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  • [Solved] Enhancing Patient Safety and Quality of Care assessment 2

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    – a year ago **files (1)** – ## assessment2nurs-fpx2035.docx **## assessment2nurs-fpx2035.docx** For this assessment, you can use a supplied template to conduct a root-cause analysis. The completed assessment will be a scholarly paper focusing on a quality or safety issue in a healthcare setting of …

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    – a year ago

    **files (1)**

    – ## assessment2nurs-fpx2035.docx

    **## assessment2nurs-fpx2035.docx**

    For this assessment, you can use a supplied template to conduct a root-cause analysis. The completed assessment will be a scholarly paper focusing on a quality or safety issue in a healthcare setting of your choice as well as a safety improvement plan.

    As patient safety concerns continue to be addressed in healthcare settings, nurses can play an active role in implementing safety improvement measures and plans. Often root-cause analyses are conducted and safety improvement plans are created to address sentinel or adverse events such as medication errors, patient falls, wrong-site surgery events, and hospital-acquired infections. Performing a root-cause analysis offers a systematic approach for identifying causes of problems, including process and system-check failures. Once the causes of failures have been determined, a safety improvement plan can be developed to prevent recurrences. The baccalaureate nurse's role as a leader is to create safety improvement plans as well as disseminate vital information to staff nurses and other healthcare professionals to protect patients and improve outcomes.

    As you prepare for this assessment, it would be an excellent choice to complete the Quality and Safety Improvement Plan Knowledge Base activity and to review the various assessment resources, all of which will help you build your knowledge of key concepts and terms related to quality and safety improvement. The terms and concepts will be helpful as you prepare your Root-Cause Analysis and Safety Improvement Plan. Activities are not graded and demonstrate course engagement.

    Nursing practice is governed by healthcare policies and procedures as well as state and national regulations developed to prevent problems. It is critical for nurses to participate in gathering and analyzing data to determine causes of patient safety issues, in solving problems, and in implementing quality improvements.

    For this assessment, use the specific safety concern identified in your previous assessment as the subject of a root-cause analysis and safety improvement plan.

    The purpose of this assessment is to demonstrate your understanding of and ability to analyze a root cause of a specific safety concern in a healthcare setting. You will create a plan to improve the safety of patients related to
    **the safety quality issue presented in your Assessment Supplement PDF in Assessment 1**. Based on the results of your analysis, using the literature and professional best practices as well as the existing resources at your chosen healthcare setting, provide a rationale for your plan.

    Use the
    [Root-Cause Analysis and Safety Improvement Plan [DOCX]](https://courseroom.capella.edu/courses/43657/files/7663319/download) template to help you to stay organized and concise.

    Additionally, be sure that your plan addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so you understand what is needed for a distinguished score.

    · Analyze the root cause of a patient safety issue or a specific sentinel event in an organization.

    · Apply evidence-based and best-practice strategies to address the safety issue or sentinel event.

    · Create a viable, evidence-based safety improvement plan.

    · Identify existing organizational resources that could be leveraged to improve your plan.

    · Communicate in writing that is clear, logical, and professional, with correct grammar and spelling, using current APA style.

    ·
    **Length of submission:** Use the provided template to create a 4–6 page root-cause analysis and safety improvement plan. A title page is not required but you must include a reference list as per the template.

    ·
    **Number of references:** Cite a minimum of 3 sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old. Use the
    [BSN Nursing Program Library Guide](https://capellauniversity.libguides.com/BSN) as needed.

    ·
    **APA formatting:** Format references and citations according to current APA style. See the
    [APA Module](https://lat.strategiced.com/redirect?linkid=2586).

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

    · Competency 1: Analyze the elements of a successful quality improvement initiative.

    · Apply evidence-based and best-practice strategies to address a safety issue or sentinel event.

    · Create a feasible, evidence-based safety improvement plan to address a specific patient safety issue.

    · Competency 2: Analyze factors that lead to patient safety risks.

    · Analyze the root cause of a specific sentinel event or a patient safety issue in an organization.

    · Competency 3: Identify organizational interventions to promote patient safety.

    · Identify existing organizational resources that could be leveraged to improve a plan.

    · Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.

    · Organize content so ideas flow logically with smooth transitions; contains few errors in grammar or punctuation, word choice, and spelling.

    · Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.

    **## assessment2nurs-fpx2035.docx**

    For this assessment, you can use a supplied template to conduct a root-cause analysis. The completed assessment will be a scholarly paper focusing on a quality or safety issue in a healthcare setting of your choice as well as a safety improvement plan.

    As patient safety concerns continue to be addressed in healthcare settings, nurses can play an active role in implementing safety improvement measures and plans. Often root-cause analyses are conducted and safety improvement plans are created to address sentinel or adverse events such as medication errors, patient falls, wrong-site surgery events, and hospital-acquired infections. Performing a root-cause analysis offers a systematic approach for identifying causes of problems, including process and system-check failures. Once the causes of failures have been determined, a safety improvement plan can be developed to prevent recurrences. The baccalaureate nurse's role as a leader is to create safety improvement plans as well as disseminate vital information to staff nurses and other healthcare professionals to protect patients and improve outcomes.

    As you prepare for this assessment, it would be an excellent choice to complete the Quality and Safety Improvement Plan Knowledge Base activity and to review the various assessment resources, all of which will help you build your knowledge of key concepts and terms related to quality and safety improvement. The terms and concepts will be helpful as you prepare your Root-Cause Analysis and Safety Improvement Plan. Activities are not graded and demonstrate course engagement.

    Nursing practice is governed by healthcare policies and procedures as well as state and national regulations developed to prevent problems. It is critical for nurses to participate in gathering and analyzing data to determine causes of patient safety issues, in solving problems, and in implementing quality improvements.

    For this assessment, use the specific safety concern identified in your previous assessment as the subject of a root-cause analysis and safety improvement plan.

    The purpose of this assessment is to demonstrate your understanding of and ability to analyze a root cause of a specific safety concern in a healthcare setting. You will create a plan to improve the safety of patients related to
    **the safety quality issue presented in your Assessment Supplement PDF in Assessment 1**. Based on the results of your analysis, using the literature and professional best practices as well as the existing resources at your chosen healthcare setting, provide a rationale for your plan.

    Use the
    [Root-Cause Analysis and Safety Improvement Plan [DOCX]](https://courseroom.capella.edu/courses/43657/files/7663319/download) template to help you to stay organized and concise.

    Additionally, be sure that your plan addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so you understand what is needed for a distinguished score.

    · Analyze the root cause of a patient safety issue or a specific sentinel event in an organization.

    · Apply evidence-based and best-practice strategies to address the safety issue or sentinel event.

    · Create a viable, evidence-based safety improvement plan.

    · Identify existing organizational resources that could be leveraged to improve your plan.

    · Communicate in writing that is clear, logical, and professional, with correct grammar and spelling, using current APA style.

    ·
    **Length of submission:** Use the provided template to create a 4–6 page root-cause analysis and safety improvement plan. A title page is not required but you must include a reference list as per the template.

    ·
    **Number of references:** Cite a minimum of 3 sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old. Use the
    [BSN Nursing Program Library Guide](https://capellauniversity.libguides.com/BSN) as needed.

    ·
    **APA formatting:** Format references and citations according to current APA style. See the
    [APA Module](https://lat.strategiced.com/redirect?linkid=2586).

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

    · Competency 1: Analyze the elements of a successful quality improvement initiative.

    · Apply evidence-based and best-practice strategies to address a safety issue or sentinel event.

    · Create a feasible, evidence-based safety improvement plan to address a specific patient safety issue.

    · Competency 2: Analyze factors that lead to patient safety risks.

    · Analyze the root cause of a specific sentinel event or a patient safety issue in an organization.

    · Competency 3: Identify organizational interventions to promote patient safety.

    · Identify existing organizational resources that could be leveraged to improve a plan.

    · Competency 5: Apply professional, scholarly, evidence-based strategies to communicate in a manner that supports safe and effective patient care.

    · Organize content so ideas flow logically with smooth transitions; contains few errors in grammar or punctuation, word choice, and spelling.

    · Apply APA formatting to in-text citations and references exhibiting nearly flawless adherence to APA format.

  • [Solved] week 2 DB response 2

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    see attachment – a year ago **files (1)** – ## Week2DBresponse2-.pdf **## Week2DBresponse2-.pdf** Table 1 Infection Description Presentation Causes/ Risk Factors Treatment per CDC Addtl info Candida Fungal infection due to candida albicans Pruritic, soreness, dyspareunia , occasionally thick vaginal…

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    Assignment Prompt & Instructions

    see attachment

    – a year ago

    **files (1)**

    – ## Week2DBresponse2-.pdf

    **## Week2DBresponse2-.pdf**

    Table 1

    Infection Description Presentation Causes/ Risk
    Factors

    Treatment per
    CDC

    Addtl
    info

    Candida

    Fungal
    infection due
    to candida
    albicans

    Pruritic,
    soreness,
    dyspareunia
    ,
    occasionally
    thick
    vaginal
    discharge
    and dysuria.
    KOH
    demonstrate
    s budding

    Pregnancy,
    immunosupression,
    antibiotic use,
    diabetes

    – Fluconazole 150
    mg single dose

    Not
    usually
    considere
    d an STI.

    BV

    Vaginal
    discharge or
    malodorous in
    childbearing
    people. N

    Mal-
    odorous/
    fishy odor,
    thin gray-
    white
    discharge,
    clue cells on

    sexual activity,
    particularly with
    new or multiple
    partners, the use of
    douching, and not
    using condoms

    Metronidazole 500
    mg BID x 7 days
    OR 0.75% gel x 5
    days

    Not
    sexually
    transmittt
    ed

    Chlamydi
    a

    STI caused by
    Chlamydia
    trachomatis

    Often
    Asymptoma
    tic;
    cervicitis,
    urethritis,
    dysuria,
    postcoital
    bleeding

    having multiple or
    new sexual
    partners, not using
    condoms during
    sex, and having a
    history of other
    STIs

    Doxycycline 100
    mg BID x 7 days
    (preferred); or
    Azithromycin 1 g
    PO x1

    Sexually
    transmitt
    ed;
    screen
    annually

    Gonorrhe
    a

    STI caused by
    Nisseria
    gonorrheae

    Purulent
    discharge,
    pelvic pain,
    dysuria,
    urethritis,
    often
    asymptomat
    ic in women

    unprotected sex,
    having multiple
    sexual partners, a
    history of other
    sexually
    transmitted
    infections (STIs),
    and being a young
    adult (under 25)

    Ceftriaxone 500
    mg IM x1 (if <150
    kg); treat
    Chlamydia
    empirically unless
    ruled out

    Sexually
    transmitt
    ed,
    screen
    annually

    Trichomo
    nas

    STI caused by
    Trichomonas
    vaginalis

    Frothy
    yellow-
    green
    discharge,
    strawberry
    cervix, foul
    odor,

    Multiple partners,
    unprotected sex

    Metronidazole 500
    mg BID x 7 days
    or 2g PO x1

    Sexually
    transmitt
    ed,
    partner
    needs to
    be
    treated

    Cervicitis
    Inflammation
    of cervix due
    to STI

    Mucopurule
    nt
    discharge,
    cervical
    bleeding
    with contact

    Chlamydia,
    Gonorrhea, HSV

    Treat based on
    organism;
    empirically cover
    Chlamydia &
    Gonorrhea

    Can
    cause
    PID if
    not
    treater

    PID

    Ascending
    polymicrobial
    infection of
    upper genital
    tract

    Pelvic pain,
    cervical
    motion
    tenderness,
    fever,
    discharge

    Untreated
    Chlamydia/
    Gonorrhea,
    multiple partners

    Ceftriaxone 500
    mg IM x1 +
    Doxycycline 100
    mg BID x 14d

    Metronidazole

    Risk for
    infertility

    HIV

    Human
    immunodeficie
    ncy virus , a
    virus that
    attacks cells
    that help the
    body fight
    infection.
    Affects the

    Acute: flu-
    like
    symptoms

    Chronic:
    becomes
    opportunisti
    c infection

    Unprotected sex,
    IV drug use, MSM,
    mother-to-child

    ART
    (Antiretroviral
    therapy) – lifelong

    Screenin
    g should
    be
    offered
    annually

    Syphilis
    STI caused by
    treponema
    pallidum

    Primary:
    Painless
    chancre

    Secondary:
    rash on
    palms, soles

    Tertiary:
    neurological
    and cardiac
    involvement

    MSM, HIV+,
    multiple partners,
    unprotected sex

    Benzathine
    penicillin G 2.4M
    units IM x1
    (early); weekly x3
    (late/unknown
    duration)

    Screen
    all
    pregnant
    patients,
    treat
    partners.

    Table 2

    Hep B

    hepatitis B
    virus is a small
    DNA virus that
    belongs to the
    “Hepadnavirid
    ae” family.

    Fatigue,
    jaundice,
    RUQ pain

    Sexual contact, IV
    drug use, perinatal
    transmission,
    healthcare
    exposure

    Supportive care
    (acute); Antivirals
    for chronic (e.g.,
    tenofovir,
    entecavir)

    Screenin
    g done to
    all
    pregnant
    patients,
    vaccine
    available

    Hep C

    Hepatitis C is a
    viral infection
    that causes
    liver swelling,
    called
    inflammation.
    Hepatitis C can
    lead to serious
    liver damage.

    Faituge,
    jaundice

    IV drug use, blood
    transfusions
    (pre-1992), sexual
    exposure

    Direct-acting
    antivirals (e.g.,
    sofosbuvir/
    velpatasvir) for 8–
    12 weeks

    Screen
    adults, no
    vaccine
    available

    HSV

    Herpes
    Simplex Virus.
    Herpes is a
    common virus
    that can cause
    cold sores or
    genital sores. It
    spreads
    through skin-
    to-skin contact

    Painless
    vesciles or
    ulcers,
    dysuria,
    systemic
    symptoms
    during
    primary
    infection

    Oral/genital
    contact,
    unprotected sex,
    vertical
    transmission

    Acyclovir 400 mg
    TID x 7–10 days
    or Valacyclovir 1g
    BID x 7–10 days

    Lifelong
    therapy

    Question Answer

    Name 10 Risk Factors for contracting STI’s
    and HIV

    1. Having unprotected sex

    2. Having multiple partners

    3. Injection of drugs with dirty needle
    sharing.

    4. History of previous STI

    5. Substance use

    6. Sex work or transactional sex

    7. Lac of access to healthcare or education

    8. Not being vaccinated against preventable
    STIs

    9. Being incarcerated or having a partner
    who is

    10.Sexual coercion or violence

    Name 5 safer sex practices

    1. Limiting sexual partners

    2. Regular STI testing, especially with new
    partners

    3. Use condoms every tine you have sex

    4. Avoid sex under the influence of drugs or
    alcohol

    5. Inspect partners for visible sore or
    symptoms

    Can HIV be transmitted through sweat, saliva,
    and tears? (Include rationale)

    No, HIV can be transmitted from one infected
    person to another through blood, semen,
    vaginal secretions, rectal fluids and breast
    milk. For HIV to occur, the HIV in these fluids
    must get into the bloodstream of an HIV-
    negative person through a mucous membrane
    through open cuts or sores, or by direct
    injection.

    Lisa is a 19-year-old female who presents to the clinic c/o abnormal vaginal discharge for one
    week after having unprotected vaginal intercourse with a new male partner she has been dating
    for a couple of weeks. Lisa’s pregnancy test is negative and her LMP was 2 weeks ago. As her
    health care provider, you will need to perform testing to determine if Lisa has contracted a
    sexually transmitted infection or other vaginal infection.

    SOAP NOTE

    Demographic: 19/ Female G0P0

    Subjective

    Chief complain: “abnormal vaginal discharge for one week after having unprotected vaginal
    intercourse with a new male partner that I have been dating for a couple of weeks.”

    Name 2 types of intercourse are at the highest
    risk for contracting HIV

    1. Unprotected vaginal sex

    2. Unprotected anal sex

    Why are women more susceptible to HIV in a
    male to female relationship (versus a male
    contracting it from a female)?

    In women, several factors can increase the risk
    of HIV transmission. For example, during
    vaginal or anal intercourse, women are at
    greater risk of acquiring HIV because
    receptive sex is generally riskier than insertive
    sex. Age-related thinning and dryness of the
    vaginal tissue—common in older women—
    can lead to microtears during intercourse,
    providing a pathway for HIV transmission.
    Biologically, women are more vulnerable to
    infection due to the larger mucosal surface
    area exposed during penile penetration.
    Additionally, young women under the age of
    17 are at even higher risk because they have
    an underdeveloped cervix and produce less
    protective vaginal mucus.

    HPI:

    Lisa is a 19 year ld female G0P0 who presents with a one week history of abnormal discharge
    after having unprotected vaginal intercourse with a new male partner.

    • Onset: one week
    • Locating: vaginal
    • Duration: ongoing
    • Characteristic: abnormal
    • Aggrevating/relieving factors: none stated
    • Treatment: none tried

    HPI questions:

    • Is there any vaginal itching, burning or odor?
    • Are you having any symptoms such as cramping, pelvic pain, fever, burning when you pee?
    • Have you had this type of discharge in the past?
    • When was the last time you were tested for STIs?

    Gyn history:

    • LMP: 2 weeks ago, stated, regular
    • Unknown if on birth control at this time
    • Sexually active, new male partner, no protection
    • No known gynocological issues at this time.

    Medical history

    • No known medical conditions
    • No known surgical conditions
    • No known drug allergies
    • Immunizations: up to date

    Family history:

    • Mother: no known medical history
    • Father: no known medical history
    • Maternal grandmother: no known medical history
    • Paternal grandmother: no known medical history,

    Social history

    • Goes to school

    • Balanced diet
    • Regular exercise
    • No drug or alcohol use
    • Sexual history: one new male partner, no protection
    • Relationship: new

    Other questions

    • Are you in a monogamous relationship?
    • Do you practice safe sex?

    Review of systems:

    • General: healthy, denies fever denies chills
    • Neuro: denies headacces or dizziness
    • Cardiovascular: denies chest pain or palpitations
    • Resp: denies shortness of breaeth or cough
    • GI: denies nausea, vomiting or diarrhea or abdominal pain
    • GU: positive abnormal discharge
    • Skin: denies rash, denies new lesions
    • Health maintenance: No Pap in the last 12 months due to age

    Objective

    Vitals: WNL

    • Temp: 98.6
    • BP: 120/80
    • HR:78
    • RR: 17
    • Heihgt: 5’4”
    • Weight: 135
    • BMI: 23.2

    Physical exam:

    • General: AAOx4, no acute distress
    • abdomen soft, non tender
    • Pelvic:

    o Vulva: normal appearance
    o Vagina: abnormal discharge
    o Cervix: normal
    o Uterus: non tender
    o Adnexa: no masses or tenderness

    POCT

    • Urine pregnancy : negative
    o Rule out pregnancy due to age and no condom use
    • Wet mount with KOH and send out check for chlamydia, gonorrhea, BV, trichomonas
    o KOH to help identify yeast, or bv or trichomonas cells
    • NAAT
    o For STI screening

    Assessment

    Final diagnosis:

    • Vaginal candidiasis B37.3 – clinical presentation of abnormal discharge

    Differential:

    • Bacterial vaginosis N76.0 – due to new sexual partner after unprotected sex
    • Trichomoniasis A59.9 – due to new sexual partner after unprotected sex
    • Chlamydia A56.0 – due to new sexual partner after unprotected sex

    Plan

    Diagnostics:

    • NAAT: Chlamydia, Gonorrhea and trichomonas
    • KOH for BV
    • Serology for HIV, syphilis, Hep B and C
    • Pap smear

    Treatments:

    • Fluconazole 150 mg Po x 1 dose orally

    o This medication is being prescribed at tis time as it is the first line therapy for uncomplicated
    candidiasis, some of the side effects are GI upset, and elevated liver enzymes. This
    medication should not be prescribed if patient has a history of liver disease.

    If STI positive: depending on what STI patient comes back positive for, prescriptions will
    change. Both patient and partner will need to be treated and abstain from sex for a week.

    Patient education:

    • Risk factors for STIs
    • Abstain from sex for 7 days until symptoms have resolved, and medication taken
    • Practice safe sex
    • Refrain from having multiple partners as it can place you at higher risks for HIV andSTIs
    • Routine STI screening

    Complications: if untrearted can causes recurect yeast infectons, risk of spreading infection to
    partner and increased risk for HIV and other STIs.

    Referals: refer to GYN follow up

    Follow up;

    • Office will call when lab results return
    • Follow up in one week if symptoms do not improve
    • Pap smear

    Health maintenance:

    • Pap smear starting at age 21
    • Hpv vaccine
    • STI screening annualy or whena new partner
    • Up to date on vaccines

    **## Week2DBresponse2-.pdf**

    Table 1

    Infection Description Presentation Causes/ Risk
    Factors

    Treatment per
    CDC

    Addtl
    info

    Candida

    Fungal
    infection due
    to candida
    albicans

    Pruritic,
    soreness,
    dyspareunia
    ,
    occasionally
    thick
    vaginal
    discharge
    and dysuria.
    KOH
    demonstrate
    s budding

    Pregnancy,
    immunosupression,
    antibiotic use,
    diabetes

    – Fluconazole 150
    mg single dose

    Not
    usually
    considere
    d an STI.

    BV

    Vaginal
    discharge or
    malodorous in
    childbearing
    people. N

    Mal-
    odorous/
    fishy odor,
    thin gray-
    white
    discharge,
    clue cells on

    sexual activity,
    particularly with
    new or multiple
    partners, the use of
    douching, and not
    using condoms

    Metronidazole 500
    mg BID x 7 days
    OR 0.75% gel x 5
    days

    Not
    sexually
    transmittt
    ed

    Chlamydi
    a

    STI caused by
    Chlamydia
    trachomatis

    Often
    Asymptoma
    tic;
    cervicitis,
    urethritis,
    dysuria,
    postcoital
    bleeding

    having multiple or
    new sexual
    partners, not using
    condoms during
    sex, and having a
    history of other
    STIs

    Doxycycline 100
    mg BID x 7 days
    (preferred); or
    Azithromycin 1 g
    PO x1

    Sexually
    transmitt
    ed;
    screen
    annually

    Gonorrhe
    a

    STI caused by
    Nisseria
    gonorrheae

    Purulent
    discharge,
    pelvic pain,
    dysuria,
    urethritis,
    often
    asymptomat
    ic in women

    unprotected sex,
    having multiple
    sexual partners, a
    history of other
    sexually
    transmitted
    infections (STIs),
    and being a young
    adult (under 25)

    Ceftriaxone 500
    mg IM x1 (if <150
    kg); treat
    Chlamydia
    empirically unless
    ruled out

    Sexually
    transmitt
    ed,
    screen
    annually

    Trichomo
    nas

    STI caused by
    Trichomonas
    vaginalis

    Frothy
    yellow-
    green
    discharge,
    strawberry
    cervix, foul
    odor,

    Multiple partners,
    unprotected sex

    Metronidazole 500
    mg BID x 7 days
    or 2g PO x1

    Sexually
    transmitt
    ed,
    partner
    needs to
    be
    treated

    Cervicitis
    Inflammation
    of cervix due
    to STI

    Mucopurule
    nt
    discharge,
    cervical
    bleeding
    with contact

    Chlamydia,
    Gonorrhea, HSV

    Treat based on
    organism;
    empirically cover
    Chlamydia &
    Gonorrhea

    Can
    cause
    PID if
    not
    treater

    PID

    Ascending
    polymicrobial
    infection of
    upper genital
    tract

    Pelvic pain,
    cervical
    motion
    tenderness,
    fever,
    discharge

    Untreated
    Chlamydia/
    Gonorrhea,
    multiple partners

    Ceftriaxone 500
    mg IM x1 +
    Doxycycline 100
    mg BID x 14d

    Metronidazole

    Risk for
    infertility

    HIV

    Human
    immunodeficie
    ncy virus , a
    virus that
    attacks cells
    that help the
    body fight
    infection.
    Affects the

    Acute: flu-
    like
    symptoms

    Chronic:
    becomes
    opportunisti
    c infection

    Unprotected sex,
    IV drug use, MSM,
    mother-to-child

    ART
    (Antiretroviral
    therapy) – lifelong

    Screenin
    g should
    be
    offered
    annually

    Syphilis
    STI caused by
    treponema
    pallidum

    Primary:
    Painless
    chancre

    Secondary:
    rash on
    palms, soles

    Tertiary:
    neurological
    and cardiac
    involvement

    MSM, HIV+,
    multiple partners,
    unprotected sex

    Benzathine
    penicillin G 2.4M
    units IM x1
    (early); weekly x3
    (late/unknown
    duration)

    Screen
    all
    pregnant
    patients,
    treat
    partners.

    Table 2

    Hep B

    hepatitis B
    virus is a small
    DNA virus that
    belongs to the
    “Hepadnavirid
    ae” family.

    Fatigue,
    jaundice,
    RUQ pain

    Sexual contact, IV
    drug use, perinatal
    transmission,
    healthcare
    exposure

    Supportive care
    (acute); Antivirals
    for chronic (e.g.,
    tenofovir,
    entecavir)

    Screenin
    g done to
    all
    pregnant
    patients,
    vaccine
    available

    Hep C

    Hepatitis C is a
    viral infection
    that causes
    liver swelling,
    called
    inflammation.
    Hepatitis C can
    lead to serious
    liver damage.

    Faituge,
    jaundice

    IV drug use, blood
    transfusions
    (pre-1992), sexual
    exposure

    Direct-acting
    antivirals (e.g.,
    sofosbuvir/
    velpatasvir) for 8–
    12 weeks

    Screen
    adults, no
    vaccine
    available

    HSV

    Herpes
    Simplex Virus.
    Herpes is a
    common virus
    that can cause
    cold sores or
    genital sores. It
    spreads
    through skin-
    to-skin contact

    Painless
    vesciles or
    ulcers,
    dysuria,
    systemic
    symptoms
    during
    primary
    infection

    Oral/genital
    contact,
    unprotected sex,
    vertical
    transmission

    Acyclovir 400 mg
    TID x 7–10 days
    or Valacyclovir 1g
    BID x 7–10 days

    Lifelong
    therapy

    Question Answer

    Name 10 Risk Factors for contracting STI’s
    and HIV

    1. Having unprotected sex

    2. Having multiple partners

    3. Injection of drugs with dirty needle
    sharing.

    4. History of previous STI

    5. Substance use

    6. Sex work or transactional sex

    7. Lac of access to healthcare or education

    8. Not being vaccinated against preventable
    STIs

    9. Being incarcerated or having a partner
    who is

    10.Sexual coercion or violence

    Name 5 safer sex practices

    1. Limiting sexual partners

    2. Regular STI testing, especially with new
    partners

    3. Use condoms every tine you have sex

    4. Avoid sex under the influence of drugs or
    alcohol

    5. Inspect partners for visible sore or
    symptoms

    Can HIV be transmitted through sweat, saliva,
    and tears? (Include rationale)

    No, HIV can be transmitted from one infected
    person to another through blood, semen,
    vaginal secretions, rectal fluids and breast
    milk. For HIV to occur, the HIV in these fluids
    must get into the bloodstream of an HIV-
    negative person through a mucous membrane
    through open cuts or sores, or by direct
    injection.

    Lisa is a 19-year-old female who presents to the clinic c/o abnormal vaginal discharge for one
    week after having unprotected vaginal intercourse with a new male partner she has been dating
    for a couple of weeks. Lisa’s pregnancy test is negative and her LMP was 2 weeks ago. As her
    health care provider, you will need to perform testing to determine if Lisa has contracted a
    sexually transmitted infection or other vaginal infection.

    SOAP NOTE

    Demographic: 19/ Female G0P0

    Subjective

    Chief complain: “abnormal vaginal discharge for one week after having unprotected vaginal
    intercourse with a new male partner that I have been dating for a couple of weeks.”

    Name 2 types of intercourse are at the highest
    risk for contracting HIV

    1. Unprotected vaginal sex

    2. Unprotected anal sex

    Why are women more susceptible to HIV in a
    male to female relationship (versus a male
    contracting it from a female)?

    In women, several factors can increase the risk
    of HIV transmission. For example, during
    vaginal or anal intercourse, women are at
    greater risk of acquiring HIV because
    receptive sex is generally riskier than insertive
    sex. Age-related thinning and dryness of the
    vaginal tissue—common in older women—
    can lead to microtears during intercourse,
    providing a pathway for HIV transmission.
    Biologically, women are more vulnerable to
    infection due to the larger mucosal surface
    area exposed during penile penetration.
    Additionally, young women under the age of
    17 are at even higher risk because they have
    an underdeveloped cervix and produce less
    protective vaginal mucus.

    HPI:

    Lisa is a 19 year ld female G0P0 who presents with a one week history of abnormal discharge
    after having unprotected vaginal intercourse with a new male partner.

    • Onset: one week
    • Locating: vaginal
    • Duration: ongoing
    • Characteristic: abnormal
    • Aggrevating/relieving factors: none stated
    • Treatment: none tried

    HPI questions:

    • Is there any vaginal itching, burning or odor?
    • Are you having any symptoms such as cramping, pelvic pain, fever, burning when you pee?
    • Have you had this type of discharge in the past?
    • When was the last time you were tested for STIs?

    Gyn history:

    • LMP: 2 weeks ago, stated, regular
    • Unknown if on birth control at this time
    • Sexually active, new male partner, no protection
    • No known gynocological issues at this time.

    Medical history

    • No known medical conditions
    • No known surgical conditions
    • No known drug allergies
    • Immunizations: up to date

    Family history:

    • Mother: no known medical history
    • Father: no known medical history
    • Maternal grandmother: no known medical history
    • Paternal grandmother: no known medical history,

    Social history

    • Goes to school

    • Balanced diet
    • Regular exercise
    • No drug or alcohol use
    • Sexual history: one new male partner, no protection
    • Relationship: new

    Other questions

    • Are you in a monogamous relationship?
    • Do you practice safe sex?

    Review of systems:

    • General: healthy, denies fever denies chills
    • Neuro: denies headacces or dizziness
    • Cardiovascular: denies chest pain or palpitations
    • Resp: denies shortness of breaeth or cough
    • GI: denies nausea, vomiting or diarrhea or abdominal pain
    • GU: positive abnormal discharge
    • Skin: denies rash, denies new lesions
    • Health maintenance: No Pap in the last 12 months due to age

    Objective

    Vitals: WNL

    • Temp: 98.6
    • BP: 120/80
    • HR:78
    • RR: 17
    • Heihgt: 5’4”
    • Weight: 135
    • BMI: 23.2

    Physical exam:

    • General: AAOx4, no acute distress
    • abdomen soft, non tender
    • Pelvic:

    o Vulva: normal appearance
    o Vagina: abnormal discharge
    o Cervix: normal
    o Uterus: non tender
    o Adnexa: no masses or tenderness

    POCT

    • Urine pregnancy : negative
    o Rule out pregnancy due to age and no condom use
    • Wet mount with KOH and send out check for chlamydia, gonorrhea, BV, trichomonas
    o KOH to help identify yeast, or bv or trichomonas cells
    • NAAT
    o For STI screening

    Assessment

    Final diagnosis:

    • Vaginal candidiasis B37.3 – clinical presentation of abnormal discharge

    Differential:

    • Bacterial vaginosis N76.0 – due to new sexual partner after unprotected sex
    • Trichomoniasis A59.9 – due to new sexual partner after unprotected sex
    • Chlamydia A56.0 – due to new sexual partner after unprotected sex

    Plan

    Diagnostics:

    • NAAT: Chlamydia, Gonorrhea and trichomonas
    • KOH for BV
    • Serology for HIV, syphilis, Hep B and C
    • Pap smear

    Treatments:

    • Fluconazole 150 mg Po x 1 dose orally

    o This medication is being prescribed at tis time as it is the first line therapy for uncomplicated
    candidiasis, some of the side effects are GI upset, and elevated liver enzymes. This
    medication should not be prescribed if patient has a history of liver disease.

    If STI positive: depending on what STI patient comes back positive for, prescriptions will
    change. Both patient and partner will need to be treated and abstain from sex for a week.

    Patient education:

    • Risk factors for STIs
    • Abstain from sex for 7 days until symptoms have resolved, and medication taken
    • Practice safe sex
    • Refrain from having multiple partners as it can place you at higher risks for HIV andSTIs
    • Routine STI screening

    Complications: if untrearted can causes recurect yeast infectons, risk of spreading infection to
    partner and increased risk for HIV and other STIs.

    Referals: refer to GYN follow up

    Follow up;

    • Office will call when lab results return
    • Follow up in one week if symptoms do not improve
    • Pap smear

    Health maintenance:

    • Pap smear starting at age 21
    • Hpv vaccine
    • STI screening annualy or whena new partner
    • Up to date on vaccines

  • [Solved] week 2 DB response

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    see attachment – a year ago **files (1)** – ## Week2DBresponse–.pdf **## Week2DBresponse–.pdf** Infe ctio n Description Presentation Causes/Risk Factors Treatment per CDC Additional Info Can dida Fungal infection (yeast) Vulvar itching, thick white discharge Antibiotics use, diabetes, pregnancy, t…

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    see attachment

    – a year ago

    **files (1)**

    – ## Week2DBresponse–.pdf

    **## Week2DBresponse–.pdf**

    Infe
    ctio
    n

    Description Presentation
    Causes/Risk

    Factors
    Treatment per

    CDC Additional Info

    Can
    dida

    Fungal
    infection
    (yeast)

    Vulvar
    itching, thick
    white
    discharge

    Antibiotics use,
    diabetes,
    pregnancy, tight
    clothes

    Fluconazole
    150 mg PO
    single dose

    Not sexually
    transmitted

    BV
    Bacterial
    vaginosis

    Thin gray
    discharge,
    fishy odor

    Douching,
    multiple partners,
    new sex partner

    Metronidazole
    500 mg PO
    BID x 7 days

    Not an STI, but
    related to sexual
    activity

    Chl
    amy
    dia

    Bacterial STI

    Often
    asymptomatic,
    discharge,
    dysuria

    Unprotected sex,
    <25 yrs, multiple
    partners

    Doxycycline
    100 mg BID x
    7 days

    Screen all
    sexually active
    females <25

    Gon
    orrh
    ea

    Bacterial STI
    Purulent
    discharge,
    pelvic pain

    Same as
    chlamydia

    Ceftriaxone
    500 mg IM +
    doxycycline

    Often co-infected
    with chlamydia

    Tric
    hom
    onas

    Protozoan
    STI

    Frothy
    yellow-green
    discharge,
    odor

    Unprotected sex,
    multiple partners

    Metronidazole
    2g PO single
    dose

    Treat both
    partners

    Cer
    vicit
    is

    Inflammation
    of cervix
    often due to
    STI

    Bleeding,
    discharge,
    pelvic pain

    Chlamydia,
    gonorrhea

    Treat based on
    causative
    organism

    Can lead to PID

    PID

    Infection of
    upper
    reproductive
    tract

    Pelvic pain,
    fever, cervical
    motion pain

    Untreated STIs
    Ceftriaxone +
    doxycycline +
    metronidazole

    Risk for
    infertility

    HIV

    Virus
    affecting
    immune
    system

    Fever, fatigue,
    weight loss

    Needle sharing,
    sex, mother-to-
    child

    Antiretroviral
    therapy (ART)

    Lifelong
    management

    Syp
    hilis

    Bacterial STI
    (Treponema
    pallidum)

    Chancre, rash,
    systemic
    symptoms

    Sexual contact
    with infected
    person

    Penicillin G
    benzathine IM

    Multiple stages;
    test with RPR/
    VDRL

    Table 2: STI Knowledge Questions

    SOAP Note – Tina, 27-year-old Female

    Subjective:

    Chief Complaint (CC):
    “My vagina is burning, and I have painful blisters.”

    HPI (OLDCARTS):

    Hep
    B

    Liver
    infection due
    to HBV

    Fatigue,
    jaundice,
    nausea

    Sexual contact,
    needle use

    Supportive,
    antivirals for
    chronic cases

    Vaccine available

    Hep
    C

    Liver
    infection due
    to HCV

    Often
    asymptomatic,
    may cause
    fatigue

    Blood-to-blood
    contact, needle
    sharing

    Direct-acting
    antivirals
    (DAAs)

    No vaccine;
    chronic if
    untreated

    HS
    V

    Herpes
    simplex virus
    (type 1 or 2)

    Painful
    vesicles/
    ulcers, fever

    Sexual contact
    Acyclovir,
    Valacyclovir

    Recurrent; no
    cure, only
    symptom
    management

    Question Answer

    Name 10 Risk Factors for
    contracting STIs and HIV

    Unprotected sex, multiple partners, new partner, age <25,
    MSM, history of STIs, drug use, sex work, inconsistent
    condom use, partner with STI

    Name 5 safer sex practices
    Use condoms, limit partners, regular testing, mutual
    monogamy, avoid sex under influence

    Can HIV be transmitted
    through sweat, saliva, and
    tears?

    No. HIV is not transmitted through sweat, saliva, or tears due
    to insufficient viral load

    Name 2 types of intercourse at
    highest risk for contracting
    HIV

    Anal sex (receptive), vaginal sex (receptive)

    Why are women more
    susceptible to HIV in male-to-
    female transmission?

    Larger mucosal surface area exposed, higher viral load in
    semen, potential microtears during sex

    • The patient presented with a C/C of vaginal burning and painful blisters that began 3 days
    ago. The area of concern is in her left labia minora. The patient describes that blisters as
    painful and having a burning sensation with visible fluid-filled vesicles. Friction, urination,
    and tight clothing worsen the pain. The patient describes relief with cool compresses, and
    loose clothing. The discomfort is constant with intermittent sharp pain. She rates the pain a
    6/10.

    Medical History:

    • no previous medical history

    • no known allergies to drugs, food, or environmental factors

    • no recent illnesses or hospitalizations

    • vaccinations are up to date

    Surgical History:

    • No prior surgical history

    Social History:

    • #2 sexual partners in the last 6–12 months

    • Use of protection (condoms)

    • Tobacco, alcohol, recreational drug use, x2 a month socially

    • sexual practices (oral, vaginal, anal)

    Medications:

    • Currently not on any medication

    Allergies:

    • NKDA (No Known Drug Allergies)

    Objective:

    Vital Signs:

    • Temp: 98.6°F

    • HR: 76 bpm

    • BP: 112/70

    • RR: 16/min

    • SpO₂: 98% RA

    Physical Exam:

    • Genital Exam: Multiple small grouped vesicles on an erythematous base noted on the left
    labia minora, tender to palpation. No foul-smelling discharge. No cervical motion tenderness.
    No inguinal lymphadenopathy.

    • Other Systems: Normal

    Point of Care Testing (POCT):

    • HSV PCR swab from lesion: High sensitivity and specificity for HSV-1 and HSV-2 (CDC,
    2021)

    • HIV rapid test: Recommended for new STI evaluation

    • Urine NAAT for gonorrhea and chlamydia: Evaluate for co-infections

    • Syphilis RPR and Hepatitis B/C screening: Per CDC recommendations for STI screening

    Assessment/Diagnosis:

    Presumptive Diagnosis:

    • Genital Herpes Simplex Virus (HSV) Infection – ICD-10: A60.9

    Rationale:

    • Classic presentation of painful, fluid-filled vesicles on erythematous base, localized on labia
    minora, recent unprotected sex, no previous known episodes.

    Differential Diagnoses:

    1. Contact Dermatitis: Less likely—symptoms typically bilateral and not vesicular.

    2. Chancroid: Rare in the U.S.; painful ulcers with ragged borders, not grouped vesicles.

    3. Syphilis (Primary): Typically a painless chancre; not vesicular.

    Plan:

    Pharmacologic Treatment (Assuming HSV PCR Positive):

    • Acyclovir 400 mg tablet PO TID for 10 days

    Patient Education:

    • Medication Use: Take all medication as prescribed, even if symptoms improve early.

    • Side Effects: May include nausea, headache, dizziness.

    • Transmission: Avoid sexual activity until lesions are fully healed. HSV can be transmitted
    even when asymptomatic.

    • Safe Sex: Use condoms consistently to reduce recurrence transmission risk.

    • Partner Notification: Partners should be informed and may need testing.

    • Chronic Management: Discuss suppressive therapy if recurrences occur frequently (>6/
    year).

    Non-Pharmacologic Management:

    • Keep area clean and dry.

    • Use sitz baths and loose clothing.

    • Apply cool compresses to soothe discomfort.

    Follow-Up:

    • Return to clinic in 1–2 weeks or sooner if symptoms worsen.

    • Retesting or management for other STI test results as they return.

    Complications of Non-Treatment:

    • Increased risk of HIV transmission

    • Severe and prolonged outbreaks, especially in immunocompromised patients

    • Psychological distress

    • Neonatal HSV transmission risk in future pregnancies

    – Table 2: STI Knowledge Questions
    – SOAP Note – Tina, 27-year-old Female
    – Subjective:
    – Objective:
    – Assessment/Diagnosis:
    – Plan:
    – Pharmacologic Treatment (Assuming HSV PCR Positive):
    – Patient Education:
    – Non-Pharmacologic Management:
    – Follow-Up:
    – Complications of Non-Treatment:

    **## Week2DBresponse–.pdf**

    Infe
    ctio
    n

    Description Presentation
    Causes/Risk

    Factors
    Treatment per

    CDC Additional Info

    Can
    dida

    Fungal
    infection
    (yeast)

    Vulvar
    itching, thick
    white
    discharge

    Antibiotics use,
    diabetes,
    pregnancy, tight
    clothes

    Fluconazole
    150 mg PO
    single dose

    Not sexually
    transmitted

    BV
    Bacterial
    vaginosis

    Thin gray
    discharge,
    fishy odor

    Douching,
    multiple partners,
    new sex partner

    Metronidazole
    500 mg PO
    BID x 7 days

    Not an STI, but
    related to sexual
    activity

    Chl
    amy
    dia

    Bacterial STI

    Often
    asymptomatic,
    discharge,
    dysuria

    Unprotected sex,
    <25 yrs, multiple
    partners

    Doxycycline
    100 mg BID x
    7 days

    Screen all
    sexually active
    females <25

    Gon
    orrh
    ea

    Bacterial STI
    Purulent
    discharge,
    pelvic pain

    Same as
    chlamydia

    Ceftriaxone
    500 mg IM +
    doxycycline

    Often co-infected
    with chlamydia

    Tric
    hom
    onas

    Protozoan
    STI

    Frothy
    yellow-green
    discharge,
    odor

    Unprotected sex,
    multiple partners

    Metronidazole
    2g PO single
    dose

    Treat both
    partners

    Cer
    vicit
    is

    Inflammation
    of cervix
    often due to
    STI

    Bleeding,
    discharge,
    pelvic pain

    Chlamydia,
    gonorrhea

    Treat based on
    causative
    organism

    Can lead to PID

    PID

    Infection of
    upper
    reproductive
    tract

    Pelvic pain,
    fever, cervical
    motion pain

    Untreated STIs
    Ceftriaxone +
    doxycycline +
    metronidazole

    Risk for
    infertility

    HIV

    Virus
    affecting
    immune
    system

    Fever, fatigue,
    weight loss

    Needle sharing,
    sex, mother-to-
    child

    Antiretroviral
    therapy (ART)

    Lifelong
    management

    Syp
    hilis

    Bacterial STI
    (Treponema
    pallidum)

    Chancre, rash,
    systemic
    symptoms

    Sexual contact
    with infected
    person

    Penicillin G
    benzathine IM

    Multiple stages;
    test with RPR/
    VDRL

    Table 2: STI Knowledge Questions

    SOAP Note – Tina, 27-year-old Female

    Subjective:

    Chief Complaint (CC):
    “My vagina is burning, and I have painful blisters.”

    HPI (OLDCARTS):

    Hep
    B

    Liver
    infection due
    to HBV

    Fatigue,
    jaundice,
    nausea

    Sexual contact,
    needle use

    Supportive,
    antivirals for
    chronic cases

    Vaccine available

    Hep
    C

    Liver
    infection due
    to HCV

    Often
    asymptomatic,
    may cause
    fatigue

    Blood-to-blood
    contact, needle
    sharing

    Direct-acting
    antivirals
    (DAAs)

    No vaccine;
    chronic if
    untreated

    HS
    V

    Herpes
    simplex virus
    (type 1 or 2)

    Painful
    vesicles/
    ulcers, fever

    Sexual contact
    Acyclovir,
    Valacyclovir

    Recurrent; no
    cure, only
    symptom
    management

    Question Answer

    Name 10 Risk Factors for
    contracting STIs and HIV

    Unprotected sex, multiple partners, new partner, age <25,
    MSM, history of STIs, drug use, sex work, inconsistent
    condom use, partner with STI

    Name 5 safer sex practices
    Use condoms, limit partners, regular testing, mutual
    monogamy, avoid sex under influence

    Can HIV be transmitted
    through sweat, saliva, and
    tears?

    No. HIV is not transmitted through sweat, saliva, or tears due
    to insufficient viral load

    Name 2 types of intercourse at
    highest risk for contracting
    HIV

    Anal sex (receptive), vaginal sex (receptive)

    Why are women more
    susceptible to HIV in male-to-
    female transmission?

    Larger mucosal surface area exposed, higher viral load in
    semen, potential microtears during sex

    • The patient presented with a C/C of vaginal burning and painful blisters that began 3 days
    ago. The area of concern is in her left labia minora. The patient describes that blisters as
    painful and having a burning sensation with visible fluid-filled vesicles. Friction, urination,
    and tight clothing worsen the pain. The patient describes relief with cool compresses, and
    loose clothing. The discomfort is constant with intermittent sharp pain. She rates the pain a
    6/10.

    Medical History:

    • no previous medical history

    • no known allergies to drugs, food, or environmental factors

    • no recent illnesses or hospitalizations

    • vaccinations are up to date

    Surgical History:

    • No prior surgical history

    Social History:

    • #2 sexual partners in the last 6–12 months

    • Use of protection (condoms)

    • Tobacco, alcohol, recreational drug use, x2 a month socially

    • sexual practices (oral, vaginal, anal)

    Medications:

    • Currently not on any medication

    Allergies:

    • NKDA (No Known Drug Allergies)

    Objective:

    Vital Signs:

    • Temp: 98.6°F

    • HR: 76 bpm

    • BP: 112/70

    • RR: 16/min

    • SpO₂: 98% RA

    Physical Exam:

    • Genital Exam: Multiple small grouped vesicles on an erythematous base noted on the left
    labia minora, tender to palpation. No foul-smelling discharge. No cervical motion tenderness.
    No inguinal lymphadenopathy.

    • Other Systems: Normal

    Point of Care Testing (POCT):

    • HSV PCR swab from lesion: High sensitivity and specificity for HSV-1 and HSV-2 (CDC,
    2021)

    • HIV rapid test: Recommended for new STI evaluation

    • Urine NAAT for gonorrhea and chlamydia: Evaluate for co-infections

    • Syphilis RPR and Hepatitis B/C screening: Per CDC recommendations for STI screening

    Assessment/Diagnosis:

    Presumptive Diagnosis:

    • Genital Herpes Simplex Virus (HSV) Infection – ICD-10: A60.9

    Rationale:

    • Classic presentation of painful, fluid-filled vesicles on erythematous base, localized on labia
    minora, recent unprotected sex, no previous known episodes.

    Differential Diagnoses:

    1. Contact Dermatitis: Less likely—symptoms typically bilateral and not vesicular.

    2. Chancroid: Rare in the U.S.; painful ulcers with ragged borders, not grouped vesicles.

    3. Syphilis (Primary): Typically a painless chancre; not vesicular.

    Plan:

    Pharmacologic Treatment (Assuming HSV PCR Positive):

    • Acyclovir 400 mg tablet PO TID for 10 days

    Patient Education:

    • Medication Use: Take all medication as prescribed, even if symptoms improve early.

    • Side Effects: May include nausea, headache, dizziness.

    • Transmission: Avoid sexual activity until lesions are fully healed. HSV can be transmitted
    even when asymptomatic.

    • Safe Sex: Use condoms consistently to reduce recurrence transmission risk.

    • Partner Notification: Partners should be informed and may need testing.

    • Chronic Management: Discuss suppressive therapy if recurrences occur frequently (>6/
    year).

    Non-Pharmacologic Management:

    • Keep area clean and dry.

    • Use sitz baths and loose clothing.

    • Apply cool compresses to soothe discomfort.

    Follow-Up:

    • Return to clinic in 1–2 weeks or sooner if symptoms worsen.

    • Retesting or management for other STI test results as they return.

    Complications of Non-Treatment:

    • Increased risk of HIV transmission

    • Severe and prolonged outbreaks, especially in immunocompromised patients

    • Psychological distress

    • Neonatal HSV transmission risk in future pregnancies

    – Table 2: STI Knowledge Questions
    – SOAP Note – Tina, 27-year-old Female
    – Subjective:
    – Objective:
    – Assessment/Diagnosis:
    – Plan:
    – Pharmacologic Treatment (Assuming HSV PCR Positive):
    – Patient Education:
    – Non-Pharmacologic Management:
    – Follow-Up:
    – Complications of Non-Treatment:

  • [Solved] W-DISC 3

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    Executive Solution Overview

    PLEASE SEE ATTACHED DOCUMENT FOR INSTRUCTIONS AND REQUIREMENT DUE DATE MAY 18, 2025 NO PALGIO MORE THAN 10% 400 WORDS MINIMUM – [\ \ DISCUSSION.docx](https://www.sweetstudy.com/files/discussion-docx-10293873 "DISCUSSION.docx") – a year ago

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    PLEASE SEE ATTACHED DOCUMENT FOR INSTRUCTIONS AND REQUIREMENT

    DUE DATE MAY 18, 2025

    NO PALGIO MORE THAN 10%

    400 WORDS MINIMUM

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    DISCUSSION.docx](https://www.sweetstudy.com/files/discussion-docx-10293873 "DISCUSSION.docx")

    – a year ago

  • [Solved] Summarize why you believe this nursing practice problem (pressure injury) is an issue in your current or past area of practice.

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    In-depth study guidance and analytical solution covering Summarize why you believe this nursing practice problem (pressure injury) is an issue in your current or past area of practice..

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  • [Solved] Summarize why you believe this nursing practice (pressure injury) problem is an issue in your current or past area of practice.

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    In-depth study guidance and analytical solution covering Summarize why you believe this nursing practice (pressure injury) problem is an issue in your current or past area of practice..

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  • [Solved] Provide a reply as aDNP student to the following post, use APA 7 format and at least 2 different scholarly references.

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    To will In today’s complex healthcare environment, nurses are increasingly expected to do more than provide bedside care; we are being called to lead change. As a nurse working toward achieving a Doctor of Nursing Practice (DNP) role, I see these expectations as a chance to help close the gap betwee…

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    To will

    In today’s complex healthcare environment, nurses are increasingly expected to do more than provide bedside care; we are being called to lead change. As a nurse working toward achieving a Doctor of Nursing Practice (DNP) role, I see these expectations as a chance to help close the gap between what we know from research and what happens in practice. The DNP is not just about learning new skills but about a mindset change from carrying out orders to supporting the design of better care systems. It has not been an easy transition, especially coming from an FNP background, where the focus has often been on direct clinical care rather than systems-level change. However, with the proper education, support, and leadership, it will become possible to step into that larger role.

    The DNP Matters in Making Evidence Real

    There is much research out there showing what works in patient care, but too often it never makes it to the bedside. That is where the DNP comes in. We are trained to take the evidence and translate it into real-world change. Melnyk and colleagues (2022) emphasize how DNP-prepared nurses are uniquely positioned to lead improvements in safety, quality, and outcomes. This focus on applying evidence aligns directly with DNP Essential III, which uses data and scholarship to drive practice (AACN, 2006). Moreover, none of that happens in a vacuum; we also need leadership tools from DNP Essentials II to drive those changes within real healthcare systems (AACN, 2006).

    As I plan my DNP project, I am grounding it in Dr. Katie Love’s Empowered Holistic Nursing Education (EHNE) theory. Her work emphasizes the importance of supporting nurses in thinking critically, reflecting, and leading, not just following orders (Love, 2014). That kind of empowerment doesn’t stop in the classroom. It has to be present in the workplace, too.

    That’s where Transformational Leadership comes in. This leadership style is about more than managing. It’s about inspiring. Transformational leaders support their teams, encourage innovation, and make space for autonomy (Boamah et al., 2018). Research shows that transformational leadership improves job satisfaction, reduces burnout, and improves patient outcomes (Boamah et al., 2018). If we want empowered nurses, we need leaders who create the kind of culture where empowerment is possible. That is the vision I want to carry into my project.

    Career Goals and Uncertainty

    In the short term, I am still working out the details of my DNP project, and I will be honest, there is some uncertainty there. However, that is part of the journey. Coming from an FNP role where everything is protocol-driven, it is a shift to think more independently and design solutions myself. That’s exactly what the DNP is helping me develop. My practicum will be key in shaping the direction of my project, which I hope will focus on a practice change initiative within a healthcare setting.

    In the long term, I am not certain if I will stay in my current organization or move into a leadership role as someone who supports bedside nurses the way I wish I had been supported early in my career. There is plenty of evidence that when nurses are empowered and supported to think and act autonomously, job satisfaction goes up, turnover goes down, and patients do better (Spence Laschinger & Read, 2016). That is what I want to help create.

    Conclusion

    The DNP is not just a degree. It is a transformation. It is about becoming the kind of nurse who does not just participate in the system, but helps redesign it. While my project is still taking shape, I know that grounding it in empowerment, strong leadership, and evidence-based practice will set a foundation for the project and the kind of nurse leader I want to become. I hope that implementing this kind of leadership will help me make nursing better, for the patients, and for nurses, too.

    **References**

    American Association of Colleges of Nursing. (2006). _The essentials of doctoral education for advanced nursing practice_. [https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf](https://www.aacnnursing.org/Portals/42/Publications/DNPEssentials.pdf)

    Boamah, S. A., Spence Laschinger, H. K., Wong, C., & Clarke, S. (2018). Effect of transformational leadership on job satisfaction and patient safety outcomes. _Nursing Outlook, 66_(2), 180–189. https://doi.org/10.1016/j.outlook.2017.10.004

    Love, K. (2014). A midrange theory of Empowered Holistic Nursing Education: A pedagogy for a student-centered classroom. _Creative Nursing, 20_(1), 47–58. https://doi.org/10.1891/1078-4535.20.1.47

    Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2022). _Evidence-based practice in nursing & healthcare: A guide to best practice_ (5th ed.). Wolters Kluwer.

    Spence Laschinger, H. K., & Read, E. A. (2016). The effect of authentic leadership, person-job fit, and civility norms on new graduate nurses’ experiences of coworker incivility and burnout. _Journal of Nursing Administration, 46_(11), 574–580. https://doi.org/10.1097/NNA.0000000000000403

    – a year ago

  • [Solved] Provide a reply as a DNP student to the following post, use APA78 7 format and at least 2 different scholarly references no older than 5 years old.

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    To Dinorah: Building a culture that supports and recognizes Evidence-Based Practice (EBP) is critical to facilitating effective choices, achieving better outcomes, and spurring innovation in healthcare and public policy. EBP combines the best evidence obtained from research, practical expertise, and…

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    To Dinorah:

    Building a culture that supports and recognizes Evidence-Based Practice (EBP) is critical to facilitating effective choices, achieving better outcomes, and spurring innovation in healthcare and public policy. EBP combines the best evidence obtained from research, practical expertise, and stakeholder preferences in a way that made actions evidence-based instead of based on tradition or intuition. Developing such a culture demands conscious efforts to emphasize critical thinking, data literacy, and collaborative practices while eradicating systemic obstacles deterring evidence-informed practices.

    One of the cornerstones of EBP is its capacity to improve outcomes by diminishing the use of outdated or inefficient practices. For example, in healthcare, hospitals that value EBP tend to implement clinical guidelines based on rigorous research, such as standardized protocols for treating sepsis, leading to a decrease in mortality rates (Cullen et al., 2022). Likewise, in education, schools that integrate evidence-based teaching practices such as formative assessments or structured literacy interventions report significant gains in student achievement. On the contrary, neglecting EBP in organizations may lead them to continue these inefficiencies, such as businesses that stick to unproven marketing strategies and policymakers that implement programs without pilot testing. When institutions encourage EBP, they convey that decisions should be driven by data, promoting accountability and constant advancement.

    The significance of leadership in introducing EBP into organizational DNA cannot be underestimated. Leaders must demonstrate evidence-informed behaviors, such as assuming assumptions or requiring data before approving initiatives. In healthcare, the success of Kaiser Permanente in integrating EBP can be attributed to the leadership mandates in which clinicians must practice evidence-based care pathways with the assistance of electronic health records to highlight deviations (Rockette, 2021). To imitate such success, organizations can make EBP training compulsory, offer access to research databases, and reward staff who promote data-driven initiatives.

    Rewarding EBP also requires structural supports that reduce the barriers to accessing and implementing evidence. This involves investing in programs for training to enhance data literacy, like workshops on statistical analysis or critical appraisal. Organizations such as Johns Hopkins University collaborate with hospitals to train healthcare professionals to translate research to practice, thus closing the distance between the academic world and the real frontline environment (Cullen et al., 2022). Also, organizations can establish interdisciplinary EBP hubs where practitioners work alongside researchers to solve real-world problems. For instance, the education sector has experienced success with initiatives such as the Regional Educational Laboratory (REL) network in the U.S. that links schools with researchers to measure interventions such as tutoring programs or behavioral supports.

    Additionally, there is a need to balance incentives with EBP. Performance evaluations should be given to employees who exhibit evidence-based decision making, and cost savings can indicate this, better patient outcomes, and innovative solutions. In the corporate world, Amazon, for example, links executive bonuses to verified metrics using data analytics, helping to establish a culture that supports strategic aims based on evidence. Similarly, the public acknowledgment, like awards for excellence in EBP, reinforces its value as demonstrated by such initiatives as the awards given to nurses working towards advancing clinical practices by application of research by the American Nurses Association.

    In conclusion, appreciation and remuneration of EBP are not just a technical adjustment; it is a cultural change that requires leadership buy-in, structural support, and aligned incentives. Organizations open avenues to innovation, equity, and sustainability when EBP is integrated into routine business operations, from healthcare protocols to educational reforms. As global challenges increase, institutions that nurture curiosity, rigor, and collaboration will be best equipped to succeed. This is in line with DNP Essential II, which recognizes the essential role of leadership in shaping cultures that promote evidence-based decision-making, systems thinking, and quality improvement (Giddens et al., 2022). This imperative emphasizes that Doctor of Nursing Practice (DNP)-prepared nurses must spearhead efforts to transform healthcare systems through evidence-based integration, optimized outcomes, and the removal of systemic obstacles to innovation.

    **References**

    Cullen, L., Hanrahan, K., Farrington, M., Tucker, S., & Edmonds, S. (2022). _Evidence-based practice in action: Comprehensive strategies, tools, and tips from University of Iowa Hospitals & Clinics_. Sigma Theta Tau.

    Giddens, J., Douglas, J. P., & Conroy, S. (2022). The revised AACN essentials: Implications for nursing regulation. _Journal of Nursing Regulation_, _12_(4), 16-22. https://doi.org/10.1016/S2155-8256(22)00009-6

    Rockette, E. D. (2021). _Exploring Frontline Care Management Organization Leaders’ Evidence-Based Practice Implementation and Facilitation Strategies: A Qualitative Descriptive Study_ (Doctoral dissertation, Grand Canyon University).

    – a year ago

  • [Solved] Pharm week 2 Reply to Peer 2

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    **Initial Post: Eye Conditions – AM Case Study** Concerning pharmacologic treatment for AM, initiating a topical broad-spectrum antibiotic to avoid bacterial superinfection is appropriate, and his marred contact lens history should be considered. The fluoroquinolone eye drops, including moxifloxacin…

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    **Initial Post: Eye Conditions – AM Case Study**

    Concerning pharmacologic treatment for AM, initiating a topical broad-spectrum antibiotic to avoid bacterial superinfection is appropriate, and his marred contact lens history should be considered. The fluoroquinolone eye drops, including moxifloxacin or ciprofloxacin, are widely used for their effectiveness against Pseudomonas aeruginosa, which is one of the most common causes of contact lens-related infections (Drago, 2024). These should be given regularly- generally one drop every hour while awake during the first 24-48 hours, then titrated according to clinical response. Furthermore, lubricating eye drops have symptomatic relief, whereas cycloplegic agents such as cyclopentolate can be prescribed to alleviate ciliary spasms and attendant pain if photophobia is present. Oral analgesics like acetaminophen or NSAIDs can also be used to alleviate discomfort.

    AM should receive immediate follow-up care within 24 hours after initiating treatment. This follow-up is crucial here to confirm that the abrasion is healing and there is no microbial keratitis progression that causes corneal ulcers and vision loss if left untreated. If there is no improvement or the lesion worsens, then AM should be referred to an ophthalmologist for further diagnosis, possible corneal cultures, and more aggressive therapy. Further follow-up may be required until the symptoms are completely resolved and corneal healing is confirmed.

    AM also requires adequate counseling on safe contact lens practices to avoid future episodes. He should be warned against sleeping in contact lenses, even occasionally, because this heightens the risk of corneal hypoxia and infection (Rhee et al., 2024). He should wash and dry his hands before dealing with lenses, strictly follow the schedule for cleaning and replacement, and keep lenses protected from water, for example, showering or swimming. Education in detecting early signs of eye irritation or infection, along with a cessation of lens use at the first sensation of discomfort, will help keep his ocular health intact in the long term.

    **References**

    Drago, L. (2024). Topical Antibiotic Therapy in the Ocular Environment: The Benefits of Using Moxifloxacin Eyedrops. Microorganisms, 12(4), 649. [https://doi.org/10.3390/microorganisms12040649](https://doi.org/10.3390/microorganisms12040649)

    Rhee, M. K., Ahmad, S., Amescua, G., Cheung, A. Y., Choi, D. S., Jhanji, V., … & Varu, D. M. (2024). Bacterial keratitis preferred practice pattern®. Ophthalmology, 131(4), P87-P133. [https://www.aaojournal.org/article/S0161-6420(24)00007-1/abstract](https://www.aaojournal.org/article/S0161-6420(24)00007-1/abstract)

    – a year ago

  • [Solved] Pharm week 2 Reply to Peer 1

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    1-For the pharmacologic management of AM, who presents a corneal abrasion associated with contact lens wear, we recommend the immediate suspension of the lenses and the instauration of a broad spectrum antibiotic eye drop with activity against Pseudomonas, preferably a fourth generation fluoroquinol…

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    1-For the pharmacologic management of AM, who presents a corneal abrasion associated with contact lens wear, we recommend the immediate suspension of the lenses and the instauration of a broad spectrum antibiotic eye drop with activity against Pseudomonas, preferably a fourth generation fluoroquinolone (for example, moxifloxacin or gatifloxacin) in an initial schedule of instillation every 2-4 hours during the first 24-48 hours and then four times a day until complete epithelial healing. Intensive lubrication with artificial tears is associated to favor re-epithelialization and a cycloplegic eye drop (homatropine 1%) can be added once a day to alleviate pain due to ciliary spasm. Anesthetics should not be prescribed because of the risk of delayed healing and corneal complications (Cassano et al., 2021).

    2-AM should be re-evaluated within 24 to 48 hours to check for complete healing of the corneal epithelium and to rule out the appearance of infiltrates or signs of infection; at this visit, visual acuity should be assessed, fluorescein staining should be repeated and if possible, slit-lamp examination should be performed to confirm closure of the epithelial defect and the absence of edema or stromal inflammation. During follow-up it is essential to reinforce the total suspension of contact lenses until complete recovery, to insist on the correct instillation of antibiotic and lubricants, and to monitor the appearance of alarm symptoms, increased pain, hypopyon, purulent discharge or worsening of vision that would require urgent referral to an ophthalmologist. Once the erosion has closed without complications, adaptation to new contact lenses can be started gradually under specialized supervision (Kobia-Acquah et al., 2021).

    3-AM should be advised to immediately discontinue contact lens wear until complete healing of the corneal epithelium to avoid the introduction of microorganisms and prevent the development of Pseudomonas keratitis or other pathogens. Once the ophthalmologist confirms corneal repair, AM should debut a new pair of monthly lenses, strictly adhere to the replacement schedule, employ proper cleaning and disinfection techniques, and avoid swimming, showering or sleeping with the lenses to minimize the risk of reinfection and new abrasions (Flanagan et al., 2020).

    References

    Cassano, F., Cardascia, N., Tegola, M. G. L., Boscia, F., & Alessio, G. (2021). Scedosporium apiospermum contact lens-related keratitis: A case report and literature review. _Medical Hypothesis, Discovery & Innovation Ophthalmology Journal_, _10_(2), 80–85. https://doi.org/10.51329/mehdiophthal1425

    Flanagan, G., Velez, T., Gu, W., & Singman, E. (2020). Contact Lens Wear, Corneal Complications, and U.S. Service Member Readiness. _Military Medicine_, _185_(11–12), e2071–e2075. https://doi.org/10.1093/milmed/usaa187

    Kobia-Acquah, E., Akowuah, P. K., Antwi-Adjei, E. K., Forkuo, P. M., Koomson, N. Y., Odotei, S. O., Alabi, E., & Donkor, R. (2021). Contact lens complications among wearers in Ghana. _Contact Lens & Anterior Eye: The Journal of the British Contact Lens Association_, _44_(1), 67–71. https://doi.org/10.1016/j.clae.2019.11.003

    – a year ago