Accurate diagnosis and treatment planning

Nr 304 Rua
REQUIRED UNIFORM ASSIGNMENT GUIDELINES
THE HEALTH HISTORY AND PHYSICAL EXAMINATION
PURPOSE
As you learned in NR302, before any nursing plan of care or intervention can be implemented or
evaluated, the nurse conducts an assessment, collecting subjective and objective data from an
individual. The data collected are used to determine areas of need or problems to be addressed by
the nursing care plan. This assignment will focus on collecting both subjective and objective data,
synthesizing the data, and identifying health and wellness priorities for the person. The purpose of
the assignment is twofold.
To recognize the interrelationships of subjective data (physiological, psychosocial, cultural and
spiritual values, and ... Show more content on Helpwriting.net ...
2. Objective Data–Physical Exam Components to Be Included
During the lab experiences, you will conduct a series of physical exams that includes the following
systems.
Keep notes on each part of the physical exam as you complete them to reference as you write the
paper.
Refer to the course textbook for detailed components of each system exam. Remember, assessment
of the integumentary system is an integral part of the physical exam and should be included
throughout each system.
From NR302 o HEENT (head, eyes, ears, nose, and throat) o Neck (including thyroid and lymph
chains) o Respiratory system o Cardiovascular system
From NR304 o Neurological system o Gastrointestinal system o Musculoskeletal system o
Peripheral vascular system
REMEMBER: Make notes of the physical examination findings, ensuring that you have addressed
all of the components listed on the Return Demonstration Checklist. Students are also encouraged to
take notes about their experiences while conducting the physical examination for reference when
creating the assignment, particularly the reflection section.
Needs Assessment (10 points)
1. Based on the health history and physical examination findings, determine at least two health
education needs for the individual. Remember, you may identify an educational topic that is focused
on wellness.

2. Select two peer–reviewed journal articles that provide evidence–based support for the health
teaching needs you
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Chronic Acalculous Cholecystitis
When a patient comes with abdominal pain, it can be due to different causes. The pain may be
visceral, somatoparietal or referred pain as an indicator of a wide variety of systemic and local
causes. Visceral pain is from abdominal distention or stretching of the muscle fibers, carried by
sympathetic nerve fibers, presents as dull, poorly localized pain in the mid areas of the abdomen.
Somatic pain occurs once the parietal peritoneum is inflamed or irritated, and passed by sensory
fibers. Somatic pain is better defined and more localized, high intensity, and also associated with
tenderness and spasm of the localized muscle groups.
Differential diagnosis
Chronic Acalculous Cholecystitis: Here Ms. G presented with right upper abdominal pain, ... Show
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G: Ms. G appears ill–looking, uncomfortable and clutching her abdomen, as she is experiencing
pain, she rated her pain as eight on the scale of 0 to 10 as 10 being the worse pain. The pain of Ms.
G is in her upper abdomen and radiating to her upper right back and right scapular tip consistent
with Collins sign. The pain initially stated as achy but changed to colicky in nature and became
more constant. The pain started after she ate and vomited few times before arrival. Percussion of
Ms. G's abdomen is significant for tenderness to palpation towards her upper right quadrant a
positive murphy's sign, without rebound tenderness. Bowel sounds are normal. Ms. G's clinical
presentation is consistent with Cholecystitis. The pain for Cholecystitis usually starts within an hour
post food; it can last from one to five hours and increases steadily over ten to twenty minutes along
with Collins sign, and the pain doesn't relieve after vomiting.
Diagnostic tests
CBC with differential
Leukocytosis with a left sided shift is the common abnormality in Cholecystitis. A high white blood
cell count suggests inflammation, an abscess, gangrene, or a perforated gallbladder.
Gall bladder ultrasound
Gall bladder ultrasound typically helps in establishing the diagnosis of Cholecystitis. A sonographic
Murphy's sign, (when the ultrasound probes the ultrasound patient will have pain) is a useful
diagnostic

Scaphoid Report Sample
Summery
Background
Clinical evaluation of suspected scaphoid injury is based on history, inspection and physical
examination. Improving the accuracy of the non–radiological part of the evaluation will limit
unnecessary immobilization and expensive imaging modalities when standard radiographs appear
normal.
Objectives
To provide an overview of available clinical evaluation tests for scaphoid fractures and to compare
their diagnostic accuracies.
Methods
We performed a systematic review of all studies assessing diagnostic characteristics of clinical
evaluation in scaphoid fractures by searching MEDLINE, EMBASE, Cochrane, and CINAHL
databases. Only studies on clinical testing prior to radiographic evaluation and with acceptable
reference standard for occult fractures were included. Thirteen relevant articles were analysed that
described a total of 25 tests. Diagnostic characteristics of the tests were used to construct
contingency tables. If possible, data were pooled and summary receiver operating characteristic
curves (SROC) were fitted.
Results
The search provided 2072 titles of which 13 were relevant and eligible for data extraction. A total of
23 tests were described, 10 of them ... Show more content on Helpwriting.net ...
Specificity of ASB ranged from 0.03 to 0.98; for LTC, 0.22 to 0.97. Owing to considerable
heterogeneity, pooled estimate points were not calculated. Other high–sensitivity tests were
scaphoid tubercle tenderness, with sensitivity and specificity ranging from 0.82 to 1.00 and 0.17 to
0.57, respectively, and painful ulnar deviation, ranging from 0.67 to 1.00 and 0.17 to 0.60,
respectively. Three studies showed that combining tests increased the specificity and post–test
fracture probability while maintaining high sensitivity. Quality assessment mainly showed high or
unclear risk of bias and applicability concerns in reference standard and patient selection. Twelve
study designs were prospective, one was

I Am Becoming A Nurse Practitioner Essay
Clinical Reflective
Going back to when I was a novice nurse, I was nervous, scared, afraid of making medication error,
charting errors or fail to recognized patients worsening symptoms. These fears, made me vigilant,
focused and kept me on my toes at all times. No matter which part of nursing I ended up as I grew
up the from medical surgical nursing to stepdown unit nursing to intensive care nursing, I felt those
fears in every step of my growth and they helped me be a better nurse for my pateints. Today, I am
in the advanced practitioner program to become a nurse practitioner who is responsible for:
interviewing, assessing, diagnosing, counseling and treating patients. To provide safe and quality
healthcare, I am expected to have good critical thinking and decision making abilities (Maten–
Speksnijder, Grypdonck, Pool, & Streumer, 2012). while I can recognize clinically deteriorating
patients and recommend treatments, I am now responsible for providing treatments. I am now
recognizing that facts about being not only responsible for the patient, but also to provide safe care
that keeps the patient out of the hospital and out of the ICU. Knowing these facts, I am yet again,
faced with the fears of my limited clinical practice knowledge as a practitioner. The amount of
information that I have received and learned during this clinical rotation was both exciting and
overwhelming at the same time, because I realized as a novice student nurse practitioner (NP), the
limited depth of

Analysis of the Paul Cronan Case Essay
Analysis of the Paul Cronan Case
I. Legal Analysis, Issue 1
Issue: Does party bringing suit (Plaintiff – Paul Cronan) qualify under the ADA for disability?
Rule:
In Review of ADA and the principles set forth at that time, there are several relevancies to consider
here. A disability is described as follows:
"For purposes of nondiscrimination laws (e.g. the Americans with Disabilities Act, Section 503 of
the Rehabilitation Act of 1973 and Section 188 of the Workforce Investment Act), a person with a
disability is generally defined as someone who (1) has a physical or mental impairment that
substantially limits one or more "major life activities," (2) has a record of such an impairment, or (3)
is regarded as having such an ... Show more content on Helpwriting.net ...
This information is readily available on the World Wide Web at the following location
http://www.usdoj.gov/crt/ada/publicat.htm#Anchor–14210.
II. Legal Analysis, Issue 2
Issue: Is New England Telephone guilty of discrimination against Paul Cronan strictly because he
has a disease that is disabling called HIV/AIDS?
Rule: "The ADA prohibits discrimination in all employment practices, including job application
procedures, hiring, firing, advancement, compensation, training, and other terms, conditions, and
privileges of employment. It applies to recruitment, advertising, tenure, layoff, leave, fringe benefits,
and all other employment–related activities."
This information is readily available on the World Wide Web at the following location
http://www.usdoj.gov/crt/ada/pubs/ada.txt In relation to the situation, the following data is also
pertinent: "Employment discrimination is prohibited against "qualified individuals with disabilities."
This includes applicants for employment and employees. An individual is considered to have a
"disability" if he or she has a physical or mental impairment that substantially limits one or more
major life activities, has a record of such an impairment, or is regarded as having such an
impairment. Persons discriminated against because they have a known association or relationship

with an individual with a disability also are protected.
The first part of the

Analysis Of ' The 's '
C.A. describes herself as, "nice, loving and smart." She states that her mood is, "fine." When asked
about her body and physical abilities, she claims that she feels, "not normal." She feels that her
health is, "lower than normal and fine." When asked if she thinks people like her, she stated, "Yes,
because I am nice." She nodded when asked if she thought she was well taken care of. She said she
was "a very hard worker" when she was a secretary. She states she is a positive person because she
"smiles sometimes."
Objective
Pt does not seemed concerned with her physical image unless she is reminded. When asked if she
wants her hair brushed or lip gloss, she shrugs her shoulders. She only keeps eye contact when
speaking for a few moments and then looks away when she loses her thought or attention and
becomes confused. She cannot recall a lot of information from her past. Her mood is rarely altered
and she continues to have a flat personality. She is never angry, and always complies with what you
tell her to do. She is never aggressive and often thanks those helping her.
Values & Beliefs Pattern
Subjective
C.A. reports that she is Catholic, but says that she doesn't attend mass often. She reports that she
forgets to pray. She doesn't recall any cultural practices from when she was a child. Pt says she is of
German descent. She was unable to recall any German traditions.
Objective
Pt has a prayer book in her room. She is Catholic. Pt did not verbalize any specific religious

Obesity and Careful Physical Examination
The past several decades have seen an escalating trend in the rate of childhood obesity not only in
the United States where 25%–30% of children are affected, but also in many of the industrialized
nations. Childhood obesity has continued to be a major issue in the public health care system. The
economic cost of the medical expenses as well as the lost income resulting from the complications
of obesity both in children and adults has been estimated at almost $100 billion (Barnes, 2011).
Overweight children are more exposed to the danger of becoming overweight in their adulthood
unless they ensure healthier eating habits and exercise. It is worth noting that the current lifestyle in
which many children spend a lot of time watching ... Show more content on Helpwriting.net ...
Theories of etiology
Childhood obesity has been attributed to a combination of factor including genetic, environmental,
and developmental whose diverse interaction in individuals generate the tendency of overeating
characteristic of people with obesity. Regarding the genetic basis of childhood obesity, twin studies
have revealed that about 50% of the risk of developing obesity is inherited. Recent studies have
emphasized that the interaction between the environment and genes play a significant role in the
development of childhood obesity (Kiess et al. 2001, p. 31). Obesity is though to be contributed by
defects in the genes that regulate metabolic processes such energy homeostasis, insulin levels,
adipogenesis, thermogenesis, and the production of the hormone leptin. Obesity can be contributed
by individual defects or a combination of these factors (Richardson (CPNP.), 2010, p. 88).
Since the discovery of leptin receptors, research in obesity has gone to a higher degree with rodent
models revealing that leptin as a product of adipocytes regulates food intake by feeding back the
hypothalamus with the body fatness. Following the observation that leptin levels in human serum
are high, it has prompted the hypothesis that insensitivity to leptin in overweight individuals
progressively leads to obesity (Kiess et al. 2001, p. 31). In fact, British researchers have found that a
significant number of severely obese children have a deletion of the gene

What Type Of Information Is This ( Soap ) And Why?
1. How do you document what you see? What type of information is this (SOAP) and why?
Flat, grouped, oval shaped areas of macules that are different from the surrounding tissue hypo–
pigmented and less than 0.5 cm spread across the upper chest above the bilateral nipple line. It is not
palpable, slight scaly.
This information is the objective data. The information is the descriptions of the fact, and it is
primarily gathered through physical examinations (Bickley & Szilagyi, 2013).
2. What is your differential diagnoses now? Why?
a. Pityriasis (tinea versicolor). Tinea versicolor is primarily located in the upper trunk, axillae, neck,
upper arms, abdomen, thighs, genitals. It is usually white, pink or brown in color, scaling, round or
oval ... Show more content on Helpwriting.net ...
3. Would you perform any additional lab tests? If so, describe why and how you would do this test.
I would like to perform skin scraping and potassium hydroxide preparation test. The test is to assess
if fungal or dermatophytic spores and hyphae are present from the skin lesion (Dains et al., 2016).
Carefully scrape the skin lesion with scalpel. It is important to collect the cells from active area of
the lesion like the outer are of the lesion. A drop of 20% potassium hydroxide is applied. The sample
is then warmed and left for a few minutes. Add 40% of dimethyl sulfoxide to the potassium
hydroxide solution for faster result. Under microscopic examination, fungal hyphae are dark and
blue–black with the light gray background.
Other lab tests can be considered, IgM, IgG for the diagnosis of Erythema in fectiosum, measles,
rubella Pityriasis (tinea versicolor). Patch testing can be done to determine if the allergic dermatitis
is present. In this case, patient will need to have referrals to dermatologist for patch testing.
Antistreptolysin O titer or strep culture is helpful in the diagnosis of autoimmune disorder psoriasis.
4. What do you think is the most likely diagnosis? Why? How did you decide?
Pityriasis (tinea versicolor). The appearance of the hypopigmentation is characterized by macular
eruption (Dains et al., 2016). Area is fine scaling. It is primary located on the upper trunk of the
body. Diagnosis with need to

A Research Study On Medical Billing And Medical Records
I participated in taking patients histories, doing physical examinations, reviewing lab results and
prescribing the appropriate treatment, I helped in performing administrative duties and updating
patients' medical records. At the clinic's pharmacy, I assisted the pharmacist in explaining the
medication route of administration, dosing and frequency. I also involved in introducing public
health awareness and vaccination projects during our local medical tours.
My responsibilities were taking patients' histories, doing physical examinations, performing
EKGs, reviewing the patient medications, discussing the management plan and updating the
electronic medical records, also I participated in inpatient rounds in the afternoon at Piedmont
Hospital & Emory Midtown Hospital. It was a great experience working with nurses and helping
them giving vaccinations and doing lab work. And from my interaction with the office staff, I
learned more about medical billing and medical coding and this assisted me better understand the
administrative work. My involvement in research at the same time had helped me applying the
concepts of the scientific research in clinical medicine.
During my hand on rotation with Dr. Renfus at Children 's Medicine, I participated by obtaining
histories, performing physical exams, reviewing lab work and discussing differential diagnosis with
assessment and plan. I was directly involved in patients ' care and I had a direct access to patient
medical electronic

Physical Exam Paper
Running head: PHYSICAL EXAMINATION (PE) WRITTEN DOCUMENTATION Nursing 200:
Complete Physical Examination (PE) Written Documentation Indiana State University College of
Nursing, Health, and Human Services Nursing 200: Complete Physical Examination (PE) Written
Documentation The format for this paper is based on : Jarvis (2008). Examiner: , SN ISU Date:
4/12/09 Patient: S.C. Age: 20 Occupation: Full–time nursing student taking 14 hours Language
spoken: English Gender: Marital Status Race: Caucasian Ethnic affiliation / association: American
Measurements (2 points): Weight (in lbs & kgs) 125 lbs 56.8kgs Height (in in & cm) 60 inches 15.2
cm Waist–to–hip ratio .82 BMI 21.2 ... Show more content on Helpwriting.net ...
Heart & Peripheral Vascular (2 points): Carotid arteries 2+ bilat, external jugular visible in supine
position, not visible when elevated. No visible chest wall pulsations, no heave, lift, apical pulse in
5th intercostals space at midclavicular line, pulse 61, regular rate, rhythm. Aortic, pulmonic valves,
S2>S1. Erb's point, S2=S1. Tricuspid, mitral valves, S1>S2. No gallops, murmurs, extra heart
sounds. All pulses present 2+ bilat, no lymphadenopathy. Legs absent of varicosities, tenderness,
edema, atrophy, warm bil. Epitrochlear lymph nodes not palpable, no Homan's signs. Thorax &
Lungs (2 points): AP less than transverse diameter; respiratory rate and pattern relaxed, even; chest
expansion symmetrical; tactile fremitus equal bilat; no tenderness, lumps, lesions; resonant to
percussion over lung fields; vesicular breath sounds clear over lung fields; no adventitious sounds.
Bronchial sounds, inspiration < expiration over trachea and larynx. Bronchovesicular,
inspiration=expiration

The Knowledge And Understanding Of Health Assessments
The knowledge and understanding of health assessments are essential to a nurse's role in promoting
health, preventing illness, and caring for others. Health assessments are conducted every day in
nursing and other health profession. This essay aims to discuss the importance of understanding the
purpose of conducting a health assessment, considering how a health assessment might be
conducted differently on the setting and age of the patient or client and further develop the written
communication skills critical to professional practice.
Every patient that walks through the door has a health assessment performed on. Health assessment
is defined by the collection of information, or data, concerning an individual's health status (Gulis &
Paget, 2014). The two main components of a health assessment consist of a health interview and
physical examination (Sanchez–Soberon, 2015). A health interview collects subjective data, sourced
data from the patient, this is primary data, however, in some cases secondary data can be collected
from a significant other. The aim is to collect both, the subjective data as well as record a health
history. A health interview involves, effective communication between all personnel, note–taking. It
is important to collect data related to health history, this includes, biographical data, reasons for
seeking care, present health, past health, family history, overall health, and health management
(Frixou, 2016). Physical examinations involve investigation

Health Services
TQM IMPROVEMENT PLAN PAPER TABLE OF CONTENTS I. Executive Summary 2 II. Area
Profile A. Vision Mission 3 B. Organization Structure 4 C. Address/Location 5 D. Products/Services
5 III. Competitors 8 IV. Statement of the Problem E. Objective 9 V. Date Gathering F. Questionnaire
10 G. Results and Interpretation 11 VI. Review of Related Literature 23 VII. Tools for Quality
Improvement H. Affinity Diagram 26 I. Fishbone Diagram 28 J. Pareto Diagram 31 VIII.
Conclusion 33 IX. Recommendation 34 APPENDIX I. ... Show more content on Helpwriting.net ...
THERESAAGUSTIN, RN School Nurse I CARLO ANTON METRA, RN School Nurse II JEZEL
FAUSTINO, RN School Nurse I NIKKO TOLEDO, RN School Nurse I DANILO MONSALVE
Utility Staff ANN ROSE EMPLEO Utility Staff C. Address / Location University Health Service,
Ground Floor Administration Building, Far Eastern University, Nicanor Reyes Street Sampaloc,
Manila, Philippines D. Products / Services Services Offered by University Health Services *
Consultation and evaluation of any health related complaints * Annual physical and dental
examination of all freshmen * Issuance and verification of medical certificate, disability sickness
notification * Pre – employment medical evaluations * Issuance of prescription for medicines as
indicated by the physicians and dentists * Initial dose of medicines administered at the University
Health Service * Nebulization for asthmatic patients * Vaccine administration at reduced cost *
Minimum charges for diagnostics x–rays, dental extractions, dental filling (laser) dental prophylaxis
(cleaning) * Free dental services for all students: Dental extractions, Dental fillings (laser), dental
prophylaxis

Physical Examination
Comprehensive History and Physical Examination Example
Patient Name: Joan Evans Sex: Female DOB: September 21, 1930 Date: 9/22/2016
Chief Complaint: "I have pain in my lower back"
History of Present Illness: JE is a 86–year–old Caucasian female that has low back pain. She states
that her low back pain is a 10/10 at its worst, but that pain medication makes it feel better. The pain
is not made worse or better through any of her day to day activities. The patient states that the pain
started 20 years ago when she was trying to move her disabled husband out of bed. Ever since the
pain comes and goes, but for the past few months the pain has been constant. The pain is not
describable, JE says that it is the worst pain she has ever felt. ... Show more content on
Helpwriting.net ...
She is alert and aware and cooperative. She observably in pain and discomfort. She is able to
answers appropriately, however she is unable to recall dates of events.
Well developed, well–nourished Caucasian male who is alert and cooperative and appears in mild
discomfort but no distress. He is a good historian and answers questions appropriately.
Assessment:
1) Back Pain, is managed and controlled with pain medication
2) Left Humerus Fracture is healed
3) Hypertension, well controlled
Plan:
1) At this point the patient states that her pain is occasionally unbearable, however does not want
any changes to her medication. The patient is aware of the possible options but does not want any
changes to be made
2) The patient was advised to continue to do her room–prescribed therapy in order to keep
physically active.
3) The patient is struggling with depression and wishes not to see her next birthday. JE was advised
to talk to the nursing staff and to continuously reach out to her community for support. The patient
was encouraged to continue to read and participate in her book club that meets weekly to boost her
moral.
Justin Festa, PA

Aft Task 3
AFT Task 3 As our Joint Commission audit approaches, Nightingale Community Hospital has
conducted a tracer patient survey to assess our compliance. The tracer methodology tracks a selected
patient's care from admission to discharge, allowing us to evaluate our systems of providing care
and to ensure that we are meeting the Joint Commissions standards of providing safe, quality
healthcare. Our tracer patient was a 67 year old female who presented with a fever and drainage five
weeks after an open hysterectomy. She was admitted for a suspected postoperative infection,. She
underwent another surgery to treat the abscess that formed from the initial surgery and had a central
line inserted for long–term antibiotics. She is scheduled to ... Show more content on Helpwriting.net
...
A random sample of inpatient admission charts will be reviewed by the Chief Nursing Officer to
identify the extent of this problem. Chart review and data compilation will be completed within 30
days. 2. Nightingale leadership will update the hand–off policy and form as soon as possible and
within 30 days, to include verification that the history and physical is completed prior to the end of
shift when patient is admitted. 3. Staff will receive education on the updated policy as well as
training on the new hand–off form. Unit supervisors will be responsible for ensuring knowledge and
implementation of new procedures. Chief Nursing officer will schedule at least one group training
within two weeks after the policy has been updated. Unit supervisors will be available to provide
one on one training and answer questions regarding this policy and implementation as needed. 4.
Staff will receive written material outlining the role and importance of the history and physical exam
in patient care. Signatures acknowledging receipt and understanding of materials will be collected
by unit supervisors and submitted to HR to be included in the employees' files. 90 percent of staff
will have signed acknowledgment in their employee file within 90 days. Unit supervisors will be
responsible for ensuring 100 percent compliance within 180 days. 5. Compliance will be reassessed
90 days

The Main Purpose Of Alcoholic Anonymous Essay
The main purpose of Alcoholic Anonymous (A.A.) is to help members keep an open mind on the
subject and can stay sober. Using the 12 steps designed by A.A. assists people to break through their
denial and to see the problems alcohol has caused in their lives. The Twelve Steps are the core of
A.A's program of recovery from alcoholism. They are based on the trial–and error experience of
A.A's early members and have worked for millions of alcoholics since then. In recent years, there
are about 1.2 million people who belong to one of A.A.'s 55,000 meeting groups in the United
States.
On October 9 2016, after the clinical, I attended the A.A meeting located at St. Patrick 's Roman
Catholic Church 9511 4th Ave Brooklyn. The open meeting started at 4pm and was held with
approximately 35 to 40 attendees for one hour. The room was located at the basement of the
building but it was clean, cozy and bright. There were many chairs and one big C shape desk in the
front so some people could be sitting around the table while most of people were sitting behind the
table. One interesting thing was that there was a person who translated the entire meeting in sign
language for the deaf so the meeting looked more formal and organized. Unlike my imagination that
people would have unkempt, addicting appearances, and borderline offensive hygiene, the majority
of the members had clean and nice looking, well kempt, and healthy appearances. As soon as we
entered the room, one woman welcomed us and

Unique Jargon Of Our Chosen Profession. What Was To Follow
unique jargon of our chosen profession. What was to follow was an application of that which we had
just survived.
The fourth quarter at Keystone was devoted to a number of separate pursuits. The first order of
business was the final course of the year, an eclectic undertaking known as Clinical Medicine. The
second item on the agenda was preparation for Part I of the National Boards.
Clinical Medicine was an overture of what was to follow for the next two years. It was an
introduction to the various clinical clerkships, as well as the one and only course in medical school
that concerned itself with such skills as taking a medical history, examining a patient, and applying
the knowledge that had been gained over the past two years to the ... Show more content on
Helpwriting.net ...
Interestingly, Keystone was one of the medical colleges that minimized the value of the National
Boards. In fact, professors in virtually every course mentioned there would be certain material on
the boards they didn 't feel was important enough to present in their lectures. In spite of the
institution 's obvious disregard for the National Boards, passing Parts I and II of the exam was still
considered a prerequisite for graduation from Keystone.
To the trained observer, there are certain signs on a medical school campus that can be used to tell
the time of year. For example, the appearance of frantic students who smell like cadavers indicates
the season is fall. A truly astute observer can even tell if it is early, mid, or late fall by how frantic
the student seems and how powerfully the essence of cadaver fills the air.
In the same manner, the trained observer knows it is spring by the sudden blossoming of a new class
of second–year medical students, who bedecked in the short white coats that are the trademark of
the upper–year medical student, can be seen trying to figure out how to open their new black
medical bags.
In a sense, wearing our new white coats for the first time, even if it was only to make sure Seymour
and Ira got the sizes right, was more awkward than any of our previous experiences in medical
school. So too was filling up our black bags with the new medical

Case of Perpetual Mercy Hospital
Case of Perpetual Mercy Hospital
Problem
The broad focus of this case is one of strategy planning. Perpetual Mercy Hospital has to determine
the best course of action to help the Downtown Health Clinic achieve its stated objectives of
expanding the hospital's referral base, increasing referrals of privately insured patients, establishing
a liaison with the business community, and becoming self–supporting within three years of its
opening. This last objective is jeopardized by the possibility of a competing clinic opening 5 blocks
north of the DHC's location. The underlying problem is that the DHC may not be self–sufficient
within the projected timeframe, regardless of competition.
Alternatives
The following alternatives have been ... Show more content on Helpwriting.net ...
Revenue reflects an expected 8% increase in charges across the board.
Personnel costs ($168,376)
Incremental personnel costs x 33%
Additional physician (260 days times 8 hr/day at $66/hr) + ($137,280)
Cost for expanded coverage ($192,844)
While costly, the expanded hours would also allow the DHC to support scheduling more
employment physicals.
Competition
All nearby ambulatory care clinics are servicing suburban patients. Another firm, believed to be
Medcenter, has sponsored a study to determine if enough demand exists to establish a new clinic
five blocks north of the DHC. This new clinic would compete directly with the DHC for patients in
an overlapping area covering 3,424 workers. Medcenter is fairly successful in its current location,
and has a reputation for being aggressive and market–oriented. Their current facility already offers
12–hour office days and has 2 physicians on 8–hour shifts. Medcenter appears to be interested in
developing employer services of its own.
Annualized patient visits 3,807
Current physical exam visits in northern region x 20%
Estimated loss due to competition x 33%
Personal illness/exam charge x $54
Total estimated loss to competition $13,705
Company
PROFILE

Perpetual Mercy Hospital is a 600–bed, independent, not–for–profit general hospital. It is located on
the southern periphery

Comprehensive Health Assessment Paper
Running head: A COMPREHENSIVE HEALTH ASSESSMENT OF M. H. 1
A Comprehensive Health Assessment of M. H.
Nicole M. Henneberg
Empire State College
A COMPREHENSIVE HEALTH ASSESSMENT OF M. H. 2 The purpose of this paper is to
discuss the results of a comprehensive health assessment on a patient of my choosing. This
comprehensive assessment included the patient 's complete health history and a head–to–toe
physical examination. The complete health history information was obtained by interviewing the
patient, who was considered to be a reliable source. Other sources of data, such as medical records,
were not available at the time of the interview. Physical examination data was obtained ... Show
Her current prescription medications include a 225 mg tablet of Venlafaxine HCL once daily for
anxiety related dizziness, and a 20 mg tablet of Atorvastatin for high cholesterol. She drinks alcohol
socially, approximately two 12 ounce beers a day. She is a former smoker of one pack of cigarettes a
day for nearly forty years. Her quite date was September, 2011. She denies the use of street drugs.
A COMPREHENSIVE HEALTH ASSESSMENT OF M. H. 4
Review of Systems M. H. states that she is generally in good overall health. No cardiac, respiratory,
endocrine, vascular, musculoskeletal, urinary, hematologic, neurologic, genitourinary, or
gastrointestinal problems.
No history of skin disease. Skin is pink, dry, and void of bruising, rashes, or lesions. No recent hair
loss; head is normocephalic. Pupils equally reactive to light; no history of glaucoma or cataracts.
Ears are in normal alignment; no history of chronic infections, hearing loss, tinnitus, or discharge.
Nose and sinus history includes clear nasal discharge "since last October", and occasional nose
bleeds; states she use to get nose bleeds often as a child. Mouth and throat are absent of lesions; no
bleeding gums, sore throat, dysphagia, hoarseness, or altered taste. Neck is void of pain, swelling,

Diverticulitis Essay
Presentation
A 46 year old grossly obese man was seen in the Emergency Room on 9/16/08.
His chief complaint was lower left quadrant pain, vomiting, and frequent urination.The patient also
admits to constipation, nausea, and a fever of 102.2.
He admits to a 25 pound weight gain over the last few months. The patient was evaluated and
diagnosed with diverticulitis. During his 3–day hospital stay, he has recieved IVfluids, IV
antibiotics, and morphine for pain.
History
Past Medical History: The patient has a remarkable medical history, a healthy individual, up untill
7/15/06 when he under went a laparoscopic cholecystectomy, and was admitted.
Diet History/Vitamin and Mineral Supplements: The patient had no specific ... Show more content
on Helpwriting.net ...
Tests:
Digital Rectal Exam
Abdominal CT Scan
Blood Cultures
Hemacult
Urinalysis
Medications
Current medications include a daily multivitamen, IV ciproflaxin, prevacid a.m., morphine for pain,
and IV fluids.
Diagnosis/Discussion
The patient had a sudden onset of lower left quadrant pain and was diagnosed with diverticulitis.
The patient has no diet regimen, which may be the likely cause of his onset with this disease. His
primary complaint of lower left quadrant pain, is being felt by the inflamation and infection that is
occuring in his sigmoid colon, located in the lower left quadrant in the hypogastric region.
Diverticulitis is an inflamation and infection in the diverticuli, which are holes, or weak spots found
in the colon.

This inflamation and infection can effect many tissues if preforations allow the leakage of infection
into the abdominal cavity, such as the bladder, skin, and small intestines. In this case, fortunately the
patient was spared with a mild case and only resulted in a 3–day hosp. stay. The lining of the
sigmoid colon is made up of simple columnar epithelium cells. Their main function is for secretions
and absorbtion.
When there is a problem in the colon, and these cells are inflamed and infected, they do not work
like they were intended and the homeostasis in the body is effected, resulting in

Physical Examination And Laboratory Testing
Introduction to case study
Genitourinary problem in female have a number of symptoms and these symptoms requires clinical
skills to focus on problem history and examination. The context of assessing genitourinary problem
is based on a number issues such as gynaecological background, family history, obstetric history and
sexual history. Having lower pain being experienced in upper urinary track and iliac fossa pain
experienced in ectopic pregnancies are some of the symptoms produced by genitourinary
pathology(Detollenaere, et al., 2015). According to description of 51 years old female, having lower
abdominal pain and 100 degrees temperature and the problem persisting for a while should
undertake genitourinary examination as well as laboratory tests.Therefore, the study reveals
genitourinary problem from examination, findings and treatment framework.
Physical examination and laboratory testing
Physical examination involves assessment of vital signs, temperature, respiratory and pulse rate and
Blood pressure. Generally, physician should observe general appearance of comfort or distress of
patient, apparent state of health, state of hydration, color and nutrition status. Furthermore, it is
important to match the patient's physical appearance with the stated age. Getting to abdominal
inspection and examination, physician should assess abdominal contour, scars, symmetry and
dilatation of the veins. The movement of the abdominal walls in relation to respiration are also
essential

Minimum Requirement : Infant / Toddler Child Development...
Toddler Teacher. Minimum requirement: Infant/Toddler Child Development Associate (CDA). Then
on to complete 15 credits, 30 credits, 45 credits up to an Associate or Bachelor Degree in Early
Childhood Education or a related field. Two years of experience working with young children.
Excellent interpersonal skills, flexible hours, and basic computer skills required. Ability to:
complete basic paperwork, respond to emergency situations, analyze and solve problems, move and
play with small children. Perform multiple tasks and meet deadlines.
Special requirements: Ability to work and cooperate with others, required to pass physical
examination, T.B. test, MI state police ICHAT and MI Dept. of Human Services Child
Abuse/Neglect screenings. An Equal Opportunity Employer AA M/F Vet/Disability Auxiliary aids
and services are available upon request to individuals with disabilities.
Other essential duties and responsibilities of Toddler Teachers:
Maintain individual portfolios of each child and gauge their weekly progress in various skills via
anecdotal observations
Bring creative ideas to make learning fun and interesting for the children
Conduct large and small group activities and also provide individualized activities for targeted skills
development in each child
Communicate effectively with the parents to discuss the progress and needs of children
Maintain the classroom according to state and program approved standards of orderliness,
cleanliness and hygiene

Physical Therapy : Spine ( Lumbar / Cervical Thoracic )
1. Physical Therapy 3X6 – Spine (Lumbar/Cervical/Thoracic) Regarding Physical Therapy 3X6–
Spine (Lumbar/Cervical/Thoracic); CA MTUS supports an initial course of physical therapy with
objective functional deficits and functional goals. The claimant has basically whole body pain with
limitations in range of motion and tenderness in most all body parts. Medical necessity has been
established. However, initial 6 visits are given. Additional requests should include functional
improvement, discussion of functional goals and patient's progress in meeting these goals.
Recommend modified certification of PT 2X3 Spine (Lumbar/Cervical/Thoracic). 2. MRI – Spine
(Lumbar/Cervical/Thoracic) Regarding MRI–Spine (Lumbar/Cervical/Thoracic); the ... Show more
content on Helpwriting.net ...
However, plain films were not obtained. There is no clear rationale for the indication of shoulder
MRI with unequivocal objective findings and absence of plain films. In addition, there is no focal
neurological deficit on the exam. There are no sensory or motor deficits noted. Medical necessity
has not been established. Recommend non–certification. 4. MRI – right wrist Regarding MRI right
wrist; CA MTUS criteria for hand/wrist MRI include normal radiographs and acute hand or wrist
trauma or chronic wrist pain with a suspicion for a specific pathology. However, as noted above, no
plain films were obtained. There is no documentation or indication of an acute trauma to the wrist.
Recommend non–certification. 5. MRI – Left knee Regarding MRI left knee; CA MTUS
recommends MRI for an unstable knee with documented episodes of locking, popping, giving way,
recurrent effusion, clear signs of a bucket handle tear, or to determine extent of ACL tear
preoperatively. In addition, ODG criteria include acute trauma to the knee, significant trauma,
suspect posterior knee dislocation; nontraumatic knee pain and initial plain radiographs either
nondiagnostic or suggesting internal derangement. This is a chronic injury patient. There is no
documentation of any acute injury to the knees. In addition, there is no documentation of locking,
giving away, recurrent effusion, or signs of a bucket handle tear

History Of Evaluation And Management ( E / M ) Codes
Issues and Trends Purpose and history of Evaluation and Management (E/M) Codes Accurate and
comprehensible medical records documents are crucial for a positive outcome for the patient and
health care providers. Health records sequentially convey significant details concerning patient's
health history and future care plans. These records are pertinent when initiating care in the acute and
chronic setting for the patient. Medicare, Medicaid, and other personal health care providers
necessitate rational documentation to guarantee that a procedure and/or examination is consistent
with the individual's health care coverage. The documentation also authorizes the place of health
care treatment, eligible medical requirement and suitability of diagnosis and/or therapy, and that the
services rendered were appropriately documented. Precise and reliable medical documentation
should be recorded at the time of treatment or shortly after the intervention. Inappropriate
documentation can result in erroneous and inappropriate imbursement for provided health care
services. Evaluation and Management (E/M) coding principles and guidelines were founded by
Congress in 1995 and amended two years later. E/M codes are based on the foundation of the
Current Procedural Terminology (CPT) codes recognized by the American Medical Association
(AMA). Active health care suppliers access E/M coding for medical reimbursement by Private
Insurances, Medicaid, and Medicare programs. The E/M codes are a

The Most Common Medical Conditions
Most of patients were of different age group including men women and children. They used to
presents with a variety of complaints with minor and major illnesses. Sometimes they present with a
critical illness which requires meticulous care. I worked with a group of specialists who were easily
available from local hospitals to help manage the patients promptly. Following are some essential
element of practice.
2.1 Knowledge of Medical Conditions – common:
The most common medical conditions that used to encounter on a daily basis in the children under
five years were respiratory, gastrointestinal disorders of infectious origin, mostly viral and some
bacterial in origin. In older group, osteoarthritis, COPD, prostate enlargement, ischemic heart
disease, heart failure, hypertension dementia, depression and neurological disorders such as stroke
and Parkinson disease. Others common illnesses were diabetes, asthma, urinary tract infection, skin
rash, contact dermatitis, traumatic injury, insomnia. In women, menopausal disorder and menstrual
irregularities, dysmenorrhea, and contraceptive advice were some of the common presentation in the
practice.
Lifestyle related problems such smoking, tobacco, alcohol–related disorders were common
occurrences. Many of young patients came with sexually transmitted infection such as Chlamydia,
Gonorrhoea, Herpes, Syphilis, Hepatitis, and HIV.
2 Knowledge of Medical Conditions – treatable: There were many medical conditions which could
be

Physical Examination and B. Discharge Summary
Multiple Choice Questions 1. Rosemary Lane told the healthcare professional that she has been
suffering from a headache with pressure above her eyebrows and a low grade fever for the past four
days. This is known as _______________. A. subjective information B. objective information C. an
assessment D. a diagnosis 2. In a hospital setting, the care provider takes the patient 's history,
details the reason the patient is being admitted and performs a physical exam. The report of this
information is known as the: A. initial progress note B. discharge summary C. history and physical
D. SOAP note 3. The SOAP documentation format is most commonly used in which healthcare
setting? A. hospital inpatient B. physician 's ... Show more content on Helpwriting.net ...
Though they have helped reduce the pain somewhat, the patient would like to visit other options.
This is known as the ____________ in a history of present illness (HPI). A. location B. timing C.
severity D. modifying factors 9. The review of systems (ROS) is documented for patient care
purposes and also factors into the ________________ for the patient 's visit. A. care plan B. charges
C. diagnosis D. assessment 10. Neil Rabinski was asked by the care provider if he has had any
difficulty breathing, shortness of breath, or noticeable wheezing. This is part of the review of
systems for the __________________ system. A. gastrointestinal B. head/eyes/ears/nose/mouth C.
respiratory D. cardiovascular 11. The fact that a patient has experienced recent weight loss, fatigue,
and loss of appetite would be included in which part of the review of systems (ROS)? A. general B.
gastrointestinal C. neurologic D. constitutional 12. Which of the following professionals would not
perform a physical examination (PE)? A. medical assistant B. physician 's assistant C. nurse midwife
D. nurse practitioner 13. The healthcare professional who types reports for care providers is known
as a/an ______________. A. dictator B. transcriptionist C. transcriber D. scribe 14. Which of the
following is an advantage of dictation and transcription? A. most physicians prefer it to

Bp Psychology Case Study
Bozena Czekalski
John is a 16 year old African American male. He presents for a pre–participation physical exam for
football. He has been in good health since his last PE 1 year ago. He lives with his mom and 12 year
old sister. He will be a sophomore in high school this fall.
PMH: Last tetanus at 11 years of age Last Menactra 11 years of age
PSH: none
Nutrition/exercise: No breakfast, Lunch – fast food from school cafeteria, Dinner – what mom cooks
– meat/potatoes; Snacks – chips, milk
Home: Lives with mom & sister – good relationship
Education: 11th grade, plays football, gets C's in most classes. Wants to be a pro football player
Activities: Plays soccer and runs track
Drugs/Drinking: Tried marijuana 3 X this summer with ... Show more content on Helpwriting.net ...
al., 2013, p. 114).
What guidance do you offer for John's mother?
Johns is an inexperienced adolescent in negotiation and he may often argue a point to excess.
Arguing is a normal behavior for teenagers that reflect their use of more abstract thinking skills.
Discuss the need for clear rules, expectations and consequences before trouble has occurred.
Discuss the need of parents to be involved in John's life to be there to answer questions and
concerns when they arise.
Discuss the importance of being involved in John's school (meet his teachers and stay in touch with
them to help John succeed).
Continue involving John in family activities, even if he is not interested.
Encourage to keep promises made to teenagers (that will help with establishing trust, respect and
being a role model).
Be a role model.
Continue to supervise John's

Evaluation Of The Standardized Patient Experience
Reflective Evaluation
The standardized patient experience was useful and interesting for me because I became more
confident and active during nursing practice after that practice exam. This practical exam helped me
recall my professional experience from year 2012 and 2013 when I worked as a nurse in my country.
After that practice exam, I knew how staff nurses deal and communicate with patients from a
different culture and spoke different language. My specialization is nursing education, but I wanted
to take more practical classes during the course or study to obtain first hard experience and
confidence in dealing with patients.
I had the opportunity to elicit a comprehensive health history by using skillful interviewing
techniques. However, I was nervous and panicky because I thought the time will be not adequate to
complete the practical exam. I applied my skills and experience during health history section, but
the problem was I did not deal with any real patient during nursing practical about two years ago.
After I introduced myself to the patients, I started to ask and write patient name, age, and chief
complaint. Then, I started to ask patients about subjective data which included a history of present
illness, past medical history, family history, and personal and social history. I did an appropriate job
with subjective data. I did not ask patients about sexual history during subjective data based on their
situation and age. Also, according to my previous experience

Mr C Case Study
Physical examination Mr. C is a well–developed, well–groomed appropriate weight elderly black
man sitting upright and breathing without difficulty. Mr. C walk with a slight limp. Mr. C does not
use a cane. Mr. C is slow to rise from his seated position and appears to have some discomfort. Vital
signs Height: (without shoes) 5' 10". Weight: (dressed) 160lbs. BMI: 22.96. BP: 110/70 (right arm
supine) HR: 70. RR 16. Temperature (oral) 98.6F. Skin Nail without cyanosis or clubbing, palms
good character warm and moist. HEENT: 1. Head: Normocephalic/atraumatic average texture, no
lesions 2. Eyes: Vision 20/30 both eyes. Extraocular motions full, gross visual fields full to
confrontation, 3. Conjunctiva pink: sclerae white, pupils ... Show more content on Helpwriting.net
...
Ears: Hearing poor left ear. Tympanic membrane landmarks well visualized. Acuity good to
whispered voice right ear poor in left ear. Weber midline AC >BC 5. Nose: Mucosa pink. No
discharge, no obstruction 6. Mouth: Oral mucosa pink, pharynx no exudates. Uvula moves up in
midline. Normal gag reflex. 7. Neck: Neck supple so loose skin present. Trachea midline thyroid not
palpable. No masses 8. Lymph nodes: Small no tender, mobile and non–tender tonsillar and
posterior cervical nodes Bilaterally, No adenopathy. 9. Thorax and Lungs: Thorax symmetric. Lungs
resonant, breath sound vesicular with no added Sounds. Diaphragms descends 4 cm bilaterally 10.
Cardiovascular: Regular rhythm with an occasional extra beat. Carotid brisk without bruits. 11.
Abdomen: Soft, flat, bowel sounds present, no bruits. Nontender to palpation. Liver edge, spleen,
kidney not felt. No masses. Liver span 10cm by percussion. 12. Extremities: Skin warm and smooth
without lesion 13. Peripheral vascular: 2+ knee edema noted, no stasis pigmentation of ulcers noted.
Pulses 2+ 14. Neurological: Awake, alert and fully oriented. Cranial nerves III–XII intact except for
decreased

Importance And Importance Of Physical Examination
1 build a relationship with your doctor
2.1 Significance in personal life:
It is very useful in our personal life as physical examination includes all the basic assessment which
can give you an idea about your own health. It is also very beneficial in terms of assessing your
family members when they are in need or sick. This examination also helps you to maintain your
and your family's health in terms of your growth and development which includes BMI, Nutritional
guidance etc.
2.2 Significance in Social Context:
Importance of Physical examination in society plays a great role in health promotion. Healthy life is
always been a motive of health promotion and In every society there are institutions which are
focusing of health promotion. Many ... Show more content on Helpwriting.net ...
In many cases I observe that people are getting their checkup of physical examination done in every
6 months which is a good thing, they are very much interested in healthy life style and are ready to
maintain their health status.
2.3 Application in current Job:
As we are in nursing profession and working in clinical setting all the day, we encounter many
patients and we used to do physical examination every shift as per our hospital policy and we report
document in their file the observations and then doctors revisit, so the continuity of care must be
provided.
This again helps us in building competency in our assessment skill which will be beneficial for us
and for the patients.
2.4 Current Research:
Many researches have been done on the importance of physical assessment and it also shows that
regular physical examination helps in decreasing morbidity and mortality rates. It also helps the
health care workers to detect the diagnosis earlier and to treat them with promptness. Early
identification of Cancers are also been treated effectively and increase patients prognosis.
Concept 3: Assessment of Integumentary System
Introduction:
Integumentary system comprises of the skin and its appendages which includes hairs, scales,

feathers, hooves, and nails.
Significance of the Integumentary

Symptoms And Treatment Of A Tooth
TERMINOLOGY
CLINICAL CLARIFICATION o Localized collection of purulent material associated with a tooth
due to bacterial invasion of the pulp space1,2 CLASSIFICATION1 o Gingival abscess
 Involves marginal gingiva or interdental papilla o Periapical abscess
 Present at the apex of the root of a tooth o Periodontal abscess
 Localized within the tissues adjacent to the periodontal pocket o Pericoronal abscess
 Localized within the tissue surrounding the crown of a partially or fully erupted tooth o
Combined periodontic–endodontic abscess
 Localized, circumscribed areas of infection that originate from the periodontal and/or pulpal
tissues
 Infection invades both the periodontal tissue the pupal tissue DIAGNOSIS CLINICAL
PRESENTATION ... Show more content on Helpwriting.net ...
poorly controlled diabetes mellitus, AIDS) or taking immunosuppressive medications (e.g.
chemotherapy, may have an increased risk for systemic infections caused by dental abscess6
DIAGNOSTIC PROCEDURES Primary diagnostic tools2
 Superficial abscesses often detectable by physical examination and palpation
 Periapical x–ray or orhtopantogram recommended if the abscess is not visible or palpable on
physical examination

Management Communication: Case Study 6-2 Essay
October 9, 2013
To: Ms. Dana Donnley, Director of Employee Communication
From: Mr. X, Employee Communication Manager
Subject: Suggestions to persuade employees to participate in the wellness program
I believe that we need to address three very important challenges in order to persuade all the
employees to participate in our wellness program. First, making the employees understand that this
program is entirely for their benefit, second, convincing them that the results of the physical will be
entirely confidential and third, persuading the employee's spouses also to participate in the program.
I believe that the following communication strategies can be useful.
Sending letters to each employee well before their ... Show more content on Helpwriting.net ...
Attached: Letter to Employees
The Employee
Whirlpool Corporation
Benton Harbor
Michigan
U.S.A
Dear Employee,
I wish you a very happy birthday in advance!
I'm pleased to inform you that our company would like to offer a wellness program to you and your
spouse as a birthday gift. Our wellness program is all about investing in your health and helping you
live a healthier lifestyle and make better choices. We believe that healthier the employee and his or
her family happier he or she is and a happier employee can serve our customers better and help our
company prosper.
This program includes a free mini–physical done by our company doctor. This is a screening
program designed to let you know the general condition of your health. It is fairly comprehensive.
The doctor will record your physical details, test various functions and reflexes and provide you a
complete work–up. After the test is completed he will doctor see the results and mail them to you.

You can then contact your family physician and seek appropriate treatment, if needed.
I would like to stress and assure that the results are confidential and neither the doctor nor the
company keeps any record of the same. You will receive the originals and no copies will be made.
Since the company sponsors this program you could save the money that you might spend on the
physical and since, it covers your spouse's physical also you could even save more. The

Practical CSA
Practical CSA Historically, one practical CSA was administered at the end of the third year (YR3)
and a second practical CSA was administered at the beginning of the fourth year (YR4.) It was
determined these two exams were no longer appropriately sequenced and did not meet the
assessment needs of the DCP. In response to recommendations made in the 2015 YR3 and YR4 CSA
Outcomes report, the YR4 practical exam was discontinued and the YR3 practical exam was
renamed the practical CSA. In correlation with this realignment, administration of the practical CSA
shifted to the end of Q9, when students have completed their introductory clinical experience.
Successful completion of the practical CSA is also an eligibility criterion for assignment of ... Show
This is consistent with observations made previously on the YR4 CSA exam. This led to the
recommendation to order advanced imaging that was not indicated for this patient. Many students
also failed to identify ultrasound as a viable treatment options and several mentioned afterwards that
this modality is rarely utilized in the CHC, partially due to clinician preference, but also because
there was not currently a functioning unit available. The SP–16 cohort struggled with the
interpretation of lung auscultation findings in the general exam PEP, missing a diagnosis of
bronchitis. Many misdiagnosed pneumonia, resulting in the recommendation of unnecessary
imaging and/or referral for antibiotics. As evident from the above discussion, students performed
better on stations assessing practical skills than the PEP stations focused on critical thinking. It
should also be noted that students tended to struggle more on PEP stations utilizing short–answer
questions testing recall. Many left responses blank or did not adequately focus their answers as
appropriate. It also appears as though students performed better on PEP stations in which they were
asked to identify differential diagnoses and follow–up procedures over those requiring a diagnosis /
problem list with

Essay on Reflective Nursing Case Study
Case Study One
In this case study I will use Gibbs (1988) model of reflection to write a personal account of an
abdominal examination carried out in general practice under the supervision of my mentor, utilising
the skills taught during the module thus far.
What happened
During morning routine sick parade I was presented with a 21 year old male soldier experiencing
severe acute, non specific, abdominal pain. Under the supervision of the medical officer (MO) I
proceeded to carry out a full assessment and abdominal examination, using Byrne and Long's (1976)
model to structure the consultation. I requested the patients' consent before conducting the
examination, as is essential before commencement of any medical procedure, be it a ... Show more
Thus allowing me to form a differential diagnosis and rule out certain causes, such as; constipation,
and indigestion. Subsequently, the physical examination enabled me to confirm a diagnosis of acute
abdomen. As the patient was not experiencing any worrying (red flag) symptoms associated with
abdominal emergencies, such as; appendicitis or pancreatitis. However, I did forget certain aspects
of the physical examination and had to be prompted by the MO. Although with more practice such
incidence would be reduced.
Analysis
I was happy that I managed to rule out any distinct causes of the abdominal pain by performing the
examination to collect data, analyse it, and use the results to make an appropriate decision (Schon,
1984). However, had I performed the examination without assistance I may not have gained all the
information required to confirm diagnosis, as I did forget some aspects.
Conclusion
The MO seemed happy with my diagnosis and care plan, though he did highlight the importance of
practicing the physical examination skills in order to become a more competent practitioner. Overall
I feel gaining knowledge and skills in translating a patients' history and physical examination
results, has enabled me to become more confident in making a diagnosis and has improved my
decision making skills.
Action Plan
In order to become a more capable and effective practitioner I must continue to

Chest Pain Diagnostic Studies
How would you evaluate and manage a pediatric patient who has a chest pain? Which diagnostic
studies would you recommend for this patient and why? When would you refer the patient to a
specialist? Chest pain is a common presenting symptom among nearly 10% of school–age children
seeking health care services. Studies have shown that at least 80% of pediatric patients seeking
medical evaluation for chest pain are not cardiac related, hence, the diagnosis of non–cardiac chest
pain (NCCP). On the other hand, if cardiac cause is a possibility, a prompt referral to a cardiologist
is extremely important. (Lee, J. L., Gilleland, J., Campbell, R. M., Johnson, G. L., Simpson, P.,
Dooley, K. J., & Blount, R. L. 2013). A complete health history detailing ... Show more content on
Helpwriting.net ...
2016). The diagnostic testing to be done would depend on the site of injury. A head CT scan,
ophthalmologist consult should be considered for a child less than 2 years of age diagnose with
occult skeletal, retinal, or intracranial trauma. Abdominal CT scan may be ordered if abdominal
trauma is suspected. Laboratory testing to include: CBC with platelets, PT/PTT, LFT's, lipase,
amylase, and if any concerns with of bone, calcium, magnesium, phosphate, alkaline phosphate, and
vitamin D levels should be considered (Hornor, G. (2012). A comprehensive physical and
psychosocial examination to identify abnormal bruising, tear, and any traumatic injuries that focuses
on the reported explanation. Essential elements includes: what occurred, when, where, and who was
present. It's important to pay close attention to historical details helps establish a timeline of events,
identify any inconsistencies in the care history. Inquire if the child has certain medications or
medications that could have aided in bruising. Frenula injuries in non–ambulatory children are
alarming for abusive injury and should prompt for another diagnostic evaluation (Hornor, G.

A Short Note On Health And Dental Insurance
Health History Date: August 15th Name: Mr. ZNK Address: 1121 Maryland Avenue, Beltsville, MD
20707 Telephone: 3016554386 Age: 30 Date of birth: April 24,1984 Birthplace: Accra, Ghana
Gender: Male Marital status: Single Race: African Religion: Non Occupation: Automotive
technician Health insurance: Medical & dental insurance from work Source: Client Reliability:
Client is alert to person, place ,situation, and time and is able to provide needed information during
assessment Present Health/Illness Reason for seeking care: Medical checkup for frequent urination
that started one week ago. Urine amount each time is very small. Daily activities get interrupted and
"I am hesitant to drink fluids but that has not prevented it". Health beliefs and practices: Visit the
doctor as often as possible, especially if I feel like something is not right in my body. Health
patterns: Try to eat right and exercise regularly Medications: No medications. Tylenol once in
awhile for headache Health goals: Work on having annual checkup with my doctor Past History
Childhood illnesses: Chicken pox, measles and asthma Immunizations: Had all the childhood
vaccines in Accra. Other vaccines like hepatitis vaccine I had in the US Medical illnesses: History of
asthma and seasonal flu Hospitalization: None Surgery: None Injury: Sustained a laceration on scalp
at age 10 and had a suture. Blood transfusion: None Emotional/psychiatric problems: I get
overwhelmed at times with pressure

Patient Cohort Essay
Patient Cohort From January 2001 to December 2014, a single surgeon (TPG) performed 3777
consecutive metal–on–metal HRA procedures, of which, 27% were women. Choosing December
2014 as our date range cut–off point ensured a minimum of 2 years of follow–up results for both
study groups. Group 1 consisted of 357 cases in 309 females performed before 2008, prior to the
establishment of the newly developed surgical interventions. Group 2 comprises 654 resurfacings in
556 females. Group 2 females were significantly older, at a mean of 54 years compared to 50 years
(p30% uncovered, and in all patients who have had an acetabular complication on the opposite hip,
or who have a DEXA scan T–score 30. We have also demonstrated that a slowed weight bearing
protocol and alendronate can prevent EFF [26]. Over time we evolved to develop a comprehensive
protocol which establishes three groups based on proven risk factors: Group A, femoral neck T–
score >0 and BMI 30; and Group C, Femoral neck T–score< –1.5. Group A patients progress to
WBAT. They typically use crutches for 2 weeks, and a cane for another 2 weeks. Group B patients
also progress to WBAT but are prescribed alendronate for 6 months. Patients from ... Show more
Metal ion levels are an excellent indicator for potential wear failure [35–37]. We converted serum
and plasma test results to whole blood ion level values using Smolder's method [35,38]. We then
used whole blood values for all comparisons. Based on previous research, we defined five categories
of ion levels for both unilateral and bilateral patients [31,35,38,39]: normal, optimal, acceptable,
problematic, and potentially toxic. These reference values are presented in the legend of Table

Complete Physical Assessment
| Complete Physical Assessment | Fort Hays State University | NURS603L Health Assessment
Across the Lifespan Lab for RNs | Katie Houp | 4/24/2014 |
Complete Physical Assessment of 40 year old male patient seen for assessment purposes. |
Complete Physical Examination
Date: 4/24/2014 Examiner: Katie Houp
Patient: Matt Gender: M Age: 40 Occupation: Medic
General Survey of Patient
Patient is Alert and Orientated to time place and events, appears slightly younger than stated age of
40 years old. Is of African American descent with medium brown pigmentation. Appears well
nourished, denies any unplanned weight changes in recent months. Posture and Position: Sitting
straight, relaxed with interview process, ... Show more content on Helpwriting.net ...
CN IX, X, XII (Glossopharyngeal, Vagua, and Hypoglossal) Intact– Uvula rises on phonation,
Tongue without tremors and is midline, Gag reflex present
Chest and Lungs 1. Thoracic cage configuration equal and symmetric expansion 2. Tactile fremitus
equal bilaterally. No Lumps or tenderness noted 3. Spinous processes: Normal spinal curvature
evident. 4. Percussion over lung fields resonant; diaphragmic excursion approximated at 5cm and
equal bilaterally 5. Breath Sounds clear without adventitious sounds all lobes
Heart
1. Precordium;– PMI not visible, palpable in 5th ICS, MCL normal size, 2. Apical Pulse, Apical rate
and rhythm: Ausculated to have regular rate and rhythm 3. Heart Sounds S1 heard best at apex, S2
heard best at base, no extra sounds or murmurs identified.
Abdomen
1. Contour, symmetry flat without scars or lesions noted, umbilicus is midline and inverted 2. Bowel
Sounds Active x 4 quadrants without bruits noted 3. Vascular Sounds not ausculated. 4. Light and
deep palpation without tenderness, mass or guarding evidenced. 5. Palpation of liver – edge not
palpated, percussion approximated at 8 cm in Right mid clavicular line. Spleen non palpable.
Upper Extremities: 1. Upper Extremities are symmetrical in appearance without scaring, lesions or
tenderness evident. Skin is dry and cool to touch; nails are manicured, capillary refill within 2
seconds noted. 2. Pulses:

Communication And Post Operative Units
Communication: Today I had the pleasure of being in both the pre–operative and post–operative
units. Communication within the members of both the teams were very efficient. I noticed the nurses
work much more independently and focus more on one on one patient care. However, the nurses in
pre–op did communicate a great deal with members of the surgical team. The nurses would call and
inform the surgical team when a patient was prepared to enter surgery. Also, the surgical team would
contact the pre–op nurses regularly to give them an update on how procedures were going in the
OR. For example, if a surgeon was ahead of schedule they would contact the pre–op nurses to
inform them that they could begin preparing the next patient ahead of time. Or vice versa, in cases
that the surgeon was behind schedule. On the other hand, in post–op the nurse was also very
independent. She would wait for a phone call from the PACU nurse, to receive a quick SBAR report
of the patient just a few minutes before the patient was transferred. Via the telephone, the PACU
nurse would inform the post–op nurse of current vitals, along with the types of anesthetics the
patient received and outcomes of the procedure. Mainly, the nurses communicated with the patient
and their family. Along with performing full body assessments, the pre–op nurses spent most of their
time asking patients detailed questions regarding their health history, current health status, and use
of medications. In addition, the pre–op

Dr. Quyyumi During The Community Health Fair
I had the opportunity to work with Dr. Quyyumi during the Community Health Fair that is held
twice every year. This charity clinic provides care for underserved and uninsured patients. My duties
included patient triage, focused history and physical exam, blood drawing and performing pap
smears. The experience allowed me to practice my clinical skills and provide care to patients in
need.
I participated in taking patients ' histories, doing physical examinations, reviewing lab results and
prescribing the appropriate treatment, I helped in performing administrative duties and updating
patients' medical records. At the clinic's pharmacy, I assisted the pharmacist in explaining the
medication route of administration, dosing, and frequency. I also involved in introducing public
health awareness and vaccination projects during our local medical tours.
I had the opportunity to work with Dr. Moussa at Scottish rite hospital. I assisted in obtaining
histories, performing physical exams, reviewing lab work and discussing differential diagnosis with
assessment and plan. The experience allowed me to practice my clinical knowledge while learning
about inpatient medicine.
My responsibilities were taking patients' histories, doing physical examinations, performing EKGs,
reviewing the patient medications, discussing the management plan and updating the electronic
medical records, also I participated in inpatient rounds in the afternoon at
Piedmont Hospital and Emory Midtown Hospital.

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