cystitis case study – a year ago
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see attachment – a year ago **files (1)** – ## Week1DBresponse2.pdf **## Week1DBresponse2.pdf** Subjective CC: Follow-up for abnormal Pap smear showing HSIL and positive high-risk HPV. HPI: Ellen is a 35-year-old G1P0 female who presents following an abnormal Pap smear result indicating High-Grade S…
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– a year ago
**files (1)**
– ## Week1DBresponse2.pdf
**## Week1DBresponse2.pdf**
Subjective
CC:
Follow-up for abnormal Pap smear showing HSIL and positive high-risk HPV.
HPI:
Ellen is a 35-year-old G1P0 female who presents following an abnormal Pap smear result
indicating High-Grade Squamous Intraepithelial Lesion (HSIL) with positive high-risk
HPV. She reports no symptoms and states the abnormal results were discovered about a
week ago during routine screening. She has had only two previous Pap smears,
performed 7 and 14 years ago, both of which were normal. She denies any vaginal
bleeding, discharge, pelvic pain, or discomfort. There are no aggravating or relieving
factors, as she is asymptomatic. Ellen is in a monogamous relationship with a female
partner for the past 5 years but identifies as bisexual and has had previous sexual
relationships with both males and females. She has no history of STIs or abnormal Pap
results. Her last menstrual period was 5 days ago and was normal. She is G1P0 with a
therapeutic abortion at age 25. She and her partner are currently undecided about
having children in the future. She denies any significant past medical history, surgical
history, or chronic illness. Her BMI is within normal limits, and her pregnancy test is
negative.
Medications:
None stated
Allergies:
No known drug allergies (NKDA) stated in case study
LMP:
5 days ago; regular cycles
Gyn/OB History:
• G1T0P0A1L0 (1 therapeutic abortion at age 25)
• Menarche age : ( Not stated in case study)
• Regular menstrual cycles, no menorrhagia, dysmenorrhea, or intermenstrual bleeding
• No contraception currently; sexually active with a female partner
• No history of STIs
• No prior abnormal Pap smears
• No prior cervical procedures or treatments
• HPV vaccine status unknown
PMH:
Unremarkable (none stated)
Chronic Illness / Major Trauma:
Denies any chronic conditions, surgeries, or hospitalizations
Family History:
No known history of cervical, uterine, ovarian, or breast cancer
No family history of hereditary cancer syndromes
Social History:
• Sexual orientation: Bisexual
• Relationship: Monogamous with female partner for 5 years
• Past partners: Males and females
• Tobacco: Denies use
• Alcohol: Rare social use
• Illicit drugs: Denies use
• Occupation: Not stated
• Exercise: Occasional walking ( none stated , hypothetical )
• Diet: Balanced
• HPV vaccination: None stated
Subjective Review of Systems (ROS):
General: Denies fatigue, fever, night sweats, chills, or unintended weight loss
Skin: Denies rashes, new moles, pruritus, or lesions
HEENT: Denies headaches, vision changes, sore throat, nasal congestion, or hearing loss
Neck: Denies lumps, swelling, or pain
Cardiovascular: Denies chest pain, palpitations, syncope, or edema
Respiratory: Denies cough, dyspnea, wheezing, or hemoptysis
GI: Denies nausea, vomiting, abdominal pain, constipation, diarrhea, or rectal bleeding
GU: Denies dysuria, hematuria, urgency, frequency, or incontinence
Gynecological: Per patient Menses are regular. LMP 5 days ago
• Denies abnormal uterine bleeding, intermenstrual or postcoital bleeding
• Denied vaginal discharge, odor, or pruritus
• Denies dyspareunia or pelvic pain
• No known uterine or ovarian disorders
• Denies hot flashes or signs of perimenopause
Musculoskeletal: Denies joint pain, swelling, stiffness, or muscle weakness
Neurological: Denies dizziness, syncope, numbness, or headaches
Endocrine: No heat/cold intolerance, polyuria, polydipsia, or hirsutism
Psychiatric: Denies anxiety, depression, sleep disturbance, or mood changes
Hematologic: No easy bruising or prolonged bleeding
Allergic/Immunologic: Denies seasonal allergies, food or medication reactions
1. Additional HPI Questions:
• Do you have any unusual vaginal bleeding (after intercourse or between periods)?
• Have you experienced any vaginal discharge, pelvic pain, or painful intercourse?
• Have you ever had a colposcopy or cervical procedure in the past?
• Are your menstrual cycles typically regular?
• Have you received the HPV vaccine?
1. Additional Medical History Questions:
• Any history of immunosuppression (HIV, long-term corticosteroids)?
• Any prior abnormal Pap smear or HPV testing?
• Any surgeries, especially gynecologic ( LEEP, D&C)?
• Any chronic conditions such as diabetes, autoimmune disorders, or thyroid disease?
• Any family history of cervical cancer?
1. Additional Social History Questions:
• Are you or your partner planning pregnancy in the near future?
• Have your previous partners (male or female) had a history of STIs or abnormal Pap
smears?
• Do you use any form of contraception or protection during sexual activity?
• What is your occupation? (May tell you about patient exposures, stress, or healthcare
access)
• Do you have access to transportation and healthcare?
(Mito & Feldman, 2025)
Objective
General:
Well-nourished, well-appearing 35-year-old female in no distress
Vital Signs: (Hypothetical VS)
• BP: 116/72 mmHg
• HR: 78 bpm
• Temp: 98.4°F
• RR: 14
• BMI: 24.7
Objective ROS:
Skin: Warm, dry, intact. No rashes, lesions, or pigmentation changes.
HEENT: Normocephalic, atraumatic. Sclerae white, conjunctivae clear. Oropharynx
moist, no lesions or erythema. No cervical lymphadenopathy.
Neck: Supple, no thyroid enlargement, no masses, no lymphadenopathy.
Cardiovascular: RRR (regular rate and rhythm), no murmurs, gallops, or rubs. No
peripheral edema.
Respiratory: Clear to auscultation bilaterally. No rales, wheezes, or rhonchi. Normal
chest expansion.
Abdomen: Soft, non-distended. No tenderness, guarding, rebound, or palpable masses.
No hepatosplenomegaly. Bowel sounds normal in all quadrants.
Genitourinary / Pelvic Exam:
• External Genitalia: No lesions, warts, discharge, or erythema.
• Speculum Exam: Cervix pink, no visible lesions, masses, or discharge. Cervical os
closed.
• Bimanual Exam: Uterus normal size, non-tender. No adnexal masses or tenderness.
No cervical motion tenderness.
Musculoskeletal: Full range of motion. No joint swelling, tenderness, or deformity.
Neurological: Alert and oriented. CN II–XII grossly intact. No motor or sensory deficits.
Psychiatric: Appropriate mood and affect. Cooperative. Good eye contact. No signs of
anxiety or depression.
Point-of-Care Testing (POCT):
Pregnancy Test: Negative
Additional POCT to Perform and Why:
1. Rapid HIV Test
a. Why: HPV-related cervical dysplasia (HSIL) is more likely in immunocompromised
individuals. HIV screening is standard in STI evaluations and recommended at least
once for all adults aged 15–65 per USPSTF and CDCguidelines.
2. Urine NAAT for Chlamydia and Gonorrhea
a. Why: Despite no history of STIs, Ellen has had past male partners, which still places
her at risk. These infections are often asymptomatic and can contribute to cervical
inflammation and complicate HSIL management. NAAT is the most sensitive method
and can be done via urine or vaginal swab..
3. HPV Genotyping (in-office or sent out)
a. Why: If not already done, genotyping for HPV 16 and 18 (highest risk types) can
guide urgency of management. This is especially relevant in women ≥30 years or with
HSIL.
4. Wet mount or vaginal pH testing: Only if patient is complaining of abnormal
discharge, odor, or itching, help evaluate for bacterial vaginosis, candidiasis, or
trichomoniasis, which may need to be treated before cervical procedures like
colposcopy.
(Mito & Feldman , 2025)
Assessment / Diagnosis
Final Diagnosis: High-Grade Squamous Intraepithelial Lesion (HSIL) of cervix with
positive high-risk HPV-ICD-10 Code: R87.619 –
Rationale / Pertinent Positives:
• HSIL on Pap indicates moderate to severe cervical dysplasia (CIN 2/3)
• Positive high-risk HPV, which increases the risk of progression to cervical cancer
• Limited history of prior Pap tests (only 2 in the past 14 years)
• No prior abnormal results or STI diagnoses
• Denies immunocompromising conditions
(Wright, 2025)
Pertinent Negatives:
• No abnormal vaginal bleeding, pain, or discharge reported
• No visible cervical lesions on pelvic exam
• Negative pregnancy test
• No history of smoking, which is a cofactor for cervical dysplasia progression
(Wright, 2025)
Differential Diagnoses:
1. Cervical Intraepithelial Neoplasia (CIN 2/3) ICD- N87.1
• Rationale: CIN 2/3 often underlies HSIL cytology; caused by persistent high-risk HPV
infection.
(Schmeler, 2025)
2. Cervical Cancer – ICD-10 Code: C53.0
• Rationale: While less likely without symptoms, HSIL may indicate or mask early
cervical cancer, especially in women with poor screening history.
(Schmeler, 2025) (Wright,
2025)
Explain Ellen’s Pap smear results (pathophysiology) and the action(s) that will be taken
next to follow up this abnormality, including patient education (explain the procedure
to the patient).
Ellen’s Pap test shows significant changes in the cells on her cervix. These changes are
called HSIL, which means that some cells look very abnormal. This doesn’t mean she has
cancer, but it does mean there is a higher risk that these abnormal cells could become
cancer in the future if not treated.The test also shows that she has a high-risk type of
HPV (human papillomavirus). HPV is a common virus that spreads through sexual
contact. Some types of HPV can cause cervical cancer over time, especially if the
infection lasts for many years.
(Palefsky, 2025)
Next Steps:
The best way to find out how serious these changes are is to do a procedure called a
colposcopy.
• Colposcopy is done in the clinic and is similar to a Pap smear, but the provider uses a
special microscope to look more closely at the cervix.
• If any areas look suspicious, small samples (biopsies) will be taken and sent to the lab.
• This helps confirm whether the abnormal cells are moderate or severe, and what
treatment is needed.
(Palefsky, 2025) ( Schmeler, 2025)
What to Tell the Patient (Patient Education):
I would explain to the patient in these words “ Ellen you pap test shows some abnormal
cells on your cervix that we want to look at more closely. It’s not cancer, but we want to
make sure it doesn’t turn into cancer in the future. We’ll do a simple in-office procedure
called a colposcopy. It’s like a longer Pap test and may involve taking a small sample of
tissue. It’s important we check this now so we can treat it early if needed. Most women
do very well after early treatment, and this can help protect your future health.”
Plan: Colposcopy with biopsy is the recommended next step to confirm how abnormal
the cells are and decide if treatment like LEEP (loop electrosurgical excision procedure)
or cryotherapy is needed.
Diagnostic Tests:
• Colposcopy with directed cervical biopsies (This test allows for visualization of the
cervix and biopsy is taken to determine the exact grade of CIN ( CIN 2 or 3) or
presence of invasive cancer.)
Lab Tests:
1. HPV Genotyping ( Should be done if cytology was only taken during pap smear. This
test looks for high risk HPV (especially types 16 or 18).
1. STI Testing (chlamydia, gonorrhea, syphilis, HIV) (important to check because some
infections can weaken the immune system and make HPV worse or harder to clear.)
1. Pregnancy Test (Already done and negative) (Important to check because some
treatments like LEEP or biopsies can affect a pregnancy.
1. Blood Tests (CBC) (It checks for anemia or infection if Ellen needs treatment like
LEEP)
(Schmeler, 2025) (Wright, 2025)
Treatment (Pending Colposcopy Results):
If results are CIN 1 (Mild Dyplasia)
Treatment:
• Observation is preferred, especially in young or reproductive-age women.
• Repeat Pap + HPV co-testing at 12 months or colposcopy at 12 months.
• If abnormalities persist for >2 years, consider excisional treatment ( LEEP).
(Einstein et al., 2025) (Wright, 2025)
CIN 2 -3
Treatment: Excisional treatment (LEEP or cold knife conization).
Screening guidelines post-treatment
Negative Margins: HPV- testing 6 months later
• If HPV is positive, then colposcopy and biopsies should be performed and managed
based on these results.
• If HPV is negative, then HPV testing should occur annually for three years.
• If HPV remains negative, then HPV testing can occur every three years for at least 25
years.
Positive Margins: HPV testing in six months or colposcopy
• If HPV is negative, then HPV testing should occur annually for three years. If testing
remains negative, then HPV every three years for at least 25 years.
• If positive, then colposcopy with biopsy. If it continues to be positive, excision must
be done again.
(Einstein et al., 2025) (Wright, 2025)
Medication:
None at this time unless STI identified
Referrals:
• Refer to GYN for colposcopy within 4 weeks
• Referral to GYN oncology only if invasive cancer is identified on biopsy
Education:
• HSIL is not cancer but is considered pre-cancer, meaning that abnormal cells may
become cancer if not treated.
• A colposcopy is needed to get a closer look at the cervix.
• If abnormal cells are found on biopsy, a procedure like LEEP or cryotherapy may be
recommended to remove them.
• HPV is very common, and most people get it at some point, this is not a sign of
infidelity or risky behavior.
• Continue regular follow-ups, early detection and treatment prevent cervical cancer.
What to expect from the colposcopy:
• Done in the office, takes 10–20 minutes.
• May feel pressure or mild cramping.
• Spotting is normal afterward.
• Avoid sex, douching, or tampons for 48 hours after.
Education regarding her current female partner:
• HPV can be transmitted between female partners through skin-to-skin contact,
shared sex toys, or genital contact.
• Encourage her partner to:
o Get regular Pap smears if she has a cervix.
o Receive the HPV vaccine (if age 9–45), especially if not already vaccinated.
• Emphasize that HPV is common and can be dormant for years, so this does not mean
recent transmission.
• Discuss safe sex practices, including cleaning shared items and using barrier
protection if appropriate.
(Wright, 2025)
Health Maintenance:
• Review/update immunizations including HPV
• Lifestyle: stress reduction, healthy diet, smoking cessation if applicable
• Encourage regular Pap screening per follow-up recommendations
Follow-up:
• Colposcopy results in 1–2 weeks post-procedure
• Return to clinic to review pathology and determine next steps
• Emphasize importance of follow-up due to cancer risk
If biopsy confirms CIN 2 or 3, treatment options will be considered. à(LEEP procedure)
1. What patient education is important to include for this patient?
Key points to educate Ellen:
• HSIL is not cancer but is considered pre-cancer, meaning that abnormal cells may
become cancer if not treated.
• A colposcopy is needed to get a closer look at the cervix.
• If abnormal cells are found on biopsy, a procedure like LEEP or cryotherapy may be
recommended to remove them.
• HPV is very common, and most people get it at some point—this is not a sign of
infidelity or risky behavior.
• Continue regular follow-ups early detection and treatment prevent cervical cancer.
(Wright, 2025)
Explain what to expect from the colposcopy:
• Done in the office, takes 10–20 minutes.
• May feel pressure or mild cramping.
• Spotting is normal afterward.
• Avoid sex, douching, or tampons for 48 hours after.
(American Cancer Society, 2024)
1. Is there any education or advice you would give to Ellen regarding her current
female partner?
Yes. Although Ellen is in a monogamous relationship with a female partner, it's important
to know that:
• HPV can be transmitted between female partners through skin-to-skin contact,
shared sex toys, or genital contact.
• Encourage her partner to:
o Get regular Pap smears if she has a cervix.
o Receive the HPV vaccine (if age 9–45), especially if not already vaccinated.
• Emphasize that HPV is common and can be dormant for years, so this does not mean
recent transmission.
• Discuss safe sex practices, including cleaning shared items and using barrier
protection if appropriate.
**## Week1DBresponse2.pdf**
Subjective
CC:
Follow-up for abnormal Pap smear showing HSIL and positive high-risk HPV.
HPI:
Ellen is a 35-year-old G1P0 female who presents following an abnormal Pap smear result
indicating High-Grade Squamous Intraepithelial Lesion (HSIL) with positive high-risk
HPV. She reports no symptoms and states the abnormal results were discovered about a
week ago during routine screening. She has had only two previous Pap smears,
performed 7 and 14 years ago, both of which were normal. She denies any vaginal
bleeding, discharge, pelvic pain, or discomfort. There are no aggravating or relieving
factors, as she is asymptomatic. Ellen is in a monogamous relationship with a female
partner for the past 5 years but identifies as bisexual and has had previous sexual
relationships with both males and females. She has no history of STIs or abnormal Pap
results. Her last menstrual period was 5 days ago and was normal. She is G1P0 with a
therapeutic abortion at age 25. She and her partner are currently undecided about
having children in the future. She denies any significant past medical history, surgical
history, or chronic illness. Her BMI is within normal limits, and her pregnancy test is
negative.
Medications:
None stated
Allergies:
No known drug allergies (NKDA) stated in case study
LMP:
5 days ago; regular cycles
Gyn/OB History:
• G1T0P0A1L0 (1 therapeutic abortion at age 25)
• Menarche age : ( Not stated in case study)
• Regular menstrual cycles, no menorrhagia, dysmenorrhea, or intermenstrual bleeding
• No contraception currently; sexually active with a female partner
• No history of STIs
• No prior abnormal Pap smears
• No prior cervical procedures or treatments
• HPV vaccine status unknown
PMH:
Unremarkable (none stated)
Chronic Illness / Major Trauma:
Denies any chronic conditions, surgeries, or hospitalizations
Family History:
No known history of cervical, uterine, ovarian, or breast cancer
No family history of hereditary cancer syndromes
Social History:
• Sexual orientation: Bisexual
• Relationship: Monogamous with female partner for 5 years
• Past partners: Males and females
• Tobacco: Denies use
• Alcohol: Rare social use
• Illicit drugs: Denies use
• Occupation: Not stated
• Exercise: Occasional walking ( none stated , hypothetical )
• Diet: Balanced
• HPV vaccination: None stated
Subjective Review of Systems (ROS):
General: Denies fatigue, fever, night sweats, chills, or unintended weight loss
Skin: Denies rashes, new moles, pruritus, or lesions
HEENT: Denies headaches, vision changes, sore throat, nasal congestion, or hearing loss
Neck: Denies lumps, swelling, or pain
Cardiovascular: Denies chest pain, palpitations, syncope, or edema
Respiratory: Denies cough, dyspnea, wheezing, or hemoptysis
GI: Denies nausea, vomiting, abdominal pain, constipation, diarrhea, or rectal bleeding
GU: Denies dysuria, hematuria, urgency, frequency, or incontinence
Gynecological: Per patient Menses are regular. LMP 5 days ago
• Denies abnormal uterine bleeding, intermenstrual or postcoital bleeding
• Denied vaginal discharge, odor, or pruritus
• Denies dyspareunia or pelvic pain
• No known uterine or ovarian disorders
• Denies hot flashes or signs of perimenopause
Musculoskeletal: Denies joint pain, swelling, stiffness, or muscle weakness
Neurological: Denies dizziness, syncope, numbness, or headaches
Endocrine: No heat/cold intolerance, polyuria, polydipsia, or hirsutism
Psychiatric: Denies anxiety, depression, sleep disturbance, or mood changes
Hematologic: No easy bruising or prolonged bleeding
Allergic/Immunologic: Denies seasonal allergies, food or medication reactions
1. Additional HPI Questions:
• Do you have any unusual vaginal bleeding (after intercourse or between periods)?
• Have you experienced any vaginal discharge, pelvic pain, or painful intercourse?
• Have you ever had a colposcopy or cervical procedure in the past?
• Are your menstrual cycles typically regular?
• Have you received the HPV vaccine?
1. Additional Medical History Questions:
• Any history of immunosuppression (HIV, long-term corticosteroids)?
• Any prior abnormal Pap smear or HPV testing?
• Any surgeries, especially gynecologic ( LEEP, D&C)?
• Any chronic conditions such as diabetes, autoimmune disorders, or thyroid disease?
• Any family history of cervical cancer?
1. Additional Social History Questions:
• Are you or your partner planning pregnancy in the near future?
• Have your previous partners (male or female) had a history of STIs or abnormal Pap
smears?
• Do you use any form of contraception or protection during sexual activity?
• What is your occupation? (May tell you about patient exposures, stress, or healthcare
access)
• Do you have access to transportation and healthcare?
(Mito & Feldman, 2025)
Objective
General:
Well-nourished, well-appearing 35-year-old female in no distress
Vital Signs: (Hypothetical VS)
• BP: 116/72 mmHg
• HR: 78 bpm
• Temp: 98.4°F
• RR: 14
• BMI: 24.7
Objective ROS:
Skin: Warm, dry, intact. No rashes, lesions, or pigmentation changes.
HEENT: Normocephalic, atraumatic. Sclerae white, conjunctivae clear. Oropharynx
moist, no lesions or erythema. No cervical lymphadenopathy.
Neck: Supple, no thyroid enlargement, no masses, no lymphadenopathy.
Cardiovascular: RRR (regular rate and rhythm), no murmurs, gallops, or rubs. No
peripheral edema.
Respiratory: Clear to auscultation bilaterally. No rales, wheezes, or rhonchi. Normal
chest expansion.
Abdomen: Soft, non-distended. No tenderness, guarding, rebound, or palpable masses.
No hepatosplenomegaly. Bowel sounds normal in all quadrants.
Genitourinary / Pelvic Exam:
• External Genitalia: No lesions, warts, discharge, or erythema.
• Speculum Exam: Cervix pink, no visible lesions, masses, or discharge. Cervical os
closed.
• Bimanual Exam: Uterus normal size, non-tender. No adnexal masses or tenderness.
No cervical motion tenderness.
Musculoskeletal: Full range of motion. No joint swelling, tenderness, or deformity.
Neurological: Alert and oriented. CN II–XII grossly intact. No motor or sensory deficits.
Psychiatric: Appropriate mood and affect. Cooperative. Good eye contact. No signs of
anxiety or depression.
Point-of-Care Testing (POCT):
Pregnancy Test: Negative
Additional POCT to Perform and Why:
1. Rapid HIV Test
a. Why: HPV-related cervical dysplasia (HSIL) is more likely in immunocompromised
individuals. HIV screening is standard in STI evaluations and recommended at least
once for all adults aged 15–65 per USPSTF and CDCguidelines.
2. Urine NAAT for Chlamydia and Gonorrhea
a. Why: Despite no history of STIs, Ellen has had past male partners, which still places
her at risk. These infections are often asymptomatic and can contribute to cervical
inflammation and complicate HSIL management. NAAT is the most sensitive method
and can be done via urine or vaginal swab..
3. HPV Genotyping (in-office or sent out)
a. Why: If not already done, genotyping for HPV 16 and 18 (highest risk types) can
guide urgency of management. This is especially relevant in women ≥30 years or with
HSIL.
4. Wet mount or vaginal pH testing: Only if patient is complaining of abnormal
discharge, odor, or itching, help evaluate for bacterial vaginosis, candidiasis, or
trichomoniasis, which may need to be treated before cervical procedures like
colposcopy.
(Mito & Feldman , 2025)
Assessment / Diagnosis
Final Diagnosis: High-Grade Squamous Intraepithelial Lesion (HSIL) of cervix with
positive high-risk HPV-ICD-10 Code: R87.619 –
Rationale / Pertinent Positives:
• HSIL on Pap indicates moderate to severe cervical dysplasia (CIN 2/3)
• Positive high-risk HPV, which increases the risk of progression to cervical cancer
• Limited history of prior Pap tests (only 2 in the past 14 years)
• No prior abnormal results or STI diagnoses
• Denies immunocompromising conditions
(Wright, 2025)
Pertinent Negatives:
• No abnormal vaginal bleeding, pain, or discharge reported
• No visible cervical lesions on pelvic exam
• Negative pregnancy test
• No history of smoking, which is a cofactor for cervical dysplasia progression
(Wright, 2025)
Differential Diagnoses:
1. Cervical Intraepithelial Neoplasia (CIN 2/3) ICD- N87.1
• Rationale: CIN 2/3 often underlies HSIL cytology; caused by persistent high-risk HPV
infection.
(Schmeler, 2025)
2. Cervical Cancer – ICD-10 Code: C53.0
• Rationale: While less likely without symptoms, HSIL may indicate or mask early
cervical cancer, especially in women with poor screening history.
(Schmeler, 2025) (Wright,
2025)
Explain Ellen’s Pap smear results (pathophysiology) and the action(s) that will be taken
next to follow up this abnormality, including patient education (explain the procedure
to the patient).
Ellen’s Pap test shows significant changes in the cells on her cervix. These changes are
called HSIL, which means that some cells look very abnormal. This doesn’t mean she has
cancer, but it does mean there is a higher risk that these abnormal cells could become
cancer in the future if not treated.The test also shows that she has a high-risk type of
HPV (human papillomavirus). HPV is a common virus that spreads through sexual
contact. Some types of HPV can cause cervical cancer over time, especially if the
infection lasts for many years.
(Palefsky, 2025)
Next Steps:
The best way to find out how serious these changes are is to do a procedure called a
colposcopy.
• Colposcopy is done in the clinic and is similar to a Pap smear, but the provider uses a
special microscope to look more closely at the cervix.
• If any areas look suspicious, small samples (biopsies) will be taken and sent to the lab.
• This helps confirm whether the abnormal cells are moderate or severe, and what
treatment is needed.
(Palefsky, 2025) ( Schmeler, 2025)
What to Tell the Patient (Patient Education):
I would explain to the patient in these words “ Ellen you pap test shows some abnormal
cells on your cervix that we want to look at more closely. It’s not cancer, but we want to
make sure it doesn’t turn into cancer in the future. We’ll do a simple in-office procedure
called a colposcopy. It’s like a longer Pap test and may involve taking a small sample of
tissue. It’s important we check this now so we can treat it early if needed. Most women
do very well after early treatment, and this can help protect your future health.”
Plan: Colposcopy with biopsy is the recommended next step to confirm how abnormal
the cells are and decide if treatment like LEEP (loop electrosurgical excision procedure)
or cryotherapy is needed.
Diagnostic Tests:
• Colposcopy with directed cervical biopsies (This test allows for visualization of the
cervix and biopsy is taken to determine the exact grade of CIN ( CIN 2 or 3) or
presence of invasive cancer.)
Lab Tests:
1. HPV Genotyping ( Should be done if cytology was only taken during pap smear. This
test looks for high risk HPV (especially types 16 or 18).
1. STI Testing (chlamydia, gonorrhea, syphilis, HIV) (important to check because some
infections can weaken the immune system and make HPV worse or harder to clear.)
1. Pregnancy Test (Already done and negative) (Important to check because some
treatments like LEEP or biopsies can affect a pregnancy.
1. Blood Tests (CBC) (It checks for anemia or infection if Ellen needs treatment like
LEEP)
(Schmeler, 2025) (Wright, 2025)
Treatment (Pending Colposcopy Results):
If results are CIN 1 (Mild Dyplasia)
Treatment:
• Observation is preferred, especially in young or reproductive-age women.
• Repeat Pap + HPV co-testing at 12 months or colposcopy at 12 months.
• If abnormalities persist for >2 years, consider excisional treatment ( LEEP).
(Einstein et al., 2025) (Wright, 2025)
CIN 2 -3
Treatment: Excisional treatment (LEEP or cold knife conization).
Screening guidelines post-treatment
Negative Margins: HPV- testing 6 months later
• If HPV is positive, then colposcopy and biopsies should be performed and managed
based on these results.
• If HPV is negative, then HPV testing should occur annually for three years.
• If HPV remains negative, then HPV testing can occur every three years for at least 25
years.
Positive Margins: HPV testing in six months or colposcopy
• If HPV is negative, then HPV testing should occur annually for three years. If testing
remains negative, then HPV every three years for at least 25 years.
• If positive, then colposcopy with biopsy. If it continues to be positive, excision must
be done again.
(Einstein et al., 2025) (Wright, 2025)
Medication:
None at this time unless STI identified
Referrals:
• Refer to GYN for colposcopy within 4 weeks
• Referral to GYN oncology only if invasive cancer is identified on biopsy
Education:
• HSIL is not cancer but is considered pre-cancer, meaning that abnormal cells may
become cancer if not treated.
• A colposcopy is needed to get a closer look at the cervix.
• If abnormal cells are found on biopsy, a procedure like LEEP or cryotherapy may be
recommended to remove them.
• HPV is very common, and most people get it at some point, this is not a sign of
infidelity or risky behavior.
• Continue regular follow-ups, early detection and treatment prevent cervical cancer.
What to expect from the colposcopy:
• Done in the office, takes 10–20 minutes.
• May feel pressure or mild cramping.
• Spotting is normal afterward.
• Avoid sex, douching, or tampons for 48 hours after.
Education regarding her current female partner:
• HPV can be transmitted between female partners through skin-to-skin contact,
shared sex toys, or genital contact.
• Encourage her partner to:
o Get regular Pap smears if she has a cervix.
o Receive the HPV vaccine (if age 9–45), especially if not already vaccinated.
• Emphasize that HPV is common and can be dormant for years, so this does not mean
recent transmission.
• Discuss safe sex practices, including cleaning shared items and using barrier
protection if appropriate.
(Wright, 2025)
Health Maintenance:
• Review/update immunizations including HPV
• Lifestyle: stress reduction, healthy diet, smoking cessation if applicable
• Encourage regular Pap screening per follow-up recommendations
Follow-up:
• Colposcopy results in 1–2 weeks post-procedure
• Return to clinic to review pathology and determine next steps
• Emphasize importance of follow-up due to cancer risk
If biopsy confirms CIN 2 or 3, treatment options will be considered. à(LEEP procedure)
1. What patient education is important to include for this patient?
Key points to educate Ellen:
• HSIL is not cancer but is considered pre-cancer, meaning that abnormal cells may
become cancer if not treated.
• A colposcopy is needed to get a closer look at the cervix.
• If abnormal cells are found on biopsy, a procedure like LEEP or cryotherapy may be
recommended to remove them.
• HPV is very common, and most people get it at some point—this is not a sign of
infidelity or risky behavior.
• Continue regular follow-ups early detection and treatment prevent cervical cancer.
(Wright, 2025)
Explain what to expect from the colposcopy:
• Done in the office, takes 10–20 minutes.
• May feel pressure or mild cramping.
• Spotting is normal afterward.
• Avoid sex, douching, or tampons for 48 hours after.
(American Cancer Society, 2024)
1. Is there any education or advice you would give to Ellen regarding her current
female partner?
Yes. Although Ellen is in a monogamous relationship with a female partner, it's important
to know that:
• HPV can be transmitted between female partners through skin-to-skin contact,
shared sex toys, or genital contact.
• Encourage her partner to:
o Get regular Pap smears if she has a cervix.
o Receive the HPV vaccine (if age 9–45), especially if not already vaccinated.
• Emphasize that HPV is common and can be dormant for years, so this does not mean
recent transmission.
• Discuss safe sex practices, including cleaning shared items and using barrier
protection if appropriate.
Case study – a year ago **files (1)** – ## template610.docx **## template610.docx** Instructions · Review the following case study. · Construct a subjective data set for the case study on the provided SOAP note template from the information provided. · Structure the subjective data set on the SOAP n…
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Order on TutorsGallery →Case study
– a year ago
**files (1)**
– ## template610.docx
**## template610.docx**
Instructions
· Review the following case study.
· Construct a subjective data set for the case study on the provided SOAP note template from the information provided.
· Structure the subjective data set on the SOAP note template in the format provided in your lecture materials.
· Submit the Word file containing your subjective data set on the SOAP note template into Canvas.
NU610 Unit 1 Case Study
A 19-year-old female presents with a complaint of headaches frequently. She reports that she has had
them since she was a teenager, but they have become more debilitating recently. The episodes occur
once or twice a month and last for up to 2 days. The pain begins in the right temple or the back of the
right eye and spreads to the entire scalp over a few hours. She describes the pain as a sharp, throbbing
sensation that gradually worsens and is associated with sever nausea. Several factors aggravate the pain
including loud noises and movement. She has taken several over the counter medication like naproxen
and acetaminophen for the pain but the only thing that makes it better is going to sleep in a dark quiet
room. Reports no drug allergies but has seasonal and allergies to pet dander. A thorough history reveals
her mother suffers from migraines. Last menses 4 weeks ago, is sexually active uses condoms. Currently
a freshman in college. Denies alcohol, illicit drug and tobacco use. Last health visit was over the
Summer, up to date on health maintenance for her age. She denies fever, chills, night sweats or neck
stiffness. She denies visual changes other than photophobia. She denies chest pain, palpitations,
shortness of breath or cough. She denies abdominal pain, has some nausea with the headaches but no
vomiting. Denies numbness, tingling, weakness or changes in mood. Vital signs: temperature 98.5, BP
112/70, HR 62, RR 17, 99% RA, Ht. 68 inches, Wt. 151 lbs. Alert and oriented to self, place, time and
situation. Appears stated age with skin warm and dry. Normocephalic, PERRL, TM gray with adequate
conf of light bilaterally, no tenderness over sinuses. Mucous membranes pink and dry. No palpable
masses, adenopathy or thyroid enlargement. Regular heart rate and rhythm without murmurs. No
edema. Lungs clear bilaterally, no use of accessory muscles. Soft, non-tender, non-distended abdomen
with normoactive bowel sounds. Normal visual acuity using Snellen chart 20/20, face symmetrical with
symmetrical smile and puffing out cheeks. Weber and Rinne test performed with normal bone and air
conduction. Palate and uvula at rest are free of fasciculations and symmetry noted at test and when pt.
says “ah.” Positive gag reflex. Shrug shoulders spontaneously and against resistance, hypoglossal nerve
intact. Muscle tone inspected, palpated without atrophy and strength 5/5. Bicep, patellar and Achilles
reflexes 2+ bilaterally with negative Babinski. Able to distinguish light and deep touch. Able to
complete heel to shin, gait steady.
SOAP Note _______
NU___:_________
Herzing University
Name:_________________________
Typhon Encounter #: _____________________
Comprehensive:____Focused:____
S: SUBJECTIVE DATA
CC: What are they being seen for? This is the reason that the patient sought
care, stated in their own words/words of their caregiver, or paraphrased.
HPI: Use the “OLDCART” approach for collecting data and documenting
findings. [O=onset, L=location, D=duration, C=characteristics,
A=associated/aggravating factors, R=relieving factors, T=treatment,
S=summary]
PMH: This should include past illness/diagnosis, conditions, traumas,
hospitalizations, and surgical history. Include dates if possible.
ALLERGIES State the offending medication/food and the reactions.
MEDICATIONS Names, dosages, and routes of administration along with indication of
use.
SH Related to the problem, educational level/literacy, smoking, alcohol,
drugs, HIV risk, sexually active, caffeine, work and other stressors.
Cultural and spiritual beliefs that impact health and illness. Financial
resources.
FH Use terms like maternal, paternal, and the diseases along with the ages
they were deceased or diagnosed if known.
HEALTH
PROMOTION &
MAINTENANCE
Required for all SOAP notes: Immunizations, exercise, diet, etc.
Remember to use the United States Clinical Preventative Services Task
Force (USPSTF) for age-appropriate indicators. This should reflect what
the patient is presently doing regarding the guidelines. Other wellness
visits including but not limited to dental and eye exams.
Constitutional
Head
Eyes
Ears, Nose, Mouth, Throat
Neck
Cardiovascular/Peripheral
Vascular
Respiratory
Breast
ROS
(put N/A in sections
not completed day of
exam)
Gastrointestinal
SOAP Note _______
NU___:_________
Herzing University
Name:_________________________
Typhon Encounter #: _____________________
Comprehensive:____Focused:____
Genitourinary
Musculoskeletal
Integumentary
Neurological
Psychiatric (screening tools: Ex:
PHQ-9, MMSE, GAD-7)
Endocrine
Hematologic/Lymphatic
Allergic/Immunologic
Other
O: OBJECTIVE DATA
HR: RR: BP: Temp:
SpO2%: Ht: Wt: BMI:
VITALS:
Age: LMP: PAIN:
General Appearance
Head
Eyes
ENT, Mouth
Neck
Cardiovascular/Peripheral Vascular
Respiratory
Breast
Gastrointestinal
Genitourinary Male
• External Exam
• Internal Exam
Genitourinary Female
• External Exam
• Internal Exam
Musculoskeletal
Integumentary
Neurological
Psychiatric
Endocrine
PHYSICAL
EXAM
(Pertinent data
related to
presenting
problem or
visit type. Put
N/A in sections
not completed
day of exam)
Hematologic/Lymphatic
SOAP Note _______
NU___:_________
Herzing University
Name:_________________________
Typhon Encounter #: _____________________
Comprehensive:____Focused:____
Allergic/Immunologic
Other
A: ASSESSMENT AND DIAGNOSIS
DIAGNOSIS ICD-10 CODES
1.
2.
PRIORITIZE
DIAGNOSIS
3.
VISIT CODES CPT BILLING CODES
POC TESTINGDIAGNOSTICS
TESTS REVIEWED
P: PLAN
ACTIONS 1. Diagnosis:
Diagnostics Order: labs, diagnostics testing (tests that you planned
for/ordered during the encounter that you plan to review/evaluate
relative to your work up for the patient’s chief complaint.)
Therapeutic: changes in meds, skin care, counseling, include full
prescribing information for any pharmacologic interventions
including quantity and number of refills for any new or refilled
medications. (Ex: Amoxicillin 500mg, PO, q12h, x 7 days, #14, no
refills)
Education: information clients need in order to address their health
problems. Include follow-up care. Anticipatory guidance and
counseling.
SOAP Note _______
NU___:_________
Herzing University
Name:_________________________
Typhon Encounter #: _____________________
Comprehensive:____Focused:____
Consultation/Collaboration: referrals or consult while in clinic with
another provider. If no referral made was there a possible referral
you could make and why? Advance care planning.
2. Diagnosis:
Diagnostics Order:
Therapeutic:
Education:
Consultation/Collaboration:
3. Diagnosis:
Diagnostics Order:
Therapeutic:
Education:
Consultation/Collaboration:
PREVENTITIVE
(Used for
comprehensive exams)
Enter Guidance, Health Promotion, and/or Disease Prevention for
patient, family, and/or caregiver.
FOLLOW UP
**## template610.docx**
Instructions
· Review the following case study.
· Construct a subjective data set for the case study on the provided SOAP note template from the information provided.
· Structure the subjective data set on the SOAP note template in the format provided in your lecture materials.
· Submit the Word file containing your subjective data set on the SOAP note template into Canvas.
NU610 Unit 1 Case Study
A 19-year-old female presents with a complaint of headaches frequently. She reports that she has had
them since she was a teenager, but they have become more debilitating recently. The episodes occur
once or twice a month and last for up to 2 days. The pain begins in the right temple or the back of the
right eye and spreads to the entire scalp over a few hours. She describes the pain as a sharp, throbbing
sensation that gradually worsens and is associated with sever nausea. Several factors aggravate the pain
including loud noises and movement. She has taken several over the counter medication like naproxen
and acetaminophen for the pain but the only thing that makes it better is going to sleep in a dark quiet
room. Reports no drug allergies but has seasonal and allergies to pet dander. A thorough history reveals
her mother suffers from migraines. Last menses 4 weeks ago, is sexually active uses condoms. Currently
a freshman in college. Denies alcohol, illicit drug and tobacco use. Last health visit was over the
Summer, up to date on health maintenance for her age. She denies fever, chills, night sweats or neck
stiffness. She denies visual changes other than photophobia. She denies chest pain, palpitations,
shortness of breath or cough. She denies abdominal pain, has some nausea with the headaches but no
vomiting. Denies numbness, tingling, weakness or changes in mood. Vital signs: temperature 98.5, BP
112/70, HR 62, RR 17, 99% RA, Ht. 68 inches, Wt. 151 lbs. Alert and oriented to self, place, time and
situation. Appears stated age with skin warm and dry. Normocephalic, PERRL, TM gray with adequate
conf of light bilaterally, no tenderness over sinuses. Mucous membranes pink and dry. No palpable
masses, adenopathy or thyroid enlargement. Regular heart rate and rhythm without murmurs. No
edema. Lungs clear bilaterally, no use of accessory muscles. Soft, non-tender, non-distended abdomen
with normoactive bowel sounds. Normal visual acuity using Snellen chart 20/20, face symmetrical with
symmetrical smile and puffing out cheeks. Weber and Rinne test performed with normal bone and air
conduction. Palate and uvula at rest are free of fasciculations and symmetry noted at test and when pt.
says “ah.” Positive gag reflex. Shrug shoulders spontaneously and against resistance, hypoglossal nerve
intact. Muscle tone inspected, palpated without atrophy and strength 5/5. Bicep, patellar and Achilles
reflexes 2+ bilaterally with negative Babinski. Able to distinguish light and deep touch. Able to
complete heel to shin, gait steady.
SOAP Note _______
NU___:_________
Herzing University
Name:_________________________
Typhon Encounter #: _____________________
Comprehensive:____Focused:____
S: SUBJECTIVE DATA
CC: What are they being seen for? This is the reason that the patient sought
care, stated in their own words/words of their caregiver, or paraphrased.
HPI: Use the “OLDCART” approach for collecting data and documenting
findings. [O=onset, L=location, D=duration, C=characteristics,
A=associated/aggravating factors, R=relieving factors, T=treatment,
S=summary]
PMH: This should include past illness/diagnosis, conditions, traumas,
hospitalizations, and surgical history. Include dates if possible.
ALLERGIES State the offending medication/food and the reactions.
MEDICATIONS Names, dosages, and routes of administration along with indication of
use.
SH Related to the problem, educational level/literacy, smoking, alcohol,
drugs, HIV risk, sexually active, caffeine, work and other stressors.
Cultural and spiritual beliefs that impact health and illness. Financial
resources.
FH Use terms like maternal, paternal, and the diseases along with the ages
they were deceased or diagnosed if known.
HEALTH
PROMOTION &
MAINTENANCE
Required for all SOAP notes: Immunizations, exercise, diet, etc.
Remember to use the United States Clinical Preventative Services Task
Force (USPSTF) for age-appropriate indicators. This should reflect what
the patient is presently doing regarding the guidelines. Other wellness
visits including but not limited to dental and eye exams.
Constitutional
Head
Eyes
Ears, Nose, Mouth, Throat
Neck
Cardiovascular/Peripheral
Vascular
Respiratory
Breast
ROS
(put N/A in sections
not completed day of
exam)
Gastrointestinal
SOAP Note _______
NU___:_________
Herzing University
Name:_________________________
Typhon Encounter #: _____________________
Comprehensive:____Focused:____
Genitourinary
Musculoskeletal
Integumentary
Neurological
Psychiatric (screening tools: Ex:
PHQ-9, MMSE, GAD-7)
Endocrine
Hematologic/Lymphatic
Allergic/Immunologic
Other
O: OBJECTIVE DATA
HR: RR: BP: Temp:
SpO2%: Ht: Wt: BMI:
VITALS:
Age: LMP: PAIN:
General Appearance
Head
Eyes
ENT, Mouth
Neck
Cardiovascular/Peripheral Vascular
Respiratory
Breast
Gastrointestinal
Genitourinary Male
• External Exam
• Internal Exam
Genitourinary Female
• External Exam
• Internal Exam
Musculoskeletal
Integumentary
Neurological
Psychiatric
Endocrine
PHYSICAL
EXAM
(Pertinent data
related to
presenting
problem or
visit type. Put
N/A in sections
not completed
day of exam)
Hematologic/Lymphatic
SOAP Note _______
NU___:_________
Herzing University
Name:_________________________
Typhon Encounter #: _____________________
Comprehensive:____Focused:____
Allergic/Immunologic
Other
A: ASSESSMENT AND DIAGNOSIS
DIAGNOSIS ICD-10 CODES
1.
2.
PRIORITIZE
DIAGNOSIS
3.
VISIT CODES CPT BILLING CODES
POC TESTINGDIAGNOSTICS
TESTS REVIEWED
P: PLAN
ACTIONS 1. Diagnosis:
Diagnostics Order: labs, diagnostics testing (tests that you planned
for/ordered during the encounter that you plan to review/evaluate
relative to your work up for the patient’s chief complaint.)
Therapeutic: changes in meds, skin care, counseling, include full
prescribing information for any pharmacologic interventions
including quantity and number of refills for any new or refilled
medications. (Ex: Amoxicillin 500mg, PO, q12h, x 7 days, #14, no
refills)
Education: information clients need in order to address their health
problems. Include follow-up care. Anticipatory guidance and
counseling.
SOAP Note _______
NU___:_________
Herzing University
Name:_________________________
Typhon Encounter #: _____________________
Comprehensive:____Focused:____
Consultation/Collaboration: referrals or consult while in clinic with
another provider. If no referral made was there a possible referral
you could make and why? Advance care planning.
2. Diagnosis:
Diagnostics Order:
Therapeutic:
Education:
Consultation/Collaboration:
3. Diagnosis:
Diagnostics Order:
Therapeutic:
Education:
Consultation/Collaboration:
PREVENTITIVE
(Used for
comprehensive exams)
Enter Guidance, Health Promotion, and/or Disease Prevention for
patient, family, and/or caregiver.
FOLLOW UP
Topic: Substance uses among adolescents. **Please explain in your discussion post an overview of the following items as these will help you for next week.** What is your topic? Who is affected by this topic? How does it affect the community as a whole? Cost Associated to the issues Short-term effect…
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Order on TutorsGallery →Topic: Substance uses among adolescents.
**Please explain in your discussion post an overview of the following items as these will help you for next week.**
What is your topic?
Who is affected by this topic?
How does it affect the community as a whole?
Cost Associated to the issues
Short-term effects versus long-term effects
– a year ago
In-depth study guidance and analytical solution covering practical nursing.
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In-depth study guidance and analytical solution covering pathophysiology.
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Assignment attached – a year ago **files (1)** – ## assessment4instructionsNurs4065.docx **## assessment4instructionsNurs4065.docx** Create a presentation focusing on the fundamental principles of care coordination. The intended audience is nursing colleagues at your practicum site (though you do no…
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– a year ago
**files (1)**
– ## assessment4instructionsNurs4065.docx
**## assessment4instructionsNurs4065.docx**
Create a presentation focusing on the fundamental principles of care coordination. The intended audience is nursing colleagues at your practicum site (though you do not actually need to present to them if you choose not to). In your presentation, include:
· A narrative script.
Your presentation should include the following:
· Effective strategies for collaborating with patients and families: Outline strategies for collaborating with patients and their families to achieve desired health outcomes.
· Consider drug-specific educational interventions and cultural competence strategies.
· Provide evidence to support the selected strategies. This could include research studies, best practices, or relevant literature.
· Aspects of change management and patient experience: Explain how aspects of change management directly impact elements of the patient experience.
· Explain how these aspects contribute to high-quality, patient-centered care.
· Consider factors such as communication, transitions of care, and patient engagement.
· Rationale for coordinated care plans: Explain the rationale behind coordinated care plans.
· Base your explanation on ethical decision making.
· Discuss the reasonable implications and consequences of an ethical approach to care.
· Consider any underlying assumptions that may influence decision making.
· Impact of healthcare policy provisions: Explain how specific healthcare policy provisions may impact outcomes and patient experiences.
· Discuss the logical implications and consequences of these provisions.
· Provide evidence to support your conclusions. This could include policy documents, research, or case studies.
· Nurse's role in coordination and continuum of care: Raise awareness of the nurse's vital role in care coordination and the continuum of care.
· Highlight how nurses contribute to high-quality, patient-centered care.
· Fine-tune your presentation to suit your audience (practicum colleagues).
· Stay focused on key issues related to resources, ethics, and policy in care provision.
· APA formatting and references.
· Cite 3–5 credible sources from peer-reviewed journals or professional industry publications to support your presentation.
· Include your source citations on a references page appended to your narrative script.
**Presentation Format and Length**
·
**Narrative script**: Write and submit
**a detailed narrative script** in APA formatting for your video presentation, 3–5 pages in length. Include a properly formatted APA reference list at the end of the script. This script will be submitted to Turnitin.
**## assessment4instructionsNurs4065.docx**
Create a presentation focusing on the fundamental principles of care coordination. The intended audience is nursing colleagues at your practicum site (though you do not actually need to present to them if you choose not to). In your presentation, include:
· A narrative script.
Your presentation should include the following:
· Effective strategies for collaborating with patients and families: Outline strategies for collaborating with patients and their families to achieve desired health outcomes.
· Consider drug-specific educational interventions and cultural competence strategies.
· Provide evidence to support the selected strategies. This could include research studies, best practices, or relevant literature.
· Aspects of change management and patient experience: Explain how aspects of change management directly impact elements of the patient experience.
· Explain how these aspects contribute to high-quality, patient-centered care.
· Consider factors such as communication, transitions of care, and patient engagement.
· Rationale for coordinated care plans: Explain the rationale behind coordinated care plans.
· Base your explanation on ethical decision making.
· Discuss the reasonable implications and consequences of an ethical approach to care.
· Consider any underlying assumptions that may influence decision making.
· Impact of healthcare policy provisions: Explain how specific healthcare policy provisions may impact outcomes and patient experiences.
· Discuss the logical implications and consequences of these provisions.
· Provide evidence to support your conclusions. This could include policy documents, research, or case studies.
· Nurse's role in coordination and continuum of care: Raise awareness of the nurse's vital role in care coordination and the continuum of care.
· Highlight how nurses contribute to high-quality, patient-centered care.
· Fine-tune your presentation to suit your audience (practicum colleagues).
· Stay focused on key issues related to resources, ethics, and policy in care provision.
· APA formatting and references.
· Cite 3–5 credible sources from peer-reviewed journals or professional industry publications to support your presentation.
· Include your source citations on a references page appended to your narrative script.
**Presentation Format and Length**
·
**Narrative script**: Write and submit
**a detailed narrative script** in APA formatting for your video presentation, 3–5 pages in length. Include a properly formatted APA reference list at the end of the script. This script will be submitted to Turnitin.
In terms of intervention and spiritual care, how do you support a patient facing an ethical dilemma, with consideration for their worldview? If you were that patient, what care would you want provided? Initial discussion question posts should be a minimum of 200 words and include at least two refere…
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Order on TutorsGallery →In terms of intervention and spiritual care, how do you support a patient facing an ethical dilemma, with consideration for their worldview? If you were that patient, what care would you want provided?
Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format.
– a year ago
How does your own definition of spiritual care compare with the Christian definition of spiritual care? Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. – a year ago
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Order on TutorsGallery →How does your own definition of spiritual care compare with the Christian definition of spiritual care?
Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format.
– a year ago
In-depth study guidance and analytical solution covering dr judy r mark.
Immediate access to the full model answer, formatted citations, and rubric breakdown.
Have this question answered from scratch according to your specific instructions and deadline.
Order on TutorsGallery →Full assignment prompt and step-by-step guidance are included in the downloadable solution file.