Category: Nursing

Planning is the key to successful completion of this course and program-related objectives. The Individual Success Plan (ISP) assignment requires early collaboration with the course faculty and your course preceptor. Students must establish a plan for successful completion of

The required 50 community direct clinical practice experience hours, 50 leadership direct clinical practice hours, and 25 indirect clinical experience hours.

Completion of work associated with program competencies.

Work associated with completion of the student’s capstone project change proposal.

Students will use the “Individual Success Plan” to develop an individual plan for completing practice hours and course objectives. As a part of this process, students will identify the number of hours set aside to meet course goals.

Student expectations and instructions for completing the ISP document are provided in the “NRS-493 Individual Success Plan” resource, located in the Study Materials and in the assignment instructions.

Students should apply concepts from prior courses to critically examine and improve their current practice. Students are expected to integrate scholarly readings to develop case reports that demonstrate increasingly complex and proficient practice.

After the ISP has been developed by the student and approved by the course faculty, students will initiate a preconference with the faculty and preceptor to review the ISP.

You are not required to submit this assignment to LopesWrite.

 

NRS-493 Individual Success Plan

REQUIRED PRACTICE HOURS: 100 Direct Clinical Experience (50 hours community/50 hours leadership) – 25 Indirect Clinical Experience Hours.

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Complete Contact Information

Student Information

GCU

Name:

 

E-mail:

 

 

Phone Number:

 

 

Course Faculty Information

GCU

Name:

 

E-mail:

 

 

Phone Number:

 

 

Practicum Preceptor Information

Practice Setting

Name:

 

E-mail:

 

 

Phone Number:

 

 

 

 

 

ISP Instructions

Use this form to develop your Individual Success Plan (ISP) for NRS-493, the Professional Capstone and Practicum course. An individual success plan maps out what you, the RN-to-BSN student, needs to accomplish in order to be successful as you work through this course and complete your overall program of study. You will also share this with your preceptor at the beginning and end of this course so that he or she will know what you need to accomplish.

In this ISP, you will identify all of the objectives and assignments relating to the 100 direct clinical practice experience hours and the 25 indirect clinical practice hours you need to complete by the end of this course. Use this template to specify the date by which you will complete each assignment. Your plan should include a self-assessment of how you met all applicable GCU RN-to-BSN Domains & Competencies (see Appendix A).

General Requirements

Use the following information to ensure successful completion of each assignment as it pertains to deliverables due in this course:

Use the Individual Success Plan
to develop a personal plan for completing your clinical practice experience hours and self-assess how you will meet the GCU RN-to-BSN University Mission Critical Competencies
and
the Programmatic Domains & Competencies (Appendix A) related to that course.

Show all of the major deliverables in the course, the topic/course objectives that apply to each deliverable, and lastly, align each deliverable to the applicable University Mission Critical Competencies and the course-specific Domains and Competencies (see Appendix A).

Completing your ISP does not earn clinical practice experience hours, nor does telephone conference time, or time spent with your preceptor.

Within the Individual Success Plan,
ensure you identify all graded course assignments and indirect clinical assignments listed in the table on the next page.

 

 

 

 

 

 

Topic

Graded Assignment

Indirect Clinical Assignments

Topic 1

1.      Individual Success Plan

2.      Reflection Journal Entry

1.      List of potential topics for the change proposal

Topic 2

1.      Topic Selection Approval Paper

2.      Reflection Journal Entry

1.      Search the literature for supporting journal articles

2.      Summary of topic category; community or leadership

Topic 3

1.      PICOT Question Paper

2.      Reflection Journal Entry

1.      List of objectives

Topic 4

1.      Literature Evaluation Table

2.      Reflection Journal Entry

1.      List of measurable outcomes

Topic 5

1.      Reflection Journal Entry

1.      Summary of the strategic plan

2.      Midterm Evaluation Tool

Topic 6

1.      Literature Review Table

2.      Reflection Journal Entry

1.      List of resources

Topic 7

1.      Reflection Journal Entry

1.      Summary of the evaluation plan

2.      Remediation-if required

Topic 8

1.      Benchmark Written Capstone Project Change Proposal

2.      Reflection Journal Entry

 

Topic 9

1.      Reflection Journal Entry

1.      Professional Presentation

Topic 10

1.      Finalized ISP

2.      Scholarly Activity Summary

3.      Benchmark-Reflection Journal Summary

1.      Summary of presentation

2.      Final Clinical Evaluation Tool

3.      Practice Clinical Evaluation Tool-Agency

4.      Practice Clinical Evaluation Tool-Preceptor

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Application-based Learning Course Assignments

List of Current Course Objectives

Assignment

Date Due

Self-Assessment:

Programmatic Domains & Competencies

(see Appendix A)

Self-Assessment:

GCU RN-to-BSN

University Mission Critical Competencies

 (see Appendix A)

Date

Assignment

Completed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

By typing in his/her signature below, the student agrees to have read, understood, and be accountable for the instructions, assignments, and hours shown above and that all questions have been satisfactorily answered by the faculty.

Preceptors will sign upon initial receipt and at the end of the course to confirm that assignments have been complete with your guidance.

 

Student Signature

Name:

 

Date:

 

Preceptor Signature [Upon Initiation of Course]

Name:

 

Date:

 

Preceptor Signature [Upon Completion of Course]

Name:

 

Date:

 

 

APPENDIX A:

GCU RN-to-BSN Domains & Competencies

University’s Mission Critical Competencies

How does this Individual Success Plan support the GCU Mission?

MC1: Effective Communication:
Therapeutic communication is central to baccalaureate nursing practice. Students gain an understanding of their ethical responsibility and how verbal and written communication affects others intellectually and emotionally. Students begin to use nursing terminology and taxonomies within the practice of professional and therapeutic communication. Courses require students to write scholarly papers, prepare presentations, develop persuasive arguments, and engage in discussion that is clear, assertive, and respectful.

MC2: Critical Thinking:
Courses require students to use critical thinking skills by analyzing, synthesizing, and evaluating scientific evidence needed to improve patient outcomes and professional practice.

MC3: Christian Worldview:
Students will apply a Christian worldview within a global society and examine ethical issues from the framework of a clearly articulated system of professional values. Students will engage in discussion of values-based decisions made from a Christian perspective.

MC4:

Global Awareness, Perspectives, and Ethics:
The concept of global citizenship is introduced to baccalaureate students in the foundational curriculum. Some courses will focus on the human experience across the world health continuum. The World Health Organization (WHO) definitions of health, health disparities, and determinants of health are foundational to nursing practice.

MC5: Leadership:
Students are required to develop skills and knowledge associated with their professional role. Courses require students to develop self-leadership skills such as time management, setting priorities, self-control, and evaluation of their abilities and performance.

 

Domains and Competencies

How does this Individual Success Plan support the Program Domains and Competencies?

Domain 1: Professional Role

Graduates of Grand Canyon University’s RN-BSN program will be able to incorporate professional values to advance the nursing profession through leadership skills, political involvement, and life-long learning.

Competencies:

1.1:
      Exemplify professionalism in diverse health care settings.

1.2:
      Manage patient care within the changing environment of the health care system.

1.3:
      Exercise professional nursing leadership and management roles in the promotion of patient safety and quality care.

1.4:
      Participate in health care policy development to influence nursing practice and health care.

1.5:
      Advocate for autonomy and social justice for individuals and diverse populations.

 

Domain 2: Theoretical Foundations of Nursing Practice

Graduates of Grand Canyon University’s RN-BSN program will have acquired a body of nursing knowledge built on a theoretical foundation of liberal arts, science, and nursing concepts that will guide professional practice.

Competencies:

2.1:
      Incorporate liberal arts and science studies into nursing knowledge.

2.2:
      Comprehend nursing concepts and health theories.

2.3:
      Understand and value the processes of critical thinking, ethical reasoning, and decision making.

Domain 3: Nursing Practice

Graduates of Grand Canyon University’s RN-BSN program will be able to utilize the nursing process to provide safe quality care based on nursing best practices.

Competencies:

3.1:
      Utilize the nursing process to provide safe and effective care for patients across the lifespan

3.2:
      Implement patient care decisions based on evidence-based practice.

3.3:
      Provide individualized education to diverse patient populations in a variety of health care settings.

3.4:
      Demonstrate professional standards of practice.

Domain 4: Communication/Informatics

Graduates of Grand Canyon University’s RN-BSN program will be able to manage information and technology to provide safe quality care in a variety of settings. In addition, graduates will be able to communicate therapeutically and professionally to produce positive working relationships with patients and health care team members.

Competencies:

4.1:
      Utilize patient care technology and information management systems.

4.2:
      Communicate therapeutically with patients.

4.3:
      Promote interprofessional collaborative communication with health care teams to provide safe and effective care.

Domain 5: Holistic Patient Care

Graduates of Grand Canyon University’s RN-BSN program will be able to provide holistic individualized care that is sensitive to cultural and spiritual aspects of the human experience.

Competencies:

5.1:
      Understand the human experience across the health-illness continuum.

5.2:
      Assess for the spiritual needs and provide appropriate interventions for individuals, families, and groups.

5.3:
      Provide culturally sensitive care.

5.4:
      Preserve the integrity and human dignity in the care of all patients.

Reducing Infections in the Dialysis Department

The PICOT Question

For patients undergoing dialysis at the dialysis department (P),  can optimization of nursing infection preventive measures through direct supervision and step wise check-list use during and after dialysis (I) compared to the practices (absence of step-wise checklist use) (C) reduce the number of infections to the lowest cases possible and by at least 50%   (O) over a period of nine weeks (T)?.

Dialysis Related BSIs and Evidence Based Solutions

Center for Disease control (CDC), through research and evaluation has come up with interventions, auditing tools and checklists for use in BSI infection prevention (CDC, 2020). Strict implementation and adherence of such interventions and protocols have been shown to be a solution to BSIs. These interventions reduce infection rates by 20-50% (Fisher, 2020). Lee et al (2018) discovered that the main causative problem of BSIs was inconsistent hemodialysis tunneled catheter care (HTC) protocol in the dialysis units, lack of standardized audits for the protocols and lack of patient education. Through proper implementation of infection control protocols such as ‘scrub the hub’ protocols, standardized audits, nurse and patient education, infections were reduced by up to 50% (Lee K. G., 2018). Another investigation applied strict implementations of the aseptic techniques and sterile dressing coupled with nurses training and patient education towards infection control. This resulted to more than 50% infection reduction in a 24-chair dialysis unit within a month (Hoffman, 2018).

Dialysis Related BSIs and Nursing Interventions

The CDC in conjunction with the American Society of Nephrology’s Nephrologists Transforming Dialysis Safety Initiative came up with interventions which are considered the gold standard preventive measures for BSIs. When implemented strictly, nurses can optimally prevent BSIs. This study aims at carrying out full implementation of these interventions. These interventions include; hand hygiene, catheter exit-connection and disconnection using aseptic technique and antiseptic use, catheter lumen and hub care and the assessment of these techniques every three months with nursing staff training and audits. Other nursing interventions include early patient referral to nephrologists, more specialized teams, and vascular access coordinators, implantation of early-stick grafts and early peritoneal dialysis  (Fisher, 2020).

Dialysis Related BSIs and
Patient Care

Patient care before, during and post-dialysis is key in infection prevention. Prior to vascular access, it is important to remove any restrictive jewelry and clothes from the patient’s arm. Other clinicians should be informed so as to avoid procedures such as blood pressure measurements and venipunctures on the same arm. When examining the patient, nurses should always disinfect their hands and put on gloves as an infection preventive measure. The vascular access should be checked for patency and smooth blood flow at least three times daily (Rushing, 2019).

Post dialysis, the patient should be moved in a manner that will avoid any trauma or pressure on the arm. The vascular access should be checked on a daily basis for signs of infection such as swelling, tenderness, open sores and purulent discharge. Patent education on self-care and infection prevention is paramount and this is the responsibility of his/her nurse. Patient self-care is key in preventing infections associated with dialysis and proper practice effectively reduces infections (Rushing, 2019)

Health Care Agency Involved in BSI Prevention

CDC in collaboration with the National Safety Healthcare Network (NHSN) developed a surveillance and feedback platform for data sharing and comparisons from different facilities in the US. This plays a role in informing policy making towards mitigation methods (CDC, 2020). Agency for Healthcare Research and Quality also provides support to researches and facilities aiming at reducing BSIs (AHRQ, 2020).

BSIs and Nursing Practice

Dialysis associated BSIs is a significant issue in nursing practice. In the US, BSIs arise mainly due to the failure to strictly implement and stick to the nursing protocols put in place for dialysis infection control. This largely depends on nurses and can be solved through strict nursing practice, regulations and standardized audits in dialysis units. This will lead to reduced infections, reduced hospitalizations, better clinical outcomes and reduced hospital bill burdens to patients (Fisher, 2020).

References

AHRQ
. (2020, June 08). Retrieved from https://www.ahrq.gov/patient-safety/settings/esrd/resource/clinicalcare.html

CDC
. (2020, June 07). Retrieved from https://www.cdc.gov/dialysis/prevention-tools/audit-tools.html

Fisher, M. G. (2020). Prevention of Bloodstream Infections in Patients Undergoing Hemodialysis. .
Clinical Journal of the American Society of Nephrology
, 132-151.

Hoffman, S. (2018). Reducing Blood Stream Infections from Tunneled Dialysis Catheters. . .
Nephrology Nursing Journal.

Lee, K. G. (2018). Reducing tunneled catheter-related infection in hemodialysis patients with nationwide standardization of catheter care protocol.
The journal of vascular access
, 110-111.

Lee, K. G. (2018). Reducing tunneled catheter-related infection in hemodialysis patients with nationwide standardization of catheter care protocol. .
The journal of vascular access
, 110-111.

Rushing, J. (2019). Caring for a patient’s vascular access for hemodialysis, .
Nursing Management
, 47.

 

Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention used to address the problem must be a nursing practice intervention. Include a comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and specify the timeframe needed to implement the change process.  Formulate a PICOT question using the PICOT format (provided in the assigned readings) that addresses the clinical nursing problem.

The PICOT question will provide a framework for your capstone project change proposal.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Describe the problem in the PICOT question as it relates to the following:

Evidence-based solution

Nursing intervention

Patient care

Health care agency

Nursing practice

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the 
LopesWrite Technical Support articles
 for assistance.

 

PICOT Question Paper

No of Criteria: 
9
 
Achievement Levels: 
5

Criteria

Achievement Levels

Description

Percentage

Unsatisfactory

0.00 %

Less Than Satisfactory

75.00 %

Satisfactory

79.00 %

Good

89.00 %

Excellent

100.00 %

Content

80.0

PICOT Question

20.0

A PICOT question is not presented.

An incomplete PICOT question is presented. The PICOT does not follow the correct format.

A PICOT question is presented. The PICOT generally follows the correct format.

A PICOT question is presented. Some detail is needed for clarity.

A PICOT question is presented and provides a clear framework for the capstone project change proposal.

Nursing Intervention

20.0

The intervention and comparison are omitted

The intervention used to address the problem is not based on a nursing practice intervention. A comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and timeframe needed to implement the change process, are omitted.

A nursing intervention used to address the problem is presented. A comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and timeframe needed to implement the change process, are summarized. Some information is needed. There are minor inaccuracies.

A nursing intervention used to address the problem is presented. A comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and timeframe needed to implement the change process, are discussed.

A nursing intervention used to address the problem is clearly presented. A comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and timeframe needed to implement the change process, are thoroughly discussed.

Clinical Problem and Patient Outcome

20.0

The clinical problem and how it can result in a positive patient outcome are omitted.

The clinical problem and how it can result in a positive patient outcome are incomplete.

The clinical problem and how it can result in a positive patient outcome are summarized. More information and rationale are needed.

The clinical problem and how it can result in a positive patient outcome are presented. Some minor detail is needed for clarity.

The clinical problem and how it can result in a positive patient outcome are thoroughly discussed. Strong rationale is offered for support.

PICOT Problem

20.0

The PICOT problem as it relates to evidence-based solution, nursing intervention, patent care, health care agency, and nursing practice is omitted.

The PICOT problem as it relates to evidence-based solution, nursing intervention, patent care, health care agency, and nursing practice is incomplete.

The PICOT problem as it relates to evidence-based solution, nursing intervention, patent care, health care agency, and nursing practice is summarized. More information and rationale are needed.

The PICOT problem as it relates to evidence-based solution, nursing intervention, patent care, health care agency, and nursing practice is described. Some minor detail is needed for clarity.

The PICOT problem as it relates to evidence-based solution, nursing intervention, patent care, health care agency, and nursing practice is described. Some minor detail is needed for clarity.

Organization, Effectiveness, and Format

20.0

Thesis Development and Purpose

5.0

Paper lacks any discernible overall purpose or organizing claim.

Thesis is insufficiently developed or vague. Purpose is not clear.

Thesis is apparent and appropriate to purpose.

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Argument Logic and Construction

5.0

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

5.0

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English.

Paper Format (use of appropriate style for the major and assignment)

2.0

Template is not used appropriately, or documentation format is rarely followed correctly.

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

Template is used, and formatting is correct, although some minor errors may be present.

Template is fully used; There are virtually no errors in formatting style.

All format elements are correct.

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

3.0

Sources are not documented.

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Total Percentage  
100

PICOT question

           
Any patient that answers yes to current smoker during a physical with their primary care physician will receive educational information from nursing staff on ways to quit smoking and resources to help them quit smoking to see if they are able to become and stay a non-smoker for 6 months versus how many patients become non-smokers with no interventions from nursing staff.

Evidence-based Solution

           
There is not enough easily accessible education for patients in regards to smoking cessation. Currently there is no information provided to patients when they answer yes to being a current smoker. Not only would there be tips available to help quit smoking but also additional resources. “Many people find support groups and hotlines helpful when quitting tobacco” (American Heart Association, 2020). There will also be information available on the dangers of smoking. This is important to share with patients as per The World Health Organization it is the cause for 7 million deaths annually (McWilliams, et al., 2019, p.1059).

Nursing Intervention

           
The nursing intervention will be completed by nursing staff within the clinical environment. When a patient answers yes to being a current smoker, the nursing staff will then provide the patient with education and resources to help them quit smoking. This should only take 3-5 minutes and the patient can take the pamphlet home with them. The pamphlet will include how to contact nursing staff with additional questions or support for the patient to use as needed.

Patient Care

           
This pamphlet will provide information on ways to quit smoking without the use of medication for patients. It will also provide resources for additional information available online. It will also allow patients to have access to nursing staff to ask questions and provide additional support.

Health Care Agency

           
The health care agency this program will assist is ProHealth Care Medical Group. There are generally classes offered from ProHealth Care but unfortunately due to COVID all classes are cancelled and there is no information online about what classes were previously offered to determine if smoking cessation classes were previously offered. This organization has 12 locations that offer family practice and/or primary care services. Once this project is complete this pamphlet for smoking cessation education can be used at all of the 12 locations.

Nursing Practice

Providing education to patients is a nurse’s duty. Having information available to assist the education can be beneficial to the nurse and the patient. The patient may have additional questions outside of the patient information pamphlet, if the nurse is unable to provide the patient an answer at that point, they can inform the patient they will find the answer, and call them at a later time. Providing the pamphlet ensures that all patients are getting the same information, as well as resources to use to help them with their smoking cessation.

 

 

 

 

 

References

American Heart Association. (2020). Help! I want to quit smoking. Retrieved from https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/help-i-want-to-quit-smoking

McWilliams, L., Bellhouse, S., Yorke, J., Lloyd, K., & Armitage, C. J. (2019). Beyond “planning”: A meta-analysis of implementation intentions to support smoking cessation.
Health Psychology
, 38(12), 1059–1068. https://doi-org.lopes.idm.oclc.org/10.1037/hea0000768.supp

ProHealth Care. (2020). Medical services. Retrieved from www.prohealthcare.com

Benchmark- Capstone Change Project Objectives

The implementation of the project will help to increase awareness of urinary catheter use as evidenced by nurses being able to report proper indications for urinary catheter placement.

Nurses will be provided education and understand proper criteria for urinary catheter placement. Proper aseptic technique will also be reviewed in addition to standardization of catheter supplies.

The implementation of this project will assist inpatient nursing staff in close tracking and monitoring for early indication of urinary catheter removal as evidenced by decreased urinary catheter placement days.

Inpatient nursing staff will be educated on tracking and monitoring of indications for continued use of urinary catheters. Inpatient nursing staff will discontinue urinary catheters once specific criteria is met by the patient utilizing the protocol.

The implementation of this project will provide nursing staff with specific criteria for discontinuation and shorten urinary catheter days as evidenced by decreased rates of catheter associated urinary tract infections hospital-wide.

All urinary catheters will be monitored for appropriate indication for use as well as proper timing for removal. Rates of CAUTI will be monitored hospital-wide by the infection prevention nurse.

 

With the implementation of this project, patients will have decreased lengths of urinary catheter placement therefore have reduced risk of catheter associated urinary tract infections. This will directly affect all patients, regardless of their cultural background as every patient is at risk for CAUTI. It is essential to ensure risk of urinary catheter placement is discussed, along with including the patient in the decision to place a catheter to ensure patient autonomy. If a patient develops CAUTI, their hospital length of stay may be increased which will directly affect their ability to achieve wellness and recovery. With patients from diverse populations, their access to care and insurance coverage may be limited. It is essential to prevent extended length of stay for patients regardless of their ability to pay as hospital acquired infections affect all patients. Evidence-based, patient centered care should always be practiced to ensure safe outcomes are achieved.

 

 

 

Review your problem or issue and the cultural assessment. Consider how the findings connect to your topic and intervention for your capstone change project. Write a list of three to five objectives for your proposed intervention. Below each objective, provide a one or two sentence rationale.

After writing your objectives, provide a rationale for how your proposed project and objectives advocate for autonomy and social justice for individuals and diverse populations.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to LopesWrite.

Benchmark Information

This benchmark assignment assesses the following programmatic competencies:

RN to BSN

1.5
:
  Advocate for autonomy and social justice for individuals and diverse populations
.

 

Benchmark – Capstone Change Project Objectives

No of Criteria: 
8
 
Achievement Levels: 
5

Criteria

Achievement Levels

Description

Percentage

1: Unsatisfactory

0.00 %

2: Less Than Satisfactory

75.00 %

3: Satisfactory

79.00 %

4: Good

89.00 %

5: Excellent

100.00 %

Content

80.0

Objectives

25.0

A list of objectives for the proposed intervention is omitted. Fewer than three objectives are presented.

NA

NA

NA

Three to five objectives are presented.

Rationale for How Findings Relate to the Topic and Proposed Intervention

30.0

Rationale for each objective is omitted.

Rationale is incomplete. There are omissions. Rationale provided does not explain the relationship of findings to the topic and proposed intervention.

General rationale is provided for each objective and generally summarizes the relationship of most findings to the topic and proposed intervention. There are some inaccuracies or minor omissions.

Rationale is provided for each objective and explains the relationship of findings to the topic and proposed intervention. Some detail is needed for clarity.

Rationale is clearly provided for each objective and thoroughly explains the relationship of the findings to the topic and proposed intervention.

Rationale for How Proposed Project and Objectives Advocate for Autonomy and Social Justice for Individuals and Diverse Populations (C1.5)

25.0

Rationale for how proposed project and objectives advocate for autonomy and social justice for individuals and diverse populations is omitted.

Incomplete rationale for how proposed project and objectives advocate for autonomy and social justice for individuals and diverse populations is presented. Advocacy is not established.

Rationale for how proposed project and objectives advocate for autonomy and social justice for individuals and diverse populations is summarized. Some advocacy is established.

Rationale for how proposed project and objectives advocate for autonomy and social justice for individuals and diverse populations is presented. Advocacy is generally established.

Well-supported rationale for how proposed project and objectives advocate for autonomy and social justice for individuals and diverse populations is presented. Advocacy for autonomy and social justice for individuals and diverse populations is clearly established.

Organization and Effectiveness

15.0

Thesis Development and Purpose

5.0

Paper lacks any discernible overall purpose or organizing claim.

Thesis is insufficiently developed or vague. Purpose is not clear.

Thesis is apparent and appropriate to purpose.

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Argument Logic and Construction

5.0

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

Argument is orderly, but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.

Criteria 3Mechanics of Writing (includes spelling, punctuation, grammar, language use)

5.0

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English.

Format

5.0

Paper Format (use of appropriate style for the major and assignment)

2.0

Template is not used appropriately or documentation format is rarely followed correctly.

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

Template is used, and formatting is correct, although some minor errors may be present.

Template is fully used; There are virtually no errors in formatting style.

All format elements are correct.

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

3.0

Sources are not documented.

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Total Percentage  
100

Objective:

 

The implementation of a new graduate preceptorship will increase compliance with an organizations policies and procedures as evidenced by nurses being able to state understanding and provide descriptions to those procedures.

 

Rationale:

The project is based upon the compliance and understanding of how implementing the policy and procedures will illicit the care desired, prudent care, but also compliancy.

 

Rationale:

The nurses will be able to prove competency and demonstrate required tasks and standards of care outlined and regulated by JCACHO standards. (Joint Commission for Accreditation of Healthcare Organizations).

Objective:

The implementation of a new graduate preceptorship will increase job retention within the organization over a 3-year period.

 

Rationale:

The project focuses on assuring nurses are prepared and supported during their new graduate orientation by providing mentorship and a 12-week orientation with supplemental education opportunities.

 

Rationale:

The nurse will feel educated, supported, and competent as a part of the plan for check ins as well as performance reviews. This will be evidenced by he/she remaining in their current role or within the organization at the 3-year mark.

 

Objective:

The evaluation tool used to measure the effectiveness of the orientation and training program for mentors and mentees will be evaluated annually regarding efficacy and relevance to the program.

 

Rationale:

The purpose of the tool is to measure the outcome response and objectively find out if the program works for nurses. What improvements need to be made, adaptations or withdrawals.

 

Rationale:

Program feedback and implementation will be utilized to maintain a functioning program adaptable to all treatment areas.

 

Rationale:

Review of evidenced based practice, changes to policy, JCACHO standards will also be implemented into the program for continued development.

Students are required to submit weekly reflective narratives throughout the course that will culminate in a final, course-long reflective journal due in Topic 10. The narratives help students integrate leadership and inquiry into current practice.

This reflection journal also allows students to outline what they have discovered about their professional practice, personal strengths and weaknesses, and additional resources that could be introduced in a given situation to influence optimal outcomes. Each week students should also explain how they met a course competency or course objective(s).

In each week’s entry, students should reflect on the personal knowledge and skills gained throughout the course. Journal entries should address one or more of the areas stated below.  In the Topic 10 graded submission, each of the areas below should be addressed as part of the summary submission.

New practice approaches

Interprofessional collaboration

Health care delivery and clinical systems

Ethical considerations in health care

Practices of culturally sensitive care

Ensuring the integrity of human dignity in the care of all patients

Population health concerns

The role of technology in improving health care outcomes

Health policy

Leadership and economic models

Health disparities

While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation 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.

You are not required to submit this assignment to LopesWrite.

 

NRS-493 Professional Capstone and Practicum Reflective Journal

No of Criteria: 
13
 
Achievement Levels: 
5

Criteria

Achievement Levels

Description

Percentage

1: Unsatisfactory

0.00 %

2: Less Than Satisfactory

75.00 %

3: Satisfactory

79.00 %

4: Good

89.00 %

5: Excellent

100.00 %

Group 1

100.0

New Practice Approaches

8.0

New practice approaches are not present.

New practice approaches are present, but they are incomplete or otherwise lacking in required detail.

New practice approaches are present. Some minor details or elements are missing, but the omissions do not impede understanding.

New practice approaches are present and complete. The submission provides the basic information required.

New practice approaches are present, complete, and incorporate additional relevant details and critical thinking to engage the reader.

Interprofessional Collaboration (C4.3)

8.0

Interprofessional collaboration information is not present.

Interprofessional collaboration information is present, but it is incomplete or otherwise lacking in required detail.

Interprofessional collaboration information is present. Some minor details or elements are missing, but the omissions do not impede understanding.

Interprofessional collaboration information is present and complete. The submission provides the basic information required.

Interprofessional collaboration information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Health Care Delivery and Clinical Systems

8.0

Health care delivery and clinical systems information is not present.

Health care delivery and clinical systems information is present, but it is incomplete or otherwise lacking in required detail.

Health care delivery and clinical systems information is present. Some minor details or elements are missing, but the omissions do not impede understanding.

Health care delivery and clinical systems information is present and complete. The submission provides the basic information required.

Health care delivery and clinical systems information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Ethical Considerations In Health Care (C2.3)

8.0

Information regarding ethical considerations in health care is not present.

Information regarding ethical considerations in health care is present, but it is incomplete or otherwise lacking in required detail.

Information regarding ethical considerations in health care is present. Some minor details or elements are missing, but the omissions do not impede understanding.

Information regarding ethical considerations in health care is present and complete. The submission provides the basic information required.

Information regarding ethical considerations in health care is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Practice of Culturally Sensitive Care (C5.3)

8.0

Information regarding the practice of culturally sensitive care is not present.

Information regarding the practice of culturally sensitive care is present, but it is incomplete or otherwise lacking in required detail.

Information regarding the practice of culturally sensitive care is present. Some minor details or elements are missing, but the omissions do not impede understanding.

Information regarding the practice of culturally sensitive care is present and complete. The submission provides the basic information required.

Information regarding the practice of culturally sensitive care is present and complete, and incorporates additional relevant details and critical thinking to engage the reader.

Preservation of Integrity of Human Dignity in the Care of All Patients (C5.4)

8.0

Information regarding the preservation of integrity and human dignity in the care of all patients is not present.

Information regarding the preservation of integrity and human dignity in the care of all patients is present, but it is incomplete or otherwise lacking in required detail.

Information regarding the preservation of integrity and human dignity in the care of all patients is present. Some minor details or elements are missing, but the omissions do not impede understanding.

Information regarding the preservation of integrity and human dignity in the care of all patients is present and complete. The submission provides the basic information required.

Information regarding the preservation of integrity and human dignity in the care of all patients is present and complete, and incorporates additional relevant details and critical thinking to engage the reader.

Population Health Concerns

8.0

Information regarding population health concerns is not present.

Information regarding population health concerns is present, but it is incomplete or otherwise lacking in required detail.

Information regarding population health concerns is present. Some minor details or elements are missing, but the omissions do not impede understanding.

Information regarding population health concerns is present and complete. The submission provides the basic information required.

Information regarding population health concerns is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Role of Technology in Improving Health Care Outcomes (C4.1)

8.0

Information on the role of technology in improving health care outcomes is not present.

Information on the role of technology in improving health care outcomes is present, but it is incomplete or otherwise lacking in required detail.

Information on the role of technology in improving health care outcomes is present. Some minor details or elements are missing, but the omissions do not impede understanding.

Information on the role of technology in improving health care outcomes is present and complete. The submission provides the basic information required.

Information on the role of technology in improving health care outcomes is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Health Policy

8.0

Health policy information is not present.

Health policy information is present, but it is incomplete or otherwise lacking in required detail.

Health policy information is present. Some minor details or elements are missing, but the omissions do not impede understanding.

Health policy information is present and complete. The submission provides the basic information required.

Health policy information is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Leadership and Economic Models

8.0

Information on leadership and economic models is not present.

Information on leadership and economic models is present, but it is incomplete or otherwise lacking in required detail.

Information on leadership and economic models is present. Some minor details or elements are missing, but the omissions do not impede understanding.

Information on leadership and economic models is present and complete. The submission provides the basic information required.

Information on leadership and economic models is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Health Disparities

8.0

Information on health disparities is not present.

Information on health disparities is present, but it is incomplete or otherwise lacking in required detail.

Information on health disparities is present Some minor details or elements are missing, but the omissions do not impede understanding.

Information on health disparities is present and complete. The submission provides the basic information required.

Information on health disparities is present, complete, and incorporates additional relevant details and critical thinking to engage the reader.

Outline of Overall Personal Discovery

8.0

Outline of what student discovered about professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and how the student met the competencies aligned to this course is not present.

Outline of what student discovered about professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and how the student met the competencies aligned to this course is present, but it is incomplete or otherwise lacking in required detail.

Outline of what student discovered about professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and how the student met the competencies aligned to this course is present. Some minor details or elements are missing, but the omissions do not impede understanding.

Outline of what student discovered about professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and how the student met the competencies aligned to this course is present and complete. The submission provides the basic information required.

Outline of what student discovered about professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and how the student met the competencies aligned to this course is present and complete, and incorporates additional relevant details and critical thinking to engage the reader.

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

4.0

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.

Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.

Writer is clearly in command of standard, written, academic English.

Total Percentage  
100

This is a writing-intensive course. The professional capstone practicum project offers students the opportunity to propose a resolution to an issue or problem significant to nursing practice within a clinical environment. Students identify, design, and propose an evidence-based solution within a health care organization with guidance from faculty and a preceptor in the field. The proposal must reflect synthesis and integration of course content and professional practice. Development of the capstone project is guided by the baccalaureate program student learning outcomes. Clinical hours: 100. Prerequisites: NRS-430V, NRS-429VN, NRS-434VN, NRS-428VN, HLT-362V, NRS-433V, PHI-413V, NRS-451VN, NRS-410V, and NRS-440VN.

Objective Data Collection: 1 of 1 (100.0%)

Hover To Reveal…

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

Found:

 Indicates an item that you found.

Available:

 Indicates an item that is available to be found.

Category

Scored Items

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

Patient Data

Not Scored

Thorough examinations will yield better patient data. The following actions reveal the objective data of the patient’s case.

Wound Treatment

Finding:

Inspected wound

Finding:

Measured wound: 2 cm x 1.5 cm, 2.5 mm deep

(Found)

Pro Tip: Measuring a patient’s wound will help you track whether it worsens or heals in future visits.

Example Question:

Finding:

Swabbed wound and sent to lab for C & S

(Found)

Pro Tip: Sending a culture of wound drainage to a medical lab will help you choose the best antibiotic for that microbe type, and can rule out dangerous infections such as MRSA.

Example Question:

Finding:

Cleansed and irrigated wound with normal saline and applied dry sterile dressing.

Education & Empathy
: 10 of 11 (90.9%)

During the patient interview, there are a number of opportunities to provide patient education and empathy. The opportunities listed below are those identified by nursing experts to be of particular importance to this patient. A
Model Statement
is provided as an example of an appropriate response to each opportunity.

Opportunities marked as
Not Encountered
are opportunities that were not elicited in the interview

Opportunities marked as
Not Followed Up
are missed opportunities that were present in the interview, but where no statements were made

Opportunities marked as
Followed Up
were followed up by students, and include the dialogue between student and patient

1 Expression of pain

Followed Up

Description:
Tina expresses frustration about her level of pain.

Why are you here today?

Question

12:13 PM EDT

I got this scrape on my foot a while ago, and I thought it would heal up on its own, but now it’s looking pretty nasty. And the pain is killing me!

Am sorry to hear that?

Empathize

12:13 PM EDT

I appreciate you saying that.

Do you have problems moving around after the accident? (Clarified to: Are you having trouble getting around?)

Question

12:36 PM EDT

Yes! I mean, I literally can’t put weight on my foot, the pain is so sharp. (Clarified to: if I have mobility problems)

Am sorry to hear that

Empathize

12:37 PM EDT

Thanks.

Model Statement:
“I’m sorry to hear that your pain is returning. We want you to be in as little pain as possible. Together we can figure out the best way to reduce your pain quickly.”

2 Impact of injury on daily life

Followed Up

3 Gaps in health literacy around diabetic diet

Followed Up

Description:
Tina describes controlling her diabetes by avoiding “sweets.”

How did you manage diabetes now?

Question

01:13 PM EDT

I just watch what I eat and try to stay away from sweets.

Great, that’s a good way to control diabetes?

Educate

01:13 PM EDT

Alright, thanks for letting me know.

Model Statement:
“Staying away from sugar is a great start. I can give you some more information on what a balanced diet looks like for someone with diabetes. For example, many starchy foods break down into glucose in the body, like pasta, and so you can eat those in moderation, too. Most people with diabetes feel better when they limit all starches, eat protein, and take regular medication.”

4 Lack of treatment with diabetes medication

Followed Up

5 Lack of blood glucose monitoring

Followed Up

6 Gaps in health literacy around asthma control

Not Followed Up

Description:
Tina describes increased inhaler use and decreased effectiveness, indicating that her asthma is uncontrolled.

how many times do you use the inhaler?

Question

12:49 PM EDT

I don’t use it every day. Maybe two or three times a week. Although I guess lately, once I have to use it once, sometimes I need it again that day.

have you been been hospitalized for asthma?

Question

12:50 PM EDT

I went a bunch of times when I was little, for asthma attacks.

What else have you used for the asthma?

Question

12:51 PM EDT

Model Statement:
“It sounds like your asthma is giving you some problems, and you’re not getting full relief from your inhaler. I would like to talk with you about changing your medication and your regimen, to reduce your frequent breathing problems, so that you feel better day-to-day. Most patients find that using a daily inhaler is an easy way to reduce your asthma symptoms even more.”

7 Loss of a family member

Followed Up

8 Counseling around past drug use

Followed Up

9 Gap in sexual health literacy

Followed Up

Description:
Tina reveals that she doesn’t fully understand the importance of testing for STIs.

did you use condoms?

Question

02:16 PM EDT

I was on the pill so we didn’t need them.

Condom use is important to prevent STDS

Educate

02:17 PM EDT

OK, I understand.

Have you been tested for STDs with your boyfriend? (Clarified to: Has your friend been checked for sexually transmitted infections?)

Question

02:55 PM EDT

When we were together, he told me he didn’t have any STDs, and I believed him. I don’t know if he was ever tested. (Clarified to: if my sexual partner has been tested for STIs)

It is good to be tested for STDs to be sure

Educate

02:56 PM EDT

Sure, I think I understand what you mean.

Model Statement:
“There are many sexually transmitted infections that don’t necessarily present symptoms, for either men or women, and can persist for years if left untreated. The only way to be certain you and your partners are free of STIs is for both of you to get tested. This can be done as a part of a typical gynecological exam. Because your past partner was not tested, I would recommend that you get tested during your next annual pap smear.”

10 Risk for hypertension

Followed Up

11 Describes problematic menstrual cycle and symptoms

Followed Up

Description:
Tina describes her periods as painful, long, and heavy.

How are your periods?

Question

02:23 PM EDT

My periods are always the same–they’re bad. Cramps. Lots of bleeding for more than a week.

Seems your periods are heavier than normal, maybe we should discuss a way to make them less heavy, such as hormonal pills

Educate

02:25 PM EDT

Thanks for telling me.

What do you take for cramps?

Question

02:25 PM EDT

I take Advil. I try a heating pad sometimes and that only helps a little.

Sorry for the discomforts

Empathize

02:27 PM EDT

Thanks for understanding.

Model Statement:
“Those periods sound painful and difficult to deal with. I’m sorry you have so many challenging symptoms. If you are interested, we can talk about hormonal birth control options that can make your periods less painful, or even lighter.”

Information Processing
: 40 of 40 (100.0%)

Each relevant diagnosis is scored on a four-point scale:

Priority (1 point):
the correct priority of the diagnosis was chosen

Evidence (up to 2 points):
the strength of the patient cue(s) selected as evidence for the identified diagnosis

Required Evidence:
selecting at least one cue that
directly indicates
the presence of a problem or risk is worth 2 points

Supporting Evidence:
selecting at least one cue that is a
contributing factor
or
cause
of a problem or risk, without the presence of Required Evidence, is worth 1 point

Planning (1 point):
the plan proposed to address the diagnosis includes at least one correct component

Relevant Diagnoses

1. Acute pain of the foot

4 of 4 points

Priority
1 / 1

Student Response:

High

Correct Priority:
High

Priority Pro Tip:
Managing acute pain is an immediate high priority, because other health concerns cannot be effectively addressed while a patient experiences severe pain.

Evidence
2 / 2

Relevant

“I’d say a 7. It hurts a lot, and the pain pills haven’t kicked in yet.”
Required Evidence

Irrelevant

(None provided)

Evidence Pro Tip:
Tina reports intense pain and rates her pain on a numerical scale. She also reports characteristics of the pain, including its duration of one week; this timespan defines her pain as acute.

Planning
1 / 1

Relevant

Intervene – Prescribe:
Prescribe medications to treat pain.

Educate – Medication:
Educate the patient on medications used for pain relief.

Educate – Medication:
Educate the patient on non-pharmaceutical methods to reduce pain intensity.

Irrelevant

(None provided)

Planning Pro Tip:
Intervene to reduce the pain by prescribing an appropriate analgesic and educating the patient on its effective use and potential side effects. Provide the patient with options for non-pharmacological pain relief, such as RICE (rest, ice, compression, elevation).

2.

4 of 4 points

3.

4 of 4 points

4.

4 of 4 points

5.

4 of 4 points

6.

4 of 4 points

Priority
1 / 1

Student Response:

Low

Correct Priority:
Low

Priority Pro Tip:
Tina’s hypertension should be addressed in this visit, as reducing her blood pressure may reduce her risks relating to cardiovascular sequelae. However it is lower priority than her acute complaints as her hypertension will not be significantly improved in a single visit.

Evidence
2 / 2

Relevant

“Blood pressure: 142/82”
Required Evidence

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

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

“It’s . . . oh, I don’t remember exactly because I never write it down. Let me try to remember . . . I feel like it’s usually around 140. And the bottom number is 80 or 90. I do know the last time in the ER it was something like 141/92. They said it was on the high side. [AUDIO COMING SOON]”
Required Evidence

Irrelevant

“Well, he passed away. But he had a couple things . . . Type 2 diabetes, like me, and high cholesterol and blood pressure.”

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

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

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

Evidence Pro Tip:
Hypertension is established via measurement of elevated blood pressure (systolic > 140 or diastolic > 90) on two separate occasions. Tina’s records reveal an elevated BP at the time of her ER visit, so the elevated BP at today’s visit establishes Tina’s diagnosis of hypertension. Tina’s risk factors include: race, family history of hypertension, diet, and diabetes.

Planning
1 / 1

Relevant

Assess – Cardiovascular:
Assess renal arteries for bruits, with auscultation.

Educate – Disease Process:
Educate the patient on associated risks of hypertension with diabetes.

Educate – Disease Process:
Educate the patient on relation of genetic and lifestyle factors, including diet, with hypertension.

Irrelevant

Educate – Health Maintenance:
Educate the patient on the role of lifestyle changes, including diet and exercise, in improving health outcomes.

Educate – Disease Process:
Educate the patient on the risks of morbidity and mortality due to obesity and comorbidities.

Planning Pro Tip:
Tina should be educated regarding hypertension (pathophysiology, associated risks relating to morbidity and mortality, and lifestyle interventions). It is important to consider Tina’s risk for secondary hypertension. Auscultate for renal artery bruits as they may be present in renal artery stenosis. Other causes of secondary hypertension should also be considered including hyperaldosteronism, pheochromocytoma, etc.

7.

4 of 4 points

8.

4 of 4 points

9.

4 of 4 points

10.

4 of 4 points

Priority
1 / 1

Student Response:

Low

Correct Priority:
Low

Priority Pro Tip:
PCOS is the root cause of several of Tina’s symptoms and should be addressed. However it is lower priority than Tina’s acute problems; addressing her pain and hyperglycemia are more immediate needs to improve her status.

Evidence
2 / 2

Relevant

“Yeah, I’ve noticed some hairs on my chin that I have to pluck, and I’m…I guess you can see that I’m kind of getting a mustache, which I hate. I’m embarrassed about it. I think I need to start waxing it… I have some belly hair, too.”
Required Evidence

“It’s not regular. Sometimes it’s every month, but sometimes it’s more like every two months. I don’t write it down or anything. I probably get…six periods a year.”
Required Evidence

“It’s type 2.”
Supporting Evidence

“BMI: 31”
Supporting Evidence

Irrelevant

(None provided)

Evidence Pro Tip:
The Rotterdam criteria should be used to establish a diagnosis of PCOS. At least two of the following must be present: ovulatory dysfunction (Tina reports infrequent menstruation), androgen excess (Tina reports excess hair in a male pattern), or poly-cystic ovaries. Diabetes, obesity, and acanthosis nigricans – all reported by Tina – are common signs and symptoms of PCOS.

Planning
1 / 1

Relevant

Assess – Genitourinary:
Assess for enlarged ovaries by palpation.

Assess – Integumentary:
Assess severity of hair growth at areas including upper lip, chin, chest, thighs, upper arm, forearm, back, abdomen.

Educate – Disease Process:
Educate the patient on the pathophysiology of polycystic ovarian syndrome.

Irrelevant

Assess – Genitourinary:
Perform pelvic exam.

Assess – Integumentary:
Assess for presence of axillary and pubic hair by inspection.

Intervene – Labs:
Order a pelvic ultrasound.

Planning Pro Tip:
A pelvic exam should be performed in order to assess for palpable enlargement of the ovaries. An ultrasound may be needed to evaluate for cysts of the ovaries. Educate Tina regarding PCOS and its relationship to diabetes. Work with Tina to assist her in establishing GYN care. Further assessment and lab work may be performed to evaluate for androgen excess.

Transcript

Started:
May 24, 2020 |
Total Time:
350 min

Height: 170 cm

Exam Action

05/22/20 12:11 PM EDT

Weight: 90 kg

Exam Action

05/22/20 12:11 PM EDT

BMI: 31

Exam Action

05/22/20 12:11 PM EDT

Random blood glucose: 238

Exam Action

05/22/20 12:11 PM EDT

Temperature: 101.1 F

Exam Action

05/22/20 12:11 PM EDT

Blood pressure: 142/82

Exam Action

05/22/20 12:11 PM EDT

Respiratory rate: 19

Exam Action

05/22/20 12:11 PM EDT

O2 sat: 99%

Exam Action

05/22/20 12:11 PM EDT

Heart rate: 86

Exam Action

05/22/20 12:11 PM EDT

Hello. My name is Joan and I will be interviewing you today and later examine you.

Greet

05/22/20 12:12 PM EDT

Hey.

What is your name?

Question

05/22/20 12:12 PM EDT

Tina Jones.

Why are you here today?

Question

05/22/20 12:13 PM EDT

I got this scrape on my foot a while ago, and I thought it would heal up on its own, but now it’s looking pretty nasty. And the pain is killing me!

Am sorry to hear that?

Empathize

05/22/20 12:13 PM EDT

I appreciate you saying that.

When did you get the scrape?

Question

05/22/20 12:14 PM EDT

Well, I got the scrape a week ago, but the scrape and the pain got a lot worse in the last few days.

How severe is the pain?

Question

05/22/20 12:14 PM EDT

It’s really bad.

Can you describe the pain?

Question

05/22/20 12:15 PM EDT

It’s throbbing and like, sharp if I try to put weight on it.

Did you hurt any other part?

Question

05/22/20 12:15 PM EDT

No, I caught myself on the railing so I didn’t fall on the ground. Only my foot got hurt.

how has the pain changed over time?

Question

05/22/20 12:16 PM EDT

At first, it seemed like it was healing up fine and it didn’t give me a lot of pain. But the last two days, the pain got way worse.

Does the pain radiate anywhere else?

Question

05/22/20 12:17 PM EDT

The pain’s worse in my foot, but I feel it moving up into my ankle, too.

How painful is the ankle? (Clarified to How did you hurt your ankle?.)

Question

05/22/20 12:18 PM EDT

I was going down the back steps, and I tripped. . . I caught the railing, but I guess I kind of turned my ankle a little bit. And I scraped up my foot on the edge of the step. (Clarified to how I hurt my ankle.)

is it possible for you to stand on your foot?

Question

05/22/20 12:18 PM EDT

No, I can’t put weight on my foot without really sharp pain.

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

Question

05/22/20 12:19 PM EDT

I’d say a 7. It hurts a lot, and the pain pills haven’t kicked in yet. (Clarified to how I would rate my pain on a scale.)

can you tell me where the pain is located?

Question

05/22/20 12:19 PM EDT

It feels like the pain is just centered around the scrape, like around the ball of my foot. That’s where it hurts the most, but my whole foot feels some pain.

Which foot did you injure?

Question

05/22/20 12:20 PM EDT

My right foot.

Were you wearing shoes?

Question

05/22/20 12:20 PM EDT

Seems you love your work

Empathize

05/22/20 12:40 PM EDT

Thanks for saying that.

Do you have other health problems?

Question

05/22/20 12:40 PM EDT

Um, the only things I know I’m diagnosed with are diabetes. And asthma.

When were you diagnosed with asthma?

Question

05/22/20 12:42 PM EDT

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

when dod you last have an asthma attack (Clarified to When was your last asthma attack?.)

Question

05/22/20 12:43 PM EDT

It’s really rare for me to have an attack now. Three days ago I had some breathing problems, but I guess probably my last full attack was in high school. (Clarified to when my last asthma attack was.)

How was your asthma when you were in high school?

Question

05/22/20 12:44 PM EDT

I was always a pretty average student. . . never the best, never the worst.

how do you know when you have asthma attack? (Clarified to What happens when you have an asthma attack?.)

Question

05/22/20 12:44 PM EDT

I haven’t had an asthma attack in a while, but I used to get them growing up, and my chest would feel really tight, like I couldn’t take in air, and I would wheeze really bad and get all sweaty. It was way worse than now, especially because I would use my inhaler and it wouldn’t help. It was really scary. (Clarified to to tell you about my asthma attacks.)

Do you get tight chest?

Question

05/22/20 12:45 PM EDT

Well. . . when my asthma gets bad my chest feels pretty tight, like I can’t take in air.

Do you get breathing difficult? (No matching questions found.)

Question

05/22/20 12:46 PM EDT

Do you get breathing difficulties during asthma attacks?

Question

05/22/20 12:46 PM EDT

I haven’t had a full attack in years, but when my breathing gets bad, I just use my inhaler.

What about wheezing? (Clarified to How is your wheezing?.)

Question

05/22/20 12:47 PM EDT

I’m not wheezing right now . . . But I did wheeze a little bit a few days ago at my cousin’s house. I had to use my inhaler. (Clarified to how my wheezing is.)

What do you use for your asthma? inhaler?

Question

05/22/20 12:48 PM EDT

It’s just a regular Proventil inhaler.

how many times do you use the inhaler?

Question

05/22/20 12:49 PM EDT

I don’t use it every day. Maybe two or three times a week. Although I guess lately, once I have to use it once, sometimes I need it again that day.

have you been been hospitalized for asthma?

Question

05/22/20 12:50 PM EDT

I went a bunch of times when I was little, for asthma attacks.

What else have you used for the asthma? (No matching questions found.)

Question

05/22/20 12:51 PM EDT

What else have you used for the asthma?what causes your asthma?

Question

05/22/20 12:51 PM EDT

When I used to have asthma attacks all the time, all different things could cause them. . . sometimes I couldn’t tell what was doing it. My breathing problems haven’t turned into a full attack in years, though.

What happens when you are around cats?

Question

05/22/20 12:52 PM EDT

Whenever I’m around cats, I start sneezing, my eyes get itchy. . . and my asthma starts to act up.

Do you have latex allergies?

Question

05/22/20 12:53 PM EDT

Nope.

Do you have food allergies?

Question

05/22/20 12:53 PM EDT

Nope, no food allergies that I know of.

are you allergic to dust?

Question

05/22/20 12:53 PM EDT

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

Are you allergic to pollen ?

Question

05/22/20 12:54 PM EDT

Not that I’ve noticed.

are you allergic to mold?

Question

05/22/20 12:54 PM EDT

None that I know of.

Are you allergic to penicillin ?

Question

05/22/20 12:55 PM EDT

Yes.

what type of reaction do you have to penicillin?

Question

05/22/20 12:55 PM EDT

I don’t remember that well because the last time I had penicillin I was pretty little. . . I think I got a rash, like, hives. The doctor told me not to take it again after that.

Do you have other allergies?

Question

05/22/20 12:55 PM EDT

Well, besides cats, I’m allergic to penicillin.

any other seasonal asthma triggers?

Question

05/22/20 12:58 PM EDT

No, not really.

Any past asthma medications? (No matching questions found.)

Question

05/22/20 12:59 PM EDT

Any past asthma medications?When were you diagnosed of Diabetes? (Clarified to How old were you when you were diagnosed with diabetes?.)

Question

05/22/20 1:00 PM EDT

I was diagnosed when I was 24. (Clarified to when I was diagnosed with diabetes.)

What type of diabetes do you have?

Question

05/22/20 1:01 PM EDT

It’s type 2.

do you take any medication for diabetes?

Question

05/22/20 1:02 PM EDT

I don’t take anything for my diabetes anymore.

why did you stop? (Clarified to Why did you stop taking diabetes medication?.)

Question

05/22/20 1:02 PM EDT

I just got sick of dealing with it! (Clarified to why I stopped taking my diabetes medication.)

Were you unable to afford the medication? (No matching questions found.)

Question

05/22/20 1:02 PM EDT

WIts not advisable to stop medication without consulting your doctor, it can have negative effects?

Educate

05/22/20 1:04 PM EDT

Sure, I think I understand what you mean.

What diabetes medication were you taking?

Question

05/22/20 1:04 PM EDT

It was Metformin.

would you afford the metformin? (Clarified to Did you have issues affording the metformin?.)

Question

05/22/20 1:05 PM EDT

I haven’t had trouble affording medication . . . Cost wasn’t really the issue with the metformin. I just got really sick of having to take it, and I hated the side effects. [AUDIO COMING SOON] (Clarified to if I had problems affording the metformin.)

had you any other challenges accessing metformin? (No matching questions found.)

Question

05/22/20 1:06 PM EDT

what dosage of metformin were you taking?

Question

05/22/20 1:07 PM EDT

Honestly, I don’t remember what the dose was when I was taking it.

How many times were you taking metformin?

Question

05/22/20 1:07 PM EDT

I think it was one pill, twice a day.

when did you stop taking metformin?

Question

05/22/20 1:08 PM EDT

About three years ago, honestly.

when did you start taking metformin?

Question

05/22/20 1:09 PM EDT

When I was 24, right after I was first diagnosed.

did you tell your doctor that you stopped taking metformin?

Question

05/22/20 1:10 PM EDT

No, I just stopped taking it because I was sick of dealing with taking it everyday and feeling gassy all the time.

Its good to have a plan with the doctor before stopping medication

Educate

05/22/20 1:11 PM EDT

OK, I understand.

How old are you now?

Question

05/22/20 1:11 PM EDT

I don’t get sweaty, but sometimes I wake up hot and have to kick off my sheets.

How is your appetite?

Question

05/22/20 1:31 PM EDT

My appetite’s been huge lately. . . I feel like I’m hungry all the time.

Do you notice any change in weight?

Question

05/22/20 1:31 PM EDT

Yeah, I’ve lost some weight recently.

Are you trying to lose weight?

Question

05/22/20 1:31 PM EDT

No, I’m not trying to lose weight, but I did lose a little recently without meaning to. About ten pounds in the last month. [AUDIO COMING SOON]

Do you have hypertension?

Question

05/22/20 1:32 PM EDT

No, I’ve never been diagnosed with blood pressure problems.

Do you check your blood pressure regularly?

Question

05/22/20 1:33 PM EDT

I almost never check it. I mean, maybe twice a year I might? It’s not something I think about.

do you know your blood pressure range?

Question

05/22/20 1:33 PM EDT

It’s . . . oh, I don’t remember exactly because I never write it down. Let me try to remember . . . I feel like it’s usually around 140. And the bottom number is 80 or 90. I do know the last time in the ER it was something like 141/92. They said it was on the high side. [AUDIO COMING SOON]

The standard rate reading 12 120/80. Sure that on the higher side, you need to monitor it as well.

Educate

05/22/20 1:35 PM EDT

Alright, thanks for letting me know.

When did you have your last immunization?

Question

05/22/20 1:37 PM EDT

I think the last time I got shots was when I enrolled in college the first time. Oh, and I got a tetanus booster about a year ago.

Have you received the influenza vaccine ?

Question

05/22/20 1:38 PM EDT

No.

Did you complete your childhood immunizations? (Clarified to Are you up to date on immunizations?.)

Question

05/22/20 1:39 PM EDT

I’m pretty sure they are all taken care of. (Clarified to if I am up to date on shots.)

Do you use over the counter medications?

Question

05/22/20 1:41 PM EDT

I take Tylenol for a headache sometimes, or Advil for cramps, but not often.

What dosage of tylenol?

Question

05/22/20 1:41 PM EDT

I just take one or two of the 500 mg acetaminophen. I usually get the headaches at night from reading — squinting I guess — and so I take one or two and go to bed. [AUDIO COMING SOON]

what dosage of advil do you take?

Question

05/22/20 1:42 PM EDT

I just take the regular kind I think — 200 mg. It’s not extra strength or anything. [AUDIO COMING SOON]

How long have you been taking tramadol ?

Question

05/22/20 1:44 PM EDT

I started needing them two days ago.

when did you take the last tramadol?

Question

05/22/20 1:44 PM EDT

This morning I took two pain pills right before I came here, at around 8:30.

Do you take vitamin supplements?

Question

05/22/20 1:46 PM EDT

I don’t take vitamins or supplements.

Do you take herbal drugs? (Clarified to Do you take any herb supplements?.)

Question

05/22/20 1:46 PM EDT

No, I don’t take anything herbal. (Clarified to if I take herbal supplements.)

What is your highest level of educations?

Question

05/22/20 1:47 PM EDT

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

How is college life? (Clarified to Is college a stressful time?.)

Question

05/22/20 1:48 PM EDT

I don’t get stressed out much, but sometimes having such a hectic schedule can be a lot. Right now, though, I’m mostly worried about my foot. (Clarified to if college is stressful.)

Do you have financial problems accessing education ?

Question

05/22/20 1:49 PM EDT

I’m doing okay–I earn a pretty good wage at my job, but I do have to be careful with money since I’m still paying tuition. Right now I’m lucky to be able to save some money by living at my Mom’s house instead of paying rent.

Any financial problems accessing healthcare?

Question

05/22/20 1:50 PM EDT

I’m doing okay–I earn a pretty good wage at my job, but I do have to be careful with money since I’m still paying tuition. Right now I’m lucky to be able to save some money by living at my Mom’s house instead of paying rent.

Great, its good to continue with education nd also save money when you can.

Educate

05/22/20 1:51 PM EDT

OK, I understand.

What is your major at the college?

Question

05/22/20 1:52 PM EDT

I’m going to get my bachelor’s in accounting.

Do you have a belief system?

Question

05/22/20 1:53 PM EDT

Yeah. We go to First Baptist, and we do a lot with our church community. Even before a service, it’s pretty social; we go early so we can meet and talk with everybody. And I go to the Wednesday night Bible study group. There’s other events, too, pot-lucks, all of that. Oh, and once a month the church organizes like a volunteer event, so I try to do that. We spend a lot of time with our church family.

sounds like you have great social and religious conections

Empathize

05/22/20 1:54 PM EDT

I appreciate you telling me that.

Do you smoke tobacco?

Question

05/22/20 1:54 PM EDT

No. I think it’s gross.

Do you hang around people who smoke?

Question

05/22/20 1:55 PM EDT

Yeah, a couple of my friends smoke when we go out. I don’t like being around smokers, though.

Its good to avoid smoke, it is not good for asthma

Educate

05/22/20 1:55 PM EDT

That makes sense.

Do you smoke marijuana?

Question

05/22/20 1:56 PM EDT

Um, yeah, I’ve done that before. In high school, and after high school… I definitely don’t anymore, though.

how old were you then? (No matching questions found.)

Question

05/22/20 1:57 PM EDT

why did you stop smoking?

Question

05/22/20 1:58 PM EDT

It just wasn’t that fun anymore, plus it started to bother my asthma.

Do you vape?

Question

05/22/20 1:59 PM EDT

I’ve never vaped or smoked an e-cigarette. [AUDIO COMING SOON]

do you smoke the pot?

Question

05/22/20 1:59 PM EDT

Um, yeah, I’ve done that before. In high school, and after high school… I definitely don’t anymore, though.

At what age did you smoke?

Question

05/22/20 2:00 PM EDT

I started when I was about fifteen, and I stopped when I was twenty or twenty-one.

Do you drink alcohol?

Question

05/22/20 2:00 PM EDT

I do sometimes, yeah, when I go out with my friends.

How much alcohol do you take in a sitting? (Clarified to How much alcohol do you usually drink in one sitting?.)

Question

05/22/20 2:01 PM EDT

I never have more than two or three. If I go over that, I feel like hell the next day, so I stick to just a few. (Clarified to how much alcohol I drink in one sitting.)

How often do you drink?

Question

05/22/20 2:01 PM EDT

No more than once or twice a week, sometimes less.

Its good not to take a lot of alcohol and also to stop taking recreational drugs, they are addictive. (No matching questions found.)

Question

05/22/20 2:04 PM EDT

Its good not to take a lot of alcohol and also to stop taking recreational drugs, they are addictive.

Educate

05/22/20 2:04 PM EDT

Sure, I think I understand what you mean.

Do you take coffee?

Question

05/22/20 2:05 PM EDT

Never. I don’t like it. Too bitter for my taste.

Do you take carbonated sodas? (No matching questions found.)

Question

05/22/20 2:09 PM EDT

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

Question

05/22/20 2:10 PM EDT

Do you smoke the pot?

Question

05/22/20 2:10 PM EDT

Um, yeah, I’ve done that before. In high school, and after high school… I definitely don’t anymore, though.

Am happy that you stooped smoking pot, its not good for your health, especially asthma. (No matching questions found.)

Question

05/22/20 2:11 PM EDT

Am happy that you stooped smoking pot, its not good for your health, especially asthma.

Educate

05/22/20 2:11 PM EDT

Alright, thanks for letting me know.

Who do you love with? (Clarified to Who do you live with?.)

Question

05/22/20 2:12 PM EDT

Right now I live back at home with my mom and my sister. (Clarified to who I live with.)

Have you been abused?

Question

05/22/20 2:12 PM EDT

No, no way. I’ve never been hurt or anything in the way that you’re talking about.

Sorry for the discomforts

Empathize

05/22/20 2:27 PM EDT

Thanks for understanding.

Do you have a boyfriend?

Question

05/22/20 2:27 PM EDT

Um, not right now.

Have you had a boyfriend in the past?

Question

05/22/20 2:28 PM EDT

Um, not right now.

How many boyfriends you had? (Clarified to How many boyfriends have you had?.)

Question

05/22/20 2:28 PM EDT

Oh, gosh…I guess four or five. (Clarified to how many boyfriends I have had.)

Have you tested for HIV/AIDS?

Question

05/22/20 2:54 PM EDT

No. I don’t think I need one. I don’t know anybody with HIV or AIDS.

Have you tested for STDs? (Clarified to Have you been tested for STDs?.)

Question

05/22/20 2:54 PM EDT

Yeah, I’m sure they did those tests when I went for a pap smear before. (Clarified to if I have ever been tested for STDs.)

Have you been tested for STDs with your boyfriend? (Clarified to Has your friend been checked for sexually transmitted infections?.)

Question

05/22/20 2:55 PM EDT

When we were together, he told me he didn’t have any STDs, and I believed him. I don’t know if he was ever tested. (Clarified to if my sexual partner has been tested for STIs.)

It is good to be tested for STDs to be sure

Educate

05/22/20 2:56 PM EDT

Sure, I think I understand what you mean.

When were you tested for stds?

Question

05/22/20 2:56 PM EDT

I guess probably the last time I went for a pap smear…that was, um, maybe four years ago now.

Do you have any symptoms for STDs?

Question

05/22/20 2:57 PM EDT

No. I’ve never had any symptoms like that.

Any vaginal discharge?

Question

05/22/20 2:58 PM EDT

Um, I have hardly any discharge, and it’s, like, clear.

Have you had any muscle pain?

Question

05/22/20 2:59 PM EDT

No.

Any joint pain?

Question

05/22/20 3:00 PM EDT

No.

Joint swelling? (Clarified to Do you have any joint pain or swelling?.)

Question

05/22/20 3:00 PM EDT

Not really. (Clarified to if I have any joint pain or swelling.)

what about back pain?

Question

05/22/20 3:01 PM EDT

My back’s fine.

How are your eyes?

Question

05/22/20 3:01 PM EDT

I’ve actually been noticing problems lately. When I’m reading or studying I’ll notice that things start to get kind of blurry.

Do you wear eye glasses?

Question

05/22/20 3:02 PM EDT

I don’t wear glasses–or contacts.

Do you have any problem with moth or jaw? (Clarified to Do you have mouth or jaw problems?.)

Question

05/22/20 3:02 PM EDT

No, neither. (Clarified to if I have mouth or jaw problems.)

Have you had any dental problems?

Question

05/22/20 3:03 PM EDT

Nope, no problems.

Any change in sense of taste?

Question

05/22/20 3:04 PM EDT

No, I think my sense of taste is fine.

Do have a painful mouth?

Question

05/22/20 3:04 PM EDT

No.

Any difficulties swallowing?

Question

05/22/20 3:05 PM EDT

Nope.

Any sore throat?

Question

05/22/20 3:05 PM EDT

No, it’s fine.

Any swollen glands?

Question

05/22/20 3:05 PM EDT

No, not that I noticed.

Have you had a breast exam?

Question

05/22/20 3:05 PM EDT

I haven’t had a mammogram. I’ve just had the exam where the doctor felt around for lumps.

any pain in the breasts

Question

05/22/20 3:06 PM EDT

No. Maybe some soreness before my period, but that seems pretty typical.

any discharge from nipples?

Question

05/22/20 3:06 PM EDT

Uh, no, definitely not.

have you nosebleed?

Question

05/22/20 3:07 PM EDT

No.

Any chest pains?

Question

05/22/20 3:07 PM EDT

No, my chest feels tight when I have breathing problems, but it doesn’t hurt.

Any irregular heartbeat? (Clarified to Have you ever had an irregular heartbeat?.)

Question

05/22/20 3:08 PM EDT

I think my heart’s fine. I don’t really notice how it beats. (Clarified to if I have had an irregular heartbeat.)

do you have problems with your bowel problems? (Clarified to Do you have difficulty moving your bowels?.)

Question

05/22/20 3:09 PM EDT

No. No problems like that. (Clarified to if I have trouble moving my bowels.)

Have you noticed any changes with your skin?

Question

05/22/20 3:11 PM EDT

Well…I guess I was noticing the other day that the skin around my neck is looking weird. Like the skin is getting darker. And my skin’s breaking out, but that’s how it is.

What is your general heath condition?

Question

05/22/20 3:12 PM EDT

Generally? My foot has just been hurting from a scrape I got. [AUDIO COMING SOON]

Are you tired or fatigued?

Question

05/22/20 3:13 PM EDT

Most days I feel pretty exhausted by the end of the day…I’m tired now, too, but I think that’s just because I slept terribly.

How is your sleep pattern?

Question

05/22/20 3:13 PM EDT

I try to be in bed by eleven or midnight, and I get up at seven or eight.

Do eyes itch?

Question

05/22/20 3:14 PM EDT

No. That only happens around cats or dust.

Any hearing problem?

Question

05/22/20 3:14 PM EDT

No.

Any ear discharge?

Question

05/22/20 3:15 PM EDT

No.

does your mother have any health problem?

Question

05/22/20 3:17 PM EDT

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

Does your father have medical problems?

Question

05/22/20 3:17 PM EDT

Well, he passed away. But he had a couple things . . . Type 2 diabetes, like me, and high cholesterol and blood pressure.

Am sorry to hear that.

Empathize

05/22/20 3:17 PM EDT

I appreciate you telling me that.

When did your farther pass away? (Clarified to When did your father pass away?.)

Question

05/22/20 3:17 PM EDT

It was last year… I guess a little over a year ago. (Clarified to when my dad died.)

How old was your father when he passed away?

Question

05/22/20 3:18 PM EDT

Last year when Dad passed, he was only 58.

How did you cope with your fathers death?

Question

05/22/20 3:18 PM EDT

Well, right after he died, after the funeral and everything, I just tried to get through that. Mom was having such a hard time, crying a lot, everything made her sad, she was kinda depressed. So I guess at first I just focused on getting things done–groceries, laundry, insurance papers and stuff. Knowing that Mom needed me kinda helped me get through day by day. There was about a month where it was hard for us to get to church. Even getting up and ready for church was too overwhelming. But our church family helped us out, and gave us rides to church and brought meals and all that, so they really helped build us back up. Things were only hard like that for a few months.

You are lucky you have a great support system that helped you cope easily.

Empathize

05/22/20 3:20 PM EDT

Thanks for saying that.

What was the cause of your fathers death?

Question

05/22/20 3:20 PM EDT

He died in a car accident.

Am sorry to hear that

Empathize

05/22/20 3:20 PM EDT

I appreciate you saying that.

No, I’m fine right now.

Measured wound: 2 cm x 1.5 cm, 2.5 mm deep

Exam Action

05/22/20 4:25 PM EDT

Swabbed wound and sent to lab for C & S

Exam Action

05/22/20 4:25 PM EDT

Cleansed and irrigated wound with normal saline and applied dry sterile dressing.

Exam Action

05/22/20 4:25 PM EDT