breast development by 12 y. (FEMALES) Precocious puberty before 9/ delayed if no testicular/scrotal growth by 14 years (MALES)   Primary amenorrhea: NO menarche by 15 y. with or w/o secondary sex characteristics.   Osgood-Schlatter: knee pain in young adults, overuse. Repetitive stress pain, tenderness, swelling at the tendon’s insertion site. The tibial tuberosity. Rule out avulsion fracture if there is an acute onset and order a lateral xray. RICE. Usually stops when the growth stops. EXAM   Legg-calve perthes disease: aseptic/avascular necrosis of the femoral head. Could be due to vascular disruption. Insidious onset of KNEE PAIN that migrates up to the groin. AFEBRILE. Positive Trendelenburg’s test.   Slipped capital femoral epiphysis – spontaneous dislocation of femoral head. Pain in groin that is referred to the knee. Unable to properly flex. No ambulation is permitted cuz this will cause irreversible damage. Could be due to puberty or hormonal changes. U will have a shortening of the leg with this.   Klinefelter syndrome- More female traits in males cuz they got an xtra X.   Turners Syndrome- Females with ONLY ONE X. Webbed neck, lymphedema. Short stature. AANP Exam tips

Recruitment and Selection Processes Nursing essay

Think back to an experience, either recent or particularly memorable, in securing a position in a healthcare setting. How did you become aware of the position? Was the job description an accurate representation of the duties and responsibilities of the position? What was the interview process like and were there aspects you would recommend changing? When you were hired, did you feel this was a position that you would want to retain and in which you could grow?

Photo Credit: Getty Images/iStockphoto

This Assignment will involve you in following key steps in the recruitment and selection process. No doubt you have experienced this process from the candidate’s perspective. In keeping with your human resource functions as a nurse executive, for this Assignment, you will consider the recruitment and interview process from the hiring perspective. As you do, consider how you can apply your own experiences and insights, in combination with the Learning Resources you use, to develop the most effective recruitment and selection plan that strengthens a healthcare setting with high-quality employees. Recruitment and Selection Processes Nursing essay.

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Note: There are two parts to this Assignment. Both Parts 1 and 2 will be due on Day 7 of Week 2. Plan your time accordingly. Access and review the document, Recruitment and Selection Plan: Guidelines and Worksheet (located in the Learning Resources), for support in completing the Assignment. The preparation steps this week are intended to guide completion of Part 1 of your Assignment.

Part 1: Job Description Analysis

To Prepare:

Review the Learning Resources on human resource management and recruitment, job analysis, and job design.

Identify a job description from your current healthcare organization or where you have previously worked. Choose a job description that will enable you to determine the type of employees you are looking for as well as the selection criteria.

Based on the job description, develop a recruitment and selection plan. For Part 1, you will focus on developing and refining the job description. Consider:

What are the responsibilities of this job? Recruitment and Selection Processes Nursing essay

What are the competencies and KSAOs (knowledge, skills, abilities, other attributes) required for this job?

How would you evaluate a candidate to determine fit for this position, both in terms of technical competencies for the job and fit with the culture and values of the organization?

How could the job description be improved to ensure a successful hiring process?

Consider how you could use social media, such as LinkedIn or online employment recruitment sites, to maximize the field of qualified recruits.

If you are on LinkedIn, explore how the site functions as a recruitment source. If you are not on LinkedIn, create a profile for this Assignment, and then begin your research.

Identify and explore recruitment websites (e.g., Indeed, ZipRecruiter, CareerBuilder) that have been used to recruit for this type of position. Depending on the job, also explore discipline-specific websites where jobs are advertised (e.g., Nurse.org, ANA’s Career Center). Pay particular attention to how jobs are presented to interested job seekers.

Part 1 Assignment: Job Description Analysis Recruitment and Selection Processes Nursing essay

In 2–3 pages, include the following:

Explain the role of the nurse executive in developing job descriptions and why it represents an essential human resource management function.

Analyze the job description you have selected as the focus of your Assignment. Include the source of the job description and critique the job description for clarity and accuracy.

Explain how well the job description defines the required employee attributes for the job and how it could be improved. If information is available, describe how the tasks and competencies associated with this job may have changed since the job description was conceived.

Write a new or revised job description that reflects your analysis and which you would use for advertising the position and recruiting candidates for the job.

Explain how you would use social media and online job search technology to maximize presentation of the job description and reach a broader share of potential recruits.

Describe two examples of how jobs similar to your chosen position are presented to interested job seekers from the social media and online job sites you visit.

Part 2 Assignment: Interview and Selection Plan

Based on the job description you created or revised in Part 1, design an interview and selection process for that job. In 3–4 pages, include the following:

Describe the ideal candidate for this job, and explain the sources of information you would use in evaluating applicants.

Explain an overview of your process to identify, and select that candidate.

Focusing on the interview, explain:

Who within the healthcare organization would be involved in the interview process, and why

Pre-interview guidance and preparation for interviewers and recruits

How interview outcomes would be compiled Recruitment and Selection Processes Nursing essay

How differences in interview ratings would be resolved

List five essential questions you would ask in an interview to evaluate key employee characteristics for this job. For each question, explain what you would look and listen for in the candidate’s response.

Explain how you would measure a candidate and assess the recruit’s fitness for the position.

Analyze your interview and selection process for potential challenges, and explain how you would address those challenges to improve the process and outcomes, including retaining good employees.

By Day 7 of Week 1

Note: There is no Assignment due in Week 1.

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

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Learning Resources

Required Readings (click to expand/reduce)

Fried, B. J., & Fottler, M. D. (Eds.). (2018). Fundamentals of human resources in healthcare (2nd ed.). Chicago, IL: Health Administration Press. Recruitment and Selection Processes Nursing essay

Chapter 5, “Recruitment, Selection, and Retention” (pp. 113–149)

(Previously read in Week 1).

Dattner, B., Chamorro-Premuzic, T., Buchband, R., & Schettler, L. (2019, April). The legal and ethical implications of using AI in hiring. Harvard Business Review. Retrieved from https://hbr.org/2019/04/the-legal-and-ethical-implications-of-using-ai-in-hiring

Markman, A. (2019, April). Should you try to convince a star employee to stay? Harvard Business Review. Retrieved from https://hbr.org/2019/04/should-you-try-to-convince-a-

 

Recruitment and Selection Processes

The process of recruiting the best candidate for a particular task is a complicated process, which involves a series of activities. Similarly, recruiting an applicant to fill the position of a nurse manager in a healthcare organization. In most cases, nurse executives are charged with this responsibility. While identifying and selecting the best candidate, a nurse executive requires to conduct job description analysis. Additionally, these personnel requires to conduct an interview and develop the selection plan.

Part 1: Job Description Analysis

The role of the nurse executive in developing job descriptions

The job position of nurse executives involves performing both leadership and management duties. One of the key duties of nurse executives entails working with other employees in the healthcare organization. Nurse executives are considered as managers who are in charge of employees working in their area of specialization. Therefore, they are involved in developing job descriptions. They state the duties to be performed by the job applicant in the areas of specialization. Thus, involving nurse executives in designing job description allows them to get the best candidate for a particular task in the healthcare facility. Additionally, executives inform the current workers about new policies and programs, which have been introduced by the management. In this case, their role represents an essential human resource management function since they deal with the employees, which is the main duty of the HR department in the organization (Fried & Fottler, 2018) Recruitment and Selection Processes Nursing essay.

Analysis of the job description

The selected job description involves the position of the nurse manager. It was obtained from
Monster
, which is a recruitment website. The job description is accurate and clear. It illustrates the expected duties of the nurse manager. For instance, the job applicant should identify the service requirements of the patients. Additionally, he or she maintains nursing guidelines, which are set in the organization. Lastly, the applicant should maintain nursing operations in the healthcare facility.

The effectiveness of job description in defining employee’s attributes

The attributes of the suitable candidate for the position are well defined by the job description. The description clearly illustrates the duties to be performed by the required employee as a bit demanding and involving. Therefore, the candidate should possess some qualities such as patience, dedication, commitment, and hardworking to perform these duties as expected. However, this job description can be improved by indicating the required quality at the end of each task, thus enabling the candidate to conduct self-evaluation before applying for this job position. However, tasks and competencies associated with this position have changed from when the job description was developed due to changes in the technology. Therefore, the preferred candidate should feed all the records of the operations of the area of supervision in the computer. Thus, he or she should be conversant with the latest technology.

Revised job description

The nurse manager revised job duties are as follows

Use technology to keep updated records of the area of supervision,

Identify service requirements of the patients,

Maintains nursing guidelines, which are set in the organization, and

Maintains nursing operations in the healthcare facility. Recruitment and Selection Processes Nursing essay.

Use social media and online job search technology to maximize the presentation of the job description

Both social and online job search technology would be used to enhance the presentation of this job description to potential applicants (Dattner et al, 2019). In social media, I would post this job description to Facebook groups of nurses. Most of these nurses are experienced and would be fit for this position. On the other hand, I would use job search technology to look for candidates with the required skills and eventually send the job description to them.

How Nurse Manager Job positions are presented on social media and online job sites

Nurse Manager Job positions are presented to potential applicants the social media and online job sites. On social media, the recruiting company has posted the job description on its Facebook page, thus making it accessible to all Facebook users who visit the page. On the online job sites, the company has posted the job description for a nurse manager on its official website.

Part 2 Assignment: Interview and Selection Plan

Qualities of the ideal candidate for this job

The ideal candidate for this job should be able to perform the described tasks beyond expectations. Therefore, he or she should possess to be conversant with the latest technology. Additionally, the candidate is able to supervise other nurses working under him. The ideal applicant should be able to communicate and inform others of what they are supposed to do at a particular time. Finally, he or he should be flexible, thus making changes within the shortest time possible if need be.

The applicant would be evaluated based on information obtained from the department where he or she will be working. The department head should state exactly what he or she wants to hear from the applicant to decide whether he or she is fit for the position. Additionally, information obtained from nursing guidelines would be used as a source of information for evaluating the candidate. Recruitment and Selection Processes Nursing essay. This guideline clear states the knowledge and competence that every practitioner should possess depending on one’s area of practice in the healthcare sector.

Process of identifying and selecting the best candidate

The process of identifying and selecting the best candidate involves as a series of activities. First, job applicants from various candidates need to be evaluated. Then, the applications are sorted out depending on the qualifications and skills of the candidates. The application of the most qualified candidates is separated from the rest for re-evaluation. The next step involves listing down these candidates on the order of merit. These candidates are then contacted using the provided contacts for an interview. The candidates are advised to bring their credentials during the interview. Upon conducting the interview, the candidate who meets the expectations of the interviewers is selected to fill the job position.

Individuals from healthcare organization involved in the interview process

The overall head of the healthcare organization would be involved in the interview process. Being experienced than most staff members in the organization, he or she would assist in interviewing and selecting the best candidate. Additionally, the head of the unit where the candidate will be working would be involved in the interview process. The departmental head will assist in selecting the candidate who is best suited for the job position. Thus, involved individuals will enhance the success of the interview process.

Pre-interview guidance and preparation for interviewers and recruits

Both interviewers and recruits need to prepare for the upcoming interview. Before the interview, the interviewers need to review the tasks to be performed by the candidate and the qualities of the preferred candidate. This practice will enable them to select the best candidate for the position. On the other hand, recruits need to be conversant with the organization before the interview. They should review the organization’s website and learn about its key achievements, activities, and operations. Additionally, they should analyze the job description keenly and try to match it with their qualifications, thus ensuring they are qualified for the advertised position.

How to interview outcomes would be compiled

The results of the interview would be compiled through a series of activities. First, the interviewer should start by summarizing details provided by each applicant during the interview. This would involve noting both the strengths and weaknesses of every applicant. The candidates are then ranked based on their strengths starting with the applicant with most strengths and least weaknesses. The leading applicant is declared suitable for the position.

How differences in interview ratings would be resolved

Differences in interview ratings would be resolved through comparative evaluations. This evaluation technique will help the interviewer to calibrate across candidates. Additionally, it will help in minimizing the reflex to rely on stereotypes to guide their impressions.

Five essential interview

The following questions would be asked to applicants during the interview to evaluate their characteristics for this job.

How would you use technology to update records of the area of supervision? In this question, I would listen to the candidate’s ability to use the latest technology in performing the tasks.

How would you identify the service requirements of the patients? In this question, I would listen to the candidate’s ability to listen to clients and identify their requirements. Recruitment and Selection Processes Nursing essay.

iii.        How would you maintain nursing guidelines, which are set in the organization? In this question, I would listen to the candidate’s ability to maintains and protect nursing guidelines.

How would you maintain nursing operations in the healthcare facility? In this question, I would look at the client’s ability to maintain nursing operations in the organization.

How would you ensure that other employees under you are working as expected? In this question, I would look at the client’s ability to influence others.

How to measure a candidate and assess the recruit’s fitness for the position

A candidate would be measured by his or her ability to respond to interview questions appropriately. A recruit would be considered fit for the position if his or her responses meet the expectations of the interviewer and are in line with the job description.

Potential challenges

The first potential challenge in the interview and selection process is choosing the wrong candidate for the job. These challenges would be addressed by being keen and attentive when listening to applicants during the interview. Additionally, all applicants would be asked similar questions. The second potential challenge is the interview taking longer than expected. This challenge will be addressed by adhering to schedule strictly during the interview process. The organization can retain good employees through both monetary and non-monetary rewards (Markman, 2019).

Summary

The success of nurse executives in identifying and selecting the best candidate for a nurse manager position greatly depends on two major activities. First, a nurse executive requires to conduct job description analysis to understand the requirements of the job position. Secondly, the nurse practitioner requires to conduct an interview and develop the selection plan. Therefore, these two activities will ensure that the best candidate is selected for the job position.

 

 

References

Dattner, B., Chamorro-Premuzic, T., Buchband, R., & Schettler, L. (2019). The legal and ethical implications of using AI in hiring.
Harvard Business Review
. Retrieved from
https://hbr.org/2019/04/the-legal-and-ethical-implications-of-using-ai-in-hiring
.

Fried, B. J., & Fottler, M. D. (2018).
Fundamentals of human resources in healthcare
(2nd ed.). Chicago, IL: Health Administration Press. Recruitment and Selection Processes Nursing essay

Markman, A. (2019). Should you try to convince a star employee to stay?
Harvard Business Review
. Retrieved from
https://hbr.org/2019/04/should-you-try-to-convince-a-

Monster Worldwide. (2019).
Nurse Manager Sample Job Description
. Retrieved from
https://hiring.monster.com/employer-resources/job-description-templates/nurse-manager-job-description/ 
  Recruitment and Selection Processes Nursing essay

Leik’s Exam Tips

 

Medication

1) Aspirin irreversibly suppresses platelet function for up to 7 days (due to irreversible

acetylation).

2) Discontinue ASA if patient complains of tinnitus (possible aspirin toxicity).

3) For chronic use, the recommended dose is 81 mg/day (some exceptions exist).

4) Aspirin given post-MI or after a stroke/TIA is considered tertiary prevention.

5) Avoid using in children with viral infections who are less than 16 years of age (Reye’s

syndrome).

1) Memorize the FDA category and dose of finasteride (Proscar 5 mg PO once a day).

2) Accutane is a potent teratogen. Reproductive-aged females must use 2 reliable forms of

birth control and must have a negative pregnancy test 1 month before, during, and 1 month

after Accutane.

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3) High-dose vitamin A is teratogenic in animal studies—avoid “mega-doses” of vitamins in

pregnancy.

4) Avoid mixing warfarin with sulfa drugs—can increase INR and bleeding risk.

HEENT

■Treatment for otitis externa is Cortisporin Otic drops.

■ Otitis externa’s common bacterial pathogen is Pseudomonas.

■ Ruptured spleen is a catastrophic event. Avoid contact sports (i.e., 4 weeks) until ultrasound

documents resolution.

■ Betimol (timolol) has the same contraindications as oral beta blockers.

■ Cholesteatoma, periorbital sinusitis complication.

■ Do not use amoxicillin if used in the past 3 months. Advance to second-line antibiotics such

as Augmentin or Ceftin.

■ Penicillin-allergic patients, use macrolides, sulfas (avoid cephalosporins, especially if had

Class I reaction or anaphylaxis from penicillins).

■ Learn to recognize a description of eye findings such as pinguecula, pterygium, chalazion.

■ Rinne test result of BC greater than AC with conductive hearing loss (i.e., cerumenosis,

AOM).

■ Weber test result is lateralization to the “bad” or affected ear with conductive hearing loss.

■ Weber or Rinne are testing the acoustic or CN 8.

■ Lateralization on the Weber exam is an abnormal finding.

■ Normal finding in Rinne test is air conduction that lasts longer than bone conduction (AC

greater than BC).

■ Remember what 20/40 vision means: patient can see at 20 feet what a person with normal

vision can see at 40 feet.

■ Carbamide peroxide (similar to hydrogen peroxide) is one of the most common OTC treatments

for cerumenosis.

Dermatology

 

Differentiate between contact dermatitis and atopic dermatitis. The best clue is the unilateral

location and the shape of the lesions in contact dermatitis.

■ Rashes that are very pruritic at night and located on the interdigital webs and/or penis are

scabies until proven otherwise. Treat entire family. Wash linens/clothes in hot water.

■ Preferred antibiotic is Augmentin for human, dog, and cat bites.

■ Do not confuse actinic keratosis (precursor to squamous cell cancer) with seborrheic keratoses

(benign).

■ Diagnose hidradenitis suppurativa, psoriasis, RMSF, meningococcemia, erythema migrans

(Lyme disease), contact dermatitis, rosacea.

■ Instead of silvery scales, may see “covered with fi ne scales” with psoriasis.

■ Psoralens (tar-derived topicals) used to treat psoriasis, antimetabolite (methotrexate).

■ How to treat mild and moderate acne. Mild acne is treated only with topicals.

■ Accutane in females: Use two forms of reliable birth control.

■ “Herald patch” or a “Christmas tree” pattern is found in pityriasis rosea.

■ PHN (post-herpetic neuralgia) prophylaxis: Tricyclic antidepressants (TCA), amitriptyline

(Elavil).

■ A clue in a case scenario on cellulitis may involve a patient walking barefoot.

■ Recognize erysipelas versus other types of cellulitis.

■ Treatment for rosacea is topical metronidazole gel.

■ Recognize herpetic whitlow.

 

Cardiac

There are usually 2 or 3 questions regarding murmurs on the exam.

■ Learn to use the mnemonics “MR. ASH” and “MS. ART.”

■ Memorize the locations of the mitral area as well as the aortic area.

■ Regarding mitral murmurs, the word mitral will not be used because it is an obvious clue.

■ All murmurs with “mitral” in their names are only described as located:

– on the apex of the heart or the apical area or

– on the 5th ICS on the left side of the sternum medial to the midclavicular line.

■ On the exam, only the systolic murmurs radiate (to the axilla in mitral regurgitation and to the

neck with aortic stenosis).

■ S3 is a sign for CHF; S4 is a sign of LVH.

■ A split S2 is best heard at the pulmonic area.

■ Memorize the mnemonic “Motivated Apple” to help you remember the names of the valves

that are responsible for producing S1 and S2.

■ Grading murmurs: First time thrill is palpated is at Grade IV.

■ If you forget on which side of the sternum the aortic or pulmonic area lies (left or right?):

– The “r” in aortic is for the “right side.”

– The “l” in pulmonic is for the “left side.”

■ Rule out AAA in an older male who has a pulsatile abdominal mass that is more than 3 cm in

width. The next step is to order an abdominal ultrasound and CT.

No EKG strips are included in the exam. Instead, the symptoms of the arrhythmia or its

appearance on the EKG strip will be described.

■ Atrial fibrillation and PAT are usually in the exams.

■ PAT and AF have many causes, such as alcohol intoxication, hyperthyroidism, stimulants

such as theophylline, decongestants, cocaine, and heart disease.

■ Learn the proper procedure to check for pulsus parodoxus.

Follow JNC 7 guidelines for both ANCC and AANPCP exams until JNC 8* is released.

■ Eye findings: Learn to distinguish the findings in hypertensive retinopathy (copper and silver

wire arterioles, AV nicking) from those in diabetic retinopathy (neovascularization, microaneurysms,

hard exudates, cotton wool spots).

■ Know how to treat isolated systolic HTN in the elderly.

■ To assess orthostatic hypotension, measure both the sitting AND standing BP.

■ Know the side effects of thiazide diuretics such as hyperglycemia, hyperuricemia,

hypertriglyceremia.

■ Spironolactone side effect of gynecomastia.

■ Memorize the numbers for a normal BP and for Stage I and II HTN.

■ ACE inhibitors: The drug of choice for diabetics, causes a dry cough (10%).

■ Careful when combining ACE inhibitors with potassium-sparing diuretics (i.e., triamterene,

spironolactone) because of increased risk for hyperkalemia.

■ Bilateral renal artery stenosis: ACE inhibitors will precipitate acute renal failure.

■ Alpha-blockers are not first-line drugs for HTN except if patient has preexisting BPH.

■ Women with HTN and osteopenia/osteoporosis should receive thiazides. Thiazides help bone

loss by slowing down calcium loss (from the bone) and stimulating osteoclasts.

A case of DVT will have a positive Homan’s sign (in the exam). In real-life practice, most

cases of DVT are asymptomatic.

■ Memorize INR of 2.0 to 3.0.

■ Learn how to manage elevated INR (see Table 7.1).

■ Memorize presentation of a patient with NYHA Class II heart disease.

Raynaud’s phenomenon: Think of the colors of the American flag as a reminder of this disorder.

■ Medicines for Raynaud’s phenomenon include calcium-channel blockers (nifedipine, amlodipine).

Advise all patients with hypertension (or prehypertension) to lower dietary salt intake.

■ Borderline cholesterol, high cholesterol, HDL, LDL goal for CHD or DM.

■ Low HDL (less than 40 mg/dL) is a risk factor of CHD even though total cholesterol, triglyceride,

and LDL are normal.

■ To lower triglycerides, advise patient to reduce intake of simple carbohydrates, junk foods,

and fried foods.

■ To increase HDL, increase aerobic-type exercises and take niacin.

■ Become familiar with dietary sources of magnesium, potassium, and calcium.

■ Niacin and fibrates are best at lowering triglycerides.

■ If patient has markedly high triglycerides (500 or higher), lower triglyceride first (niacin or

Tricor) before treating the high cholesterol and LDL levels. High triglycerides increase risk of

acute pancreatitis.

Pulmonary

First-line treatment for COPD (2011 guidelines) is an inhaled anticholinergic (Atrovent) AND/

OR a long-acting B2 agonist (salmeterol, formoterol).

■ Ipratropium (Atrovent) is an anticholinergic.

■ Salmeterol and formoterol are long-acting B2 agonists.

■ Do not use long-acting B2 agonists (salmeterol, formotorol) for rescue treatment.

■ The only drug class for rescue treatment is the short-acting B2 agonist (SABA), such as

albuterol and Xopenex.

■ The only treatment known to prolong life in COPD patients is supplemental oxygen therapy.

Recognize presentation of bacterial pneumonia versus atypical pneumonia.

■ The No. 1 bacterium in CAP is Streptococous pneumoniae (and No. 2 is Haemophilus

influenzae). Phlegm is rust-colored or blood-tinged.

■ The No. 1 bacterium in atypical pneumonia is Mycoplasma pneumoniae.

■ COPD: First-time treatment, start with Atrovent. Add salmeterol if poorly controlled.

■ COPD/smoker with pneumonia: More likely to have H. influenzae bacteria.

■ Know the drug classes of the meds used to treat acute bronchitis (such as antitussives, mucolytics,

and so on).

■ Presentation and treatment of pertussis (whooping cough).

■ Symptomatic treatment for acute bronchitis. Do not pick antibiotics as a treatment option for

acute bronchitis

A PPD result may be listed as 9.5 mm. If the patient falls under the 10-mm group, then it is

negative (by definition) unless the patient has the signs/symptoms and/or CXR findings suggestive

of TB.

■ Memorize the criteria for the 5-mm and 10-mm results.

■ Small children exposed to active TB have a high chance of coming down with the disease

Memorize factors needed to figure out PERF (use HAG mnemonic).

■ Do not confuse asthma “rescue” drugs with “long-term control or maintenance” drugs.

■ Remember that all asthmatics need a short-acting B2 agonist (i.e., albuterol).

■ Chronic use of high-dose inhaled steroids can cause osteoporosis, mild growth retardation in

children, glaucoma, cataracts, immune suppression, hypothalamic-pituitary-adrenal suppression,

and other effects.

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■ Recognize respiratory failure. Severe respiratory distress: tachypnea, disappearance of or

lack of wheezing, accessory muscle use, diaphoresis, and exhaustion.

■ First-line treatment for severe asthmatic exacerbation or respiratory distress is an adrenaline

injection.

 

Endocrine

If patient has elevated TSH (or very low TSH), next step is to order free T3 and T4 (free T4 is

low in hypothyroidism).

■ Starting dose of levothyroxine (Synthroid) is 25 mcg/day.

■ Check TSH every 6 to 8 weeks (do not order earlier than 6 weeks) to monitor treatment response.

■ Radioactive iodine treatment results in hypothyroidism for life. Supplemented with thyroid

hormone (i.e., Synthroid) for life.

■ PTU preferred for pregnant women.

■ Thyroid cancer risk factors (history of neck irradiation in childhood or a painless nodule larger

than 2.5 cm).

■ Chronic amenorrhea and hypermetabolism results in osteoporosis. Supplement: calcium with

vitamin D, weight-bearing exercises.

Do not use any oral antidiabetic drugs on type 1 diabetics.

■ Memorize the specific key findings of diabetes versus hypertension.

■ Moderate to severe heart disease or heart failure is a contraindication to glitizone drugs such

as Avandia or Actos because they cause water retention, which may precipitate CHF.

■ Mild type 2 diabetics do not need drug therapy if able to control blood glucose by diet and

exercise alone

Gastrointestinal 

Barrett’s esophagus is a precancer (esophageal cancer). Diagnosed by upper endoscopy

with biopsy.

■ Lifestyle factors to teach patient (no mints, avoid caffeine, etc.).

■ Cullen’s and Grey–Turner’s sign.

■ Acute pancreatitis classic pain (severe midepigastric radiates to midback).

■ Rovsing’s sign.

■ Acute appendicitis presentation.

■ Psoas and obturator signs positive for acute appendicitis.

■ How to perform psoas maneuver.

■ Distinguish whether question is about H. pylori negative ulcers or H. pylori positive ulcers.

■ Both treatment regimens have appeared on the exams before.

■ Barrett’s esophagus is a precursor for esophageal cancer.

■ Worrisome symptoms of esophageal cancer and PUD.

■ H. pylori serology IgG positive plus symptoms of PUD: Treat with antibiotics plus PPI.

■ Treatment as for acute diverticulitis.

■ IBS: Increase fiber intake.

■ There will be a serology question (as just shown). You will have to figure out what type of viral

hepatitis the patient has (A, B, or C). It is usually a patient with hepatitis B.

■ PCR tests are not antibody tests. They test for presence of viral RNA. A positive result means

that the virus is present.

■ Hepatitis C has highest risk of cirrhosis and liver cancer.

■ A lone elevation in the GGT is a sensitive indicator of possible alcoholism.

■ The alkaline phosphatase is normally elevated during the teen years.

■ A person must have hepatitis B to become infected with hepatitis D.

■ ALT more sensitive to liver damage than AST.

■ GERD and treatment.

 

Renal

 

■ Memorize definition of UTI (greater than 10,000 CFU/mL of one organism).

■ Recognize classic case of UTI and acute pyelonephritis.

■ Can use 3-day treatment for healthy women with uncomplicated UTIs.

■ WBC casts with proteinuria associated with pyelonephritis.

■ Become familiar with urinalysis results of UTIs.

■ Serum creatinine better measure of renal function compared with the BUN or BUN: creatinine

ratio. The eGFR is considered a good measure of renal function in primary care.

■ Right kidney sits lower than the left kidney because of displacement by the liver.

■ Large numbers of epithelial cells in the urine mean contamination.

■ Memorize the normal WBC count (10.5) and the neutrophil or segs (greater than 80%).

■ Neutrophils make up from 50% to 75% of all the WBCs in a sample.

■ If band forms (immature WBCs) are seen, it is indicative of a serious bacterial infection.

■ The serum creatinine and the GFR are preferred to BUN when checking renal function.

 

Neuro

Memorization tips on cranial nerves:

CN 1: You have one nose

CN 2: You have two eyes

CN 8: The number 8 stands for two ears sitting on top of each other

CN 11: The number reminds you of the shoulders shrugging together

■ Because cranial nerves are listed only by number on the test (not by name), the correct

chronological order is important. Memorize the mnemonic to guide you.

■ Herpes zoster infection (shingles) of CN 5 ophthalmic branch can result in corneal blindness.

■ Rash at tip of nose and the temple area: Rule out shingles infection of the trigeminal nerve.

■ Cranial nerves are listed by number only.

■ Write down on scratch paper with corresponding cranial nerve “numbers.”

■ Distinguish the drugs used for abortive treatment versus chronic prophylaxis.

■ Answer options may list the drug class instead of the generic name.

Recognize both Tinel’s and Phalen’s signs.

■ Learn classic presentation of CTS.

■ Headache treated with high-dosed oxygen is cluster headache.

■ Headache treated with high-dosed anticonvulsants is trigeminal neuralgia.

■ With the exception of muscle tension headaches, which are bilateral, all of the headaches

seen on the exam (and notes) are unilateral.

■ Muscle tension: Bandlike head pain; may last for days.

■ Migraine: Throbbing, nausea, photophobia, phonophobia.

■ Trigeminal neuralgia (tic douloureux): Pain on one side of face/cheek is precipitated by talking,

chewing, cold food, or cold air on affected area.

■ Temporal arteritis: Indurated temporal artery, pain behind eye/scalp.

■ Cluster: Only HA accompanied by tearing and nasal congestion; severe pain is behind one

eye/one side of head. Occurs several times a day. Spontaneously resolves. Seen more in

middle-aged males.

 

Hematological

■ The screening test for all anemias is the CBC (hemoglobin/hematocrit).

■ The diagnostic test for thalassemia and sickle cell anemia is the hemoglobin electrophoresis.

■ Learn to differentiate the lab results of thalassemia from iron-deficiency anemia.

■ If the ferritin level is low, the patient has iron-deficiency anemia.

■ If the ferritin level is normal to high, the patient has thalassemia minor/trait.

■ The ethnic background may not be “revealed” in a question about thalassemia.

 

■ Pernicious anemia (PA) results in:

– B12-deficiency anemia.

– Macrocytic/megaloblastic anemia.

– Neurologic symptoms.

■ A cheap screening test for sickle cell is the SickledexTM, but gold standard is hemoglobin

electrophoresis.

■ If the parietal antibody test (antiparietal antibody) and/or the intrinsic factor antibody test

(anti-intrinsic factor) are elevated, the patient has pernicious anemia.

Order both B12 and folate levels when evaluating MCV greater than 100 (even if no neurological

symptoms).

■ Pernicious anemia results in B12 deficiency.

■ Pernicious anemia is a macrocytic anemia.

■ Learn food groups for both folate and B12.

■ RBC size is described in many ways, such as:

– MCV less than 80: Microcytic and hypochromic RBCs, small and pale RBCs.

– MCV greater than 100: Macrocytes or macroovalocytes, larger than normal RBCs, or RBCs

with enlarged cytoplasms.

■ Ethnic background may not be mentioned in a thalassemia problem, or it may be a distractor.

■ Only B12-deficiency anemia has neurologic symptoms (tingling, numbness).

 

Ortho

■ To remember valgum, think of “gum stuck between the knees” (knock knees). Opposite is

varus or bowlegs.

■ Distinguish classic presentation differences between RA and OA. With RA, the joint stiffness

lasts longer. It involves multiple joints and has a symmetrical distribution. RA is accompanied

by systemic symptoms like fatigue, fever, normocytic anemia, etc.

 

 

 

■ Heberden’s and/or Bouchard’s nodes have appeared many times on the exam. Memorize the

location of each. The following may help:

– Heberden’s: The “-den” ending on the word is the letter “D” for DIP joint.

– By the process of elimination, Bouchard’s is on the PIP joint.

– Another way to distinguish them is by using the alphabet. The letter “B” comes before the

letter “H.” Therefore, Bouchard’s node comes before Heberden’s nodes.

■ Types of treatment methods used for DJD: Analgesics, NSAIDs (PO and topical), steroid

injection on inflamed joints (NO systemic/oral steroids), surgery (i.e., joint replacement).

■ Do not confuse OA treatment with treatment for RA.

■ Treatment for RA includes all DJD treatment methods plus systemic steroids, antimalarials

(Plaquenil), antimetabolites (methotrexate), biologics (Humira, Enbrel).

Uveitis: swelling of the uvea, the middle layer of the eye that supplies blood to the retina (refer

to ophthalmologist). Patient treated with high-dose steroids for several weeks.

■ Plaquenil is an antimalarial.

■ Methotrexate is a DMARD.

■ Presentation of RA, lab findings.

■ Baker’s cyst presentation.

■ Ankylosing spondilytis presentation.

■ Anterior uveitis is complication of RA, ankylosing spondylitis.

■ Presentation of cauda equina, refer to ED.

■ X-ray of knee does not show meniscal injury or any joint cartilage.

■ The gold standard test for assessing joint damage is the MRI.

 

Psych

■ Antipsychotics lead to an increased risk of obesity, type 2 diabetes, and hyperlipidemia,

metabolic syndrome, and hypothyroidism.

■ Learn how medication use should be monitored (see Table 15.2).

■ FDA Black Box Warnings of SSRIs and antipsychotics.

■ Diagnose bipolar disorder, depression, and anorexia.

■ MAOI and high-tyramine foods to avoid.

■ St. John’s wort is used for depression, menopausal symptoms, and others. Herb-drug interactions

of St. John’s wort are indinavir (protease inhibitor), cyclosporine, oral contraceptives,

SSRIs, TCAs, and others.

■ Kava-kava and/or valerian root are both used for anxiety and insomnia. Do not mix with benzodiazepines,

hypnotics, or any CNS depressants.

■ In general, there are now more questions on alternative treatments.

■ A question on the MMSE (or the MME) will describe an action (such as asking a patient to

spell “world” backwards). The exam will ask you to indicate the name of the tool that is being

used.

■ Know how to diagnose minor depression and major depression.

■ Psychotic symptoms include delusions and paranoia (disorganized speech and behavior).

Hallucinations are common (usually auditory) with loss of ego boundaries. Flat and restricted

affect with poor social skills. Executive function is very poor (ability to plan and organize day to-day

activities). Onset is usually around the second decade. Peak incidence is between 16

and 30 years of age.

Labs

■ Rule out organic causes. CBC, chemistry profile, TSH, folate and B12 levels, urinalysis.

Toxicology screen to rule out illicit drug use.

Treatment Plan

■ Refer to psychiatrist for evaluation and treatment. If psychotic, refer to the ED.

■ Psychotherapeutic drugs: Safety considerations.

Healthcare Budget Request – Executive Summary

Develop an executive summary and structure for a healthcare budget request for your new product or service idea by completing the following:

Part 1: Executive Summary

Using the Healthcare Budget Request Template, develop a 1- to 2-page executive summary that describes the issue or opportunity that you are analyzing. In your executive summary, you should:

• Describe the healthcare issue or opportunity you selected.

• Describe the stakeholder groups impacted by this issue/opportunity.

• Explain which stakeholder groups would most likely be responsible for helping you address the healthcare issue or opportunity you selected and why. Be specific and provide examples.

• Describe the healthcare product or service that you propose to address the identified gaps/opportunities and explain why. Healthcare Budget Request – Executive Summary.

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The instructions from the Healthcare Budget Request Workbook say:

Part 1: Executive Summary

Your executive summary will be a critical first component of your formal healthcare budget request. It will be your first real opportunity to sell leadership and other stakeholders on the value of your proposed product or service. Hence it should be persuasive. It should also be informative without explaining every facet in more detail that anyone cares to read up front. It should outline why the organization should invest resources in your idea. It should be specific and focus on results.

For the purposes of this Assignment, your executive summary should be 1-2 pages in length. Be sure to review the Learning Resources and conduct your own research to review samples of executive summaries (many examples can be found online).

Be sure to save your Executive Summary and submit it to the appropriate Assignment 2 Part 1 submission link by the due date specified in the classroom.

Part 2: Workbook Template

As you progress through this course on the development of a Healthcare Budget Request, you will apply financial ratios and other calculations to make the business case for your idea. In this component of the assignment, you will customize a spreadsheet workbook and prepare it for use in your analysis. To do this, you will:

• Review the Healthcare Budget Request Workbook Step-by-Step Guide found in the Resources.Follow the instructions in the guide, which will help you:

o Create a workbook tab for each analysis you will conduct in subsequent parts of your Healthcare Budget Request.

o Format your spreadsheet and presentation of results.

o Save and close the spreadsheet file.

Submit both Part 1 and Part 2 of your Assignment by Day 7 of Week 2.

The instructions from the Healthcare Budget Request Workbook say:

Part 2: Workbook Template

As you progress through this course on the development of your Healthcare Budget Request, you will apply financial ratios and other calculations to make the business case for your idea. In this Part 2 of this Assignment, you will develop a workbook that will be used in subsequent Assignments for use in your analysis. To do this:

1) Open a blank Excel workbook. Name this “lastname_firstname_assn2part2.xlsx” (where “lastname_firstname” is your last and first name).

2) Create a worksheet for each analysis you will conduct in subsequent parts of your Health Budget Request. Name each worksheet as follows:

• A3 Estimated Expenses

• A4 Budget Development

• A5 Ratio Analysis

• A6 Financial Statement Analysis

Healthcare Budget Request – Executive Summary

3) On each worksheet, include a title/header that reads similar to the following:

You may format these however you see fit, but you should make each worksheet presentable as these will be used by stakeholders considering your budget request.

4) Save and submit the workbook to the appropriate Assignment 2 Part B submission link by the due date specified in the classroom.

 

An Executive Summary for a Healthcare Business Opportunity Proposal for the Hospital Catering Company
Healthy Meals Inc
.

Executive Summary

Mission

Healthy Meals Inc. Is a hospital catering outsourcing company that purposes to fill the void in professional catering services offered to hospitals. To cut costs and concentrate on treating patients, many hospitals are now outsourcing patient catering services. Healthy meals Inc. will provide the best tailor-made and suitable meals to all patients of Pristine Hospital of Pasadena as per their nutritional requirements.

The Management

Healthy Meals Inc. will be incorporated in the state of Texas and based in Pasadena. It will be a limited liability company co-owned by myself and another investor/ investors who will get 30% equity on financing provided. That investor is you. I will be the Chief Executive Officer running the day-to-day business of the company. Directorship of the company will be shared on a 3:1 ratio between my team and the investor.

The Services

The company will deliver meals that conform to the requirements of the hospital patients as directed by their doctors. Diabetic patients will get suitable diabetic meals as will be renal patients, hypertensive patients, low-fat diet patients, and so on. This will be possible because I have a background in nursing. Market research done by my team has showed that many hospitals within Pasadena are willing to outsource catering services if convinced they will be professional, and the company has a health expert within its ranks. Healthcare Budget Request – Executive Summary.

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Start-up Financing

The business is looking for USD 300,000 to help with the start-up costs of the company. As co-owner and founder, I have set aside USD 150,000 from my own savings to go towards starting operating expenses and working capital.

References

Answer Man (2016).
It’s a dog-eat-dog world in food service
. Retrieved 9 March 2020 from
https://www.postbulletin.com/news/answer_man/answer-man-it-s-a-dog-eat-dog-world-in/article_8fb6b4c9-070a-532a-8e4b-02c56b65c2aa.html

CFI Education Inc. (2020).
Analysis of financial statements: A guide to analyzing financial statements for financial analysts
. Retrieved 9 March 2020 from
https://corporatefinanceinstitute.com/resources/knowledge/finance/analysis-of-financial-statements/

MyAccountingCourse.com. (2019). Financial ratio analysis. Retrieved 9 March 2020 from

Financial Ratio Analysis

Nix, K. (2012).
Pristine hospital coming to Pasadena’s north side
. Retrieved 9 March 2020 from
https://www.chron.com/neighborhood/pasadena/news/article/Pristine-Hospital-coming-to-Pasadena-s-north-9555222.php

Roberts, J.G., Henderson, J.G., Olive, L.A. &  Obaka, D. (2013). A review of outsourcing of services in healthcare organizations.
Journal of Outsourcing & Organizational Information Management
. Doi: 10.5171/2013.985197

 

Executive Summary

Mission

Nurse On Wheels Inc. is a company that specialises in offering private nursing services to those who need it. The company purposes to fill the void in professional freelance nursing services where one can hire a nurse for the period of time they need her without necessarily having to employ her. Nurse On Wheels Inc. therefore targets to be the best freelance nursing service in the whole of the United States.

The Management

Nurse On Wheels Inc. will be incorporated in the state of Texas and based in Pasadena. It will be a limited liability company co-owned by myself and another investor/ investors who will get 30% equity on financing provided. That investor is you. I will be the Chief Executive Officer running the day-to-day business of the company. Directorship of the company will be shared on a 3:1 ratio between my team and the investor.

The Services

The company will provide nursing care services on short contracts for the period of time desired by the client. They will then only pay for the services as our company will equip the nurse with the equipments they need such as a stethoscope, digital thermometer, and a sphygmomanometer. Examples of potential clients for the company include families of bedridden patients who have been discharged but will need home nursing care, aged persons whose families require home nursing services, and sick persons travelling by air requiring a nurse escort among others. Market research done by my team has showed that many people are from time to time in need of private nursing services but find it hard to make arrangements with nurses who are formally employed elsewhere. Healthcare Budget Request – Executive Summary.

Start-up Financing

The business is looking for USD 300,000 to help with the start-up costs of the company. As co-owner and founder, I have set aside USD 150,000 from my own savings to go towards starting operating expenses and working capital.

References

CFI Education Inc. (2020).
Analysis of financial statements: A guide to analyzing financial statements for financial analysts
. Retrieved 9 March 2020 from
https://corporatefinanceinstitute.com/resources/knowledge/finance/analysis-of-financial-statements/

Jooble (n.d.).
Private nurse jobs in the United States
. Retrieved 9 March 2020 from
https://jooble.org/jobs-private-nurse/United-States

Learn4Good (n.d.).
Private duty nurse jobs in USA: Search and apply or post jobs for free
. Retrieved 9 March 2020 from
https://www.learn4good.com/jobs/privatedutynurse/usa_united_states/postings/

MyAccountingCourse.com. (2019). Financial ratio analysis. Retrieved 9 March 2020 from

Financial Ratio Analysis

UPMC (2020).
Private duty nursing
. Retrieved 9 March 2020 from
https://www.upmc.com/services/aginginstitute/resources-for-caregivers/senior-living-and-home-based-care-options/home-based-care-services/private-duty-nursing

 

 

An Executive Summary for a Healthcare Business Opportunity Proposal for the Private Nursing Services Company
Nurse On Wheels Inc
. Healthcare Budget Request – Executive Summary.

Executive Summary

Mission/ Healthcare Service Proposed

Nurse On Wheels Inc. is a company that will specialise in offering private nursing services to those who need it. Nurse On Wheels Inc. therefore targets to be the best freelance nursing service in the whole of the United States.

Identified Gap/ Opportunity

The company purposes to fill the void in professional freelance (private) nursing services where one can hire a nurse for the period of time they need her without necessarily having to employ her.

The Management

Nurse On Wheels Inc. will be incorporated in the state of Texas and based in Pasadena. It will be a limited liability company co-owned by myself and another investor/ investors who will get 30% equity on financing provided. That investor is you. I will be the Chief Executive Officer running the day-to-day business of the company. Directorship of the company will be shared on a 3:1 ratio between my team and the investor.

The Services

The company will provide nursing care services on short contracts for the period of time desired by the client. They will then only pay for the services as our company will equip the nurse with the equipments they need such as a stethoscope, digital thermometer, and a sphygmomanometer. Healthcare Budget Request – Executive Summary. Examples of potential clients for the company include families of bedridden patients who have been discharged but will need home nursing care, aged persons whose families require home nursing services, and sick persons travelling by air requiring a nurse escort among others. Market research done by my team has showed that many people are from time to time in need of private nursing services but find it hard to make arrangements with nurses who are formally employed elsewhere.

Stakeholders

Stakeholders who will be most impacted by this opportunity are persons with chronic illnesses who may need home care nursing for particular periods of time until remission of their condition. These are, for instance, patients with cystic fibrosis post intensive care ventilatory support who want to reduce hospitalisation costs by continuing care at home until full recovery from the respiratory episode. v.

The stakeholder groups that would be of most of assistance in helping me address this healthcare issue are the state regulatory and licensing authorities like the State Nursing Board. Their agreement to register and license the practice will be the starting point in enabling me to address this issue.

Start-up Financing

The business is looking for USD 300,000 to help with the start-up costs of the company. As co-owner and founder, I have set aside USD 150,000 from my own savings to go towards starting operating expenses and working capital.

References

CFI Education Inc. (2020).
Analysis of financial statements: A guide to analyzing financial statements for financial analysts
. Retrieved 9 March 2020 from
https://corporatefinanceinstitute.com/resources/knowledge/finance/analysis-of-financial-statements/

Jooble (n.d.).
Private nurse jobs in the United States
. Retrieved 9 March 2020 from
https://jooble.org/jobs-private-nurse/United-States

Learn4Good (n.d.).
Private duty nurse jobs in USA: Search and apply or post jobs for free
. Retrieved 9 March 2020 from
https://www.learn4good.com/jobs/privatedutynurse/usa_united_states/postings/

MyAccountingCourse.com. (2019). Financial ratio analysis. Retrieved 9 March 2020 from

Financial Ratio Analysis

UPMC (2020).
Private duty nursing
. Retrieved 9 March 2020 from
https://www.upmc.com/services/aginginstitute/resources-for-caregivers/senior-living-and-home-based-care-options/home-based-care-services/private-duty-nursing  
 Healthcare Budget Request – Executive Summary

abd dx and tx plans nurs 623 essays

Acute Gastroenteritis

Acute infection causing inflammation of the stomach and intestinal lining resulting in vomiting, diarrhea, and fever. Infection is by fecal-oral route or respiratory route. Pathogens invade the intestinal mucosa, resulting in a decreased area available for fluid absorption.

Viruses (most common), bacteria, and parasites are responsible.

Rotavirus most common in age <1 but found in adults too. The other 3 most common pathogens in adults are: norovirus, enteric adenovirus, and astrovirus. Bacterial infections are less common, but usually more severe. Campylobacter jejuni most common in children Salmonella most common cause of food borne illness in US Other common pathogens: shigella, Escherichia coli, Yersinia enterocolitica, clostridium difficile Parasitic Giardia Iamblia most common parasitic agent in US Cryptosporidium abd dx and tx plans nurs 623 essays ORDER A PLAGIARISM-FREE PAPER HERE Risk factors Improper handwashing and food preparation, daycare center attendance, recent use of antibiotics or hospitalization (C. difficile common), lack of sanitation, immunocompromised status, recent travel to developing countries Assessment findings Hyperactive bowel sounds, diarrhea (3 or more loose stools in 24 hours), blood in stool, white cells in stool (common with salmonella, shigella, and campylobacter), nausea and vomiting usually precede diarrhea, anorexia, fever, tenesmus (strong urge to defecate caused by and anal sphincter spasm), and fecal incontinence with C. difficile, abdominal cramps, dehydration (poor skin turgor, dry mucus membranes, flattened or sunken fontanels, tachycardia, tachypnea, oliguria), lethargy, pale skin color Differential diagnosis Viral, bacterial, parasitic, inflammatory bowel disease, medication/food intolerances, appendicitis, IBS, fecal impaction Diagnostic studies Usually none unless symptoms are severe and last > 48 hours,

stool for WBC: rare scattered leukocytes are normal; may suggest crohn’s disease, ulcerative colitis, ischemic colitis, shigella, salmonella, campylobacter

stool cultures: shigella, salmonella, campylobacter, E. coli most commonly identified

blood or mucus present in stool

stool for ova and parasites

urinalysis, culture, and sensitivity

abd dx and tx plans nurs 623 essays

in infants and elderly consider assessment for dehydration: BUN, specific gravity, electrolytes

Prevention

Hygiene, avoidance of risk factors, Shigella: culture all symptomatic contacts and treat those with positive stool cultures; report to local health department

Nonpharmacological management

Correct dehydration, orally if possible

Mild dehydration (3-5% volume loss): 50 mL/kg or 5 teaspoons per pound over 4 hours

Moderate dehydration (6-9% volume loss): 100 mL/kg or 10 teaspoons/pound over 4 hours

Rehydrating with soft drinks, gelatin, and apple juice is not advisable due to the high carbs, low electrolyte composition; commercially prepared rehydration products help avoid this problem Pedialyte, CeraLyte, Infalyte

Age appropriate diet ASAP

Reintroduce solid foods within 24 hours of onset of diarrhea

BRAT diet no longer recommended because it provides inadequate protein, fat, and calories

May develop temporary lactose intolerance and post infectious irritable bowel syndrome (IBS)

Monitor oral intake, urine output, and bowel movements, count wet diapers

Pharmacologic Management

Use of antidiarrheal agents is discouraged; the offending agent must be excreted.

aureus- antibiotics not recommended

Salmonella- antibiotics not recommended because it prolongs carrier state y slowing excretion or organisms, treatment recommended (Bactrim or ciprofloxacin for patients with valvular heart disease, immunocompromised states.

Shigella- Bactrim BID for 3-5 days; if acquired outside US ciprofloxacin for 10 days

coli- Bactrim Bid for 3 days, may use ciprofloxacin in adults

Campylobacter- erythromycin QID for 5 days or cipro BID for 7 days

Giardia (Protozoa)- Metronidazole 250 mg TID for 5-7 days

Difficile- Metronidazole 500 mg 3-4 times daily for 10-14 days for mild to moderate; vancomycin 125 mg every 6 hours for 10-14 days for first episode; fecal transplant for resistance/recurrence. Questran for diarrhea

Antiemetic

Promethazine adult 12.5-25 mg every 4-6 hours prn; children 2 years or older 0.5 mg/kg at 4-6 hr intervals max 25 mg

May cause fatal respiratory depression in children. Do not use in children under 2

Pregnancy category C

Cautious use in dehydrated patient

Cautious use in sleep apnea, asthma, lower respiratory disorders, glaucoma, GI or urinary obstruction

Potentiates CNS depression

If given IM, must be a deep IM injection

Selective 5-HT3 receptor antagonist

Ondansetron adult 8 mg q 8 hours; children 4-11 years 4 mg q 4 hours

For prevention of nausea/vomiting

Not recommended for children under 4 years of age

N/V associated with chemotherapy

Pregnancy/Lactation Considerations

Antibiotics indicated when there is a bacterial pathogen identified, refer if there is dehydration, intractable symptoms, or bloody diarrhea

Consultation/referral

Parenteral rehydration for intractable symptoms, neurologic symptoms, severe abdominal pain

Follow-up

Telephone contact within 24 hours, 3 days

abd dx and tx plans nurs 623 essays

Expected course

Both viral and bacterial gastroenteritis is usually self-limiting and resolves without medication in 5 days unless patient is at age extremes or immunocompromised, Salmonella and C. difficile infections: diarrhea may continue for up to 2 weeks

Possible complications

Cardiovascular from dehydration and acidosis, colonic perforation/septicemia, carrier state abd dx and tx plans nurs 623 essays.

 

Appendicitis

Inflammation of the veriform appendix, which is a projection from the apex of the cecum. Obstruction of the appendix secondary to stool, inflammation, stricture, foreign body, or neoplasm. The obstructed lumen prevents drainage. The resultant increased pressure decreases mucosal blood flow, and the appendix becomes hypoxic. Most common between ages 5-50 years, males>females.

Risk Factors

Family history, abdominal neoplasm

Assessment findings

Abdominal pain, usually severe and initially throughout the abdomen, or periumbilical area, later becomes localized to the right lower quadrant (RLQ). Anorexia, abdominal pain, nausea, and vomiting are most common symptoms (in this order). Constipation and diarrhea occur after the pain. Maximum abdominal tenderness and rigidity occurs over the right rectus muscle (McBurney’s point). Psoas sign: pain with right thigh extension. Obturator sign: pain with internal rotation of flexed right thigh. abd dx and tx plans nurs 623 essays. Fever, usually 99-101F (37.2-38.3 C). Patients frequently flex the right lower extremity when supine to relieve muscle tension. May have urinary frequency, urgency, and dysuria. Decreased bowel sounds. Elderly may present with weakness, anorexia, tachycardia, and abdominal distention.

A rectal exam should be performed on all patients with suspected appendicitis. Retrocecal appendix presents with tenderness on rectal exam.

A pelvic exam on all females with lower abdominal pain to rule out PID, adnexal mass, ectopic pregnancy, or uterine pathology.

Differential diagnosis

Mittelschmerz, ruptured etopic pregnancy, PID, gastroenteritis, gastric ulcer, duodenal ulcer, cholecystitis, urinary tract infection, Inflammatory bowel disease, recurrent abdominal pain, renal calculi

Diverticulitis, ileitis, inflammatory bowel disease and some GYN disorders can present with right sided abdominal pain.

Diagnostic studies

Urinalysis: may be positive for RBC and leukocytes

CBC: elevated WBC count indicates possible perforation

Urine pregnancy test: negative

KUB: may show gas filled appendix

CT scan: diagnostic test of choice in adults

Ultrasound is imaging study of choice in children

abd dx and tx plans nurs 623 essays

Nonpharmacologic management

Keep NPO

Instruct to refrain from using laxative, enemas, or from applying heat to abdomen

Prompt surgery is the treatment of choice: appendectomy

Pharmacological management

Preoperative antibiotics may be prescribed by surgeon (ex cefoxitin)

Consultant/referral

Prompt surgical referral

Follow-up

Routine postoperative assessment: 2 weeks, 6 weeks. May require postoperative antibiotics if perforation has occurred

Expected course

Quick recovery usually follows surgery. Activity should be restricted for 2-6 weeks

Possible complications

Ruptured appendix (often manifested by cessation of pain), abscess, peritonitis

abd dx and tx plans nurs 623 essays

Cholecystitis

Inflammation of the gallbladder usually associated with gallstone disease; can be acute or chronic. Gallstone obstructs the gallbladder-cystic duct junction; results in inflammation (90-95%) and acute pain. In a smaller number of cases, gallbladder inflammation occurs without stone formation. Obstruction of common bile duct can cause jaundice, light colored stools, and biliary colic. Obstruction of pancreatic duct can produce pancreatitis, pain over the abdomen, nausea and vomiting. Gallbladder sludge. Incidence increases with age and BMI; most common in ages 50-70 years females>males (2:1), very common in Native Americans.

Risk Factors

Pregnancy, rapid weight loss, obesity, gallstones, surgery or trauma, sickle cell anemia, parenteral alimentation over prolonged period.

Assessment findings

Patients are usually ill appearing, febrile, and tachycardic, murphy’s sign: inspiratory arrest with deep palpation of right upper quadrant (RUQ) (classic sign), RUQ pain, may be unremitting, with or without rebound pain, may radiate to right shoulder or subscapular area. Nausea and vomiting/anorexia. Attack follows meal (especially high fat) by 1-6 hours. Low grade fever, palpable RUQ mass. abd dx and tx plans nurs 623 essays.

A patient with acute cholecystitis usually lies very still because peritoneal inflammation is present and worsens with movement.

Differential diagnosis

PUD, cardiac disease, pancreatitis, hepatitis, bowel obstruction, appendicitis

Fatty food intolerance that produces pain, belching, a few minutes after eating is NOT typical of gallbladder disease.

Diagnostic studies

Ultrasound is most sensitive and specific to test to diagnose cholecystitis

Ultrasound demonstrates presence of gallstones, thickening of wall of gallbladder (4-5 mm), fluid, and enlargement.

HIDA scan helpful if ultrasound is negative but patient is suspected of having cholecystitis (positive scan demonstrates gallbladder disease if the gallbladder is unable to be visualized due to cystic duct obstruction)

Magnetic Resonance Cholangiopancreatography (MRCP, type of MRI that provides detailed images of hepatobiliary and pancreatic systems)

Endoscopic retrograde Cholangiopancreatography (ERCP) used to see biliary and pancreatic ducts to detect common bile stones. Usually this is performed after a MRCP for choledocholithiasis.

A HIDA scan cholescintigraphy is indicated if the diagnosis of gallbladder disease is still considered and the ultrasound is negative. abd dx and tx plans nurs 623 essays.

Prevention

Avoid risk factors, during parenteral feedings, administer cholestyramine (Questran) daily.

Nonpharmacological management

Severe attacks: nothing by mouth

Mild attacks: avoid fatty meals

Nasogastric tube for persistent nausea or abdominal distention

Laparoscopic or open cholecystectomy within 72 hours of diagnosis

Pharmacological management

Endogenous bile acids

Bile acid (Actigall) adults: 8-10 mg/kg per day in 2-3 divided doses; prevention 300 mg twice daily

Pregnancy category B

Not for calcified, radio-opaque or radiolucent bile pigment stones

Obtain sonogram at 6 and 12 months

After complete dissolution, repeat sonogram in 1-3 months then discontinue

Used to prevent gallstone formation in patients undergoing rapid weight loss

Measure liver enzymes at 1 and 3 months, then q 6 months while taking

Bile acid (Urso forte) adults: 13-15 mg/kg per day in 2-4 divided doses

Pregnancy category B

Take with food

Reduced absorption with bile acid sequestrants and aluminum containing antacids

Not for calcified, radio-opaque or radiolucent bile pigment stones

Obtain sonogram at 6 and 12 months

After complete dissolution repeat sonogram in 1-3 months then discontinue

Used to prevent gallstone formation in patients undergoing rapid weight loss

Measure liver enzymes at 1 and 3 months, then q 6 months while taking

abd dx and tx plans nurs 623 essays

Antiemetic

Promethazine adult 12.5-25 mg every 4-6 hours prn; children 2 years or older 0.5 mg/kg at 4-6 hr intervals max 25 mg

May cause fatal respiratory depression in children. Do not use in children under 2

Pregnancy category C

Cautious use in dehydrated patient

Cautious use in sleep apnea, asthma, lower respiratory disorders, glaucoma, GI or urinary obstruction

Potentiates CNS depression

If given IM, must be a deep IM injection

Selective 5-HT3 receptor antagonist

Ondansetron adult 8 mg q 8 hours; children 4-11 years 4 mg q 4 hours

For prevention of nausea/vomiting

Not recommended for children under 4 years of age

N/V associated with chemotherapy

Consultation/referral

Outpatient if mild symptoms, surgeon if biliary colic >6 hr, toxic appearing, or intractable pain.

Follow-up

Throughout postoperative period

Expected course

Stones may recur in bile ducts after cholecystectomy

Possible complications

Empyema of the gallbladder: bacterial invasion of the gallbladder. Emphysematous cholecystitis: infection with a gas-forming bacterium. Perforation: requires aggressive fluid replacement, antibiotics and emergency surgical exploration. Cholecystenteric fistula: gallbladder perforates into duodenum or colon; should be treated as a bowel obstruction with fluid replacement, nasogastric suction, and surgical exploration.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Inflammatory bowel disease

Inflammatory bowel diseases are chronic disorders of the GI tract distinguished by the recurrent inflammatory involvement of the intestinal segments. Teo main types are Crohns disease and ulcerative colitis.

Crohn’s disease

Chronic, slowly progressive transmural inflammation of the gastrointestinal tract, small intestine (most common), and/or large intestine, often involving the terminal ileum; disease ranges from mild to refractory in severity. Typically, several locations of the intestines with sections in between are unaffected. Idiopathic. Females>males, % have family history, Caucasians>African-Americans or Asians, peak age at onset is 15-25 years, then smaller peak at 55-65 years. Three to six-fold increased incidence in Ashkenazi Jewish population.

Risk factors

Family history, cigarette smoking

Assessment findings

Diarrhea (including nocturnal), fever, abdominal pain and tenderness, ulcers of the intestine or mouth, fatigue, weight loss, abdominal mass, fistulas, intestinal obstruction (uncommon), hematochezia, megacolon, extracolonic disease: uveitis, arthritis, dermatitis, sclerosing cholangitis (<10%), joint swelling, hepatosplenomegaly, bone age in children usually delayed by 2 years The hallmark of Crohns disease are fatigue, abdominal pain, and prolonged diarrhea with or without bleeding, weight loss, and fever. Differential diagnosis Ulcerative colitis, NSAID adverse effects, enteritis, intestinal pathogenic bacteria, malignancy, IBS, appendicitis, PUD, renal colic, celiac sprue, diverticulitis Diagnostic studies Colonoscopy with biopsy: submucosal inflammation with pseudopolyps, edema, and strictures; biopsy often reveals granulomatous inflammation Flexible sigmoidoscopy CT scan or CT enterography MRI or MRI enterography Antiglycan antibody: elevated in 75% of cases Barium X-rays Capsule endoscopy if suspicious of diagnosis despite other tests being negative Sedimentation rate: elevated CBC: anemia Albumin: below normal if severe disease Electrolytes: imbalances B12, folate: deficient Stool for leukocytes, culture and sensitivity, C. difficile, ova and parasites to rule out other causes for symptoms Fecal occult blood test Nonpharmacologic management Maintain nutrition and weight: May be helpful to decrease fat and increase fiber to treat diarrhea; fiber can be a trigger as well Low lactose diet for small intestine involvement Avoid caffeine, alcohol, nuts, seeds Sitz baths helpful if perirectal disease present Drainage of perirectal abscess if present Manage extracolonic manifestations Refer to crohns and colitis foundation of America for information and support www.ccfa.org Surgery when indicated Abscess Intestinal obstruction Ostomy placement Pharmacologic management Mesalamine (asacol, pentasa, rowasa) or sulfasalazine (Azulfidine, salazopyrin) is used for maintenance and is taken daily Antibiotics (if perirectal involvement): metronidazole (flagyl) reduces bacteria, granuloma formation Corticosteroids short-term for moderate to severe disease or budesonide x 8 weeks Immunosuppressant such as Imuran or mercaptopurine methotrexate for severe, progressive disease Biologics such as humira or remicade alone or in conjunction with Imuran Folate supplement while taking sulfasalazine, which inhibits folate absorption Antispasmotics and antidiarrheals may be helpful Pregnancy/lactation considerations Pregnancy not contraindicates, long term sulfasalazine therapy is associates with reversible sterility in males Consultation/referral Gastroenterologist Follow-up Frequency dependent on severity Monitor weight, symptoms, CBC, sedimentation rate, Vitamin B12, folate levels Changes in weight, increase in severity of symptoms, and colonoscopy findings are helpful in determining need to increase or decrease medications Endoscopy indicated if symptoms change Annual liver function tests Expected course Chronic illness with recurrences and exacerbations. Surgery usually needed every 4-7 years for the average patient. Full activities and normal, but often shortened life can be expected. Possible complications Fistulae, colon perforation, toxic megacolon, adenocarcinoma, malnutrition, bowel obstruction, ulcers, anal fissure     Diverticulitis Diverticula, outpouchings that can occur along the wall of the large intestine, become infected, with resultant inflammation. Aerobic and anaerobic bacteria invade diverticula. Chronic, low grade inflammation contributes to recurrence of diverticulitis. Diverticulosis, the presence of diverticula, is common; especially in Western cultures where low fiber diets predominate and incidence increases with age. 2,200-3,000/100,000 in US. Risk factors Low fiber diet, low residue diet, diverticulosis, age >50, smoking, NSAID/Aspirin use

Assessment findings

Abdominal pain (due to tension in the wall of the colon), typically left lower quadrant, with or without palpable mass. Rebound tenderness, board like rigidity, anorexia, nausea and vomiting, diarrhea, constipation, bloating, gas, abdominal distention, fever, chills abd dx and tx plans nurs 623 essays.

Differential diagnosis

Gynecologic disorders, urologic disorders, appendicitis, ulcerative colitis, lactose intolerance, Crohns disease, IBS, colon cancer, infective colitis, ischemic colitis

ORDER A PLAGIARISM-FREE PAPER HERE

Diagnostic studies

Abdominal computed tomography (CT) scan, with or without contrast, is least expensive and provides the most information about presence, location, and extent of inflammation but cannot detect presence of bleeding. Not indicated if recurrent disease with good response to treatment

Barium enema used to diagnosis diverticulosis

CBC: leukocytosis

Sed rate elevated

Colonoscopy/ flexible sigmoidoscopy to rule out malignancy, ulcerative colitis, or ischemic colitis

Colonoscopy and flexible sigmoidoscopy are usually contraindicated during acute diverticular episode. Generally, a colonoscopy is performed about 6 weeks after the acute episode to allow the colon to heal before insufflating the colon.

Prevention

High fiber diet (but not proven)

Many patients have been advised to avoid seeds, nuts, corn because they could become lodged in a diverticula and produce diverticulitis. Most colorectal surgeons do not believe that these should be avoided but some patients swear they are triggers. abd dx and tx plans nurs 623 essays.

Nonpharmacologic management

Bowel rest and relaxation

NPO during acute episode, advance to clear liquids in small volume at frequent intervals for 3 days, low residue diet 5-7 days, then slowly advance to high fiber diet

Surgery may be indicated if patient experiences frequent recurrences

Recommend high fiber diet

Pharmacologic management

Ciprofloxacin and metronidazole given in combination for outpatient treatment

IV antibiotics given for severe symptoms/infection

Anti-infectives

Ciprofloxacin 500 mg bid for 7-14 days

Pregnancy category C

Quinolones are associated with increased risk of tendon rupture in all ages

Cipro XR is only indicated for UTI. Use ciprofloxacin for diverticulitis

Dosage adjustment needed for renal impairment

Quinolones should not be used for pediatric patients

Drug interactions with theophylline, methylxanthines, glyburide, NSAIDS and others

Metronidazole adult: 500 mg q 6-8 hr for 7-14 days max: 4g/24 hr; 750 mg tid for 7-10 days

Pregnancy category B

Alcohol should be avoided while taking metronidazole and for at least 3 days after last dose

Potentiates the anticoagulant effect of warfarin and other anticoagulants

Dosage adjustment for renal impairment

abd dx and tx plans nurs 623 essays

Consultation/referral

Gastroenterologist if moderate or severe symptoms exist

Indications for surgical consult

Severe, repeated, or extensive disease

Carcinoma suspected

Abdominal drainage

Expected course

Symptoms completely resolve in 1-2 weeks, greater than 2/3 of patients fully recover without recurrence, and colon resection is almost always curative

Possible complications

Perforation, abscess formation, sepsis, enteroenteric or enterovesical fistula, peritonitis, bowel obstruction

 

Non-alcoholic fatty liver disease

A diagnosis of NAFLD can be made when other causes of liver disease have been excluded by either imaging or biopsy.

Thought to be related to “two hits theory”. First occurs due to insulin resistance and altered lipid metabolism resulting in fatty acids infiltrating the liver. Proinflammatory cytokines (tumor necrosis factor [TNF]-alpha and interleukin-6) and endotoxins are released causing oxidative stress and inflammation, and later steatohepatitis. Poor dietary choices (high cholesterol foods, sugary foods, especially fructose) can worsen the process. Inflammation causes more liver injury, which can result in fibrosis, and later cirrhosis and/or hepatocellular carcinoma. Three genes were discovered that have polymorphisms which contribute to the development of nonalcoholic steatohepatitis (NASH). In western countries, NAFLD is the most common liver disorder. 20% of the population is affected worldwide. 25% of Americans are affected. The most common form of liver disease for pediatric patients (3-11% od children) abd dx and tx plans nurs 623 essays.

Risk factors

Insulin resistance, metabolic syndrome, obesity, type 2 DM, CVD, HTN, dyslipidemia, particularly high triglycerides and/or low-density lipoprotein levels, male gender, older age, Hispanic ethnicity, genetic disposition

Assessment findings

Penetration of fat into liver cells (hepatic steatosis) that may result in inflammation and/or fibrosis of the liver. It can progress to cirrhosis. Disease is divided into nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). NASH is differentiated from NAFL because it is associated with significant hepatic inflammation.

Most are asymptomatic

Mild abdominal pain, particularly RUQ

Nausea

Fatigue

Dorsocervical lipohypertrophy

Elevated liver enzymes (particularly ALT> AST)

Jaundice

Pruritis

Hepatomegaly

Assessment should include a thorough review of onset of symptoms and social history (alcohol consumption, illicit drug use, history of blood transfusions, and sexual history).

Differential diagnosis

Alcohol fatty liver disease, viral hepatitis, starvation, drug related liver injury, pregnancy, autoimmune hepatitis, iron overload

Diagnostic studies

Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI): all can identify hepatic steatosis

Transient elastography: used to determine degree of liver fibrosis

Gold standard for diagnosis is liver biopsy and should be considered for patients who have elevated liver enzymes

Laboratory studies

No biomarker currently available for diagnosis

Liver function test (LFTs): may be elevated

Ferritin and uric acid levels: may be elevated

Laboratory studies to exclude other liver diseases

Total protein

Alanine transaminase (ALT)

Aspartate transaminase (AST)

Alkaline phosphatase

Albumin

Total and direct bilirubin

Viral hepatitis serologies (Hepatitis A IgG/IgM, Hepatitis B surface antigen Hepatitis B surface antibody, hepatitis B core antibody, hepatitis C antibody)

Ferritin

Total iron (plasma)

Iron binding capacity

Fasting glucose

Hemoglobin A1C

Lipid panel, including low-density lipoprotein cholesterol

Prothrombin time

Autoimmune markers (serum gammaglobulin level, antinuclear antibody, antismooth muscle antibody, and anti-liver/kidney microsomal antibody-1).

Prevention

Adequate treatment of other comorbidities (diabetes, obesity, hyperlipidemia, hypertension). Good, balanced nutrition (avoidance of high sugary and fatty foods). Hepatitis A and B vaccinations. A high rate of fatal cardiovascular events occur in patients who have NAFL.

Nonpharmacologic management

Mainstay of treatment is lifestyle changes, including diet modifications and increasing physical activity

Avoid alcohol consumption

Dietary changes, including decreasing calorie intake, low fat/low cholesterol diet and avoiding trans fats and high fructose corn syrup

Exercise (moderate physical exercise 3-4 times per week)

>3% weight loss has been shown to reduce hepatic steatosis

Support groups have been proven helpful to make necessary lifestyle changes

Psychosocial therapy is available to help with weight loss

abd dx and tx plans nurs 623 essays

Pharmacologic management

There are no current medications FDA approved for the treatment of NASH

Consultation/referral

If steatohepatitis is found on liver biopsy, referral to a gastroenterologist/hepatologist is recommended

If cirrhosis is found on liver biopsy, consider referral to a hepatologist, preferably a transplant center

Follow-up

Close follow-up ad management of other comorbidities is suggested. Weight management and physical activity should be logged and discussed at every follow up visit.

Expected course

Most common cause of death in this patient group is related to cardiovascular related events. Patients with NASH have a higher risk of liver related mortality.

Possible complications

Hepatocellular carcinoma, cirrhosis

abd dx and tx plans nurs 623 essays

 

 

Gastroesophageal reflux (GER) Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux (GER): movement of gastrointestinal contents up the esophagus or larynx facilitated by decreased lower esophageal sphincter (LES) tone. Some reflux is physiologic

Gastroesophageal reflux disease (GERD): gastric contents reflux into the esophagus or oropharynx and symptoms occur. abd dx and tx plans nurs 623 essays.

Affects up to a third of Americans at some time in their lives. Affects 81% of patients 60 years or older, common in pregnant patients. Recurrent vomiting occurs. Small minority of infants develop GERD. ER: common in pediatrics. GERD: little is known about prevalence in children and adolescents.

Risk factors

Factors which may reduce LES tone

Alcohol

Anticholinergic medications

Calcium channel blockers

Chocolate, peppermint

Fatty, spicy, and citrus foods

Hormones: estrogen, progesterone, glucagon, secretin

Obesity

Pregnancy

Meperidine

Nicotine

Theophylline

Childhood GERD predisposes GERD in adolescence and adulthood

Risk factors for GERD during childhood:

Neurologic disorder (cerebral palsy)

Congenital malformation (esophageal atresia or trachea-esophageal fistula)

Severe chronic pulmonary disease (cystic fibrosis)

Aging

Zenker’s diverticulum

Irritation of esophageal mucosa by

NSAIDS

Tetracycline

Quinidine

Caffeine

Increased gastric acid secretion: acidic foods

Delay in gastric emptying: fatty foods

Zollinger-Ellison syndrome

Obesity

Diabetes mellitus, diabetic gastroparesis

Assessment findings

Pyrosis (heartburn) is cardinal symptom, burning beneath sternum, typically postpradial and nocturnal

Regurgitation, (“sour, hot”): 60%

Chest pain: 33% send for cardiac workup

Dysphagia (present in longstanding heartburn): 15-20%

Esophageal pain referred to neck, mid back, and upper abdomen

Chronic cough, PND, clearing throat (common to have and all three)

Chronic sore throat/hoarseness

Erosion of teeth by acid

Ulceration: hematemesis, fatigue, anemia

Barrett’s esophagitis (small number of patients): replacement of the squamous epithelium of the esophagus by columnar epithelium, which may be further complicated by adenocarcinoma in 1-5% of cases

abd dx and tx plans nurs 623 essays

Infants

Recurring vomiting

Poor weight gain or weight loss

Irritability or excessive crying

Disturbed sleep

Dysphagia or refusal to eat

Arching of back during feeding

Respiratory problems/stridor

Apnea

Apparent life threatening events (ALTE)

Child or adolescent

Recurrent vomiting or regurgitation

Heartburn or chest pain

Hoarseness

Bilious vomiting and hematemesis are RED flags in children

Differential diagnosis

Cardiac disease, esophageal spasm or infection, cholelithiasis, PUD, lower respiratory infection: bronchitis, pneumonia, asthma, pulmonary edema

In infants and children consider gastrointestinal obstruction, gastrointestinal disorders, infectious disease, neurologic disorders, metabolic or endocrine disorders, renal conditions, toxic conditions, cardiac problems : chronic heart failure

Diagnostic studies

Patient with one episode of heartburn that responds well to nonpharmacologic and acid suppressant therapy may require no further investigation

Endoscopy necessary for patients with GERD symptoms who have not responded to empirical trial of PPI therapy

Endoscopy with biopsy necessary at presentation for patients with esophageal GERD syndrome with troublesome dysphagia

Manometry: motility test to determine LES and esophageal function

Ambulatory esophageal pH testing to detect pathologic reflux

Endoscopy to observe effects of esophagitis and obtain biopsy for histology

50% of symptomatic patients have NERD (nonerosive reflux disease)

Infants and children

History and physical sufficient to reliability diagnose GER, recognize complications, and initiate management in most infants with vomiting, older children with regurgitation and heartburn

Upper GI to evaluate presence of anatomic abnormalities

Esophageal pH monitoring: acid reflux

Endoscopy and biopsy assess presence and severity of esophagitis, strictures, and Barrett’s esophagus; exclude other disorders

Empiric medical therapy for a trial period to determine if GER is causing specific symptoms

Nonpharmacologic management

Education: physical causes of GERD, common aggravating and ameliorating factors, and lifestyle changes to control GERD:

Avoid recumbence until 2 hours after meals

Elevate head of bed, including entire chest

Reduce size of meals and amount of fat, acid, spices, caffeine, and sweets

Smoking cessation

Reduce alcohol consumption

Lose weight if indicated

Avoid stooping, bending after meals and tight fitting garments

Surgical interventions, crural tightening or fundoplication, reserved for patient with stricture, hemorrhage, barrett’s esophagitis, chronic aspiration or intractable symptoms

Infants

Milk thickening: reduces number of episodes of vomiting

Supine position to sleep to reduce risk of sudden infant death syndrome (SIDS)

Diet changes: hypoallergenic formula

Child or adolescent:

Position left side with head of bed elevated

Lifestyle changes

Avoid caffeine, chocolate, spicy foods

Avoid cigarette smoke and alcohol use

Weight control: obesity associated with GER

abd dx and tx plans nurs 623 essays

Pharmacologic management

Antacids

Calcium carbonate (tums) adult: chew 2-4 tabs as symptoms occur max 15 tabs/24 hrs

Pregnancy category C

Do not use maximum dosage for more than 2 weeks

FDA not evaluated and approved this OTC for reflux

Produces rapid relief of heartburn symptoms

Use with caution in patients with CHF, renal failure, edema, and cirrhosis

Blocks absorption of digoxin, tetracyclines, benzodiazepines, iron, and others

H2 antagonists

Cimetidine (Tagamet)adults and children >16 years old initial: 800 mg bid for 12 weeks; alternative 400 mg qid for 12 weeks; max 12 weeks; adult max 1600 mg/day

Children 20-40 mg/kg/day q 6 hr; infants 10-20 mg/kg/day q 6-12 hr; neonates 5-10 mg/kg/day q 8-12 hr

Pregnancy category B

Cimetidine associated with many 3A4 drug interactions

Long term therapy may be associated with B12 deficiency

May take several days for relief to occur

Allow one hour between H2 blocker and antacid consumption

Dose adjustment needed for renal and hepatic impairment

Give with food

Ranitidine (zantac) adults: 150-300 mg bid max g in hypersecretory conditions

Children >1 month-16 years old 5-10 mg/kg/day in divided doses BID or TID

Pregnancy category B

Efferdose is 25 mg. dissolve in 5 mL water. Do not chew, swallow whole or dissolve on the tongue

Contains phenylalanine

Potential drug interactions with procainamide, warfarin, glipizide, and others

Dose adjustment needed for renal and hepatic impairment

No dosage adjustment needed for geriatric patients

Famotidine (Pepcid) adult: with symptoms of GERD 20 mg bid for up to 6 weeks; treatment of esophagitis due to GERD: 20-40 mg bid for up to 12 weeks

Children < 3 months: 0.5 mg/kg/day divided once daily; 3-12 months 1 mg/kg/day divided BID; 1-6 years 1-2 mg/kg/day divided BID Pregnancy category B 20 mg twice daily was superior to 40 mg bedtime for improvement of symptoms No drug interactions have been identified No dosage adjustment needed for geriatric patients Dose adjustment needed for renal and hepatic impairment Proton Pump Inhibitors Pantoprazole (protonix) adult 40 mg daily for up to 8 weeks non erosive esophagitis 20 mg daily for 4-8 weeks Children 5 years old and older 15-<40 kg: 20 mg daily for up to 8 weeks; 5 years and older > 40 kg: 40 mg daily for up to 8 weeks abd dx and tx plans nurs 623 essays

Pregnancy category B

Lactation: probably safe

Possible interactions with antiretroviral therapy, diazepam, warfarin, phenytoin, and others

No dosage adjustment necessary for elderly

Omeprazole (Prilosec) adult: 20 mg for up to 4 weeks if esophagitis GERD: 20 mg daily ofr 4-8 weeks

Children 1-16 years > 20 kg: 20 mg once daily; 10-20 kg: 10 mg once daily; 5-10 kg: 5 mg once daily

Pregnancy category C

Lactation: probably safe

Possible interactions with antiretroviral therapy, diazepam, warfarin, phenytoin, and others

No dosage adjustment necessary for elderly or renal impairment

Dosage adjustment needed for hepatic impairment

Consultation/referral

Cardiologist: severe chest pain, radiating pain

Gastroenterologist:

Dysphagia

Unexplained weight loss

Vomiting

GI bleeding

Anemia

Palpable abdominal mass

Recurrent or refractory symptoms

Long history of alcohol and/or nicotine abuse

Regular NSAID use

Infants/children: pediatric gastroenterologist

Uncomplicated GER: if symptoms worsen or do not improve by 18-24 months

Recurrent vomiting and poor weight may require medical therapy, hospital observation, and/or endoscopy with biopsy

Infant with feeding refusal

Child over 2 years with recurrent vomiting or regurgitation

Child with dysphagia

Unresolved chronic heartburn or chest pain in older child or adolescent

Follow-up

CBC, screen for B12 deficiency and high risk of osteopenia after long term PPI use, and Barrett’s esophagitis: endoscopy and biopsy every 1 to 2 years.

Possible complications

Erosion and ulceration, stricture, barrett’s esophagitis, high-grade dysplasia, esophageal adenocarcinoma, aspiration pneumonia,

Co-existing conditions in children with GERD: esophagitis, dysphagia, odynophagia, asthma, recurrent pneumonia, upper airway syndrome, anemia, hematemesis abd dx and tx plans nurs 623 essays

Healthcare Financing Issues from the Viewpoint of the Nurse Leader: An Economic Perspective

Like in other countries, the United States also experiences issues in regard to healthcare financing. This is in contrast with what many may believe since the United States is considered superior in terms of its gross domestic product (GDP). Three of these healthcare financing issues include the return on investment (ROI) of the Affordable Care Act (ACA), the cost of retraining healthcare employees in terms of scarcity of resources, and healthcare product pricing given the location of a healthcare organization (Nunn et al., 2020).

When the ACA was signed into law, it expressly sought to shift the focus of universal healthcare from quantity to quality. Quality care was to be achieved through a set of measures and regulations in the law. Several years down the line, the return on investment of this policy decision is evident as more Americans are benefiting from the coverage by getting quality care (Cai et al., 2020). Healthcare Financing Issues from the Viewpoint of the Nurse Leader: An Economic Perspective.

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Retraining of healthcare employees is an expense that many healthcare organizations find hard to avoid. However, this is a necessity now with the emergence of novel healthcare technologies that require nurses and other healthcare staff to upskill. In all organizations, financial resources are scarce. So the decreased resources mean that budgeting for such an expense usually is not an easy task, even though the ROI is desirable (MedCognition, 2019).

Lastly, healthcare organizations, just like hotels, make a choice about location based on the purchasing power of the expected clientele in its locality. Healthcare Financing Issues from the Viewpoint of the Nurse Leader: An Economic Perspective. The predicted pricing strategy which is tied to the caliber of services the institution expects to offer. The strategy also factors in the matter of demand and supply through the carrying out market research to establish demand (Dawson, 2019).

As a solution to the cost of upskilling staff, for instance, organizations should incorporate a training fund into its strategic plan as a policy directive. This would remove the fiscal difficulty of always trying to look for areas of surplus to get funding.  Financially, a telehealth program will reduce healthcare costs for the organization, the staff, and patients as well. Healthcare Financing Issues from the Viewpoint of the Nurse Leader: An Economic Perspective

References

Cai, C., Runte, J., Ostrer, I., Berry, K., Ponce, N., Rodriguez, M…. & Hahn, J.G. (2020). Projected costs of single-payer healthcare financing in the United States: A systematic review of economic analyses.
PLoS Med 17
(1): e1003013. https://doi.org/ 10.1371/journal.pmed.1003013

Corney, M. (2009).
Funding upskilling and reskilling in the 21
st
century: From personal pension accounts to personal skill accounts
. Retrieved 12 March 2020 from
https://www.educationdevelopmenttrust.com/EducationDevelopmentTrust/files/b9/b94f7c82-d2c2-427d-badc-fde4612a2aa0.pdf

Dawson, T. (April 1, 2019). What can we learn from healthcare pricing strategies?
Price Intelligently
. Retrieved 12 March 22 from
https://www.priceintelligently.com/blog/bid/184103/3-Pricing-Strategy-Takeaways-From-Consumer-Driven-Healthcare

MedCognition (October 23, 2019).
Healthcare employee training: What’s it really costing us?
Retrieved 12 March 2020 from

Healthcare Employee Training: What’s It Really Costing Us?

Nunn, R., Parsons, J. & Shambaugh, J. (March 10, 2020).
A dozen facts about the economics of the US healthcare system
. Retrieved 12 March 2020 from
https://www.brookings.edu/research/a-dozen-facts-about-the-economics-of-the-u-s-health-care-system/
   Healthcare Financing Issues from the Viewpoint of the Nurse Leader: An Economic Perspective

Case Study on Moral Status

Based on ”Case Study: Fetal Abnormality” and other required topic study materials, write a 750-1,000-word reflection that answers the following questions:

What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity?

Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? What from the case study specifically leads you to believe that they hold the theory you selected?

How does the theory determine or influence each of their recommendations for action? Case Study on Moral Status.

What theory do you agree with? Why? How would that theory determine or influence the recommendation for action?

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Remember to support your responses with the topic study materials.

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

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. Case Study on Moral Status.

Case Study: Fetal Abnormality

Jessica is a 30-year-old immigrant from Mexico City. She and her husband Marco have been in the United States for the last three years and have finally earned enough money to move out of their Aunt Maria’s home and into an apartment of their own. They are both hard workers. Jessica works 50 hours a week at a local restaurant and Marco has been contracting side jobs in construction. Six months before their move to an apartment, Jessica finds out she is pregnant. Case Study on Moral Status.

Four months later, Jessica and Marco arrive at the county hospital, a large, public, nonteaching hospital. A preliminary ultrasound indicates a possible abnormality with the fetus. Further scans are conducted, and it is determined that the fetus has a rare condition in which it has not developed any arms and will not likely develop them. There is also a 25% chance that the fetus may have Down syndrome.

Dr. Wilson, the primary attending physician, is seeing Jessica for the first time, since she and Marco did not receive earlier prenatal care over concerns about finances. Marco insists that Dr. Wilson refrain from telling Jessica the scan results, assuring him that he will tell his wife himself when she is emotionally ready for the news. While Marco and Dr. Wilson are talking in another room, Aunt Maria walks into the room with a distressed look on her face. She can tell that something is wrong and inquires of Dr. Wilson. After hearing of the diagnosis, she walks out of the room wailing loudly and praying aloud.

Marco and Dr. Wilson continue their discussion, and Dr. Wilson insists that he has an obligation to Jessica as his patient and that she has a right to know the diagnosis of the fetus. He furthermore is intent on discussing all relevant factors and options regarding the next step, including abortion. Marco insists on taking some time to think of how to break the news to Jessica, but Dr. Wilson, frustrated with the direction of the conversation, informs the husband that such a choice is not his to make. Dr. Wilson proceeds back across the hall, where he walks in on Aunt Maria awkwardly praying with Jessica and phoning the priest. At that point, Dr. Wilson gently but briefly informs Jessica of the diagnosis and lays out the option for abortion as a responsible medical alternative, given the quality of life such a child would have. Jessica looks at him and struggles to hold back her tears.

Jessica is torn between her hopes of a better socioeconomic position and increased independence, along with her conviction that all life is sacred. Marco will support Jessica in whatever decision she makes but is finding it difficult not to view the pregnancy and the prospects of a disabled child as a burden and a barrier to their economic security and plans. Dr. Wilson lays out all of the options but clearly makes his view known that abortion is “scientifically” and medically a wise choice in this situation Case Study on Moral Status. Aunt Maria pleads with Jessica to follow through with the pregnancy and allow what “God intends” to take place and urges Jessica to think of her responsibility as a mother.

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Case Study: Foetal Abnormality

Introduction

The patient, in this case, was a 30-year-old Mexican immigrant named Jessica. She lived with her husband, Marco. Both were economically active, with Jessica working 50 hours per week. The couple lived with their aunt Maria in an apartment but were about to leave for their house. At the presentation, Jessica was pregnant, and after several ultra-sound scans, the fetus was observed to be defective. The fetus also indicated a likelihood of developing Down syndrome (25% chance). The fetus was seen to have no arm limbs and not likely to develop some. The doctor in charge, Dr. Wilson, wanted to break the news to Jessica, but the husband (Marco) viewed that it was not the appropriate time. The doctor stated that it wasn’t Marcos responsibility to choose when to communicate. After a lengthy discussion, Dr. Wilson was frustrated and went to Jessica and broke the news. Case Study on Moral Status. Dr. Wilson also proposed an abortion as a safe intervention for the problem. Jessica was in tears while Aunt Maria was comforting her that God had a reason for the pregnancy.

Christian Perception

The scenario in the case study brings about a complex moral and professionalism competition whereby critical thinking is essential. Following the Christian perspective, God is the creator of all human beings, and he does that with nobility; physical infirmity does not affect the soul. In this manner, Jessica and Aunt Maria were Christians who objected to abortion on the basis that it is sinful (Amer, 2019) Case Study on Moral Status.

The Christian doctrine emphasizes that all people are equal in the eyes of God. In his creation, all people are equal and uniquely significant. God doesn’t look at the physical ability; He is concerned with spiritual perfection. Therefore, since God is interested in the soul, the termination of the pregnancy was not permissible. Again, according to Christians, many Bible verses are leading to the perception that life begins at conception (Alexander, 2019). Therefore, the fetus was regarded as a human being with a soul. In Jeremiah 1:5, God states that He knew and appointed Jeremiah as a prophet before forming him in the womb and before he was born. In this case, God is the creator of the unborn and is concerned about their life.

God prohibits people from killing in his commandments. According to Exodus 20:1, 13, God says, “You shall not murder.” In the concept that the fetus may have a heartbeat and a soul, abortion amounts to murder. The Cristian faith doesn’t advocate abortion; it is based on the utilitarianism theory; that focuses on the outcomes to determine right and wrong (Amer, 2019). In the moral/ethical scenario presented, the most appropriate action of a Christian should bring the greatest good for the majority. The mother, father, and aunt were against termination of the pregnancy. Therefore, maintaining the pregnancy was the morally right action.

Theories of Each Participant

The three Jessica, Marco, and Maria were using the Human Becoming Theory that was first coined in by Rosemary Parse. According to the theory, the totality paradigm is included. In the totality paradigm, a human being is a combination of sociological, physiological, spiritual, sociological, as well as biological factors. Therefore, a human being continuously interacts with the environment throughout life and learn reality by interacting with the experiences. In this concept, Jessica was sacred and had obligations to act morally with the sense of social impacts. In the same case, Marco did not want to disclose the ultrasound diagnosis to his wife when she was not ready due to the psychological effects. Furthermore, Maria went straight to pray with Jessica and went forth to call the priest after discovering the results of the ultrasound scans. Therefore, she believed in spirituality and that by praying and comforting Jessica, she would find the strength to make a sound decision. The three of them did not buy the idea of abortion since it was against their Christianity life, and it would affect their social status.

For doctor Dr. Wilson, his perception followed the argument that the child may not lead a fulfilling life. The doctor perceives that there was a high of the child having down syndrome. In this case, the care for the disabled child would be expensive and complicated. Therefore, Dr. Wilson proposed an abortion for the abnormal fetus claiming that it was clinically and scientifically safe. Therefore. Dr. Wilson’s perception was based on the Self-Efficacy Theory formulated by Albert Bandura. Case Study on Moral Status. The Self-Efficacy Theory was developed from the Social Cognitive Theory (Li, 2020). The social cognitive theory suggests that self-efficacy is influenced by behavioral, environmental, and personal factors (Li, 2020). According to the theory, cognitive and personal factors have major roles in impacting life. In the situation at hand, the fetus had no arms and would probably develop none in the future. Therefore, right from delivery, the new-born would be affected by poor personal capability. The interaction of the new-born with the environment would be difficult. Therefore, the child will bring extra financial and care burden on the parents. Furthermore, the child had a 20% risk of developing down syndrome. The cognitive ability of the new-born would be affected throughout his/her life. Such occurrences would jeopardize the development of the child, such as education and cognitive behavior. Therefore, the child would not live a fulfilling or comfortable life and would compromise the financial, social, and work status of the parents. Case Study on Moral Status.

Appropriate Theory and Recommendation

The most appropriate theory, in this case, was the Human Becoming Theory (Milton, 2020). The situation at hand involved a complex interrelationship between man and the environment. The environment included the hospital, the biological factors (human and own body), social, and spiritual factors. Therefore, the decision to be taken needed to embark on the impact of the clinical procedure on the psychological, economic, and social welfare of the parties. First, the role of the nurse is to provide care and cure. The doctor was obliged to ensure that the rights of the patient are not compromised. Case Study on Moral Status. Looking at the situation, the patient was not in any health danger. Secondly, the execution of abortion would only be sound if both the life of the mother was in danger. Furthermore, putting the patient’s needs ahead of any other need should be an ethical concern of the health providers. In this case, the doctor was expected to correspond to the principle of ‘first do no harm’ (Edwards, 2020). The decision made should not harm the patient or her family. The doctor needs to have communicated professionally with the patient and the family. The doctor needs to have discussed with the patient and her family about the best clinical/nursing decision. Guiding and counseling would be appropriate before reporting the diagnostic outcomes. Furthermore, since the parents and the aunt had a common agreement of maintaining the pregnancy. It would have been appropriate to maintain the pregnancy.

References

Alexander, A. B. (2019). Christianity and Ethics. BoD–Books on Demand.

Amer, A. B. (2019). Understanding the Ethical Theories in Medical Practice. Open Journal of

Nursing, 9(02), 188.

Edwards, E. (2020). Principles of suctioning in infants, children and young people. Nursing

children and young people, 32(1).

Evans, R. L. (2019). Exodus 20 (The Ten Commandments): The Evans Practical Bible

Commentary. Abundant Truth Publishing.

Li, C. (2020). Self-efficacy theory. Routledge Handbook of Adapted Physical Education.

Milton, C. L. (2020). Ethical Truths in the Discipline of Nursing. Nursing Science Quarterly,

33(1), 19-20. Case Study on Moral Status

Quality improvement care essay

Quality improvement

The assigned topic is quality improvement, a topic that addresses four main objectives related to health care quality thus making it the most important. Firstly, it improves the experiences of medical personnel. Secondly, it reduced per capita cost of health care. Thirdly, it enhances the experiences and outcomes of patients. Finally, it improves population health. Medical personnel and practices with strong quality improvement orientation continually seek to improve their performance and patients’ outcomes, using the orientation to guide their practices to set priorities for the areas to improve and work required to achieve set goals (Black, 2016) quality improvement care essay. Although quality improvement is a common concern, the methods used are likely to vary based on resources, circumstances and concerns. These methodology differences necessitate the presentation of new skills to meet the improvement goals, thus calling attention to the need to renew the awareness of quality improvement in health care. In bringing attention to the topic of quality improvement, it is possible to leverage new skills that include how to identify areas for improvements, data awareness and use, how to plan and make changes, and how to track performance over time (Ellis, 2016) quality improvement care essay.

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Quality improvement is comparable to evidence-based practice since they both address three main goals. The first goal is disseminating best practices in health care services. The second goal is identifying excellence in the delivery of medical services. The third goal is promoting quality in a setting that supports professional practice. In addition, the two focus on translating evidence and applying it to decision-making. Still, there are three differences between the two topics. Firstly, quality improvement typically focuses on improving patient outcomes while evidence-based practice focuses on improving outcomes of medical personnel and patients. quality improvement care essay. Secondly, quality improvement does not require rigorous critical appraisal and extensive literature reviews while evidence-based practice requires rigorous critical appraisal and extensive literature reviews. Thirdly, quality improvement is typically site specific with the results not intended to offer best evidence or generalizable knowledge, while evidence-based practice is not site specific with the results intended to offer best evidence and generalizable knowledge (Cherry & Jacob, 2016; Ellis, 2016).

 

References

Black, B. (2016).
Professional nursing-e-book: concepts & challenges
. New York, NY: Elsevier Health Sciences.

Cherry, B. & Jacob, S. (2016).
Contemporary nursing: issues, trends, & management
. Amsterdam: Elsevier Health Sciences. quality improvement care essay.

Ellis, P. (2016).
Evidence-based practice in nursing
(3
rd
ed.). London: Learning Matter/SAGE Publications Ltd.

 

Your faculty will assign you one of the following three topics: quality improvement, ”traditional” research methodology, or evidence-based practice. Watch the Announcements in your email for your assigned topic.

You will provide rationale as to why your assigned topic is the most important, the best, for the provision of quality care as a nurse practitioner.

You will compare the topic you are assigned to one of the other topics you have not been assigned. For example, if you are assigned quality improvement, you may compare to a traditional research method, such as a randomized control trial. When writing this argument, you should provide a compare and contrast approach which highlights the features of the topics, how the topic informs providers and the topic’s importance to quality and safety.

Your response to this prompt should be a minimum of two (2) paragraphs of 4-5 sentences which utilize in-text citations (APA). quality improvement care essay.

which utilizes in-text citations (APA).

References are required, the use of first person should be avoided.

PS my assign topic was quality improvement. to compare and contrast you can pick any of the other two (2). whatever is comfortable for you. thank you. quality improvement care essay.