Aft Task 3

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
... Get more on HelpWriting.net ...

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

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 costsx33%
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 visits3,807
Current physical exam visits in northern regionx20%
Estimated loss due to competitionx33%
Personal illness/exam chargex$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

Physical Examination
Comprehensive History and Physical Examination Example
Patient Name: Joan Evans Sex: FemaleDOB: 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

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

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

Health Services
TQM IMPROVEMENT PLAN PAPER TABLE OF CONTENTS I. Executive Summary2 II. Area Profile A. Vision Mission3 B. Organization Structure4
C. Address/Location5 D. Products/Services5 III. Competitors8 IV. Statement of the ProblemE. Objective9 V. Date Gathering F. Questionnaire10 G.
Results and Interpretation11 VI. Review of Related Literature23 VII. Tools for Quality Improvement H. Affinity Diagram26 I. Fishbone Diagram28 J.
Pareto Diagram31 VIII. Conclusion33 IX. Recommendation34 APPENDIXI.... Show more content on Helpwriting.net ...
THERESA AGUSTIN, 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

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.

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

Importance And Importance Of Physical Examination
1build 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

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 content on Helpwriting.net ...
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

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.

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

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. AnEqual 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

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

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
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

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.
пїјMy 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

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

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 comprehensivehealth 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 more content on
Helpwriting.net ...
Her current prescription medications include a 225 mg tablet of Venlafaxine HCL once daily foranxiety 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,

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

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

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 mentalimpairment 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
This information is readily available on the WorldWide Webat 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

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 content on Helpwriting.net ...
Thus allowing me to form a differential diagnosis and rule out certain causes, such as; constipation, and indigestion. Subsequently, thephysical
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

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

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
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

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 more content on Helpwriting.net ...
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

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

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: 4/24/2014Examiner: Katie Houp
Patient: MattGender: MAge: 40Occupation: 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:

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

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

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

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
п‚§Involves marginal gingiva or interdental papilla o Periapical abscess
п‚§Present at the apex of the root of a tooth o Periodontal abscess
п‚§Localized within the tissues adjacent to the periodontal pocket o Pericoronal abscess
п‚§Localized within the tissue surrounding the crown of a partially or fully erupted tooth o Combined periodontic–endodontic abscess
п‚§Localized, circumscribed areas of infection that originate from the periodontal and/or pulpal tissues
п‚§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
п‚§Superficial abscesses often detectable by physical examination and palpation
п‚§Periapical x–ray or orhtopantogram recommended if the abscess is not visible or palpable on physical examination

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

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

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 more content on Helpwriting.net ...
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

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

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

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

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

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