Tag: Clinical-Nursing

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Adolescent Sports Evaluation shadow health Objective data

Objective Data Collection: 23 of 23 (100%)

 Correct

 Partially correct

 Incorrect

 Missed

 Growth Chart: Height & Weight

1 of 1 point

Weight Percentile 
(1/4 point)

 Below 5th percentile

 Between 5th and 95th percentile

 Above 95th percentile

Adolescent Sports Evaluation shadow health Objective data

Weight Growth Curve 
(1/4 point)

 Growth curve maintained

 Growth curve decline

Height Percentile 
(1/4 point)

 Below 5th percentile

 Between 5th and 95th percentile

 Above 95th percentile

Height Growth Curve 
(1/4 point)

 Growth curve maintained

 Growth curve declined

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 Inspected Skin

1 of 1 point

Lesions 
(1/5 point)

 No visible lesions

 Lacerations/wounds

 Erythema

 Ecchymosis

 Birthmark

 Discolorations

Color 
(1/5 point)

 Consistent with ethnic background

 Jaundice

 Cyanosis

 Pallor

Texture 
(1/5 point)

 Smooth

 Rough

Temperature 
(1/5 point)

 Warm

 Cool

Skin Hydration 
(1/5 point)

 Elastic

 Elastic Tenting

 Sluggish Turgor

 Inspected General Appearance

1 of 1 point

Posture 
(1/2 point)

 Upright posture without tension or rigidity

 Bent or hunched posture, tension or rigidity

Adolescent Sports Evaluation shadow health Objective data

Clothing 
(1/2 point)

 Clean clothing, appropriate for age, fit, season and occasion

 Dirty, disheveled, or inappropriate to age, fit, season or occasion

 Assessed Cervical Spine RoM

1 of 1 point

Flexion 
(1/4 point)

 Expected range of motion (approx. 45)

 Reduced range of motion

Extension 
(1/4 point)

 Expected range of motion (approx. 45)

 Reduced range of motion

Lateral Bending 
(1/4 point)

 Expected range of motion (approx. 40) on both sides

 Reduced range of motion on right

 Reduced range of motion on left

Rotation 
(1/4 point)

 Expected range of motion (approx. 70) on both sides

 Reduced range of motion on right

 Reduced range of motion on left

 Assessed Spine Range of Motion

1 of 1 point

Rotation 
(1/1 point)

 Expected range of motion (approx. 75-90 degrees)

 Reduced flexion

 Assessed Wrist RoM

1 of 1 point

Left Extension 
(1/4 point)

 Expected range of motion (approx. 90 degrees)

 Reduced flexion

Right Extension 
(1/4 point)

 Expected range of motion (approx. 90 degrees)

 Reduced extension

Adolescent Sports Evaluation shadow health Objective data

Left Flexion 
(1/4 point)

 Expected range of motion (approx. 90 degrees)

 Reduced flexion

Right Flexion 
(1/4 point)

 Expected range of motion (approx. 90 degrees)

 Reduced flexion

 Assessed Elbow RoM

1 of 1 point

Left: Flexion And Extension 
(1/4 point)

 Expected range of motion (approx. flexion of 160 degrees and 180 degrees of full extension)

 Reduced Extension

 Reduced Flexion

Right: Flexion And Extension 
(1/4 point)

 Expected range of motion (approx. flexion of 160 degrees and 180 degrees of full extension)

 Reduced Extension

 Reduced Flexion

Left: Supination And Pronation 
(1/4 point)

 Expected range of motion (approx. pronation of 90 degrees and 90 degrees of supination)

 Reduced Pronation

 Reduced Supination

Right: Supination And Pronation 
(1/4 point)

 Expected range of motion (approx. pronation of 90 degrees and 90 degrees of supination)

 Reduced Pronation

 Reduced Supination

 Assessed Shoulder RoM

1 of 1 point

Adduction 
(1/3 point)

 Expected range of motion (approx. 50 degrees)

 Reduced range of motion

Abduction 
(1/3 point)

 Expected range of motion (approx. 50 degrees)

 Reduced range of motion

Strength 
(1/3 point)

 0 – No muscle contraction

 1 – Barely detectable contraction

 2 – Active movement with gravity eliminated

 3 – Active movement against gravity

 4 – Active movement against gravity and resistance

 5 – Active movement against full resistance without fatigue (normal)

 Assessed Trapezius Strength

1 of 1 point

Strength 
(1/1 point)

 0 – No muscle contraction

 1 – Barely detectable contraction

 2 – Active movement with gravity eliminated

 3 – Active movement against gravity

 4 – Active movement against gravity and resistance

 5 – Active movement against full resistance without fatigue (normal)

Adolescent Sports Evaluation shadow health Objective data

 Assessed Deltoid Strength And Shoulder Rotation

1 of 1 point

Strength & Rotation 
(1/3 point)

 Symmetric

 Asymmetric

Forward Flexion 
(1/3 point)

 Expected range of motion (approx. 180 degrees)

 Reduced range of motion

Extension 
(1/3 point)

 Expected range of motion (approx. 50 degrees)

 Reduced range of motion

 Assessed Hand/Finger RoM And Strength

1 of 1 point

Left 
(1/2 point)

 0 – No muscle contraction

 1 – Barely detectable contraction

 2 – Active movement with gravity eliminated

 3 – Active movement against gravity

 4 – Active movement against gravity and resistance

 5 – Active movement against full resistance without fatigue (normal)

Right 
(1/2 point)

 0 – No muscle contraction

 1 – Barely detectable contraction

 2 – Active movement with gravity eliminated

 3 – Active movement against gravity

 4 – Active movement against gravity and resistance

 5 – Active movement against full resistance without fatigue (normal)

 Assessed Symmetry of Extremities

1 of 1 point

Extremities 
(1/1 point)

 Symmetrical

 Asymmetrical

 Assessed Leg Symmetry, Knee or Ankle Effusion

1 of 1 point

Effusion 
(1/3 point)

 Present

 Not present

Leg Symmetry 
(1/3 point)

 Symmetric

 Asymmetric

Knee Symmetry 
(1/3 point)

 Symmetric

 Asymmetric

 Assessed Calf Symmetry, Leg Strength

1 of 1 point

Calf Muscles 
(1/2 point)

 Symmetric

 Asymmetric

Leg Strength 
(1/2 point)

 0 – No muscle contraction

 1 – Barely detectable contraction

 2 – Active movement with gravity eliminated

 3 – Active movement against gravity

 4 – Active movement against gravity and resistance

 5 – Active movement against full resistance without fatigue (normal)

 Tested Hip, Knee and Ankle Range of Motion

1 of 1 point

Hip Range Of Motion 
(1/3 point)

 Symmetric, full range of motion without limitations

 Asymmetric range of motion with limitations

Knee Range Of Motion 
(1/3 point)

 Symmetric, full range of motion without limitations

 Asymmetric range of motion with limitations

Ankle Range Of Motion 
(1/3 point)

 Symmetric, full range of motion without limitations

 Asymmetric range of motion with limitations

 Tested 6 Cardinal Fields of Vision

1 of 1 point

Cardinal Fields 
(1/2 point)

 No abnormal findings

 Nystagmus

 Fixed Pupil

Convergence 
(1/2 point)

 No abnormal findings

 Unequal bilaterally

 Fixed Pupil

 Tested Peripheral Vision

1 of 1 point

Observations 
(1/1 point)

 No abnormal findings

 Reduced right visual field

 Reduced left visual field

 Tested Visual Acuity

1 of 1 point

Right 
(1/2 point)

 20/100

 20/70

 20/50

 20/40

 20/30

 20/25

 20/20

 20/15

 20/13

 20/10

Left 
(1/2 point)

 20/100

 20/70

 20/50

 20/40

 20/30

 20/25

 20/20

 20/15

 20/13

 20/10

 Romberg Test

1 of 1 point

Romberg 
(1/1 point)

 Maintains upright posture

 Difficulty remaining upright

 Auscultated Breath Sounds

1 of 1 point

Breath Sounds 
(1/2 point)

 Clear in all areas

 Diminished in some areas

 Absent in some areas

Adventitious Sounds 
(1/2 point)

 No adventitious sounds

 Wheezing

 Fine crackles

 Stridor

 Rhonchi

 Rales

 Auscultated Abdominal Aorta

1 of 1 point

Sounds 
(1/1 point)

 No bruit

 Bruit

 Auscultated Heart Sounds

1 of 1 point

Heart Sounds 
(1/3 point)

 S1 and S2 audible

 S1, S2, and S3 audible

 S1, S2 and S4 audible

 S1, S2, S3 and S4 audible

Extra Heart Sounds 
(1/3 point)

 No extra sounds

 Gallops

 Murmur

 Friction rub

 Valve clicks

Rate And Rhythm 
(1/3 point)

 Regular rate and rhythm

 Irregular rate and rhythm

 Arrhythmia

 Screened Adam’s Forward Bend

1 of 1 point

Iliac Crests 
(1/6 point)

 Equal height

 Unequal height

Scapula Prominence And Shape 
(1/6 point)

 Equal height

 Unequal height

Spine Contour 
(1/6 point)

 Expected curvature

 Decreased lordosis

 Increased lordosis

 Decreased kyphosis

 Increased kyphosis

Spine Symmetry 
(1/6 point)

 Symmetrical

 Asymmetrical

Waistline 
(1/6 point)

 Equal height

 Unequal height

Flexion 
(1/6 point)

 Expected range of motion (approx. 75-90 degrees)

 Reduced flexion

Adolescent Sports Evaluation shadow health Objective data

Samantha Monroe shadow health Documentation

Documentation / Electronic Health Record

My Provider Notes

Student Documentation

Model Documentation

Subjective

Ms. Monroe is a 13 year old female presenting for a preparticipation evaluation so she can play soccer this year. Past Medical History: No current medical problems. Tonsillectomy as a child. Medications: No prescription medications. Takes multivitamin and apple cider vinegar. Nutrition: Eats a Mediterranean diet and avoids sweets, processed foods, and white carbs. Skips lunch 1-2 times a week. Physical Activity: Plays soccer on weekends. Family Medical History: No family history of genetic heart problems. Review of Systems HEENT: Denies eye, vision, and hearing problems. Cardiovascular: Denies chest pain during exercise, hear problems. Respiratory: Denies breathing problems during exercise. Musculoskeletal: Denies joint or muscle injuries. Genitourinary: Denies starting menses.

 

 

 

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Ms. Monroe is a 13 year old female who presents today for her sports preparticipation evaluation so she can play soccer this year. She had her annual well visit 6 months ago. Past Medical History: No current medical concerns. Had a tonsillectomy as a child. Denies any missing organs. Medications: Currently not taking any prescription medications, Daily Multivitamin and drinks Apple Cider Vinegar, 1 tablespoon a day with water. No known medication allergies Nutrition: Eats a Mediterranean diet and avoids sweets, “white carbs” and processed foods. Skips lunch 1-2 times a week for the last month. Physical Activity: Plays recreational soccer on the weekends, but really wants to play for her school team. Family Medical History: Denies history of any family members with genetic heart conditions, denies any family members with early cardiac death. Social History: Reports following a Mediterrranean diet, avoiding “white carbs”, and processed foods. Skips lunch 1-2 times a week. Feels like she needs to lose her baby fat so she can look like her friends. Feels like she does not fit in and wants to look athletic. Review of Systems HEENT: Denies eye problems, vision difficulties, and hearing problems. Cardiovascular: Denies any chest pain during exercise, denies history of cardiac issues, denies any prior cardiac tests. Respiratory: Denies shortness of breath during exercise. Musculoskeletal: Report sprained ankle at age 10. Denies any current muscle or joint injuries. Neurological: Denies syncope with exercise, positive for intermittent dizziness 1-2 times after skipping lunch. Denies head injury or concussions, denies numbness, tingling or weakness. Integumentary: Denies rashes. Genitourinary: Denies starting menses.

Objective

Vitals: H 62 in., W 49.9 kg, BP 112/70, T 36.6C, HR 78 RR 16 General: Pleasant 13-year old in no acute distress. HEENT: Symmetrical head. Eyes PERLA, EOM intact. Neck with full ROM Respiratory: Symmetrical chest rise and fall, lungs clear to auscultation. Samantha Monroe shadow health Documentation CV: S1, S2 present, RRR, no murmurs or gallops. Abd: No bruit in abdomen aorta. MSK: Symmetrical bilateral extremities. Full ROM. Skin: Warm, no rash or lesions. Neuro: Alert and oriented x3, intact balance, steady gait. Samantha Monroe shadow health Documentation

Vital signs: Length=62 in., Weight=49.9 kg, BMI= 20, Blood pressure=112/70, Temp=36.6C, Heart rate= 78/min, Resp=16 breaths/min General: Well-appearing 13-year-old in no acute distress. Upright posture without tension or rigidity, clothing clean and appropriate for season HEENT Head: Symmetrical Eyes: PERRLA, EOM intact, peripheral vision equal to examiner, vision 20/20 bilaterally Neck: Neck with full ROM Resp: Symmetrical chest rise and fall, smooth even respirations, bilateral lungs clear to auscultation CV: Regular rate and rhythm, S1S2 present, no murmurs, pulse present, equal bilaterally Abd: Abdomen aorta with no bruit noted MSK: Bilateral extremities symmetrical, FROM equally strength 5+ all extremities, Adam’s forward bend-equal iliac crest height, expected curvature of spine, scapula equal height, cervical spine full range of motion, lumbar spine-full range of motion, trapezius strength +5 bilaterally Neuro: Alert and oriented x3, balance intact, sensation intact Skin: Warm, smooth, congruent with genetic background. Elastic turgor. No lesions noted Hearing/Vision: Vision 20/20 uncorrected. Hearing intact

Assessment

Pre-participation sports physical Inappropriate diet and eating habits

Pre-Participation Sports Physical Inappropriate diet and eating habits

Plan

Pre-participation sports physical 1. Clear to participate in sports Inappropriate diet and eating habits Educate on healthy nutrition Discuss strategies for reducing shame around eating, weight. Educate on detecting problematic eating behaviors. RTC in 4 weeks for reevaluation.

Preparticipation physical 1. Clear to participate in sports Inappropriate diet and eating habits 1. Will provide education on healthy nutrition and the effects of nutrition on her body. 2. Discuss the potential life threatening problems caused by improper nutrition. 3. Healthy diet includes 3 meals a day and healthy snack options especially when exercising. 4. Discuss strategies for reducing shame around eating, weight and self-perception. Coping mechanisms around self-esteem and body image to include journaling, support group, relaxation, stress management, positive self talk and affirmations. 5. Limit media intake and refrain from watching shows on weight loss or dieting. 6. Educate on identifying problematic eating behaviors. Anticipatory Guidance Safety: Review sports safety measures including female athlete triad, injury prevention, sunscreen and sun protection, diet and nutritional supplements Follow-up Return to the clinic in 4 weeks to reevaluate nutrition and eating habits Samantha Monroe shadow health Documentation.

Samantha Monroe Adolescent Sports Evaluation shadow health Treatment Plan

Treatment Plan: 21 of 21 (100.00%)

Problem Selection

8 out of 8

Primary Diagnosis

Review your answers for the Problem Selection activities. You receive one point for each correct diagnosis, and one point for each correct evidence linked to a correct diagnosis Samantha Monroe Adolescent Sports Evaluation shadow health Treatment Plan. If there are multiple correct diagnoses, you will also receive a point for correctly selecting which diagnosis is the primary diagnosis.

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Learner Selection

Model Documentation

 Diagnosis: 
Pre-Participation Sports Physical

 Identified as primary

Evidences:

 
Samantha reports the reason for her visit is a sports physical

Learner Rationale:

The patient indicates that she came for a sports physical.

Score: 
3 
out of
 3

 Diagnosis: 
Pre-Participation Sports Physical

Primary: 
Yes

Evidences:

Samantha reports the reason for her visit is a sports physical

Model Rationale:

The primary diagnosis is the reason for the patient’s visit. Because Samantha has indicated she is in the office for her sports physical, the correct primary diagnosis is Pre-Participation Sports Physical. As a primary care provider, it is critical to properly code the reason for Samantha’s visit so it can be covered by insurance Samantha Monroe Adolescent Sports Evaluation shadow health Treatment Plan.

Additional Diagnosis

Learner Selection

Model Documentation

 Diagnosis: 
Inappropriate Diet and Eating Habits

Evidences:

 
Samantha reports a desire to lose baby fat

 
Samantha reports dizziness

 
Samantha reports wanting to look more athletic

 
Samantha reports skipping lunch once or twice each week

Score: 
5 
out of
 5

 Diagnosis: 
Inappropriate Diet and Eating Habits

Evidences:

Samantha reports a desire to lose baby fat

Samantha reports dizziness

Samantha reports wanting to look more athletic

Samantha reports skipping lunch once or twice each week

Model Rationale:

Samantha’s desire to lose baby fat and appear more athletic, as well as her diet modifications, are clear indications that Samantha’s diagnosis pertains to Inappropriate Diet and Eating Habits. This subjective data, along with Samantha’s normal weight range and healthy BMI collected during physical examination, indicate that Samantha’s problematic behavior is not severe enough to meet the criteria of other eating-related diagnosis or disorders. Therefore, Inappropriate Diet and Eating Habits is the correct additional diagnosis at this time. American Psychiatric Association. (2017). Feeding and Eating Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.dsm10

Plan of Care

7 out of 7

Review your answers for the Plan of Care activity. You must select “Yes” or “No” for each of the seven care actions. You will receive one point for determining the correct answer for each care action.

Learner Selection

Model Documentation

Pharmacological Intervention

Selected:
 No

Learner Rationale:

No disease or problem was indicated by the patient

Score: 
1 
out of
 1

Recommended:
 No

This selection is not appropriate. Samantha did not indicate any illness or problem during her sports physical that would require Pharmacological Intervention. Samantha Monroe Adolescent Sports Evaluation shadow health Treatment Plan

Non-Pharmacological Intervention

Selected:
 Yes

Learner Rationale:

You should discuss with the patient about her food and dieting habits.

Score: 
1 
out of
 1

Recommended:
 Yes

Because you’ve uncovered some eating and body issues during Samantha’s visit, it is appropriate to perform Non-Pharmacological Interventions. You will talk to Samantha and Jackie about their attitudes and habits around food, dieting, and body image in order to interrupt Samantha’s disordered habits before they become more problematic. A more intuitive, holistic approach to healthy living will allow Samantha to shift her focus away from restrictive eating and weight loss towards a lifestyle that supports her well being.

Educate Patient

Selected:
 Yes

Learner Rationale:

Patient should be taught to take care of her own health.

Score: 
1 
out of
 1

Recommended:
 Yes

When a pediatric patient is old enough to take responsibility for their own care, you must educate them as well as their guardian. Clearly communicating to a patient and their guardian what care they need and why improves adherence and outcomes Samantha Monroe Adolescent Sports Evaluation shadow health Treatment Plan.

Preventive Screening and Intervention

Selected:
 No

Learner Rationale:

Samantha already got preventive screening during her 134-year old well visit.

Score: 
1 
out of
 1

Recommended:
 No

This selection is not appropriate. Samantha already had her 13-year-old well visit where she was vaccinated and screened for preventative care.

Diagnostic Testing: Labs and Imaging

Selected:
 No

Learner Rationale:

No conditions were indicated that would require testing.

Score: 
1 
out of
 1

Recommended:
 No

This selection is not appropriate. Samantha did not indicate any conditions or issues that would require labs or testing.

Referral of Care

Selected:
 No

Learner Rationale:

This selection is not appropriate.

Score: 
1 
out of
 1

Recommended:
 No

This selection is not appropriate. It’s important to follow-up with Samantha about your initial intervention strategies before referring the patient out for specialized care.

Continued Care and Follow-up

Selected:
 Yes

Learner Rationale:

A follow-up appointment is essential to see how the patient is complying with non-pharmacological interventions

Score: 
1 
out of
 1

Recommended:
 Yes

Given Samantha’s inappropriate eating habits and body image concerns, a follow-up appointment to see how well she is adhering to the non-pharmacological interventions is an appropriate selection.

Non-Pharmacological Intervention

6 out of 6

Learner Selection

Model Documentation

Discuss life-threatening health problems caused by eating disorders, such as heart failure, bone loss, hair and tooth loss, and loss of menses.

Selected:
 Yes

Learner Rationale:

 

Score: 
1 
out of
 1

Recommended:
 Yes

Given Samantha’s lack of knowledge around the consequences of eating disorders, it is critical she understand the long-term consequences of poor nutrition. Samantha’s diagnosis of Inappropriate Diet and Eating Habits requires that Samantha understand the potential risks she is taking with her behavior. Samantha Monroe Adolescent Sports Evaluation shadow health Treatment Plan Therefore, Discuss Life-threatening Health Problems is an appropriate selection at this time.

 

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Discuss limiting Samantha’s media intake, including unfollowing fitness accounts on social media and refraining from watching shows about weight loss or dieting.

Selected:
 Yes

Learner Rationale:

 

Score: 
1 
out of
 1

Recommended:
 Yes

Given that Samantha mentioned social media and peer pressure as influencing her body image and self-esteem, it is critical she limits her exposure to media that promotes dieting, weight loss, fitness, and idealized or unrealistic bodies. Samantha’s diagnosis of Inappropriate Diet and Eating Habits requires a holistic approach that considers the cultural factors that may influence her. Therefore, Limiting Media Intake is the appropriate selection at this time.

Discuss with Samantha various ways to track her calorie intake, including apps and food diaries, to ensure she meets her recommended caloric intake.

Selected:
 No

Learner Rationale:

 

Score: 
1 
out of
 1

Recommended:
 No

Given best practices and the details of Samantha’s case, this is an inappropriate intervention. Taking into account all of Samantha’s signs and symptoms, it is not appropriate to encourage Samantha to fixate further on calories or food intake. Eating Disorder Foundation. (n.d.). About eating disorders. https://eatingdisorderfoundation.org/learn-more/about-eating-disorders

Educate Samantha on identifying problematic eating behaviors, including skipping meals on purpose, misusing laxatives, counting calories, or purging via exercise or vomiting.

Selected:
 No

Learner Rationale:

 

Score: 
1 
out of
 1

Recommended:
 No

Given best practices and the details of Samantha’s case, this is an inappropriate intervention; however, Samantha could be educated on problematic eating behaviors, including in-depth examples like misusing laxatives or purging via exercise or vomiting may unintentionally give the patient more strategies to continue covert disordered eating. Eating Disorder Foundation. (n.d.). About eating disorders. https://eatingdisorderfoundation.org/learn-more/about-eating-disorders Samantha Monroe Adolescent Sports Evaluation shadow health Treatment Plan

Increase knowledge of coping mechanisms for low self-esteem and poor body image, including journaling, support groups, relaxation and stress management, positive self-talk, and affirmations.

Selected:
 Yes

Learner Rationale:

 

Score: 
1 
out of
 1

Recommended:
 Yes

Given Samantha’s poor body image, desire to lose weight, and her tendency to compare herself to her peers, it is critical she develop positive coping mechanisms to build a more neutral, if not positive, approach to her body. Coping mechanisms may include journaling, support group, relaxation and stress management, positive self-talk, and affirmations. Samantha’s diagnosis of Inappropriate Diet and Eating Habits requires a patient-centered empathetic approach. Therefore, Increase Knowledge of Coping Mechanisms is the appropriate selection at this time.

Inform Samantha that if she sets her mind to it, she can overcome her body issues and low-self esteem through proper diet and exercise.

Selected:
 No

Learner Rationale:

 

Score: 
1 
out of
 1

Recommended:
 No

Given best practices and the details of Samantha’s case, this is an inappropriate intervention. Disordered eating arises from complex, overlapping factors such as culture, fatphobia, peer pressure, and anxiety. Informing Samantha that she can simply choose to overcome her low self-esteem is not a patient-centered intervention. Eating Disorder Foundation. (n.d.). About eating disorders. https://eatingdisorderfoundation.org/learn-more/about-eating-disorders

Education

In your own words, discuss life-threatening health problems related to disordered eating with Samantha and Ms. Monroe.

Learner Response

Model Response

Forcing yourself to diet or skip meals can make you very sick because strong bones teeth, and hair require adequate nutrition.

Eating as much as you should is a very important part of staying healthy. Forcing yourself to diet or skip meals can make you very sick. Strong bones, hair, and teeth all require sufficient nutrition and calories. Eating well is important for development. Samantha Monroe Adolescent Sports Evaluation shadow health Treatment Plan You mentioned feeling self-conscious about not having your period yet, but you’re developing at a normal rate. Eating regularly will help you stay on track to develop properly, which includes getting your period. Also, you’re a soccer player — that requires a lot of energy and stamina. Eating plenty of food allows you to perform on the field and helps protect you from injury and overexertion. As an athlete, a student, and a young woman, having three meals of balanced food a day will help you achieve your goals.

Oh, um yeah. That makes sense. I don’t want any of that to happen.

Thank you. This is pretty concerning so we’ll take this very seriously.

In your own words, discuss limiting media intake with Samantha and Jackie.

Learner Response

Model Response

You should limit media exposure and remember that your body deserves to be fed, cared or, regardless of the size.

Samantha, you mentioned social media and your friends’ follower count as influencing your body-image. We’re going to talk about social media and strategies you can use to protect your mental health and body-image. It’s critical you limit your exposure to media sources that promote diet culture, fad diets, weight loss, fitness goals, and idealized, unrealistic bodies Samantha Monroe Adolescent Sports Evaluation shadow health Treatment Plan. Instead of focusing on how you look in comparison to others, try to reframe those thoughts and remind yourself that your body isn’t a problem to be solved or punished. When you see images, articles, or TV shows that make you feel bad, turn them off and remember your body deserves to be fed, cared for, and appreciated, regardless of its size.

Yeah, I mean I don’t want an eating disorder or anything like that. I just thought thinking like that was pretty normal, but I guess not.

We’re just both going to have to rethink how we see our bodies and talk about nutrition. I don’t want to see my daughter struggle with her self-esteem.

In your own words, discuss increasing knowledge of coping mechanisms with Samantha and Jackie.

Learner Response

Model Response

You can try journalling, relaxation and stress management techniques, and affirmations

Now we’re going to talk about some specific coping strategies you can use to interrupt negative thoughts about yourself and work towards a more neutral, if not positive, approach to your body. You can try journaling, relaxation and stress management techniques, replacing negative self-talk with positive things you like and appreciate about yourself, and affirmations. A good affirmation for you might be, “All bodies deserve to be fed and watered,” or “All bodies deserve care and praise.” You can also consider going to a support group for teens looking to build-up their self-esteem. Body image and disordered eating can significantly impact a person’s anxiety levels and sense of control over their lives. Try using these coping strategies the next time you have anxious, controlling, or restrictive thoughts about your body or food.

Yeah, that make sense. It’s not like I want to feel this way, you know?

I’m just glad we figured out that this was an issue. I had no idea. Samantha Monroe Adolescent Sports Evaluation shadow health Treatment Plan

Samantha Monroe Adolescent Sports Evaluation shadow health

Transcript

Started:
 Mar 05, 2022 | 
Total Time:
 306 min

All Lines
(91)
Interview Questions (54)
Statements (9)
Exam Actions (28)

Hello. Am xxxx, I will interview you and later conduct a physical exam.

Greet

03/05/22 5:41 AM EST

Hello.

What is your relationship with the patient?

Question

03/05/22 5:42 AM EST

Oh, this is my mom.

Hey, I’m Jackie Monroe. This is my daughter, Samantha.

Why are you here today?

Question

03/05/22 5:42 AM EST

I’m here for a sports physical. I’m gonna play on my school soccer team. We’re called the Nightingales, which is pretty cool. Samantha Monroe Adolescent Sports Evaluation shadow health

Any medical issue?

Question

03/05/22 5:43 AM EST

Uh, nope. No health issues.

Any history of surgery?

Question

03/05/22 5:43 AM EST

I had my tonsils removed when I was like 9, but that’s it.

Yeah, that was Samantha’s only surgery.

Any missing organ? (No matching questions found.)

Question

03/05/22 5:45 AM EST

Does your daughter have any missing organ? (No matching questions found.)

Question

03/05/22 5:46 AM EST

Have you had any of your organs removed?

Question

03/05/22 5:46 AM EST

Uh . . . no. All my organs are 100% present.

Any allergies?

Question

03/05/22 5:49 AM EST

No, I’ve never had any allergies before.

Are your vaccinations current?

Question

03/05/22 5:50 AM EST

Yeah, I’ve had all my vaccines.

I always made sure she was up to date on her vaccinations.

Are you using any medications?

ORDER SHADOWHEALTH, IHUMAN, EXAM OR WRITTEN ASSIGNMENT HERE

Question

03/05/22 5:50 AM EST

No, I don’t take anything.

Are you using any vitamins or supplements?

Question

03/05/22 5:51 AM EST

I take a multivitamin. Plus, I drink apple cider vinegar, which is kinda like a supplement.

Do you pass out during exercise? (Clarified to Have you passed out during exercise?.)

Question

03/05/22 5:52 AM EST

No way. I’ve never passed out while I was exercising. (Clarified to if I have passed out during exercise.)

Any dizziness?

Question

03/05/22 5:53 AM EST

Oh, no. I feel totally fine right now.

Have you ever been dizzy? (Clarified to Have you felt dizzy in the past?.)

Question

03/05/22 5:53 AM EST

I’ve only been dizzy like once or twice. And that was because I skipped lunch and then had to go to gym class. (Clarified to if I have felt dizzy in the past.)

Am sorry about that

Educate

03/05/22 5:54 AM EST

Thanks for the heads-up.

Any heart problems after exercising? (Clarified to Have you had heart problems after exercise?.)

Question

03/05/22 5:56 AM EST

No heart problems after exercise. (Clarified to if I have had heart problems after exercise.) Samantha Monroe Adolescent Sports Evaluation shadow health

Have you had heart problems during exercise?

Question

03/05/22 5:57 AM EST

Nope. No problems during exercise.

Have you been diagnosed with a heart problem?

Question

03/05/22 5:58 AM EST

No, I’ve never been diagnosed with any heart problems that I know of.

No, no heart problems.

How is your breathing during and after exercise?

Question

03/05/22 5:59 AM EST

My breathing is fine during and after exercise.

Any history of seizures?

Question

03/05/22 6:00 AM EST

Pretty sure I’ve never ever had a seizure.

That is correct. No seizures or anything like that.

Any injuries?

Question

03/05/22 6:01 AM EST

Um, well I did sprain my ankle when I was like 10. That’s really it, though. I’m always good to play.

Any rashes?

Question

03/05/22 6:01 AM EST

No rashes. Ew.

Any history of head injuries?

Question

03/05/22 6:02 AM EST

Nope. My head’s fine.

Have you had a concussion?

Question

03/05/22 6:03 AM EST

I’ve never had a concussion, but I did see my friend wipeout at the skatepark once. It was crazy. He was skating, then boom. I was filming, so it was, you know, pretty scarring.

Any numbness or tingling?

Question

03/05/22 6:04 AM EST

No numbness or tingling. That sounds weird.

Any weakness in your limbs?

Question

03/05/22 6:09 AM EST

Nope, no weakness.

Do you exercise in the heat?

Question

03/05/22 6:14 AM EST

Sure. We do gym outside sometimes. When soccer season starts, practice and games are outside.

Any eye problems?

Question

03/05/22 6:16 AM EST

My eyes are fine.

Have you started your periods?

Question

03/05/22 6:17 AM EST

No, I haven’t started my period yet. It’s kind of weird because all my friends have? Whenever they talk about it, like the cramps or whatever, I just pretend like I’ve had mine, too. Just to fit in.

She asked how old I was when I got my first period. I told her I was about 12.

I understand your concerns, but it’s normal for a person of your age to not have started their periods yet.

Educate

03/05/22 6:20 AM EST

Cool. Good to know.

Tell me about your family medical history.

Question

03/05/22 6:21 AM EST

Wait, like the entire family medical history or do you mean something more specific?

Any genetic conditions in your family? (Clarified to Does anyone in your family have a genetic heart condition?.)

Question

03/05/22 6:22 AM EST

I don’t know. Mom? (Clarified to if anyone in my family has a genetic heart condition.)

No, no one in the family has any genetic heart conditions.

Any heart problems in your family?

Question

03/05/22 6:22 AM EST

I don’t think anyone has heart problems, but I’m not totally sure.

You know, I can’t think of anybody in the family who’s had heart problems.

Any history of unexpected deaths in your family? (No matching questions found.)

Question

03/05/22 6:23 AM EST

Any family history of unexpected deaths before the age of 35? (No matching questions found.)

Question

03/05/22 6:24 AM EST

Has any of your family members had a pacemaker before age 35? (Clarified to Has anyone in your family had a pacemaker before 35?.)

Question

03/05/22 6:25 AM EST

I’m not sure about the pacemaker thing. (Clarified to if anyone in my family had a pacemaker before thirty five.)

To my knowledge, there isn’t anyone in the family who’s ever had a pacemaker.

Do you feel your weight is okay? (Clarified to How do you feel about your weight?.)

Question

03/05/22 6:27 AM EST

Um, I mean, I wish I could lose this baby fat. All my friends wear one size smaller than me, so it’s super awkward when they’re swapping clothes . . . and talking about their periods . . . just hard not to compare. (Clarified to how I feel about my weight.)

I told her . . . middle school is tough, especially with all the social media they’re dealing with now. But luckily time goes by faster the older you get and one day you’re my age and it’s all in the rearview Samantha Monroe Adolescent Sports Evaluation shadow health.

I understand your concerns but you should not try to fit in or compare yourself to others.

Educate

03/05/22 6:29 AM EST

Gotcha.

Do you want to lose weight? (Clarified to Why do you think you need to lose weight?.)

Question

03/05/22 6:29 AM EST

Just . . . to look more athletic, you know. Like I fit in with everybody. (Clarified to why I think I need to lose weight.)

You should not try to fit in. Everyone is unique.

Educate

03/05/22 6:30 AM EST

Um, that makes sense.

Tell me about your diet.

Question

03/05/22 6:31 AM EST

I do the Mediterranean diet. It’s healthy. I try not to eat bad stuff. No candy, white carbs, processed food.

Do you skip any meals?

Question

03/05/22 6:32 AM EST

Yeah, I skip lunch once or twice each week.

It is not advisable to skip any meal at your age because you are still growing

Educate

03/05/22 6:33 AM EST

For sure. OK.

How long have you been skipping your lunch? (Clarified to How long have you been skipping lunch?.)

Question

03/05/22 6:34 AM EST

I started skipping lunch maybe a month ago? (Clarified to how long I have been skipping lunch.)

 Inspected weight and height growth chart

Exam Action

03/05/22 6:35 AM EST

 Inspected Skin

Exam Action

03/05/22 6:48 AM EST

 Assessed appearance

Exam Action

03/05/22 6:49 AM EST

 Assessed Cervical Spine Range of Motion

Exam Action

03/05/22 6:52 AM EST

 Assessed Spine Range of Motion: Full range of motion performed without discomfort

Exam Action

03/05/22 6:53 AM EST

 Assessed wrist range of motion

Exam Action

03/05/22 7:01 AM EST

 Assessed Elbow Range of Motion

Exam Action

03/05/22 7:03 AM EST

 Assessed range of motion of shoulders – adduction and abduction: Strength equal bilaterally against full resistance

Exam Action

03/05/22 7:06 AM EST

 Assessed Trapezius Strength: Strength equal bilaterally against full resistance

Exam Action

03/05/22 7:06 AM EST

 Assessed deltoid strength and shoulder rotation

Exam Action

03/05/22 7:07 AM EST

 Assessed Hand and Finger Range of Motion and Strength: Right and left hand strength equal bilaterally against resistance

Exam Action

03/05/22 7:08 AM EST

 Assessed Symmetry of Extremities

Exam Action

03/05/22 7:09 AM EST

 Assessed leg symmetry, knee and ankle effusion Samantha Monroe Adolescent Sports Evaluation shadow health

Exam Action

03/05/22 7:09 AM EST

 Assessed Calf Symmetry and Leg Strength

Exam Action

03/05/22 7:10 AM EST

 Tested Hip, Knee, and Ankle ROM

Exam Action

03/05/22 7:11 AM EST

 Tested Cardinal Fields of Vision

Exam Action

03/05/22 7:14 AM EST

 Tested peripheral vision

Exam Action

03/05/22 7:15 AM EST

 Tested visual acuity

Exam Action

03/05/22 7:15 AM EST

 Tested balance: Expected

Exam Action

03/05/22 7:16 AM EST

 Auscultated lungs

Exam Action

03/05/22 7:17 AM EST

 Auscultated abdomen

Exam Action

03/05/22 7:18 AM EST

 Auscultated heart

Exam Action

03/05/22 7:18 AM EST

 Screened Adam’s Forward Bend

Exam Action

03/05/22 7:20 AM EST

Mrs. Monroe please step out so I can have a private conversation with your daughter.

Educate

03/05/22 7:34 AM EST

Sure, no problem.

I will be asking you some personal questions and I need you to know that you are in a safe and a nonjudgmental environment.

Educate

03/05/22 7:36 AM EST

OK. That sounds alright.

Tell me about your school life, friends and hobbies.

Question

03/05/22 7:38 AM EST

Everything’s fine. I mean . . . My grades are average. I get a lot of Bs. I feel like my friends used to be really chill but I don’t know what happened this year. It’s like everybody got super skinny and so many more followers on their social accounts. Soccer is gonna be fun, for sure, but . . . everything was easier before I turned 13.

Am sorry about that. Everything will be fine.

Empathize

03/05/22 7:39 AM EST

Thanks. I’m glad you understand.

Tell me about your support system.

Question

03/05/22 7:41 AM EST

Yeah, me and my mom are pretty close, and I have some friends who get it. We talk and stuff.

Have you ever used tobacco?

Question

03/05/22 7:42 AM EST

Definitely not. I feel like I’ve heard smoking can help you lose weight, but I’m not ever gonna do it because it’s so bad for your lungs. That would ruin my soccer game.

Have you used any drugs?

Question

03/05/22 7:43 AM EST

No. I wouldn’t ever do drugs.

Have you used alcohol?

Question

03/05/22 7:44 AM EST

I don’t drink. No way.

Are you interested in relationships and dating?

Question

03/05/22 7:45 AM EST

I’m not really interested in that yet.

Are you sexually active?

Question

03/05/22 7:45 AM EST

No.

I would like to know more about your feeling of nervousness or anxiety.

Question

03/05/22 7:54 AM EST

I mean . . . school’s a lot. Projects and tests and stuff. And I want to do really well in soccer. But I guess it’s mostly the whole “keeping up with appearances” thing. It’s like a full-time job.

Am sorry about that.

Empathize

03/05/22 7:55 AM EST

Thanks.

I noticed that you are concerned about your body image, weight, and diet.

Question

03/05/22 7:57 AM EST

Well, I’ve definitely started paying more attention to health stuff, but I thought that was a good thing. I just want to post a selfie and not have a double-chin, you know?

Have you ever considered doing anything more extreme to manage your weight?

Question

03/05/22 7:58 AM EST

No, I wouldn’t do anything dangerous. I promise.

Do you have any questions for me?

Question

03/05/22 7:59 AM EST

No, I don’t think so.

 You will now discuss the appropriate non-pharmacological interventions with Samantha and her mother, Ms. Monroe. 
You will not be automatically scored on your choices or responses in this activity, but your instructor may choose to review your responses.

Exam Action

03/06/22 8:19 AM EST

I am ready to begin the conversation with Samantha.

Question

03/06/22 8:20 AM EST

 In your own words, discuss life-threatening health problems related to disordered eating with Samantha and Ms. Monroe.

Exam Action

03/06/22 8:20 AM EST

Forcing yourself to diet or skip meals can make you very sick because strong bones teeth, and hair require adequate nutrition.

Question

03/06/22 8:23 AM EST

Oh, um yeah. That makes sense. I don’t want any of that to happen.

Thank you. This is pretty concerning so we’ll take this very seriously.

 In your own words, discuss limiting media intake with Samantha and Jackie.

Exam Action

03/06/22 8:24 AM EST

You should limit media exposure and remember that your body deserves to be fed, cared or, regardless of the size.

Question

03/06/22 8:30 AM EST

Yeah, I mean I don’t want an eating disorder or anything like that. I just thought thinking like that was pretty normal, but I guess not.

We’re just both going to have to rethink how we see our bodies and talk about nutrition. I don’t want to see my daughter struggle with her self-esteem.

 In your own words, discuss increasing knowledge of coping mechanisms with Samantha and Jackie.

Exam Action

03/06/22 8:33 AM EST

You can try journalling, relaxation and stress management techniques, and affirmations

Question

03/06/22 8:58 AM EST

Yeah, that make sense. It’s not like I want to feel this way, you know?

I’m just glad we figured out that this was an issue. I had no idea.

 You have provided Samantha and her mother education on all appropriate non-pharmacological interventions.

 

Education & Empathy 
: 4 of 4 (100.0%)

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

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

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

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

 1 Fitting in

Followed Up

 Description: 
Samantha feels like she doesn’t fit in with her peers.

Do you want to lose weight? (Clarified to: Why do you think you need to lose weight?)

Question

06:29 AM EST

Just . . . to look more athletic, you know. Like I fit in with everybody. (Clarified to: why I think I need to lose weight)

You should not try to fit in. Everyone is unique.

Educate

06:30 AM EST

Um, that makes sense.

 Model Statement: 
“At age 13, there are a lot of social pressures, coming from your friends at school, teammates at soccer, and influencers on social media. It’s important to be a part of a community that accepts and supports you. If you don’t feel accepted or supported, then you should feel comfortable discussing these issues with people you do trust, because that environment might not be healthy for you. It’s also possible that you’re being hard on yourself. I know it’s tempting to compare yourself to others, but don’t let that damage your self-worth.”

 2 Body Image

Followed Up

 Description: 
Samantha has insecurities about her body image.

Do you feel your weight is okay? (Clarified to: How do you feel about your weight?)

Question

06:27 AM EST

Um, I mean, I wish I could lose this baby fat. All my friends wear one size smaller than me, so it’s super awkward when they’re swapping clothes . . . and talking about their periods . . . just hard not to compare. (Clarified to: how I feel about my weight)

I understand your concerns but you should not try to fit in or compare yourself to others.

Educate

06:29 AM EST

Gotcha.

 Model Statement: 
“Samantha, you’ve mentioned wanting to lose baby fat and look athletic. I’m really sorry you’re having a hard time with the way people see you and the way you see yourself, but there’s nothing wrong with how you look, and you’re in good health. I know it’s easy for me to say this here in the clinic and hard for you when you’re getting compared to other people, but there’s nothing you need to change about yourself.”

 3 Menstruation

Followed Up

 Description: 
Samantha has concerns that she should have had her first period already.

Have you started your periods?

Question

06:17 AM EST

No, I haven’t started my period yet. It’s kind of weird because all my friends have? Whenever they talk about it, like the cramps or whatever, I just pretend like I’ve had mine, too. Just to fit in.

I understand your concerns, but it’s normal for a person of your age to not have started their periods yet.

Educate

06:20 AM EST

Cool. Good to know.

 Model Statement: 
“Knowing that your classmates are having their periods when you haven’t had one yet can be frustrating, but you don’t have anything to worry about. It’s typical for someone your age to not have started menstruating yet, and we can expect it to happen before you are 15. Everyone’s experience is a little bit different—sometimes I have patients who are concerned at how early they started. You’re prepared for your first period when it happens, and you’re comfortable talking about it here. That’s the maturity that matters, so do your best not to worry about where your peers are.”

 4 Skipping Meals

Followed Up

 Description: 
Samantha says that she skips lunch once or twice a week to reduce her caloric intake.

Do you skip any meals?

Question

06:32 AM EST

Yeah, I skip lunch once or twice each week.

It is not advisable to skip any meal at your age because you are still growing

Educate

06:33 AM EST

For sure. OK.

 Model Statement: 
“It’s very important to eat lunch, along with the rest of your regular meals. You’re still growing, and that takes a lot of food and energy. You’re also a soccer player, and athletes need plenty of calories and nutrients to play well and stay healthy. You definitely don’t need to feel bad about eating lunch. On top of that, skipping meals can feel pretty bad. When I miss lunch, I get a headache and feel cranky. Please go easy on yourself and your body and try not to skip lunch anymore.”

Treatment Plan
: 21 of 21 (100.00%)

Problem Selection

8 out of 8

Primary Diagnosis

Review your answers for the Problem Selection activities. You receive one point for each correct diagnosis, and one point for each correct evidence linked to a correct diagnosis. If there are multiple correct diagnoses, you will also receive a point for correctly selecting which diagnosis is the primary diagnosis Samantha Monroe Adolescent Sports Evaluation shadow health.

Learner Selection

Model Documentation

 Diagnosis: 
Pre-Participation Sports Physical

Identified as primary

Evidences:

Samantha reports the reason for her visit is a sports physical

Learner Rationale:

The patient indicates that she came for a sports physical.

Score: 
3 
out of
 3

 Diagnosis: 
Pre-Participation Sports Physical

Primary: 
Yes

Evidences:

Samantha reports the reason for her visit is a sports physical

Model Rationale:

The primary diagnosis is the reason for the patient’s visit. Because Samantha has indicated she is in the office for her sports physical, the correct primary diagnosis is Pre-Participation Sports Physical. As a primary care provider, it is critical to properly code the reason for Samantha’s visit so it can be covered by insurance.

Additional Diagnosis

Learner Selection

Model Documentation

 Diagnosis: 
Inappropriate Diet and Eating Habits

Evidences:

Samantha reports a desire to lose baby fat

Samantha reports dizziness

Samantha reports wanting to look more athletic

Samantha reports skipping lunch once or twice each week

Score: 
5 
out of
 5

 Diagnosis: 
Inappropriate Diet and Eating Habits

Evidences:

Samantha reports a desire to lose baby fat

Samantha reports dizziness

Samantha reports wanting to look more athletic

Samantha reports skipping lunch once or twice each week

Model Rationale:

Samantha’s desire to lose baby fat and appear more athletic, as well as her diet modifications, are clear indications that Samantha’s diagnosis pertains to Inappropriate Diet and Eating Habits. This subjective data, along with Samantha’s normal weight range and healthy BMI collected during physical examination, indicate that Samantha’s problematic behavior is not severe enough to meet the criteria of other eating-related diagnosis or disorders. Therefore, Inappropriate Diet and Eating Habits is the correct additional diagnosis at this time. American Psychiatric Association. (2017). Feeding and Eating Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.dsm10

Plan of Care

7 out of 7

Review your answers for the Plan of Care activity. You must select “Yes” or “No” for each of the seven care actions. Samantha Monroe Adolescent Sports Evaluation shadow health You will receive one point for determining the correct answer for each care action.

Learner Selection

Model Documentation

Documentation
/ Electronic Health Record

My Provider Notes

Student Documentation

Model Documentation

Subjective

Ms. Monroe is a 13 year old female presenting for a preparticipation evaluation so she can play soccer this year. Past Medical History: No current medical problems. Tonsillectomy as a child. Medications: No prescription medications.

Objective Data Collection
: 23 of 23 (100%)

 Correct

 Partially correct

 Incorrect

 Missed

 Growth Chart: Height & Weight

1 of 1 point

Weight Percentile 
(1/4 point)

 Below 5th percentile

 Between 5th and 95th percentile

 Above 95th percentile

Weight Growth Curve 
(1/4 point)

 Growth curve maintained

 Growth curve decline

Height Percentile 
(1/4 point)

 Below 5th percentile

 Between 5th and 95th percentile

 Above 95th percentile

Height Growth Curve 
(1/4 point)

 Growth curve maintained

 Growth curve declined

 Inspected Skin

1 of 1 point

Lesions 
(1/5 point)

 No visible lesions

Subjective Data Collection
: 26 of 27 (96.3%)

Hover To Reveal…

Hover over the 
Patient Data 
items below to reveal important information, including 
Pro Tips
 and 
Example Questions Samantha Monroe Adolescent Sports Evaluation shadow health
.

Found:

 Indicates an item that you found.

Available:

 Indicates an item that is available to be found.

Category

Scored Items

Experts selected these topics as essential components of a strong, thorough interview with this patient.

Patient Data

Not Scored

A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.

Confirmed Guardian’s Relationship

Finding:

Asked about relationship with patient Samantha Monroe Adolescent Sports Evaluation shadow health

Care and disaster management plan

Nursing care plan

The project has identified the aggregate as RISE program participants from Albany in Georgia. This population of interest comprises of opiate addicts who are seeking treatment for the addiction. Opiates are identified to include Oxycodone, Morphine, Methadone, Codeine, and Heroin. The first step in the care plan is the patient diagnosis. In this case, opiate addiction would be defined as the constant and unending need for opiates even when it causes the patient to have serious economic, social, psychological and/or physical harm and consequences that include a loss of control over the opiate use and abuse. It is important to note that a diagnosis for opiate addiction can occur with or without physical dependence. Also, the patient would be subjected to standardized tests to assess addiction and recovery. These tests include CAGE-AID Test, Recovery Attitude and Treatment Evaluation, Addiction Severity Index, and Drug Abuse Screening Test (Sperry, 2016; Wheeler, 2014).

Notable features in the diagnosis are psychological dependence and physical dependence. Psychological dependence refers to the continued use of opiates to avoid unpleasant experiences and occur that could occur if the opiate is not taken. Physical dependence ensues if ceasing to use the opiate causes adverse physical effects that could be heightened if the cessation is abrupt and rapid. As previously indicated, physical dependence is not necessarily an indication of opiate addiction; since addiction could be present with or without any physical dependence (Sperry, 2016).

An important aspect of the patient diagnosis is the client assessment for opiate dependencies, toxicities, withdrawal, and other related risk factors. Some of the notable risk factors include a vulnerability to peer pressure, present of a psychiatric disorder, proneness to self-medication, risk-taking tendencies, unsuccessful life, poor pain tolerance, and low self-esteem. The general physical symptoms and signs identified during diagnosis include poor health state, cool and moist hands, shakiness, poor hygiene, and hyperactivity. The general behavioral symptoms and signs include poor attention span, drug seeking behaviors, possession of opiates and associated paraphernalia, problems with law enforcement, school and other social institutions, poor work performance, forgetfulness, low tolerance for frustration, and irritability (Sperry, 2016).

The symptoms and signs of opiate addiction, use and abuse that the nurse would be keen on include piloerection (goose bumps), diarrhea, spasms, muscular pain, tremors, diaphoresis, poor attention span, memory loss, slurred speech, sedation, euphoria, confusion, impaired gait and coordination, and pupil constriction. The withdrawal symptoms and signs for opiates include dilated pupils, weakness, muscular spasms, dysphoria, perspiration, loss of appetite, vomiting, nausea, fever, insomnia, and piloerection (Sperry, 2016).

Once the patient has been diagnosed with opiate abuse and/or addiction condition, the next step is to conduct treatment. The first treatment approach is pharmacotherapy whereby antipsychotic medication are prescribed to manage the symptoms. These medication restore the brains natural chemical balance to eliminate or reduce the psychotic symptoms. The second treatment approach is supportive psychosocial interventions that are used as adjuncts to the psycho-education programs and pharmacotherapy. They are intended to reduce relapse, improve medication adherence, quality of life and social functioning, and alleviate residual symptoms. They include individual and group approaches (Sperry, 2016).

An important consideration when offering nursing treatment for opiate addiction is the presentation of opioid withdrawal syndrome, an uncomfortable and distressing but typically not life-threatening experience for the patient. It occurs when opiates intake is stopped or markedly decreased. The symptoms for syndrome typically include nausea, muscle cramps, joint aches, irritability, gooseflesh, pupillary dilation, feeling tired, poor sleep, depression (dysphoria), perspiration, diarrhea, yawning, vomiting, runny nose, runny eyes, and restlessness. Three of medication can be prescribed for the syndrome. Firstly, Methadone that is prescribed to prevent the withdrawal symptoms through decreasing opioid craving, relieving pain, and blocking ‘highs’ if the opioid is substituted. It helps in detoxification and maintenance of abstinence. Secondly, Buprenorphine that is prescribed to prevent the withdrawal symptoms. It blocks ‘highs’ if opioid is substituted. It acts as a pain medication and reduces opioid craving.  Thirdly, Naltrexone that is prescribed after the patient has completely withdrawn from the opiate since taking it alongside opiates could precipitate the withdrawal syndrome. It helps with detoxification and maintaining abstinence. The three medication are supplemented by counseling to improve outcomes (Sperry, 2016; Wheeler, 2014).

In addition, nursing diagnoses will be conducted for anxiety, sleep deprivation, and imbalanced nutrition as existing concerns. The nursing diagnosis for anxiety would identify feelings of apprehension caused by anticipation of danger among the patients. The nursing assessment would be conducted for presence of culture-bound anxiety states, level of anxiety, influence of cultural values and beliefs, coping techniques, and physical reactions. Nursing interventions would focus on awareness, supportive environments, interactions, conversations, and reducing sensory stimuli (Wayne, 2019a). The nursing diagnosis for sleep deprivation would identify disruptions in the quality and amount of sleep. Nursing assessment would note sleep patterns and circumstances hindering sleep. Nursing interventions would focus on helping patients to obtain optimal amounts of sleep as evidenced by improved sleep patterns, and rested appearance (Wayne, 2019c).  The nursing diagnosis for imbalanced nutrition would identify the patient’s nutritional status and if nutrient intake is less than the body requirements. Nursing assessment would note the patient’s weight, nutritional history, relevant etiological factors, review laboratory values, and check physical signs. The nursing intervention would offer nutritional support (Wayne, 2019b).

Disaster management plan

The geographical location of the aggregate is Albany, Georgia. A review of the natural disasters that have occurred in the location reveal that it has a high probability of experiencing tornadoes. In fact, its tornado index is reported at 221.78, a figure that is higher than the Georgia State average at 179.92 and the US national average at 136.45. This implies that the risk of tornado damage is higher in Albany when compared to the state average and national average. In fact, the location has experienced 82 tornado events with magnitude of 2 or higher in the period between 1951 and 2007. These events have resulted in 42 fatalities and property damage approximated at $250 million. Other natural disasters of significance to the area are thunderstorm winds, hail and floods of which 1,174, 368 and 96 events (respectively) were recorded from 1950 to 2010 within 50 miles of Albany (World Media Group, 2020).

It is evident that Albany has a higher risk of experiencing tornadoes and hail than any other natural disaster since they have occurred with the highest frequency from 1950. Strategies for handling these disasters would be presents from two perspectives. The first perspective is preparedness involving continuously planning, equipping, training and exercises. Planning for the two disasters entails identifying places in which to take shelter, familiarizing with and monitoring the warning system systems, and establishing procedures to account for individuals in case the disasters occur. Underground locations are preferred for sheltering (such as storm cellars and basements) since they offer the best protection. In addition, there is a need to implement accountability procedures presented as warning systems to ensure that aggregate remains safe in case the disasters occur. Two warning systems are typically used. Firstly, a watch system that requires the aggregate to closely monitor media stations (television and radio) for information on the disaster progress so that they are able to take shelter prior to occurrence, and can check for supply kits. Secondly, a warning system that offers information on an imminent threat if the disaster has been sighted or indicated through radar with the aggregate expected to immediately take shelter (Occupational Safety and Health Administration, 2020).

Equipping activities involve getting emergency supplies kits and keeping them in shelter locations. The recommended items for the kit include cellphones with chargers and backup batteries, local maps, manual can opener, wrench for utilities, personal sanitation items, dust masks, signal whistle, first aid kit, flashlight, battery powered radio, food and water. In addition, prescription and non-prescription medication should be stocked to include laxatives, antidiarrheal medication, and pain relievers (Occupational Safety and Health Administration, 2020).

Training and exercises activities involve ensure that the aggregate know what to do in case of an emergency. In addition, it requires regularly practicing for shelter-in-place plans, and updating procedures and plans based on lessons learned from the exercises (Occupational Safety and Health Administration, 2020).

 

 

References

Occupational Safety and Health Administration (2020).
OSHA: Tornado preparedness and response
. References https://www.osha.gov/dts/weather/tornado/preparedness.html

Sperry, L. (2016).
Handbook of diagnosis and treatment of DSM-5 personality disorders:
assessment, case conceptualization, and treatment
(3
rd
ed.). New York, NY: Routledge.

Wayne, G. (2019a).
Anxiety
. Retrieved from https://nurseslabs.com/anxiety/

Wayne, G. (2019b).
Imbalanced nutrition: less than body requirements
. Retrieved from https://nurseslabs.com/imbalanced-nutrition-less-body-requirements/

Wayne, G. (2019c).
Insomnia
. Retrieved from https://nurseslabs.com/insomnia/

Wheeler, K. (Ed.). (2014).
Psychotherapy for the advanced practice psychiatric nurse: a how-to-guide for evidence-based practice
(2
nd
ed.). New York, NY: Springer Publishing Company, LLC.

World Media Group (2020).
Albany, GA natural disasters and weather extremes
. Retrieved from http://www.usa.com/albany-ga-natural-disasters-extremes.htm

 

Instructions

Developing a Care Plan

Last week, you conducted a risk assessment to identify the health risks faced by the aggregate you selected. This week, begin working on a comprehensive care plan for the aggregate.

The care plan should propose a nursing diagnosis for the aggregate and include strategies to tackle the major health risks identified during the risk assessment.

In addition, it should include a disaster management plan with the following components:

List of disasters that might affect your aggregate (take into consideration the geographical location of the aggregate, past history, etc.)

Strategies for handling at least two disasters from the list.

Recommendation for a disaster supplies kit.

(Project Recap: Propose a nursing diagnosis and suggest interventions that address the major health risks identified from the risk assessment. In your care plan, include a list of disasters that may affect the aggregate and a disaster management plan.)

Submission Details:
Your comprehensive care plan should be in a 4- to 5-page Microsoft Word document and name your document. SU_NSG4076_W6_Project_LastName_FirstInitial.doc.
Submit your document to the Submissions Area by the due date assigned.
Support your responses with examples.
Cite all sources in APA.

(I have attached a copy of last weeks
Risk Assessment
and any other documentation you may need. Please let me know if you have any questions.)

NURS 6050 Assignment: Legislation Grid and Testimony/Advocacy Statement

Legislation Grid and Advocacy Statement

Legislation Grid

Health-related Bill Name

Promoting Physical Activity for Americans Act

Bill Number

S. 1301

Description

The identified bill is sponsored by Sharrod Brown, the senior Senator for Ohio (Govtrack, 2021). The Senator is a democrat. The bill was first introduced to the House of Representatives on April 22, 2021.The bill seeks to authorize the Secretary for Health and Human Services (HHS) to be publishing a report on physical activity and the interventions aimed at controlling specific measures of interest. The bill also requires that the secretary for HHS to publish evidence-based intervention aimed at promoting physical activity among specific populations of the community. The bill would also require that any other federal agency that would wish to promote physical activity among the community members should base on the published research-based report. NURS 6050 Assignment: Legislation Grid and Testimony/Advocacy Statement.

 

Federal or State?

Federal

Legislative Intent

The legislative intent of the bill is to foster the utilization of the latest medical innovation and research in the promotion of physical activity among the communities. The other intent is to ensure that population specific interventions are used when promoting physical activity. With the increase in the rate of obesity and lifestyle diseases, the legislative intent of the bill is to improve effectiveness of physical activity promotion practices so as to further improve the rate of community members involved in physical activity within the community. NURS 6050 Assignment: Legislation Grid and Testimony/Advocacy Statement The rate of obesity and lifestyle related diseases would be fostered in the quality of the patient intervention.

 

Proponents/ Opponents

Proponents: Sponsoring legislators, the healthcare professionals and the members of the community especially at risk of developing obesity and lifestyle diseases.

 

Opponents: The secretary for HHS would likely challenge the bill with the basis of the cost of carrying out research for publishing the report after every 10 years.

Target Population

NURS 6050 Assignment: Legislation Grid and Testimony/Advocacy Statement The bill targets all the citizens of the United States especially considering that a large proportion are at risk of being obese because of not meeting the minimum requirements for physical activity.

 

Status of the bill (Is it in hearings or committees?)

The bill was passed by the Senate on 30
th
July 2021 through a voice vote (Govtrack, 2021). The bill will be forwarded to the House for the second time before proceeding to the next subsequent stages.

 

 

General Notes/Comments

 

 

The bill, presented by Sherrod Brown is considered to offer a uniquely important opportunity for the promotion of physical activity and in essence improve the intervention to combat obesity. The bill with two sponsors is projected to be having at least 48% probability of being ascended into law because of its feasibility and relevance to the prevailing situation.

 

Legislation Testimony/Advocacy Statement

The personal position in the bill in question is to join the proponents and thus support the bill. The bill proposes a suitable approach for promoting physical activity considering that it proposes the implementation of evidence-based intervention (Bowen, et al. 2021). The rate of obesity in the United States has been consistently growing over time. The rate of obesity between 1999 and 2000 was 30.5% as compared to the rate of 42.4% between 2017 and 2018 (Gelius, et al. 2020) NURS 6050 Assignment: Legislation Grid and Testimony/Advocacy Statement. Obesity is also closely associated with an increased risk of various lifestyle diseases such as hypertension, diabetes and certain types of cancers. The lifestyle health conditions are among the top ten leading causes of death in the United States. Only 19.3% of the United States citizens meet the minimum recommended physical activity rate and thus indicating a significantly high demand for better interventions to promote physical activity. Physical activity is a key element that contributes to body weight besides diet. Promoting physical activity is therefore considered to be important.

Considering the opponents for the bill the bill base counter-arguments on the cost carrying out research to publish the reports after 10 years, it would be vital to consider that 10 years is a significantly wide interval (Bowen, et al. 2021). The opponents should also be informed about the extreme cost incurred annually due to obesity. It is estimated that the cost associated with adult obesity ranges between $147 billion to 210 billion annually (Piercy, et al. 2018). The high cost due to unproductivity at workplace and the cost of treatment for obesity related conditions is higher as compared to the cost of carrying out research for 10 years to publish a report. NURS 6050 Assignment: Legislation Grid and Testimony/Advocacy Statement The opponents should also be informed about the importance of utilizing evidence-based intervention since it helps to promote the utilization of the latest research findings into practice. Considering the dynamic nature of clinical practices, it is important to embrace research even when promoting physical activity.

References

Bowen, P. G., Opoku-Agyeman, W., Clay, O. J., McCaskill, G., Mixon, V., Sen, B. P., … & Martin, M. Y. (2021). Promoting Physical Activity Through Policy at a Single Safety-Net Clinic: A Pilot Study. 
Translational Journal of the American College of Sports Medicine
, 
6
(2), e000160.

Gelius, P., Messing, S., Goodwin, L., Schow, D., & Abu-Omar, K. (2020). What are effective policies for promoting physical activity? A systematic review of reviews. 
Preventive medicine reports
, 
18
, 101095.

Govtrack, (2021) S. 1301: Promoting Physical Activity for Americans Act. Retrieved from: https://www.govtrack.us/congress/bills/117/s1301 NURS 6050 Assignment: Legislation Grid and Testimony/Advocacy Statement

Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., … & Olson, R. D. (2018). The physical activity guidelines for Americans. 
Jama
, 
320
(19), 2020-2028.

 

Assignment: Legislation Grid and Testimony/Advocacy Statement

As a nurse, how often have you thought to yourself, 
If I had anything to do about it, things would work a little differently?
 Increasingly, nurses are beginning to realize that they do, in fact, have a role and a voice.

Many nurses encounter daily experiences that motivate them to take on an advocacy role in hopes of impacting policies, laws, or regulations that impact healthcare issues of interest. Of course, doing so means entering the less familiar world of policy and politics. While many nurses do not initially feel prepared to operate in this space effectively, the reward is the opportunity to shape and influence future health policy.

To Prepare:

Select a bill that has been proposed (not one that has been enacted) using the congressional websites provided in the Learning Resources. NURS 6050 Assignment: Legislation Grid and Testimony/Advocacy Statement.

The Assignment: (1- to 2-page Legislation Grid; 1-page Legislation Testimony/Advocacy Statement)

Be sure to add a title page, an introduction, purpose statement, and a conclusion. This is an APA paper.

Part 1: Legislation Grid

Based on the health-related bill (proposed, not enacted) you selected,
complete the Legislation Grid Template
. Be sure to address the following:

Determine the legislative intent of the bill you have reviewed.

Identify the proponents/opponents of the bill.

Identify the target populations addressed by the bill.

Where in the process is the bill currently? Is it in hearings or committees?

Part 2: Legislation Testimony/Advocacy Statement

Based on the health-related bill you selected, develop a 1-page Legislation Testimony/Advocacy Statement that addresses the following:

Advocate a position for the bill you selected and write testimony in support of your position.

Describe how you would address the opponent to your position. Be specific and provide examples.

At least 2 outside resources and 2-3 course specific resources are used. NURS 6050 Assignment: Legislation Grid and Testimony/Advocacy Statement.

Developing a Care Plan

Name

Institution

Date

 

 

Developing a Care Plan

Introduction

Care planning in nursing is a vital aspect of nursing practice as it provides the outline for patient care. A good care plan should include aspects such as accuracy, completeness, and the content should be relevant (Johnson et al., 2018). Accordingly, this paper will provide a care plan for the aggregate population (
S
outh Charlotte), as well as the disaster management plan to address the major health risks in the population.   

Comprehensive Care Plan

Assessment

The aggregate participants in
S
outh Charlotte
are older adults aged 65 years and over. The main health risks for this aggregate population include A1C management, surgical risks of diabetes, and increased BMI (obesity).

Nursing Diagnosis

Ineffective A1C management deficit and increased of infections, wound healing and slow healing surgical outcomes

Imbalanced nutrition more than body requirements as indicated by a BM1>40

Strategies to Address the Major Health Risks

A multidisciplinary team should be formed to promote health in the target population. Health promotion should include providing support for self-management education for people with diabetes. The health promotion program in
S
outh Charlotte should ensure that all older adults with diabetes take part in
diabetes self-management education. This will equip them with the required skills, knowledge, and ability for diabetes self-care, and especially managing and reducing the AIC values, as a measure of effective glycemic control (Al-Rasheedi, 2015). Effective HbA1c control will also prevent long-term complications associated with diabetes. M
oreover, the participants should be provided with self-management support that will help them implement and sustain the gained self-management skills and behaviors.

Implement an exercise program in
S
outh Charlotte targeting older adults with diabetes: The older population with type 2 diabetes will be recruited to the exercise program where they will be encouraged to perform at least two weekly sessions of resistance exercise. Evidence shows that resistance training among older adults diagnosed with type 2 diabetes reduces AIC (
Alvarez et al., 2017)
. Moreover, the increased physical activity will help in lowering the BMI for the target population and thus address the issue of obesity in this population.

Recommend compulsory influenza and
anti-pneumococcal
immunization for all older adults in South Charlotte. These immunizations will reduce respiratory infections, hospitalization, and the mortalities associated with respiratory tract infections (
Alvarez et al., 2017)
. Infections, including respiratory tract infections, are very prevalent in people with type 2 diabetes.

Smoking cessation counseling programs should be integrated into the routine element of diabetes care. In addition, all individuals with type 2 diabetes should be educated to stop smoking or inhaling secondary tobacco smoke. Tobacco smoking is attributed to numerous health risks, including the development of type 2 diabetes, cardiovascular conditions, and premature death. Smoking cessation is associated with the improvement of metabolic parameters, as well as decreased blood pressure in individuals with type 2 diabetes (
Hieshima et al., 2018)
.

Integrating nutritional therapy in diabetes treatment: All older adults with type 2 diabetes in South Charlotte should be provided with a personalized eating plan. Nutrition therapy is a key aspect of diabetes management and plays a big role in stabilizing AIC values; therefore, the older adults with type 2 diabetes should be vigorously involved in education, treatment planning, and self-management with their healthcare team, and this should include the collaborative development of the personalized eating plan (
Franz & MacLeod, 2018)
. All people with type 2 diabetes in South Charlotte should be referred and linked with a registered dietitian with the required skills and knowledge to provide diabetes-specific nutrition therapy. Emphasis should focus on providing healthy eating patterns. Also, to reduce weight in the target population, the participants should be educated to eat healthily by consuming a variety of fruits and high vegetable intake, while reducing intake of carbohydrates (
Franz & MacLeod, 2018)
. This will assist in weight loss.

Lastly, all
aggregate participants in
S
outh Charlotte should be educated on the importance of adhering to the prescribed medications. Improved adherence to treatment in individuals with type 2 diabetes will enhance glycemic control and thus reduce morbidity and mortality allied to uncontrolled type 2 diabetes (
Polonsky & Henry, 2016)
.

Disaster Management Plan

Charlotte NC region is mainly typified by a moderate climate with a clear discrepancy between warm and cold seasons. Winters are normally characterized by cold weather with a lot of snowing and heavy rainfalls. The likely disasters that may affect the aggerate population in Charlotte NC include hurricanes and flooding. Charlotte NC is a region at a high risk of flooding and storm surge associated with hurricanes. Floods and hurricanes lead to effects such as deaths, injuries, adverse effects on human health and welfare, destruction to the infrastructure, and interruptions to education and business (Tullos D. (2018).

The national climate assessment shows that Charlotte NC has a high probability of experiencing flooding and hurricanes. However, flooding the most likely environmental risk to affect Charlotte NC. This is because Charlotte NC has varying physiography that makes it extremely venerable to flooding and also hurricanes. Charlotte NC has many areas that are low-lying and flat and also coastlines and valleys that make it predisposed to flooding, after an accumulation of heavy rainfall (Lickley, et al., 2014). From the historical evidence, there is a high likelihood that Charlotte NC will continue experiencing flooding and a moderate likelihood of Charlotte NC experiencing hurricanes in the future.

To mitigate the effects of possible hurricanes and flooding, projects, and policies aimed to lower or eliminate the effects of flooding and hurricanes on people and property should be implemented (Tullos D. (2018). This should include evacuation plans and procedures in case of a disaster. Additionally, the shelter and feeding of the affected individuals should be prioritized, and more importantly provision of treatment to the injured.

Secondly, education, training, and outreach efforts emphasizing the effects of the hazards and methods to increase resiliency should be conducted. This should include educating and training the community members on the appropriate precautionary measures to take in case of flooding or hurricanes Lickley, et al., 2014). For example, community members should be educated to avoid low spots such as basements or underpasses during flooding and avoid low-lying areas. People should also be advised to always remain indoor during hurricanes since strong winds blow away anything around and if their homes are not on higher ground, to access a shelter. It is also important to avoid driving into flooded areas.  In case the emergency managers advise people to evacuate, the community members should be advised to ensure they evacuate immediately (Tullos D. (2018). This type of education will inform community members on actions to take in case of a disaster.

More importantly, healthcare providers in the area, and especially nurses who are the front-line healthcare workers should be educated and trained regarding disaster management. This will equip them with the required skills and knowledge to handle victims of disasters such as hurricanes and flooding within healthcare organizations.

Lastly, a flood/hurricane insurance program should be in place to provide residents of Charlotte NC with incentives to adopt land-use regulations and prohibit constructions lower than the 100-year flood elevation (Lickley, et al., 2014).

Conclusion

The nursing diagnosis for the aggregate population includes ineffective A1C management deficit and increased infections, wound healing and slow healing surgical outcomes; and imbalanced nutrition more than body requirements. Strategies include outreach education to the community members on diabetes self-management, including implementation of weight loss programs, promoting physical activities, and integrating a healthy diet in the diabetes treatment plan. The most likely disasters in Charlotte NC include flooding and hurricanes.

 

 

References

Al-Rasheedi A. A. (2015). Glycemic Control among Patients with Type 2 Diabetes Mellitus in Countries of Arabic Gulf.
International journal of health sciences
,
9
(3), 345–350.

Alvarez, C. E., Clichici, L., Patricia Guzmán-Libreros, A., Navarro-Francés, M., & Ena, J. (2017). Survey of vaccination practices in patients with diabetes: A report examining patient and provider perceptions and barriers.
Journal of clinical & translational endocrinology
,
9
, 15–17. https://doi.org/10.1016/j.jcte.2017.06.002

Franz, M. J., & MacLeod, J. (2018). Success of nutrition-therapy interventions in persons with type 2 diabetes: challenges and future directions.
Diabetes, metabolic syndrome, and obesity: targets and therapy
,
11
, 265–270.
https://doi.org/10.2147/DMSO.S141952
.

Hieshima, K., Suzuki, T., Sugiyama, S., Kurinami, N., Yoshida, A., Miyamoto, F., Kajiwara, K., Jinnouchi, T., & Jinnouchi, H. (2018). Smoking Cessation Ameliorates Microalbuminuria With Reduction of Blood Pressure and Pulse Rate in Patients With Already Diagnosed Diabetes Mellitus.
Journal of clinical medicine research
,
10
(6), 478–485.
https://doi.org/10.14740/jocmr3400w
.

Johnson, L., Edward, K. L., & Giandinoto, J. A. (2018). A systematic literature review of accuracy in nursing care plans and using standardized nursing language.
Collegian
,
25
(3), 355-361.

Lickley, M. J., Lin, N., & Jacoby, H. D. (2014). Analysis of coastal protection under rising flood risk.
Climate Risk Management
,
6
, 18-26.

Polonsky, W. H., & Henry, R. R. (2016). Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors.
Patient preference and adherence
,
10
, 1299–1307.
https://doi.org/10.2147/PPA.S106821
.

Tullos D. (2018). Opinion: How to achieve better flood-risk governance in the United States.
Proceedings of the National Academy of Sciences of the United States of America
,
115
(15), 3731–3734. https://doi.org/10.1073/pnas.1722412115

 

 

Developing a Care Plan
Last week, you conducted a risk assessment to identify the health risks faced by the aggregate you selected. This week, begin working on a comprehensive care plan for the aggregate and submit it to the Submissions Area by the due date assigned.

The care plan should propose a nursing diagnosis for the aggregate and include strategies to tackle the major health risks identified during the risk assessment.

In addition, it should include a disaster management plan with the following components:

List of disasters that might affect your aggregate (take into consideration the geographical location of the aggregate, past history, etc.)
Strategies for handling at least two disasters from the list
Recommendation for a disaster supplies kit
Propose a nursing diagnosis and suggest interventions that address the major health risks identified from the risk assessment. In your care plan, include a list of disasters that may affect the aggregate and a disaster management plan.

Submission Details:
Your comprehensive care plan should be in a 4- to 5-page Microsoft Word document.

Care Plan on Hemorrhage

 

Student Name

Program Name, Institution

COURSE CODE: Course Title

Instructor Name

Month, Year

 

 

Care Plan on Hemorrhage

Case Scenario

30-year-old G1 P1, Caucasian female, came to the facility at 0800hrs today, 40-week gestation female  baby weighing 10lbs 3oz, prolonged labor under  vacuum-assisted delivery and a midline episiotomy, EBL of 250ml during delivery, 600ml Oxytocin IV in 1000ml of LR given after delivery, labor complicated with chorioamnionitis, IV antibiotics given immediately after delivery, history of Asthma with inhaler use, and fundus is boggy at midline umbilicus that firms with massage, moderate bleeding and passing of clots with massage, lochia soaked 3 perineal pads within the last hour.

Pathophysiology of the disease

Hemorrhage entails blood leaking from the blood vessels to the surrounding tissue. When a vessel is damaged, the hemorrhage occurs as long as the vessel stays open and the pressure inside the vessel dominates the pressure outside of the vessel. Coagulation usually seals the vessel and prevents bleeding (Macdonald & Schweizer, 2017). Uncontained hemorrhage can lead to anticoagulant medication, hemophilia, or substantial injury to the blood vessel, resulting in extensive loss of blood and shock. The signs and symptoms include breathlessness, unconsciousness, vomiting, nausea, and swollen abdomen.

Steps of the disease

The steps of hemorrhage disorder which involve four classes. The first class involves loss of around 15% of the amount of blood. There is generally no improvement in common signs, and there is typically no need for fluid resuscitation (Gayet-Ageron et al., 2018). The second class involves 20 percent of the overall blood flow. The patient is frequently tachycardic (increased heartbeat) with a drop in the disparity among diastolic and systolic blood pressures. The body is attempting to recompense for peripheral vasoconstriction. Skin may start to appear thin and be soft when touched. The patient can undergo minor behavioral changes. Volume recovery with colloids is all that is usually needed. Transfusion of blood is not typically needed.

The third class entails a reduction of 30 to 40 per cent of flowing blood volume. The client’s blood pressure reduces, the pulse rate elevates, peripheral hypo perfusion and reduced capillary fill-up develops, and the emotional state worsens (Gayet-Ageron et al., 2018). Fluid rebirth with crystalloid and transfusion of blood is typically expected.  Class IV Hemorrhage entails a depletion of less than40 per cent of circulating blood flow. The body’s remuneration cap is exhausted and rapid resuscitation is needed to avoid death.

Nursing Diagnosis:

Measurable Goal:

Nursing Interventions:

Outcome:

Interrupted

Breastfeeding R/T

separation of

infant for medical

treatment AEB

emotional distress

second to balloon

tamponade and

uterine curettage

Patient will achieve

satisfaction with

effective breastfeeding

before discharge home

from hospital

1. Assess patients’

level of distress

and support her by

teaching that

breastfeeding can

continue when the

procedures are

complete and PPH

is under control

2. Teach patient the

importance of the

medical treatments

to manage

postpartum

hemorrhage and

complications

3. Notify Lactation

Consultant/Specialist

st to schedule time

when mother can

breastfeed after

procedure

4. Assist with

emotional distress

by providing skin to

skin, comfort,

holding techniques,

support with

latching to breast,

identifying infant

cues, and providing

resources for

breastfeeding once

bleeding is under

control

The goal was partially

met. The mother was

able to effectively

breastfeed her infant

once the postpartum

hemorrhage was under

control, but she is not

completely satisfied

with breastfeeding. She

expressed that she

would continue to

work on breastfeeding,

and she will use the

resources she was

given to get more

lactation help with a

Specialist.

Scarce Fluid

Volume R/T

extreme blood

loss after giving birth AEB

3 soaked perineal

pads within 1 hr second

to postpartum

hemorrhage

Client will have a

lochia drift of less than

1 saturated perineal

pad/hr by discharge

from hospital

1. Evaluate and record

type, quantity, and

bleeding site

2. Weigh and count

perineal pads to

assess accurate

amount of bleeding

3. Consider the location

and level  of

contractility of the

uterus/fundus with

massage

4. Monitor VS- BP and

HR to assess for s/s

of hypovolemia or

shock

The goal was met. With

the interventions in

place, the postpartum

hemorrhage was

managed and the

patient now has a

lochia flow of less than

1 saturated perineal

pad/hr before

discharge home

Severe Pain R/T

nursing and

therapeutic

interventions to

manage bleeding

AEB pain of 7 on 0-

10 pain assessment

scale second to

postpartum haemorrhage

Patient will report

below 3 on the pain

assessment scale

within 2 hours after

interventions are

performed

Clean and position

patient to promote

comfort and

decrease bleeding

2. Provide icepacks

and proper

padding to help

with pain and

swelling

3. Provide pain

medication

ordered for

interventions as

needed per patient

Provide adequate teaching for interventions such as fundal massage to manage bleeding so the patient knows what to expect

The goal was met. The

pain management and

comfort techniques in

place allowed the

patient to report a pain

of 2 on the pain

assessment scale 2

hours after

interventions were

performed

 

 

 

References

Gayet-Ageron, A., Prieto-Merino, D., Ker, K., Shakur, H., Ageron, F. X., Roberts, I., … & Gilliam, C. (2018). Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients. 
The Lancet
, 
391
(10116), 125-132.

-Macdonald, R. L., & Schweizer, T. A. (2017). Spontaneous subarachnoid haemorrhage. 
The Lancet
, 
389
(10069), 655-666.

Shakur, H., Roberts, I., Edwards, P., Elbourne, D., Alfirevic, Z., & Ronsmans, C. (2016). The effect of tranexamic acid on the risk of death and hysterectomy in women with post-partum haemorrhage: statistical analysis plan for the WOMAN trial. 
Trials
, 
17
(1), 249.