Tag: Clinical-Nursing

Developing Health Promotion Interventions for Patient Populations Paper – Smoking Cessation in Young Adults (Military Populations) 
 

 

 

Smoking Cessation in Young Adults (Military Populations) through Health Promotion Intervention

 

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Smoking Cessation in Young Adults (Military Populations)

Introduction

Cigarette smoking is one of the leading non-healthy behaviors among youths in the United States, particularly young adults (aged 18 to 25) in the military (American Lung Association, 2025). Young adults report higher levels of smoking compared to U.S adults (7.6% and 3.2%, respectively). Within the U.S military, particularly the air force, about 5.9% of the Airmen trainees, regardless of their sex, use cigarettes (Little et al., 2021a). The Centers for Disease Control and Prevention (CDC) reports that military service members smoke at significantly higher rates than civilians, with most beginning the habit in basic training or early service (CDC, 2019). Research has also established that the high rates of smoking in the military are associated with the history of tobacco advertising within the bases, availability of cheap products in the camps, and normalization of smoking (Little et al., 2021a). The consequences of smoking are serious because continued tobacco use impairs lung function, impedes recovery after strenuous military activity, and increases risks of cardiovascular disease, lung cancer, and other related chronic health conditions. Other costs associated with this unhealthy behavior include decreased combat readiness due to reduced physical and cognitive performance, as well as high healthcare costs, which are a burden to the U.S. Department of Defense and the Veterans Affairs system (Nieh et al., 2021; Patrick et al., 2024). Considering that cigarette smoking disproportionately impacts military service members, a targeted health promotion intervention is required urgently to reduce its impact.

Health Promotion Intervention and Outcome

The proposed health promotion intervention is an educational program that will help improve awareness about the dangers of cigarette smoking, teach coping skills for stress, and encourage positive behavior change among the young adult military population. If delivered in small group sessions during military training or early service, the program will provide tailored health promotion information that links smoking cessation with improved military readiness, cost savings, and long-term health. The primary health goal is to reduce smoking initiation and increase cessation rates among young service members by approximately 20% within six months of implementing the educational intervention. The outcome is measurable using self-reported smoking surveys, as it is realistic, tailored to the military training context, and directly related to improving the health of the target population (young adults in military service) and enhancing military effectiveness.

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Brief Evidence Review

Evidence suggests that smoking cessation interventions that integrate education, skill-building, and social accountability, and are delivered in supportive environments, are most effective for young adults (Little et al., 2021b; Patrick et al., 2024; Villanti et al., 2020). Studies on interventions for reducing smoking among military and civilian young adults have shown that interactive and group-based educational programs that engage the participants in discussions, allow peer support, and individualized goal settings are more effective than individual therapy (Little et al., 2021b; Villanti et al., 2020). These approaches work as they respond to the knowledge gap by teaching the young adults the health risks and costs of smoking and giving them skills to avoid negative peer influence and sustain behavior in a social setting that encourages tobacco use. Research also demonstrates that interventions offered in structured settings, such as military clinics or basic training, are effective because they align with the routines of young military service members and help encourage participation (Little et al., 2021; Patrick et al., 2024). Linking health promotion with the institutional procedures and programs fosters feasibility and effectiveness. Finally, research highlights the need to tailor smoking cessation interventions to the needs of diverse military personnel, such as those from racial minorities and low socioeconomic backgrounds (Patrick et al., 2024; Villanti et al., 2020). This calls for educational interventions that take into account the diversity within the military population.

Best Practice Alignment

The recommended educational health promotion for smoking cessation among young adults in the military service is supported by a few national health guidelines. The U.S. Preventive Services Task Force (USPSTF, 2021) assigns a Grade A rating to smoking cessation programs that incorporate behavioral counseling. USPSTF recommends behavior counseling in individual or group contexts that comprise health education and skill building for non-pregnant adults, including young adults. The recommendation highlights the importance of providing structured education, follow-up, and opportunities to prevent relapse. The CDC (2019) also insists on tailored interventions for the military population. The proposed health promotion intervention aligns with these recommendations by providing group-based education sessions with follow-up and culturally-relevant content linked to military discipline and readiness.

Developing Health Promotion Intervention

Patient Education Script

Provider:
Hi, my name is [Name], and I am the nurse practitioner working with you today. In this session, I would like to talk with you about something that affects the majority of military service members and veterans, and that is cigarette smoking. I understand you may have adopted smoking due to the stress of military life, but it can have adverse effects on your health and performance. My goal is to help you make practical changes that will lead to improved health and increased strength. Developing Health Promotion Interventions for Patient Populations Paper – Smoking Cessation in Young Adults (Military Populations)

Provider:
Did you know that service members and veterans smoke more than the general U.S. population? (CDC, 2019). Many young adults in the military service report smoking during basic training or early service (Little et al., 2021a). Smoking affects almost every organ of your body. As such, cigarette smoking increases your risk of cancer, lung disease, and heart disease (Patrick et al., 2024). It can also decrease your recovery after training or exercise. However, here is the good news: quitting even gradually can improve your energy, breathing, and long-term health, as well as your overall well-being (Villanti et al., 2020).

Provider:
The first step to quitting smoking is setting goals. Let us set a goal to cut back the number of cigarettes you smoke every day. For example, if you do around 12, let us aim only to do eight this week. Over the next month, we will work together to reduce our impact even further. But what do you do with the cravings? Studies have indicated that group support and replacing nicotine products like cigarettes with alternatives such as gum or patches enable military members to quit tobacco gradually (Little et al., 2021b).

Provider:
You may be wondering how you will track this new routine. I got you! To help you keep track, I would like you to self-monitor. This involves writing down each cigarette you smoke in a small notebook or journal. Alternatively, you can use a phone app to track tobacco use. At the end of the week, we will review the log together to see your progress. Lastly, remember to be your peer’s keeper, as the goal is to reduce smoking in the military, so encourage others to meet their goals.

Provider:
We can also set up text-message reminders in your preferred language. For instance, we may send you messages, like “Remember your goal today; choose gum or water instead of a cigarette.” These reminders can help keep you on track even during those stressful days.

Provider:
Just a brief recap. We talked about how smoking harms health and performance, and how quitting step by step can help. Your first goal is to decrease the number of cigarettes you smoke in a day. To stay on track, write down your progress in a notebook or use a smartphone app, and then we will review it together in the next session. I will also follow up by sending you supportive text messages throughout the week. What do you think about the session? Is quitting possible? Do you have any concerns? We can discuss them before we close this session.

Accountability Planning

Tracking and Monitoring

Patients can use a paper log or a calendar in their living areas, a simple smoking cessation mobile app available in English and Spanish, or receive weekly text message follow-ups.

Patient will record behavior by writing down the number of cigarettes smoked every day and the times of the day when they experience intense cravings (such as morning or when under stress)

The patient will also monitor the number of hours they stay without smoking a cigarette each day to recognize progress and promote healthy choices.

Developing Health Promotion Interventions for Patient Populations Paper – Smoking Cessation in Young Adults (Military Populations)

Goal Setting

The plan focuses on a gradual reduction in smoking behavior with realistic and step-by-step goals. In the first two weeks, the patient is expected to reduce smoking by four cigarettes, and by the end of six weeks, the daily smoking will have dropped by half. At the same time, the patient will use nicotine replacement, such as gum or patches, to manage cravings. In three to six months, the patient will aim to be tobacco-free or ensure they do not smoke more than a cigarette a week while continuing to apply quit-support services.

Motivation and Support

Patients are encouraged to celebrate small progress through praise, verbal recognition, and engaging in other fun activities, such as a hike.

Support strategies by the healthcare team include weekly text-message reminders with motivational messages, such as “Are you ready for today? Remember your goal,” and “A walk break is way healthier and fun than a smoke break.”

The nurse practitioner will also conduct follow-up sessions and make phone calls to address any challenges that may arise.

Patients will also be encouraged to get an accountability peer in the military service who will continually encourage them, help track daily goals, and promote healthy activities to replace cigarette smoking.

Roles and Responsibilities

Provider responsibilities:
Clearly state how the patient will log daily smoking behavior, review logs during follow-up sessions or through phone or text-based check-ins, provide culturally tailored suggestions (such as stress-management techniques that suit the military culture), and adjust goals if challenges arise.

Patient responsibilities
: Track daily cigarette smoking using a preferred method (either a notebook or a phone app), engage in weekly check-ins and monthly follow-ups, and share honest logs, including challenges such as cravings during work, stress, and peer influence. Patient should also celebrate their progress and engage the support of accountability friends or family to sustain motivation to quit smoking.

Integrating Social Determinants of Health (SDOH)

Social determinants of health (SDOH) affect smoking behaviors and cessation outcomes among young adults in the military. Three main SDOH influencing this population’s health are work schedules, housing instability, and financial challenges. Having irregular and stressful duty hours usually promotes smoking behavior and reduces time for cessation counseling or participation in group-based interventions. Hence, young adults in early service may require flexible education strategies delivered during routine health visits (Little et al., 2021b). Housing instability, particularly for recently admitted military persons, can increase stress and dependence on tobacco as a coping strategy; thus, it is essential to include supportive resources in the smoking cessation planning (Nieh et al., 2021). Income problems may hinder access to nicotine replacement therapy (NRT) or mobile apps. Hence, providers should consider low-cost options to ensure equity (Patrick et al., 2024). To manage the identified barriers, accountability has options, such as paper logs, phone check-ins for those with limited digital access, and support resources, to ensure optimal patient engagement while reducing structural challenges that could adversely affect cessation outcomes.

Conclusion

This smoking cessation intervention for military young adults incorporates individualized education, accountability processes, and social determinants of health modifications to manage one of the most persistent public health challenges in this population. By offering convenient and accessible counseling, incorporating inexpensive cessation aids, and modifying tracking processes to accommodate varied living and working conditions, the design directly confronts barriers to tobacco cessation. The intervention emphasizes both provider support and personal responsibility, offering a structured yet flexible system for behavior change Developing Health Promotion Interventions for Patient Populations Paper – Smoking Cessation in Young Adults (Military Populations) .

The expected outcomes include changes in knowledge of the health risks associated with tobacco, understanding of effective quitting strategies, and increased confidence in quitting over time. In the short term, this may lead to reduced smoking, improved respiratory health, and increased readiness to meet military performance standards. Long-term results include a reduced risk of chronic disease, lower healthcare costs within the Military Health System, and an improved quality of life following service (Villanti et al., 2020; Patrick et al., 2024). In addition to individual health, the intervention promotes public health equity by removing structural determinants of health that have a disproportionate impact on service members. Its broader significance is in guiding tobacco control interventions within military populations and providing direction for future research and policy efforts to reduce smoking-related disparities.

 

Acknowledgement

The author utilized artificial intelligence, specifically Grammarly Pro, in editing and refining the paper to ensure it was free from spelling errors and other grammatical structure rules. The paper was uploaded to the application, where the author reviewed the work and edited suggested areas. As such, the author takes full responsibility for the accuracy and integrity of this write-up.

References

American Lung Association. (2025, January 27).
Top 10 Populations Disproportionately Affected by Cigarette Smoking and Tobacco Use | State of Tobacco Control | American Lung Association
. Www.lung.org. https://www.lung.org/research/sotc/by-the-numbers/top-10-populations-affected

Centers for Disease Control and Prevention (CDC). (2019, October 28).
Military Service Members and Veterans
. Centers for Disease Control and Prevention.
https://www.cdc.gov/tobacco/campaign/tips/groups/military.html

Gaddey, H. L., Dakkak, M., & Jackson, N. M. (2022). Smoking Cessation Interventions.
American Family Physician
,
106
(5), 513–522. https://www.aafp.org/pubs/afp/issues/2022/1100/smoking-cessation-interventions.html

Little, M. A., Fahey, M. C., Wang, X.-Q., Talcott, G. W., McMurry, T., & Klesges, R. C. (2021a). Trends in tobacco use among young adults presenting for military service in the United States Air Force between 2013 and 2018.
Substance Use & Misuse
,
56
(3), 370–376.
https://doi.org/10.1080/10826084.2020.1868517

Little, M., Wang, X.-Q., Fahey, M., Wiseman, K., Pebley, K., Klesges, R., & Talcott, G. (2021b). Efficacy of a group-based brief tobacco intervention among young adults aged 18–20 years in the U.S. Air Force.
Tobacco Induced Diseases
,
19
(December), 1–11.
https://doi.org/10.18332/tid/143282

Nieh, C., Mancuso, J. D., Powell, T. M., Welsh, M. M., Gackstetter, G. D., & Hooper, T. I. (2021). Cigarette smoking patterns among U.S. military service members before and after separation from the military.
PLOS ONE
,
16
(10), e0257539.
https://doi.org/10.1371/journal.pone.0257539

Patrick, S., Boyle, C., LaMorte, D., & Dore, M. (2024). Tobacco use prevalence in the military health system: A retrospective study.
Military Medicine
,
189
(11-12), e2632–e2637.
https://doi.org/10.1093/milmed/usae208

U.S. Preventive Services Task Force (USPSTF). (2021). Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: Recommendation Statement.
American Family Physician
,
103
(12), online–online. https://www.aafp.org/pubs/afp/issues/2021/0615/od1.html

Villanti, A., West, J., Klemperer, E., Graham, A., Mays, D., Mermelstein, R., & Higgins, S. (2020). Smoking-cessation interventions for U.S. young adults: Updated systematic review.
American Journal of Preventive Medicine
,
59
(1), 123–136.
https://doi.org/10.1016/j.amepre.2020.01.021 
 Developing Health Promotion Interventions for Patient Populations Paper – Smoking Cessation in Young Adults (Military Populations)

Joan Silva, age 35 -Case Study: Mechanisms of Self-Defense

Case study 2

Joan Silva,
a 35-year-old female, is complaining of weight loss and generalized fatigue that has been deteriorating even more in the past 4 months. She also presents with a history of vagina infections that have been recurring. She states that she has not been on any medications apart from calcium supplements and oral contraceptives.

Does Joan meet the diagnostic criteria for AIDS? Explain your answer –
No, the patient does not meet the diagnostic criteria for AIDS, as important details such as CD4 count have not been provided. However, her symptoms, such as weight loss and fatigue, are indicative of the disease.

Why does Joan have oral and vaginal candidiasis? What is the pathophysiologic process that leads to the candidiasis? –
The patient has oral and vaginal candidiasis due to her weakened immune system caused by HIV, which leads to overgrowth of Candida fungi, which is an opportunistic infection.

The pathophysiological process that leads to candidiasis starts with adherence of Candida to host surfaces, forming a biofilm. Candida then switches from yeast to filamentous hyphae that invade tissues. It then breaks down the barrier to the host cells and penetrates into the cells. The host’s body responds through inflammation, and when it becomes overwhelmed, candidiasis develops (Wang et al., 2023).

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What does the term opportunistic infection mean? Why does it happen? Name one opportunistic infection that could happen in this case –
An opportunistic infection is an infection that takes advantage of a weakened immune system in an individual and causes severe illness. They occur due to the host’s suppressed immune system, which makes pathogens that would otherwise cause no harm be harmful. In this case, an opportunistic disease that could occur is tuberculosis.

Why does her low CD4+ cell count put Joan at high risk for opportunistic infections?
The patient’s low CD4 cell count puts her at a high risk for opportunistic infection due to the fact that the cells are crucial in the effective functioning of the immune system, such as in activating immune cells and assisting in the development of antibodies that lead to long-lived memory.

1.Explain the relationship between stress and disease. Include the pathophysiologic processes involved.
The relationship between stress and disease is physiological in that chronic stress disrupts the host’s system, making them open to various diseases, such as cardiovascular diseases. On the other hand, short-term stress is adaptive. The pathophysiological process involved is the increased secretion of glucocorticoids caused by activation of the hypothalamic-pituitary-adrenal axis that activates the CNS, leading to the release of epinephrine that prepares the body for a fight or flight response. This leads to the development of diseases such as cardiovascular disorders.

How does a patient’s coping responses affect treatment and or recovery? –
A patient’s coping response affects their treatment and recovery significantly by making them stick to their treatment plan and manage stress that boosts their recovery process in positive coping and vice versa (Jurcău & Jurcău, 2022).

References – Joan Silva, age 35

Daungsupawong, H., & Wiwanitkit, V. (2024). Blood and local eosinophil levels in chronic rhinitis: Comment. 
World Allergy Organization Journal
, 
17
(11), 100977. 
https://doi.org/10.1016/j.waojou.2024.100977

Eyerich, K., & Ring, J. (2023). Burden of disease in atopic eczema. 
Atopic Dermatitis – Eczema
, 31-33. 
https://doi.org/10.1007/978-3-031-12499-0_3

Jurcău, R., & Jurcău, I. (2022). Relationship between post-traumatic stress disorder and oxidative stress – a PubMed approach.
Health, Sports & Rehabilitation Medicine
, 
23
(4), 164-168. 
https://doi.org/10.26659/pm3.2022.23.4.164

Pattanayak, S., Sheel, S., Kumar, V., & Bhat, V. (2023). Ghee-based balm: A novel and innovative herbal therapy for patients with common cold, nasal congestion, and allergic rhinitis. 
International Journal of Pharmaceutical Sciences Review and Research
, 
82
(2). 
https://doi.org/10.47583/ijpsrr.2023.v82i02.016

Wang, Y., Liu, Z., & Chen, T. (2023). Vaginal microbiota: Potential targets for Vulvovaginal candidiasis infection. 
https://doi.org/10.2139/ssrn.4660638

Zulfakri Abdullah, M. H., & Ferryan Sofyan. (2023). The relationship between the score for allergic rhinitis and the total nasal symptoms score in individuals with suspected allergic rhinitis.
Sumatera Medical Journal
, 
6
(1). 
https://doi.org/10.32734/sumej.v6i1.7899
– Joan Silva, age 35

Case Study: Mechanisms of Self-Defense – Anna Sanchez 21-year-old female nursing student case study

Case study 1

Anna Sanchez,
A 21-year-old taking a nursing course, complains of congestion of the nose, especially during the night and morning hours, itchy eyes that also appear watery, persistent sneezing, and a tickling cough. She indicates that her symptoms have persisted for 5weeks and to counter them, she has been using Zyrtec, nasal spray, and eye drops.

What assessment questions would be useful to ask Anna about her medical and family history? Why?
-The appropriate questions to ask the patients concerning her medical and family would be, timing of the symptoms; whether it worsens at certain times than other times, how often she experiences the symptoms, characteristics of the symptoms she presents with, and whether she has been diagnosed before of conditions that present with almost similar symptoms for her medical history and whether she has close relatives with allergic diseases for family history (Pattanayak et al., 2023).

What evidence suggests that Anna does or does not have an acute severe infection? –
The patient is suffering from allergic rhinitis, following her symptoms, but the infection is not an acute severe infection due to the presence of nasal polyps and clear nasal drainage, supported by the absence of purulent discharge and clear lungs.

What type of hypersensitivity reaction is involved with allergic rhinitis? Explain this type of hypersensitivity –
Allergic rhinitis is a type 1 hypersensitivity reaction. This type of reaction is triggered by allergens such as pets, in our case, that cause the release of IgE antibodies that bind to mast cells and basophils, releasing inflammatory mediators such as histamine and tryptase. The reaction may either be immediate or delayed.

A skin test indicates that Anna is allergic to cat dander. Two months ago, Anna’s roommate brought home a cat. Why didn’t Anna’s symptoms start when the cat entered the household, rather than 3 weeks later?
Anna experienced a delayed type 1 hypersensitivity reaction due to the presentation of symptoms three weeks after exposure to her roommates cat this can be due to several factors such as continuous chronic low-exposure to the cat, presences of underlying co-morbidities such as nasal polyps and sinusitis, and other factors such as patient awareness on allergen- triggered symptoms and her young age (Zulfakri Abdullah & Ferryan Sofyan, 2023).

What class of antibodies bound to the mast cells? –
The class of antibodies that bind to mast cells is the IgE class that sensitizes the mast cells, causing inflammatory mediators such as histamine to be released in subsequent encounters with allergens.

What physiological mechanisms caused the redness of Anna’s nasal mucosa?
-The physiological mechanisms that caused redness in Anna’s nasal mucosa are vasodilation and increased vascular permeability triggered by inflammatory mediators released by mast cells, such as histamine.

Anna’s skin rash is consistent with atopic dermatitis, which is common in young people with allergies. What type of hypersensitivity reaction causes atopic dermatitis? –
Atopic dermatitis is a type 1 hypersensitivity reaction caused by overproduction of IgE antibodies (Eyerich & Ring, 2023).

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Why are there a lot of eosinophils in nasal polyps in allergic rhinitis? –
The presence of eosinophils in nasal polyps in allergic rhinitis is due to an immune response triggered by helper 2 cells that causes the secretion of Th2 cytokines, which lead to the development of eosinophils and their activation that then migrate from the blood to the nasal tissue (Daungsupawong & Wiwanitkit, 2024).

What mechanisms caused Anna’s clear postnasal drainage? –
The mechanism behind the clear postnasal drainage is vasodilation and increased vascular permeability caused by the inflammatory mediators, such as histamine, that have been released by mast cells, causing fluid leakage into the nasal cavity from the permeable vessels. Anna Sanchez 21-year-old female nursing student case study Anna Sanchez 21-year-old female nursing student case study

References

Daungsupawong, H., & Wiwanitkit, V. (2024). Blood and local eosinophil levels in chronic rhinitis: Comment. 
World Allergy Organization Journal
, 
17
(11), 100977. 
https://doi.org/10.1016/j.waojou.2024.100977

Eyerich, K., & Ring, J. (2023). Burden of disease in atopic eczema. 
Atopic Dermatitis – Eczema
, 31-33. 
https://doi.org/10.1007/978-3-031-12499-0_3

Jurcău, R., & Jurcău, I. (2022). Relationship between post-traumatic stress disorder and oxidative stress – a PubMed approach.
Health, Sports & Rehabilitation Medicine
, 
23
(4), 164-168. 
https://doi.org/10.26659/pm3.2022.23.4.164

Pattanayak, S., Sheel, S., Kumar, V., & Bhat, V. (2023). Ghee-based balm: A novel and innovative herbal therapy for patients with common cold, nasal congestion, and allergic rhinitis. 
International Journal of Pharmaceutical Sciences Review and Research
, 
82
(2). 
https://doi.org/10.47583/ijpsrr.2023.v82i02.016

Wang, Y., Liu, Z., & Chen, T. (2023). Vaginal microbiota: Potential targets for Vulvovaginal candidiasis infection. 
https://doi.org/10.2139/ssrn.4660638

Zulfakri Abdullah, M. H., & Ferryan Sofyan. (2023). The relationship between the score for allergic rhinitis and the total nasal symptoms score in individuals with suspected allergic rhinitis.
Sumatera Medical Journal
, 
6
(1). 
https://doi.org/10.32734/sumej.v6i1.7899

Assignment: Case Studies Mechanisms of Self Defense

 

Instructions:
Add in text citations where appropriate in APA format. You may also have other referenced peer reviewed materials to reference for your answers. Acceptable additional references include peer reviewed journal articles within the last 5 years, textbooks from the nursing program within the last 5 years, national guidelines, or posted additional articles within this course.

 

Chapter 09: Alterations in Immunity and Inflammation

 

Case Study Anna Sanchez Assignment: Case Studies Mechanisms of Self Defense

 

CC: “I have a cold that I cannot seem to get rid of”

HPI: This is a 21-year-old female nursing student that presents to the on-campus clinic nurse practitioner with a 5 week history of itchy and watery eyes (clear drainage), nasal congestion with occasional watery clear nasal discharge. She reports the symptoms seems worse at night and right after she wakes up in the morning. She reports she has tried over the counter medications including Afrin nasal spray, eye drops, and Zyrtec. She reports a “tickling” cough that occurs at night and episodes of repetitive sneezing. She reports some of her dorm room friends have had colds as well over the last several weeks.

Physical Examination

Vital Signs
: T. 98.4 HR. 68 R. 12 B/P 128/74 SpO2 98% on room air.

General:
Well kempt

HEENT (Head, Eyes, Ears, Nose, and Throat)
: Normocephalic, Sclera injected red, irritated orbits with erythema and swelling; tearing clear drainage bilaterally; tenderness with palpation over maxillary sinuses; outer nares with erythema, irritated skin; internal nares erythematous, boggy, moist mucosa and one medium-sized polyp on each side; pharynx slightly erythematous with clear postnasal drainage.

(NOTE: Nasal polyps are common in allergic rhinitis. They are edematous protrusions of the mucosa that are infiltrated with neutrophils, eosinophils, and plasma cells.)

Skin
: Flaking erythematous rash on the flexor surfaces of both arms

Lungs
: Clear to auscultation and percussion

Injected conjunctiva

 

2. Nasal polyp and swollen turbinate left nare

 

Answer the questions about the patient and her condition.

 

What assessment questions would be useful to ask
Anna
about her medical and family history? Why? (1 point)

 

 

What evidence suggests that Anna does or does not have an acute severe infection? Explain your answer. (1 point)

 

 

What type of hypersensitivity reaction is involved with allergic rhinitis? Explain this type of hypersensitivity. (2 point)

 

 

A skin test indicates that Anna is allergic to cat dander. Two months ago, Anna’s roommate brought home a cat. Why didn’t Anna’s symptoms start when the cat entered the household, rather than 3 weeks later? (2 point)

 

 

What class of antibodies bound to the mast cells? (1 point)

 

 

What physiological mechanisms caused the redness of Anna’s nasal mucosa? (1 point)

 

 

Anna’s skin rash is consistent with atopic dermatitis, which is common in young people with allergies. What type of hypersensitivity reaction causes atopic dermatitis? (1 point)

 

 

Why are there a lot of eosinophils in nasal polyps in allergic rhinitis? (1 point)

 

 

What mechanisms caused Anna’s clear postnasal drainage? (1 point)

 

 

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Chapter 10: Infection- Assignment: Case Studies Mechanisms of Self Defense

 

Case Study

Joan Silva, age 35, comes to her primary care provider with a history of recurrent vaginal infections
. She also mentions weight loss and generalized fatigue that has been worsening over the past 4 months. She has been previously healthy, takes no medications other than oral contraceptives and calcium supplements, and has no other significant medical history. Joan states that she became sexually active at the age of 19 and that she has had four sexual partners in her lifetime. She has never used any form of barrier protection during intercourse. She is currently in a 4-year monogamous relationship with a 37-year-old man who is in good health.

 

Physical Examination

 

Thin, anxious woman in no distress

Temperature 38°C (100.4°F) orally; pulse 96 and regular; blood pressure 138/76 sitting; respiratory rate 15

Head/Eyes/Ears/Throat
:
No alopecia; pupils equal and reactive; fundi without lesions; tympanic membranes clear; cheesy white exudate on tongue and pharynx

Neck
:
Mild anterior cervical adenopathy; no thyromegaly

Lungs
:
Clear to auscultation and percussion

Cardiac
:
Regular rate and rhythm without murmurs or gallops

Abdomen
:
Nontender, without masses

Pelvic
:
Thick, white vaginal discharge; venereal warts present

Extremities
:
Without edema; pulses full throughout

Neurologic
:
Cranial nerves, strength, sensation, reflexes, and gait all intact

 

Laboratory Results

 

HIV antibody test
: Positive, confirmed by Western blot

Complete blood count
: Decreased lymphocytes, CD4
+
= 170 cells/µL

Potassium hydroxide preparation of oral and vaginal exudate
: yeast

 

Answer the questions about Joan Silva and her condition.

 

Does Joan meet the diagnostic criteria for AIDS? Explain your answer. (1 point)

 

 

Why does Joan have oral and vaginal candidiasis? What is the pathophysiologic process that leads to the candidiasis? (2 point)

 

 

What does the term opportunistic infection mean? Why does it happen? Name one opportunistic infection that could happen in this case. (2 point)

 

Why does her low CD4+ cell count put Joan at high risk for opportunistic infections? (1 point)

 

Chapter 11: Stress and Disease

Explain the relationship between stress and disease. Include the pathophysiologic processes involved. (2 point)

 

How does a patient’s coping responses affect treatment and or recovery? (1 point) Assignment: Case Studies Mechanisms of Self Defense

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Osgood Schlatter Assignment

CONNECTING THE 3 Ps: Pathophysiology, Physical Manifestations, Pharmacology

Instructions:
Read the assigned textbook chapters. Choose
ONE
diagnosis from the list below. Fill out the assignment below by connecting essential knowledge of pathophysiology of the primary diagnosis / problem to the physical examination clinical manifestations and to the pharmacotherapies. Think about this as an APRN seeing a patient in clinical practice. Include a relevant diagnostic test and non-pharmacotherapies that could be used related to the pathophysiology of the disease. Show the connection between the pathophysiologic process of the disease and the clinical manifestations and the pharmacotherapeutic treatment and plan.

It is required that at least 3 citations / 3 references are used for this assignment. Points are included into the points listed for each section. A citation is required for the following sections: “Pathophysiology,” “Physical Findings” (Body Systems; Subjective / HPI; Objective); “Labs and Diagnostics,” “Diagnosis” (Pathophysiology of differential diagnoses), and “Pharmacotherapy” (Plan, Guidelines, and SDoH). One reference must be from the Rogers’ Pathophysiology textbook, one from Rogers & Allen 3 Ps,  and one citation must be from the most recent clinical practice guidelines for the disease.

This assignment is worth
35 points
. Please review the rubric for details of point requirements.

DIAGNOSIS CHOSEN FROM THE ONE OF THE DIAGNOSES HERE:
(
1 point)

 

Osgood Schlatter – Pediatric Patient

 

(
It is required that a different population must be chosen for each of the next assignments. For example, if you choose an adult disease for cardiovascular system, then you should choose a pediatric disease for pulmonary assignment and then choose women’s health for GI assignment).

 

Diagnosis: Osgood Schlatter
–

Pediatric Patient

 

 

PATHOPHYSIOLOGY

GET ASSIGNMENT HELP HERE

PATHOPHYSIOLOGY OF PRIMARY MEDICAL CONCERN (Disease chosen – specific to the population) (4 points)

(100-200 WORDS)

 

Osgood-Schlatter Disease (OSD) is a self-limiting traction apophysitis affecting the tibial tubercle in the growing adolescent population. The fundamental pathology is rooted in the unique anatomical state of the lower extremity during the pubertal rapid growth spurt. The tibial tuberosity is a secondary ossification center composed of vulnerable cartilaginous tissue (the apophysis). During high-impact activities common in adolescent sports, the quadriceps contract forcefully, exerting excessive and repetitive tractional stress or pulling force on this immature apophysis. This chronic, overwhelming strain causes micro-avulsions or small partial tears where the patellar tendon attaches. These repeated microtraumas initiate a vigorous, localized inflammatory response (apophysitis), leading to pain and swelling. The body attempts to heal this by forming new bone, resulting in the characteristic bony prominence.

PHYSICAL FINDINGS

 

BODY SYSTEMS THAT ARE DIRECTLY IMPACTED BY THIS MEDICAL PROBLEM
(3 points)

EXPLAIN HOW EACH SYSTEM YOU CHOSE IS AFFECTED – IT CAN BE A POSSIBLE COMPLICATION OF THE DISEASE. (Ex. Integumentary affected from diabetes related to a diabetic wound OR Neurologic system affected by diabetes related to vision changes). (
Minimum 3 body systems
)

 

 

Musculoskeletal System-
Directly Affected. This system is the site of the primary pathology. The traction apophysitis results in pain, localized swelling, and the development of the characteristic firm, tender, and often permanent bony prominence (tubercle) below the patella. It also causes muscle imbalance (tight quadriceps/hamstrings) and pain-induced limping

Neurologic System-
Secondary Effect (Pain Transmission). The intense, localized inflammation at the tibial tubercle directly stimulates local pain receptors (nociceptors), initiating the transmission of pain signals to the CNS, leading to the subjective symptom of pain and tenderness. Osgood Schlatter – CONNECTING THE 3 Ps: Pathophysiology, Physical Manifestations, Pharmacology

Integumentary System-
Secondary Effect (Inflammation). The localized inflammatory cascade causes the hallmark signs of inflammation around the tibial tuberosity: localized warmth and swelling (edema). The skin overlying the tubercle may be visibly erythematous (reddened) in the acute phase.

 

PRIORITY SUBJECTIVE SYMPTOMS / HISTORY OF PRESENT ILLNESS (HPI)

(on SOAP notes – the S stands for subjective – which is information from the patient)

 

Align the subjective symptoms to the pathophysiology of the disease. These are the things that a patient may tell you if they have the disease. 
(2 points)

 

 

THESE ARE THE SYMPTOMS (Information obtained from the patient about the problem)

 

O
nset:    
Insidious
(gradual, non-traumatic).

L
ocation: to the front of the knee, “right on the bump below my kneecap” (tibial tuberosity).

D
uration:
Intermittent
, lasting minutes to hours after activity, persisting for weeks.

C
haracteristics:
Dull, aching pain
at rest, escalating to
sharp pain
with activity.

A
ggravating factors:
Running, jumping, squatting, and kneeling
(activities involving forceful quadriceps contraction).

R
elieving factors:
Rest
and
applying ice

T
reatments: Over-the-counter NSAIDs (Ibuprofen) for pain/inflammation

S
everity:
mild to moderate
(e.g., 6-8/10 with jumping), often causing a limp after sports.

 

 

PRIORITY PHYSICAL EXAMINATION

OBJECTIVE SYMPTOMS (3 points)

(on SOAP notes – the O stands for objective – which is information from the provider)

 

Align the examination / findings to the body systems that affected.  (
Minimum 3 systems
)

 

You should build a “clinical picture” for each symptom to start ruling in or out diagnoses. In other words, viral pharyngitis vs strep vs tonsillitis vs epiglottitis, etc.

 

 

 

 

THESE ARE THE SIGNS (Information the provider actually assesses during the physical examination relevant to the problem)

 

General:
Antalgic gait (limp)
may be observed after activity, demonstrating a protective response to reduce knee stress.

Musculoskeletal:
Palpation reveals
focal, palpable, and exquisite tenderness directly over the tibial tuberosity
. Pain is reliably reproduced by performing a
resisted quadriceps contraction
and by passively forcing the knee into maximal flexion.

Integumentary:
Localized
warmth and swelling
(edema) and potential
erythema
(redness) over the tubercle in the acute inflammatory phase.

Extremities:
Assessment routinely reveals
generalized tightness of the quadriceps and hamstring muscles

 

 

MAKING THE CONNECTION:

Patho-Clinical Manifestations

Write a paragraph explaining how the subjective and objective findings are linked to the pathophysiology of the disease. 
(150-300 words) (3 points)

 

 

 

The pathophysiology is the mechanical, repetitive
traction
of the quadriceps-patellar tendon unit on the weak, cartilaginous
tibial tuberosity growth plate
, leading to
micro-avulsions
and a severe
localized inflammatory response
. The
subjective
report of
insidious-onset pain
that is
specifically localized
to the bony bump, and which is
aggravated by running/jumping
and
relieved by rest
, directly reflects this core mechanical injury. The
objective
finding of a
tender, palpable bony prominence
confirms the reactive bone formation from chronic microtrauma. Furthermore, the ability to
reproduce the pain
with
resisted knee extension
validates the presence of mechanical traction as the primary cause of symptoms, effectively ruling in OSD over other differentials.

LABS / DIAGNOSTIC TESTING

 

LAB AND DIAGNOSTIC FINDINGS THAT MAY BE ABNORMAL (2 points)

 

List the appropriate tests / labs (minimum 2) and explain the normal / abnormal result and how the lab test helps the APRN differentiate this diagnosis from others on the differential list.

 

1. Plain Film X-Ray (AP and Lateral Knee Views)-Abnormal (but diagnostic): May show soft tissue swelling, fragmentation or irregular ossification of the tibial apophysis. Differentiation: Essential to rule out acute tibial tubercle fracture or bone tumor; OSD shows chronic changes, confirming traction injury. Osgood Schlatter – CONNECTING THE 3 Ps: Pathophysiology, Physical Manifestations, Pharmacology

2. Inflammatory Markers (CBC, ESR, CRP)-Normal: WBC count, CRP, and ESR are within normal limits. Differentiation: Helps rule out infectious or systemic inflammatory arthritis (e.g., septic joint or osteomyelitis), which would show elevated values, confirming the sterile, mechanical nature of OSD.

 

MAKING THE CONNECTION:

Patho-Diagnostic Tests / Labs (3 points)

Write a paragraph explaining how the labs and/or diagnostic tests are linked to the pathophysiology of the disease. 
(150 – 300 words)

 

The tests validate the mechanical nature of the injury while excluding internal joint pathology. OSD’s core is chronic, excessive traction leading to localized micro-avulsions and sterile inflammation. Since the injury is purely mechanical, systemic laboratory tests like CBC, CRP, and ESR are predictably normal, ruling out dangerous differentials like septic arthritis. The X-ray’s utility is showing irregular ossification or fragmentation at the tubercle, which is the body’s attempt to repair the chronic micro-avulsions that define the pathophysiology. Normal bloodwork combined with these chronic imaging findings confirms a self-limiting traction apophysitis

DIFFERENTIAL DIAGNOSIS

 

2 POSSIBLE DIFFERENTIAL DIAGNOSES (DD) (1 point)

 

 

1.      Sinding-Larsen-Johansson (SLJ) Syndrome

2.     Patellar Tendinopathy (Jumper’s Knee) Osgood Schlatter – CONNECTING THE 3 Ps: Pathophysiology, Physical Manifestations, Pharmacology

 

EXPLAIN THE PATHOPHYSIOLOGY OF THE 2 DIFFERENTIAL DIAGNOSES AND WHY THEY CAN BE RULED OUT

(2 points)

 

1.     1. Sinding-Larsen-Johansson (SLJ) Syndrome: Pathophysiology is also traction apophysitis, but the site of pathology is the inferior pole of the patella (kneecap), not the tibial tuberosity. Ruled Out: Maximal tenderness is found lower, at the tibial tuberosity.

2.     Patellar Tendinopathy (Jumper’s Knee): Pathophysiology is tendinosis/tendinitis (degeneration/inflammation) of the patellar tendon body in a skeletally mature individual. Ruled Out: Patient is a growing adolescent, and pain/prominence is over the bony growth plate, not the tendon mid-substance.

PHARMACOTHERAPY / NON-PHARMACOTHERAPY / PLAN

 

PLAN

(on SOAP notes – the P stands for plan)

(4 points)

 

 

 

 

MEDS:
Ibuprofen (10 mg/kg/dose PO PRN for pain, max 40 mg/kg/day).
Goal:
Symptomatic relief of pain and inflammation; does not accelerate healing.

 

FURTHER TESTING:
No further testing is necessary. Clinical diagnosis is confirmed.

 

EDUCATION:
OSD is a
self-limiting condition
caused by stress on the growing knee; pain should guide activity level; it will resolve when the growth plate closes (typically ages 14−16).

   

     MEDS:
Take NSAID
with food
; use only PRN for pain; counsel on maximum daily dose and chronic use risks

     LIFESTYLE CHANGES (DIET, ACTIVITY):
Activity Modification (Relative Rest):
Continue activity but limit volume/intensity so pain remains below 4/10; avoid acute, sharp-pain-causing activities. Initiate daily
Home Exercise Program (HEP)
: static stretching of quadriceps/hamstrings. Apply
ice
for 15−20 minutes after activity/flare-ups.

 

FOLLOW-UP:
Return to Clinic (RTC)
in
4-6 weeks
to re-evaluate pain, functional capacity, and HEP adherence. Telehealth may be utilized to reduce patient burden

 

CLINICAL GUIDELINE FOR THIS DISEASE:
(2 point)

 

Look up the
most recent clinical guidelines
of the disease you have chosen and add the link to the guidelines here.

 

 

Osgood-Schlatter Disease – StatPearls – NCBI Bookshelf

 

MAKING THE CONNECTION:

Patho-Pharm (3 points)

Write a paragraph explaining how the pharmacotherapy (medications) is linked to the pathophysiology of the disease.
  (150-300 words)

 

The pharmacotherapy, Ibuprofen (NSAID), directly targets the inflammatory component of OSD’s pathophysiology. OSD is a traction apophysitis causing chronic micro-avulsions that trigger a vigorous, localized inflammatory response. Ibuprofen works by blocking COX enzymes, thus inhibiting the production of prostaglandins, the chemical mediators of this pain and inflammation. This provides crucial symptomatic relief to the patient. It is essential to note that the NSAID does not address the primary mechanical cause (traction) or accelerate growth plate closure; it is purely an adjunct to the core non-pharmacologic treatment of stretching and activity modification. Osgood Schlatter – CONNECTING THE 3 Ps: Pathophysiology, Physical Manifestations, Pharmacology

 

SOCIAL DETEREMINANTS OF HEALTH (SDoH)
(2 points)

Identify one SDoH that could affect a patient with this disease. Explain how it would affect the individual and the disease process AND explain your plan – as the provider – to maneuver treatment with the SDoH concern
.  (150-300 words)

 

Identified SDoH: Economic Stability / Socioeconomic Status (SES). Effect: The condition requires extensive PT and activity modification. For families lacking insurance or with high co-pays, the cost of PT creates a barrier to adherence, leading to prolonged pain or chronic symptoms. If a sports career is an economic goal, parents may push the child to “play through the pain.” Provider Plan: Prioritize a low-cost, high-access plan. Teach a comprehensive Home Exercise Program (HEP) in the clinic instead of an immediate PT referral. Connect the family with a social worker for community resources (free/low-cost athletic training). Prescribe generic Ibuprofen (PRN) to minimize medication costs. Use telehealth visits for follow-up to reduce cost and travel barriers.

THIS ASSIGNMENT ALIGNS WITH THE FOLLOWING COURSE OBJECTIVES:

1.Apply the model of homeostasis to the understanding of the theoretical/empirical basis of physiologic regulation and pathophysiologic phenomena of the human body

Describe abnormal physiological disorders in the human population.

Examine the interaction between genetics and environmental factors in the development of a given disorder

Distinguish the signs, symptoms, and diagnostic test results associated with disorders affecting the human population

Integrate the cultural, socioeconomic, gender, and age-related differences in the pathophysiologic response and treatment associated to disease or injury.

6.Interpret physiologic function and pathophysiologic dysfunction in the context of preparing to make competent clinical decisions in an advanced practice role

 

References

Osgood-Schlatter Disease – StatPearls – NCBI Bookshelf.
(2024). Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK441995/
(Meets the Clinical Guideline Requirement).

Gholve, P. A., Scher, D. M., Khakharia, S., Widmann, R. F., & Green, D. W. (2007).
Osgood Schlatter syndrome.

Current Opinion in Pediatrics, 19
(1), 44-50.

Pihlajamäki, H., & Mattila, V. M. (2014).
Osgood-Schlatter disease: a study of its incidence, severity, and prognosis in military conscripts.

Journal of Bone and Joint Surgery. American Volume, 96
(19), 1629-1636. Osgood Schlatter – CONNECTING THE 3 Ps: Pathophysiology, Physical Manifestations, Pharmacology

Johns Hopkins Evidence-Based Practice Model and Guidelines

Write a Summarizing and synthesizing research paper in which you do the following:

Using a scholarly voice, summarize each of the three articles you selected.

Using a scholarly voice, synthesize the three articles you selected.

Include a copy of your completed Appendix H.

Note: You will submit your completed Appendix H along with your 2–3-page paper. Save copies of your completed Appendix H in Word format.

Mullen, A., et al. (2022). Safewards: An integrative review of the literature within inpatient and forensic mental health units. International Journal of Mental Health Nursing, 31(5), 1090–1108. doi: 10.1111/inm.13001

Saunders, K. R. K., et al. (2023). A scoping review of trauma-informed approaches in acute, crisis, emergency, and residential mental health care. BMC Psychiatry, 23(1), 567. doi: 10.1186/s12888-023-05016-z

Pedersen, M.L., et al. (2024). A systematic review of interventions to reduce mechanical restraint in adult mental health inpatient settings. International Journal of Mental Health Nursing, 33(3), 505–522. doi: 10.1111/inm.13267

ORDER A PLAGIARISM-FREE PAPER HERE

Johns Hopkins Evidence-Based Practice Model and Guidelines

Appendix H

Summary, Synthesis, & Best-Evidence Recommendation Tool

Purpose: This tool guides the EBP team through the process of synthesizing the pertinent findings from the Best Evidence or Individual Evidence Summary (Appendix G1 or G2) to create an overall picture of the body of the evidence related to the EBP question. The team analyzes the data in each category of support for decision-making, as well as any additional organizational approaches that bring further insights.

Section I: Findings from the Individual Evidence Summary

Support for Decision-Making Synthesized Findings with Article Number(s) (This is not a simple restating of information from each individual evidence summary—see instructions)

Strong

Number of sources = Enter #

Enter text

Moderate

Number of sources = Enter #

Enter text

Limited

Number of sources =Enter #

Enter text

Further Synthesis Based on Additional Organization and Analysis (OPTIONAL)

Enter text

Johns Hopkins Evidence-Based Practice Model and Guidelines

Instructions for the Summary, Synthesis, & Best-Evidence Recommendation Tool

Section II: Best-Evidence Recommendations

The recommendations below are based on: ☒Pre-appraised evidence identified in a best evidence search  Record each recommendation in the corresponding evidence category in the table below based on the confidence/certainty listed in the clinical practice guidelines, evidence summary, or literature review with a systematic approach ☒Evidence appraised by the EBP team from a targeted search to supplement the pre-appraised evidence (single studies with a formal study design)  Record any additional or altered recommendations to the pre-appraised evidence in the corresponding evidence category in table below. See instructions for more details. ☒Evidence appraised by the EBP team from an exhaustive search (single studies, anecdotal evidence, and pre-appraised evidence that does not fully address the EBP question)  Record each recommendation in the table below based on the team’s analysis and synthesis of information in Section I Characteristics of the Recommendation(s) Best-Evidence Recommendation(s)

High certainty recommendations (Robust, well-documented, consistent & persuasive, based mostly on evidence that provides strong support for decision-making)

Enter text

Reasonable certainty recommendations (Good, mostly compelling, consistent evidence, based mostly on evidence that provides moderate to strong support for decision-making)

Enter text

Characteristics of the Recommendation(s) Recommendation(s) Lacking Adequate Evidence

Reasonable to low certainty recommendations (Good but conflicting evidence. Inconsistent results, based mostly on evidence that provides moderate support for decision making)

Enter text

Low certainty recommendations (Little to no evidence. Information is minimal, inconsistent and/or based mostly on evidence that provides limited support for decision-making)

 

Johns Hopkins Evidence-Based Practice Model and Guidelines

Section I: Findings from the Individual Evidence Summary Only complete Section I if the team completed an exhaustive evidence search and the Individual Evidence Summary Tool (Appendix G2). Support for Decision-Making Synthesized Findings With Article Number(s) (This is not a simple restating of information from each individual evidence summary—see instructions)

Strong

Number of sources = _____

This table captures key findings that answer the EBP question from an exhaustive evidence search. As a team, review the evidence that provides strong support for decision-making in the Individual Evidence Summary Tool (Appendix G2). Look for salient themes, patterns, important takeaways, consistencies, and inconsistencies.

After discussing the strong evidence and coming to a consensus as a team, record succinct statements in this box that synthesize the information, enhance the team’s knowledge, and generate new insight, perspective, and understanding to answer the EBP question.

Avoid repeating content and/or copying and pasting directly from the Individual Evidence Summary Tool. Record the article number(s) used to generate each synthesis statement to make the source of findings easy to identify.

Moderate

Number of sources = _____

Repeat the process above for evidence that provides moderate support for decision-making.

Limited

Number of sources = _____

Repeat the process above for evidence that provides limited support for decision-making.

Further Synthesis Based on Additional Organization and Analysis (OPTIONAL)

This is an optional section to reflect any additional insights the team has from further organization and analysis of the data. It may include patterns, themes, subgroups, or additional sorting. To determine if this step is necessary, the team should ask themselves, “How can the evidence be organized to explore subtleties or details in order to produce a more comprehensive understanding of the big picture?” See Chapter 9 for more information.

Section II: Best-Evidence Recommendations

Johns Hopkins Evidence-Based Practice Model and Guidelines

The recommendations below are based on: Select boxes below that reflect the type(s) of evidence used to generate the best-evidence recommendations.

Pre-appraised evidence identified in a best evidence search  Record each recommendation in the corresponding evidence category in the table below based on the confidence/certainty listed in the clinical practice guidelines, evidence summary, or literature review with a systematic approach Using the certainty or confidence schema used by the authors of the pre-appraised evidence, put each recommendation into the corresponding box.

Evidence appraised by the EBP team from a targeted search to supplement the pre-appraised evidence (single studies with a formal study design)  Record any additional or altered recommendations to the pre-appraised evidence in the corresponding evidence category in table below. See instructions for more details. Record any changes to the recommendations from the pre-appraised evidence in the corresponding box. When determining if a recommendation should be updated consider the following: o Does the new evidence provide results that are based on robust methods that the team considers compelling? o How does the certainty of any new or altered recommendations compare to the certainty of the recommendation from the pre-appraised evidence?

Evidence appraised by the EBP team from an exhaustive search (single studies, anecdotal evidence, and pre-appraised evidence that does not fully address the EBP question)  Record each recommendation in the table below based on the team’s analysis and synthesis of information in Section I Review the information from Section I. Consider the quantity and quality of information for each recommendation. Based on the descriptions below, record the best-evidence recommendation in the box that corresponds to the characteristics of the evidence used to support it. Recommendations should be succinct statements that distill the synthesized evidence into an answer to the EBP question. The team bases these recommendations on the evidence and does not yet consider their specific setting. Translating the recommendations into action steps within the team’s organization occurs in the next step (Translation and Implementation Tools, Appendices I and J).

Characteristics of the Recommendation(s) Best-Evidence Recommendation(s)

High certainty recommendations (Robust, well-documented, consistent & persuasive, based mostly on evidence that provides strong support for decision-making)

Record recommendations the team feels confident in endorsing here. Keep in mind, these can be recommendations FOR or AGAINST an intervention. Sentences can start with phrases such as:

 “The evidence endorses…”

 “The evidence recommends…”

Or end with

 “…is recommended”

 “…is indicated”

 “…is beneficial”

 “…is useful”

Reasonable certainty recommendations (Good, mostly compelling, consistent evidence, based mostly on evidence that provides moderate to strong support for decision-making)

Record recommendations the team is fairly confident in endorsing here. Sentences can start with phrases such as:

 “the evidence suggests…”

Or end with

 “…is reasonable”

 “…can be useful”

 “…can be effective”

 “…can be beneficial”

Johns Hopkins Evidence-Based Practice Model and Guidelines

Characteristics of the Recommendation(s) Recommendation(s) Lacking Adequate Evidence

Reasonable to low certainty recommendations (Good but conflicting evidence. Inconsistent results, based mostly on evidence that provides moderate support for decision making)

Record recommendations the team the team has little confidence in endorsing here. Sentences can start with phrases such as:

 “Evidence is mixed regarding…”

 “Evidence is conflicting regarding…”

 “There is little evidence to support…”

Or end with:

 “… may or may not be useful”

Low certainty recommendations (Little to no evidence. Information is minimal, inconsistent and/or based mostly on evidence that provides limited support for decision-making)

Record recommendations that team has no confidence in endorses here. Sentences can start with:

 “There is no evidence to support…”

 “Evidence is very limited on…”

 “Recommendations cannot be made on…”

Or end with:

 “….is not supported by evidence”

GRETEL 10 YEARS OLD CASE STUDY  TRANSCRIP – Hansel and GRETEL CASE STUDY

Content may be incorrect

MI

Maijeh, Ife

0 minutes 3 seconds0:03

Maijeh, Ife 0 minutes 3 seconds

Before we start, I’ll go over a couple of things today with you. I want you to know that you are in a safe environment and.

Maijeh, Ife 0 minutes 18 seconds

And um.

Maijeh, Ife 0 minutes 20 seconds

Where you can share your thoughts and your emotion. And I want you to know that your privacy is very safe here. In addition to that, I want you to know that I’m a mandatory reporter, which means that you know anything you say here today.

Maijeh, Ife 0 minutes 35 seconds

And if it’s requested by the court will be provided and I’m required by law that’s anything self-harm, anything to anyone outside of that I will be able to report as a mandatory.

Maijeh, Ife 0 minutes 55 seconds

Reporter. So with that being said, I need you to. I wanted to know if you understand this before we start. Do you understand?

Rosario, Iveliss Virginia

1 minute 7 seconds1:07

Rosario, Iveliss Virginia 1 minute 7 seconds

I understand.

MI

Maijeh, Ife

1 minute 9 seconds1:09

Maijeh, Ife 1 minute 9 seconds

OK.

Maijeh, Ife 1 minute 10 seconds

No.

Maijeh, Ife 1 minute 16 seconds

Thank you for being here today and can you tell me what brought you in today?

Rosario, Iveliss Virginia

1 minute 19 seconds1:19

Rosario, Iveliss Virginia 1 minute 19 seconds

Yes.

Rosario, Iveliss Virginia 1 minute 22 seconds

Well, my parents told me my mom. I’m not my mom. It’s just my stepmom and my dad. They think I have an issue and they want me to seek a counselor, but I don’t think I have an issue.

Rosario, Iveliss Virginia 9 minutes 44 seconds

Giving it back to them.

MI

Maijeh, Ife

9 minutes 49 seconds9:49

Maijeh, Ife 9 minutes 49 seconds

It it seems like what what I’m hearing now is that like you know the taking someone the lunchbox it’s not a big deal even though you give it back to them and  you took their lunchbox.

Maijeh, Ife 10 minutes 5 seconds

What is their reaction? What is the teacher’s reaction? Did they yell? Did they wanted to fight you? Did they wanted to say, give me back my lunch box?

Maijeh, Ife 10 minutes 16 seconds

H.

Maijeh, Ife 10 minutes 18 seconds

How did you narrate the? How did you tell them that? Oh, you just playing that you didn’t even take anything, you just take it for just for fun. What was their reaction and the teacher around them too?

Rosario, Iveliss Virginia

10 minutes 30 seconds10:30

Rosario, Iveliss Virginia 10 minutes 30 seconds

So the reactions of the teachers, they’re just as a disappointed. They don’t. I don’t think they find it funny. I don’t think anyone else found it funny, but.

Rosario, Iveliss Virginia 10 minutes 43 seconds

I guess getting the attention.

Rosario, Iveliss Virginia 10 minutes 46 seconds

Makes me feel wanted. Makes me feel special or noticed.

MI

Maijeh, Ife

10 minutes 59 seconds10:59

Maijeh, Ife 10 minutes 59 seconds

I appreciate your honest, honest, you know, honesty in this situation. Let’s go back to the fact that.

Maijeh, Ife 11 minutes 13 seconds

The whole thing started when your stepmom, you feel like you felt like she hasn’t been treating you nice than your other Sydney. Do you, uh, do you talk to her?

Rosario, Iveliss Virginia

11 minutes 19 seconds11:19

Rosario, Iveliss Virginia 11 minutes 19 seconds

No.

Rosario, Iveliss Virginia 11 minutes 22 seconds

OK.

MI

Maijeh, Ife

11 minutes 30 seconds11:30

Maijeh, Ife 11 minutes 30 seconds

One-on-one to, you know, express your feelings and what was that reaction?

Rosario, Iveliss Virginia

11 minutes 37 seconds11:37

Rosario, Iveliss Virginia 11 minutes 37 seconds

I have, and she thinks I’m.

Rosario, Iveliss Virginia 11 minutes 42 seconds

Not right. And she says that I’m just trying to get attention and trying. Um.

Rosario, Iveliss Virginia 11 minutes 51 seconds

To make a big deal out of something, that’s that’s not. But to me, I feel like he’s the perfect child at home and I’m the problem child and she doesn’t even when we do have conversations.

Rosario, Iveliss Virginia 12 minutes 7 seconds

Nothing good ever comes out of it because we always we don’t see eye to eye and I’m noticing that with my dad as well.

MI

Maijeh, Ife

12 minutes 32 seconds12:32

Maijeh, Ife 12 minutes 32 seconds

I want you to feel bad and and I think that it’s gonna be things that.

Maijeh, Ife 12 minutes 43 seconds

You experience at your age you you you’re going through a lot at at at at your age right now going to trying to understand what how things when things around you is going this way and you felt bad like other people are are being treated better than you.

Maijeh, Ife 13 minutes 2 seconds

And and before we wrap it up, and I wanted to ask you that if you have anything else that you would like to, you would like me to know before we wrap up today.

Rosario, Iveliss Virginia

13 minutes 17 seconds13:17

Rosario, Iveliss Virginia 13 minutes 17 seconds

No, that was all.

MI

Maijeh, Ife

13 minutes 18 seconds13:18

Maijeh, Ife 13 minutes 18 seconds

And then um.

Maijeh, Ife 13 minutes 24 seconds

Next time we we meet again, I would like to set up a goal with you. One of the goals that we’re going to be discussing is, is there any way you can?

Maijeh, Ife 13 minutes 40 seconds

Out of one day of the school to say, you know what, Monday, Tuesday, Wednesday, Monday, Tuesday, Wednesday. When I go to school, I’m going to the lunch box and I’m going to see their reaction, their step on reaction.

Maijeh, Ife 13 minutes 58 seconds

Do you think it’s manageable to to not to do that and just to change things around to see if what maybe your stepmom would change a little bit. OK, you’re making some changes so hopefully she will make some of that some changes. What do you think about the goal?

Rosario, Iveliss Virginia

14 minutes 15 seconds14:15

Rosario, Iveliss Virginia 14 minutes 15 seconds

OK, that sounds good. I can do that. You said Monday, Tuesday, Wednesday only for now.

MI

Maijeh, Ife

14 minutes 21 seconds14:21

Maijeh, Ife 14 minutes 21 seconds

For now, yes.

Rosario, Iveliss Virginia

14 minutes 24 seconds14:24

Rosario, Iveliss Virginia 14 minutes 24 seconds

OK, sure.

MI

Maijeh, Ife

14 minutes 27 seconds14:27

Maijeh, Ife 14 minutes 27 seconds

Well, listen, I really enjoy you. Yeah, your honesty, you’re very open-minded person. You know, I would love to have you next time we meet so that we can discuss more on to achieving a goal so that you can have that love that you deserve at home.

Maijeh, Ife 14 minutes 45 seconds

All right. All right. OK. OK. Thank you.

Rosario, Iveliss Virginia

14 minutes 47 seconds14:47

Rosario, Iveliss Virginia 14 minutes 47 seconds

OK, thank you.

Rosario, Iveliss Virginia 14 minutes 51 seconds

Thank you. Bye-bye.

MI

Maijeh, Ife

14 minutes 53 seconds14:53

Maijeh, Ife 14 minutes 53 seconds

Bye, bye.



Rosario, Iveliss Virginia

stopped transcription

ASSIGNMENT 

Hansel and GRETEL CASE STUDY

Case Presentation: Assessment & Diagnosis (CPAD) Assignment Instructions

Overview

This
Case Presentation: Assessment & Diagnosis (CPAD) Assignment
is the first part of three parts of your Benchmark Case Presentation Final (CPF) comprehensive case presentation due later in this course. The CPAD is called a formative assignment in that you will get to “practice” the assessment and diagnosis process. This is an essential first step toward the development of a sound case conceptualization and treatment plan. It is the foundation of the “golden thread” when working with a client. If you miss the mark here, it can lead your treatment plan astray and potentially do harm.

For this CPAD Assignment, you will complete an assessment and diagnosis of your client as illustrated in the
Case Presentation: Assessment & Diagnosis (CPAD) Instructions
and
Case Presentation: Assessment & Diagnosis (CPAD) Template
documents found in Canvas.

Requirements

This assignment is to be 6 to 8 pages in length, not including the title page and reference page.

Please utilize APA 7
th
edition formatting, including headings, subheadings, and intext citations.

The assignment requires at least 2 citations, one of which should be the DSM-5-TR (APA, 2022). Do not use any other version of the DSM. Additional references are to be scholarly articles published within the last five years unless they are considered seminal works in the field of study.

ORDER YOUR CUSTOM-WRITTEN PAPER HERE

Instructions

You will use the data collected during the initial Clinical Interview Roleplay (CIR) in which you were the counselor. The client you interviewed during the role play will be the client for your Benchmark Case Presentation Final (CPF). Your CPF will be comprised of three components: the Assessment and Diagnosis (CPAD), the Case Conceptualization (CPCC), and the Treatment Plan (CPTP). CASE PRESENTATION: ASSESSMENT & DIAGNOSIS (CPAD) ASSIGNMENT

As you work on the CPAD, you may notice that you need additional clinical information to complete the necessary sections. In these situations, you may have to consult with your client via your Microsoft Teams Group to gain access to missing data points.

To complete this assignment:

Review the Case Presentation: Assessment and Diagnosis (CPAD) instructions

Review the
Case Presentation: Assessment & Diagnosis (CPAD) Grading Rubric
.

Review the
Case Presentation: Assessment and Diagnosis (CPAD) Template
Follow the APA formatting as provided in the template. It is developed to help you stay aligned with assignment expectations based on the assignment instructions and grading rubric.

Write the Identifying Information and Reason for Referral/Presenting Problem.

After collecting all the clinical data, write up the Summary of Assessment.

After writing the summary, develop your DSM-5-TR diagnosis. Most often in clinical work this will include a primary diagnosis, a comorbidity, and Z-codes. You can “consult” with your clinical team as needed in the development of the diagnosis. Please write the diagnosis in the format indicated in the DSM-5-TR and the example provided.

As you begin to establish a diagnosis, consider the definition of Mental Disorder stated in the DSM-5-TR (pp. 13-14) and consider the 4 D’s of diagnosing: deviance, distress, dysfunction, and danger. Consider onset of symptoms, duration of symptoms, frequency of symptoms, severity of symptoms (mild, moderate, severe), deviance from the norm, descriptive lineaments (good insight, poor insight, absent insight), and impairment in functioning. Consider differential diagnosis, course of the disorder (partial remission, full remission), and Risk: Suicide, Homicide, and other self-harming behaviors.

After you solidify your diagnoses, develop your diagnostic impression. The impression is an integration of DSM-5-TR criteria, specifiers, severity with supporting evidence from the case study.

Note: Your assignment will be checked for originality via the Turnitin plagiarism tool.

Please
see the additional detailed explanations below
for information that needs to be included in the CPAD.

 

 

Case Presentation: Assessment & Diagnosis
Section Descriptions

 

Identifying Data

 

Date of Initial Assessment:

Client Name:

Age:

Gender:

 

Race:                                                                           Marital Status:

Sexual Orientation:                                                    Employment Status:

 

Reason for Referral/Presenting Problem

Provide a brief reason why the client has entered counseling. This may be a triggering event such as a divorce, death, pandemic, loss of employment, bullying or client reported increase in signs, symptoms, impaired functioning, etc. Ideally, offering direct quotes on how the client describes the reason, presenting problem.

 

Confidentiality

This section should include a statement indicating that you reviewed confidentiality and the limitations therein.

 

Source of Information

Provide the source and the manner in which data was obtained in the preparation of this report. This includes both formal and informal or semi-structured assessments in the summary as well as throughout the case presentation as necessary to support your conclusions.

 

Assessment

Offer clinically relevant background information on the client. Write this out in paragraph format using complete sentences, – no bullet points. Note: the case studies are limited and, if no data is present, note this under the heading below. The section should include the following in this order:

 

If no assessment data was available, then indicate how would you assess this client in real practice and the importance of assessing such area.

 

Family and Home Background/Religious Background

Identifying information about parents and siblings (names, ages, occupations, etc.).  Client’s perception of the home environment and relationships within the family. Critical family incidents may be included. Also note any events that triggered the client, family coming to counseling, e.g., precipitating events.

 

Educational History

Description of pertinent information in relation to educational background including academic achievement, school instances that were significant for understanding the individual and the client’s attitude toward education. Any assessment information would be helpful.

 

Mental Health

Historical and as well as present signs, symptoms as well as mental health test results (formal and informal) such as DSM-5-TR cross-cutting symptom measure, Beck’s Depression Inventory, Beck’s Anxiety Depression Inventory, Patient Health Questionnaire, etc.

 

Mental Status Exam

When first meeting the client, what are your observations that would include speech; mood; affect; orientation to person, place, time; thought process; delusions; hallucinations; concentration, suicide ideation, etc. Also include any self-harm, e.g., cutting and/or harm to others.

Indicate onset of symptoms, duration of symptoms, frequency of symptoms, severity of symptoms (mild, moderate, severe), deviance from the norm, descriptive lineaments (good insight, poor insight, absent insight), and impairment in functioning.

 

Risk Assessment

A description of the assessment for Suicide, Homicide, and other self-harming behaviors. Indicate the level of risk assessed.

 

Client’s Physical/Medical Health

A statement of the client’s significant health history, current treatment and medications.

 

Occupational History

A description of the client’s vocational history. Emphasis should be placed on current occupational functioning, history of work problems and reason for change. Quality of work and satisfaction and interests.

 

Sexual Adjustment

Current status, significant problems or disturbances in functioning, alternate lifestyles

 

Substance Use History

Description of client’s alcohol/drug use, patterns of use, and last use; as well as how often client uses and how much.

 

Spiritual Assessment

Does the client believe in God? Attend church? What role does religious affiliation play in the client’s life? Are spiritual resources or issues important to the client? How does the client describe God? What is the state of the client’s spiritual awareness? Additionally, an assessment of the religious background of the family is included.

 

Cultural Factors

Does the client have any factors such as acculturation, discrimination, etc. that impact the client and may be source of signs, symptoms? How would the client explain the problem from their cultural lens?

 

Barriers to Treatment/Success

Are there personality factors, stages of change influences, or contextual factors that would influence the success of treatment?

Other Pertinent Data

Provide any other data points not captured from the sections above such as signs, symptoms, severity, onset, conditions, context that provide a clearer picture for the development and discernment of the diagnosis as well as client insight and motivation to treatment. As you begin to establish a diagnosis, consider the definition of Mental Disorder stated in the DSM-5-TR (pp. 13-14) and consider the 4 D’s of diagnosing: deviance, distress, dysfunction, and danger.  Consider onset of symptoms, duration of symptoms, frequency of symptoms, severity of symptoms (mild, moderate, severe), deviance from the norm, descriptive lineaments (good insight, poor insight, absent insight), and impairment in functioning. Consider differential diagnosis, course of the disorder (partial remission, full remission), and Risk: Suicide, Homicide, and other self-harming behaviors.

Diagnostic Impressions

DSM-5 Diagnosis

Primary – F 32.1 major depressive disorder, single episode, moderate

Secondary – this may include another diagnosis such as GAD and also Z-codes.

 

Differential Diagnosis

Be sure to include diagnoses that you are still assessing for to rule them out (For example, you may be ruling out Generalized Anxiety Disorder, but the client has not yet had anxiety for 6 months or longer, so you’re keeping it as a provisional diagnosis). Make sure the rationale is directly connected to the DSM-5-TR.

 

Diagnosis Rationale

When writing up this section, make sure to offer each disorder criteria with case data to support the diagnosis. For each diagnosis, offer a separate paragraph in the diagnostic impression/rationale. Below are examples of incorrect and correct ways to write it up:

Not correct– The client has a marked fear about one or more social situations. The individual feared that he will act in a way or show anxiety symptoms that will be negatively evaluated (offered DSM criteria only).

 

Not correct – The client is depressed and noted sadness during the interview. The client isolated herself at home (problem, did not connect to DSM criteria).

 

Correct – The client has marked fear in several social situations as evidenced by her fear when presenting in class, turning in a paper, and speaking with classmates (A1). She is fearful to speak up when feeling wronged by her supervisor, avoids chatting with co-workers, and isolates herself at home when asked to attend social events (A2). Her fears are founded on the belief that she will act in ways that will be perceived negatively by instructors, classmates, and coworkers (B3). Offer criteria and case study data to support it.

 

Make sure to use Z codes as needed that are found in the back of the DSM-5-TR. At times, if no disorder is appropriate, a z-code may be the principal diagnosis.

Make sure to offer a paragraph of z-codes in the diagnostic impression/rationale.

The first paragraph is only for the principal diagnosis, the next paragraph is on the second disorder, and then additional paragraphs are for the other disorders. Each paragraph is to focus on only one disorder. It is like building a court defense. If your records are subpoenaed or you transfer a client to another counselor, they are not questioning your diagnosis as being incorrect, or inconclusive based on the diagnostic discussion. For the final paragraph, discuss your differential diagnosis.

This section should include a concise rationale for each diagnosis, differential diagnoses, and Z codes provided above.

 

References

 

At least offer the DSM-5-TR as a reference and one other scholarly reference minimum.

 

 

CASE PRESENTATION: ASSESSMENT & DIAGNOSIS (CPAD) ASSIGNMENT

 

(Client Name) Case Presentation: Assessment & Diagnosis

 

(Student’s Name)

Department of Counselor Education & Family Studies, Liberty University

 

 

 

Author Note

           
(Student Name,  
https://orcid.org/#####
)

I have no conflicts of interests to disclose.

Correspondence concerning this paper should be address to (Student Name, Address, City, State, Zip. Email: email@liberty.edu)

(Client Name ) Case Presentation: Assessment & Diagnosis

Identifying Data

Date of Initial Assessment:                                                    Age:

Client Name:                                                                          Gender:

Race:                                                                                       Marital Status:

Sexual Orientation:                                                                Employment Status:

 

Reason for Referral/Presenting Problem

 

 

Confidentiality

 

 

Source of Information

 

Assessment

Family and Home Background/Religious Background

 

Educational History

 

Mental Health

 

Mental Status Exam

Risk Assessment

 

Client’s Physical/Medical Health

 

Occupational History

 

Sexual Adjustment

 

Substance Use History

 

Spiritual Assessment

 

Cultural Factors

 

Barriers to Treatment/Success

 

Other Pertinent Data

Diagnostic Impressions

DSM-5 Diagnosis

 

Differential Diagnosis

 

Diagnosis Rationale

CASE PRESENTATION: ASSESSMENT & DIAGNOSIS (CPAD) ASSIGNMENT  References

268626__Case-Study-of-Gretel–10yrs-old_68c1a464e0fb4.pdf

PRAC 6540: AGPCNP
Clinical Skills and Procedures Self-Assessment Form

 

PRAC 6540: AGPCNP Clinical Skills and Procedures

Self-Assessment Form

Procedure

Confident

(Can complete independently)

Mostly confident

(Can complete with supervision)

Beginning

(Have performed with supervision or need supervision to feel confident)

New

(Have never performed or does not apply)

Biopsy (excision or punch)

ü

 

 

 

Cerumen removal

ü

 

 

 

Clinical breast examination

ü

 

 

 

Digital rectal exam

ü

 

 

 

EKG 12 lead placement and interpretation

ü

 

 

 

Epistaxis management/nasal packing

ü

 

 

 

Fluorescein stain of the eye

 

 

ü

 

Gait and balance assessment

 

ü

 

 

Herpes culture

 

ü

 

 

I &D abscess

ü

 

 

 

CXR interpretation

ü

 

 

 

KOH skin slide for fungus

 

ü

 

 

Laboratory/diagnostic testing-order and/or interpret

ü

 

 

 

Mini Mental Status Exam

ü

 

 

 

Nail examination and removal/nail trephination/subungual hematoma

ü

 

 

 

Nasal packing, removal of

ü

 

 

 

Pap smear

 

ü

 

 

Peak flow meter

 

ü

 

 

Prostate examination

 

ü

 

 

Remove foreign body

(ear, eye, nose, soft tissue, other)

 

ü

 

 

Skin tag removal,

tick removal

 

ü

 

 

Suturing

ü

 

 

 

PFT interpretation

 

ü

 

 

Vision/hearing

ü

 

 

 

Wart destruction/removal

 

 

 

ü

Wound care

ü

 

 

 

Radiology reports: Interpret chest X-ray, constipation

ü

 

 

 

Inject local anesthetics

ü

 

 

 

 

Summary of strengths:

            As an adult-gerontology primary care nurse practitioner (AGPCNP), I am going into this practicum feeling confident in a number of skills and procedures. These are tasks or clinical skills/procedures that I can now do independently, correctly, and without any supervision or assistance whatsoever. There are only a few that I can still complete under supervision and only one that I have never performed before (and that I look forward to perform in this practicum). Presently I am able to perform biopsy excision and the extraction of cerumen impacting the external ear canal under no supervision. In the same vein, I am now skilled and independent in correctly performing a clinical breast examination and a digital rectal examination to rule out masses and prostate enlargement respectively (Ball et al., 2023). I can now correctly perform and interpret a 12-lead electrocardiogram (EKG) with no assistance. I will start by first placing the 12 leads by myself and then doing the procedure followed by interpreting the graph – all independently.

The other clinical skills I can undertake independently include the management of nasal bleeding or epistaxis, as well as nasal packing. In addition to this, I am able to independently perform an incision and drainage (I&D) procedure on an abscess with no preventable complications (Jameson et al., 2022). I can skillfully interpret a chest X-ray (CXR) without help. But I can also independently order laboratory/diagnostic tests and interpret the results. This I do after taking history and performing physical examination, with a view to confirming the tentative diagnosis. As an AGPCNP, I am also expected to assess my patients for suspected mental health disorders, before referring them to mental health specialists like the psychiatric-mental health nurse practitioner or PMHNP. On this, I am now able to independently and correctly do a mini mental status examination (MMSE) and come up with a tentative psychiatric diagnosis (APA, 2022). The other clinical skills and procedures that I am now able to do alone and confidently with no help are nail examination and removal, nail trephination and care of a sub-ungual hematoma, the removal of nasal packing (which I stated above that I can insert independently), injection of local anesthetics (Rosenthal & Burchum, 2020), assessment of vision and hearing, suturing, interpretation of radiology reports such as chest X-rays, management of constipation, and wound care. PRAC 6540: AGPCNP Clinical Skills and Procedures Self-Assessment Form

ORDER HERE

Opportunities for growth:

            I feel that opportunities for growth for me exist in those areas of clinical skills and procedures in which I still require assistance or supervision to perform. These are the areas in which I am planning to work on during this practicum to achieve independence and proficiency. As such, the clinical skills and procedures that I still feel I cannot complete without supervision include extraction and mounting of the potassium hydroxide (KOH) skin slide for fungus, preparation of a herpes culture to grow, and gait and balance assessment (Ball et al., 2023; Jameson et al., 2022). Others are the removal of a foreign body (from the ear, the eye, the nose, soft tissues, or other locations), Pap smear taking, peak flow meter reading, pulmonary function test (PFT) interpretation, the removal of skin tags, and tick removal. The one clinical skill/procedure in which I still feel like a beginner is fluorescein stain of the eye. On the other hand, the one procedure that I have never done eve under supervision (and which I hope to do in this practicum) is wart removal or destruction as a sexually transmitted infection or STI.

 

Now, write 3–4 possible goals and objectives for this practicum experience. Ensure that they follow the SMART Strategy, as described in the Learning Resources.

           
My practicum goals/objectives for this placement are:

a.      To become proficient and independent in all the clinical procedures and skills in which I still need supervision to perform, by the end of this practicum.

b.     To become most confident or completely confident (independent) in performing fluorescein stain of the eye by the end of this practicum placement.

c.      To perform for the first time under supervision the removal of warts or destruction of the same by the end of this practicum placement.

 

 

 

References

American Psychiatric Association [APA] (2022).
Diagnostic and Statistical Manual of Mental Disorders-Text Revision (DSM-5-TR), 5
th
ed
. Author.

Ball, J., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2023).
Seidel’s guide to physical examination: An interprofessional approach, 10
th
ed
. Elsevier.

Jameson, J.L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., & Loscalzo, J. (Eds) (2022).
Harrison’s principles of internal medicine, 21
st
ed
. McGraw-Hill Education.

Rosenthal, L.D., & Burchum, J.R. (2020).
Lehne’s pharmacotherapeutics for advanced practice providers, 2
nd
ed
. Elsevier. PRAC 6540: AGPCNP Clinical Skills and Procedures Self-Assessment Form