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Excel 2016 Chapter 6 Exploring the Function Library Last
Updated: 3/27/19 Page 1
USING MICROSOFT EXCEL 2016 Independent Project 6-5
(Mac 2016)
Independent Project 6-5 (Mac 2016 Version)
Classic Gardens and Landscapes counts responses to mail
promotions to determine effectiveness. You use SUMIFS
and a nested IF formula to complete the summary. You also
calculate insurance statistics and convert birth dates
from text to dates.
Skills Covered in This Project
• Nest MATCH and INDEX functions.
• Create DSUM formulas.
• Build an IFS function.
• Build SUMIFS formulas.
• Use DATEVALUE to convert text to
dates.
1. Open the ClassicGardens-06 start file. Click the Enable
Editing button. The file will be renamed
automatically to include your name. Change the project file
name if directed to do so by your
instructor, and save it.
2. Create a nested INDEX and MATCH function to display the
number of responses from a city.
a. Click the Mailings sheet tab and select and name cells
A3:D28 as Responses
b. Click the Mailing Stats sheet tab.
c. Click cell B21 and type Carthage.
d. Click cell C21, start an INDEX function, and select the first
argument list option.
e. Choose the Responses range for the Array argument.
f. Click the Row_num box and nest a MATCH function. Select
cell B21 for the Lookup_value and
cells A3:A28 on the Mailings sheet for the Lookup_array. Click
the Match_type argument box
and type 0.
g. Click INDEX in the Formula bar. Click the Column_num box
and nest a second MATCH function to
look up cell D3 on the Mailings sheet in the lookup array
A3:D3.
h. Click the Match_type box and type 0 (Figure 6-105).
Important: There is a known bug in Excel for Mac that places
plus signs ( + ) instead of commas ( , )
between the arguments when using the Formula Builder. If this
is the case in your Excel for Mac
version, replace the plus signs with commas.
Step 1
Download
start file
Excel 2016 Chapter 6 Exploring the Function Library Last
Updated: 3/27/19 Page 2
USING MICROSOFT EXCEL 2016 Independent Project 6-5
(Mac 2016)
i. Format the results to show zero decimal places.
j. Type Smyrna in cell B21.
3. Use DSUM to summarize mailing data.
a. On the Mailings sheet, note that number sent is located in the
third column and response data is in
the fourth column.
b. Click the Criteria sheet tab. Select cell B2 and type lan* to
select data for the Landscape Design
department.
c. Click the Mailing Stats sheet tab and select cell B7.
d. Use DSUM with the range name Responses as the Database
argument. Type 3 for the Field
argument, and use an absolute reference to cells B1:B2 on the
Criteria sheet as the Criteria
argument.
e. Copy the formula to cell C7 and edit the Field argument to
use the fourth column.
f. Complete criteria for the two remaining departments on the
Criteria sheet.
g. Click the Mailing Stats sheet tab and select cell B8.
h. Use DSUM in cells B8:C9 to calculate results for the two
departments.
4. Use SUM in cells B10:C10.
5. Format all values as Comma Style with no decimal places.
6. Create an IFS function to display a response rating.
IMPORTANT: If you are using a version of Excel that does not
include the IFS function, create a
formula using nested IF functions instead where each
Value_if_false argument is the next IF
statement. The innermost nested IF statement should have a
Logical_test argument of C7/B7<10%,
Value_if_true argument of $C$18, and Value_if_false argument
of 0.
a. Click cell D7. The response rate and ratings are shown in
rows 14:18.
b. Start an IFS function and select C7 for the Logical_test1
argument. Type / for division and select
cell B7. Type >= 20% to complete the test.
c. Click the Value_if_true1 box, select C15, and press F4
(FN+F4) (Figure 6-106).
Excel 2016 Chapter 6 Exploring the Function Library Last
Updated: 3/27/19 Page 3
USING MICROSOFT EXCEL 2016 Independent Project 6-5
(Mac 2016)
d. Click the Logical_test2 box, select C7, type /, select cell B7,
and type >=15%
e. Click the Value_if_true2 box, click cell C16, and press F4
(FN+F4).
f. Complete the third and fourth logical tests and value_if_true
arguments (Figure 6-107).
g. Copy the formula in cell D7 to
cells D8:D10.
7. Use SUMIFS to total insurance
claims and dependents by city
and department.
a. Click the Employee Insurance
sheet tab and select cell E25.
b. Use SUMIFS with an absolute
reference to cells F4:F23 as the
Sum_range argument.
c. The Criteria_range1 argument
is an absolute reference to
cells E4:E23 with Criteria1 that
will select the city of
Brentwood.
d. The Criteria_range2 argument
is an absolute reference to the department column with criteria
that will select the Landscape
Design department.
e. Complete SUMIFS formulas for cells E26:E28.
f. Format borders to remove inconsistencies, if any, and adjust
column widths to display data.
8. Use DATEVALUE to convert text data to dates.
a. Click the Birth Dates sheet tab and select cell D4. The dates
were imported as text and cannot be
used in date arithmetic.
b. Select cells D4:D23 and cut/paste them to cells G4:G23.
c. Select cell H4 and use DATEVALUE to convert the date in
cell G4 to a serial number.
d. Copy the formula to cells H5:H23.
e. Select cells H4:H23 and copy them to the Clipboard.
f. Select cell D4, click the arrow with the Paste button [Home
tab, Clipboard group], and choose
Values (Figure 6-108).
g. Format the values in column D
to use the Short Date format.
h. Hide columns G:H.
i. Apply All Borders to the data
and make columns B:D each
13.57 wide. NOTE: Some
versions of Excel 2016 for Mac
use inches for row height and
column width. When viewing
the column width, if double
quotes appear when
displaying the value, enter
1.17” instead of 13.57.
Excel 2016 Chapter 6 Exploring the Function Library Last
Updated: 3/27/19 Page 4
USING MICROSOFT EXCEL 2016 Independent Project 6-5
(Mac 2016)
9. Save and close the workbook (Figure 6-109).
10. Upload and save your project file.
11. Submit project for grading.
Step 2
Upload &
Save
Step 3
Grade my
Project
Hypothyroidism
· Hypothyroidism entails an underactive thyroid.
· The thyroid gland produces insufficient hormones.
· Women above 60 years are more affected by the condition
(Alexander et al., 2017).
· Signs and symptoms depend on the severity of hormone
deficiency.
Untreated hypothyroidism has severe impacts including goiter
and memory loss.
Incidence and Prevalence
· Presently, incidence and prevalence are conducted in small
community cohorts.
· Prevalence and incidence are reported as 2-4 per 1000
individuals per year.
· Prevalence is 0.2%-0.4% for undiagnosed cases (Seo & Chung,
2015).
· Prevalence is 1%-2% for previously diagnosed cases.
· Women above 60 years are more easily affected by
hypothyroidism
In 2002, NHANES III (United States National Health and
Nutrition Examination Survey) reported the detection of overt
hypothyroidism is 0.3% in general population while 0.7% had
the subclinical hypothyroidism
Pathophysiology
· The thyroid gland is responsible for producing
triiodothyronine (T3) and thyroxine (T4).
· TSH is responsible for regulating the hormone synthesis and
release by thyroid glands.
· TSH is influenced by the TRH from the hypothalamus
(Donzelli et al., 2016).
· Both TRH and TSH are regulated by negative feedback from
thyroid hormone (T3)
· Increase in circulating thyroid hormone result in blunting of
both secretion and synthesis of serum TSH.
Low T3 and T4 increase TSH levels as a compensatory function.
Clinical Presentations
· Hypothyroidism symptoms vary with hormone deficiency.
· Initially, noticing the symptoms may be challenging
· One may relate fatigue and weight gain to old age (Seo &
Chung, 2015)
· Main signs and symptoms include fatigue, cold intolerance,
constipation, dry skin, puffy face, hoarseness, muscle weakness,
elevated blood cholesterol, muscle stiffness and tenderness,
joint pains, irregular or heavier menstrual periods, slowed heart
rate, impaired memory, and depression.
Untreated symptoms result in severe conditions such as goiter
and memory loss.
CPG Authors and Publication
· The clinical practice guideline (CPG) entails hypothyroidism
in adults.
· The CPG was developed by the American Association of
Clinical Endocrinologists and American Thyroid Association
· The CPG was developed by 9 authors including Garber, Cobin,
Gharib, Hennessey, Klein, Mechanick, Pessah-Pollack, Singer,
and Woeber.
· The most recent publication of the CPG article was 2012.
Updates to CPG was 2008 and 2010, with revisions which are
seen in the 2012 CPG.
Applicability in Primary Care Setting
· Hypothyroidism is characterized by various manifestations and
etiologies
· Effective management requires proper diagnosis and is
influenced by coexisting medical conditions (Garber et al.,
2012)
· This CPG aids in profoundly understanding the condition and
its presentation
The CPG develops recommendations which can be applied in
the diagnosis and treatment of the condition.
Clinical Applications
· The CPG enhances awareness on epidemiology, associated
hypothyroidism disorders, signs and symptoms, and
measurement approaches of T4 and T3
· In managing recommendations, key aspects included are when
antithyroid antibodies should be measured, the importance of
clinical scoring approach in performing diagnosis, and use of
diagnostic tests (Garber et al., 2012).
· CPG also focuses on pregnant women with hypothyroidism
and effective approaches that should be implemented such as
monitoring them.
Areas of future research are identified including cardiac and
cognitive benefits from managing subclinical hypothyroidism
and screening for pregnancy.
Key Actions
· Recommendation 1: Anti-thyroid peroxidase antibody
(TPOAb) evaluations are essential to consider when examining
patients with subclinical hypothyroidism: Grade B evidence.
· Grade B is considered for the recommendation since the
evidence is only predictive in nature.
· In case there are positive thyroid antibodies, the condition
occurs at 4.3% and 2.6 annually in negative thyroid antibodies.
Recommendation 7: Besides pregnancy, serum free T4
assessment should be conducted rather than total T4 in
evaluating hypothyroidism. Grade A evidence
· Recommendation 13: Patients being treated for
hypothyroidism should have TSH serum measured at 4-8 weeks
after first treatment of dose change. Grade B
· Consistent valuation aims at examining the effectiveness of
the treatment
· Recommendation 16: Treatment centered on personal factors
for individuals with TSH levels between 10 mIU/L and
laboratory reference range should be considered if the patient
demonstrates positive findings for hypothyroidism. Grade B
Recommendation 20.2: Hypothyroidism screening for aged
patients above 60 years should be considered. Grade B
Application to Clinical
· Mrs. J.R, a 62-year-old African American presents to the
clinic
· Her chief complaint was fatigue, feeling the cold, and low
energy.
· Physical assessment reveals a high BMI of 31.2, dry skin, and
hoarseness.
· Patient has diabetes and hypertension.
Patient’s husband is 72 year and suffering from HTN, and
Dementia.
Diagnosis and Management
· Primary evaluation entails evaluating the physical symptoms.
· Diagnosis entails measuring TSH where high level reveals
underactive thyroid.
· Other diagnoses as outlined in the CPG include BMR(Basic
Metabolic Rate) and total cholesterol.
· Patient’s TSH was 11.2 mlU/L which revealed
hypothyroidism.
· L-thyroxine at a strength of 50 mcg PO qDay was prescribed
as suggested by the CPG (Garber et al., 2012).
Follow-up was scheduled after 30 days of the first dosage.
Conclusion
· Hypothyroidism is described by the underactive thyroid gland
· Key symptoms are fatigue, cold sensitivity, increase in weight,
dry skin, and pain in the joints
· CPG outlines key recommendations including diagnosis and
management approaches
· These guidelines can profoundly be applied to the primary
care setting
· Hypothyroidism evaluation entails TSH levels, total
cholesterol, and BMR
Management involves L-thyroxine and a follow-up after 4
weeks.
Hello my name is Blah blah blah and I will be presenting the
clinical practice guideline on the diagnosis and management of
Gastroesophageal reflux disease also known as GERD.
Disease and Background
Incidence: GERD can occur at any age, but the incidence
increases after age 50 and common in older adults (Dunphy,
Winland-Brown, Porter, & Thomas, 2011). In 2005, the
incidence of GERD was approximately 5 per 1000 persons-years
in the overall US populations (El-Serag, Sweet, Winchester &
Dent, 2014).
Prevalence: Epidemiologic estimates of the prevalence of GERD
are based primarily on the typical symptoms of heartburn and
regurgitation (Katz, Gerson, & Vela, 2013). The prevalence is
increasing worldwide and it is the most prevalent
gastrointestinal disorder in the United States.
The prevalence of GERD ranged from 18.1-27.8% of the
population of North America. Research suggests that Caucasians
patients tend to have more severe manifestations and
complications (Dalbir, & Fass, 2018).
Pathophysiology: Esophageal reflux occurs when the gastric
volume or the intra-abdominal pressure is elevated. It can also
occur when the sphincter tone of the lower esophageal sphincter
(LES) is decreased or when the LES undergoes inappropriate
relaxation. Gravity, saliva, and peristalsis work together to
return refluxed content back to the stomach (Dunphy, Winland-
Brown, Porter, & Thomas, 2011). With repeated exposure to
gastric acid, the esophagus and esophageal mucosa becomes
inflamed and irritated causing an inflammatory response. The
esophagus then cannot eliminate the refluxed material causing a
prolonged exposure of gastric content to the esophageal mucosa
(Dunphy, Winland-Brown, Porter, & Thomas, 2011).
Clinical Presentation:
Subjective: The most typical symptom of GERD is heartburn,
ranging from mild to severe and regurgitation. Other associated
symptoms include water brash (reflux salivation), dysphagia,
sour taste in the mouth in the morning, odynophagia, belching,
coughing, hoarseness, and wheezing that usually occurs at night
(Dunphy, Winland-Brown, Porter, & Thomas, 2011). Chest pain
in the retrosternal or substernal area may also occur, which will
then need further evaluation to rule out cardiac origin. Factors
that usually make symptoms worse include reclining after
eating, eating a large meal, alcohol, chocolate caffeine,
nicotine, fatty food, and spicy food ingestion, wearing
constrictive clothing, heavy lifting, straining, or working in a
bent over position is involved to help determine a diagnosis of
GERD (Dunphy, Winland-Brown, Porter, & Thomas, 2011).
Objective: The physical exam is usually normal for patients
with GERD. The only sign may be a stool positive for occult
blood on a rectal exam resulting from microhemmorrhages in
the irritated esophageal epithelium (Dunphy, Winland-Brown,
Porter, & Thomas, 2011).
Publication and Applicability in Primary Care
The evidenced based clinical practice guidelines for the
Diagnosis and Management of Gastroesophageal Reflux Disease
from the American Journal of Gastroenterology was developed
by the American College of Gastroenterology and released in
March of 2013 with no revisions. The authors are Katz, P. O.,
Gerson, L. B., and Vela, M. F. The organization or group that
developed the clinical practice guidelines is the Nature
Publishing Group. These clinical practice guidelines is
applicable to primary care in order to properly diagnosis and
manage GERD and reduce related complications such as erosive
esophagitis, stricture, and Barrett’s esophagus (Katz, Gerson, &
Vela, 2013).
Key Action Statements & Body of Evidence
5 recommendations applicable in primary care are:
1. A presumptive diagnosis of GERD can be established in the
setting of typical symptoms of heartburn and regurgitation and
are the most reliable for making a presumptive diagnosis based
on history alone. Empiric medical therapy with a PPI is the
recommended approach to confirm GERD when it is suspected
in patients with typical symptoms. This is a strong
recommendation, moderate level of evidence (Katz, Gerson, &
Vela, 2013).
2. A cardiac cause should be excluded in patients with chest
pain before the commencement of a gastrointestinal evaluation.
Non-cardiac chest pain is and associated symptom with the
presence of GERD, therefore, cardiac etiology should be ruled
out. This is a strong recommendation, moderate level of
evidence (Katz, Gerson, & Vela, 2013).
3. Weight loss is recommended for GERD patients who are
overweight or have had recent weight gain. This is a conditional
recommendation, moderate level of evidence. GERD and obesity
have a definite correlation with body mass index, waist
circumference, and weight gain (Katz, Gerson, & Vela, 2013).
Weight gain with a normal BMI has been associated with new
onset of GERD symptoms. It has been shown that there has been
a reduction in GERD symptoms with weight loss (Katz, Gerson,
& Vela, 2013).
4. Barium radiographs should not be preformed to diagnose
GERD. Although barium radiographs detect esophagitis, the
sensitivity of this test is very low and is not recommended as a
diagnostic test without dysphagia. This is a strong
recommendation, high level of evidence (Katz, Gerson, & Vela,
2013).
5. Upper endoscopy is not required in the presence of typical
GERD symptoms. Endoscopy is recommended in the presence of
alarm symptoms and for screening of patients at high risk for
complications (Katz, Gerson, & Vela, 2013). The vast majority
of patients with heartburn and regurgitation will not have
erosions limiting upper endoscopy as an initial diagnosis test
for patients with suspected GERD. (Katz, Gerson, & Vela,
2013). This is a strong recommendation, moderate level of
evidence.
These statements are applicable to primary care in which
present key evidence supporting the recommendations.
Application in Clinical Rotation
W.S. is a 57-year-old Caucasian obese female who came in on
10/11/18 with chief complaint of intermittent epigastric pain
and heartburn x 2 weeks. It progressively worsens after eating,
smoking, and drinking coffee. Standing up helps. She tried OTC
Tums, which temporarily relieved the discomfort. Discomfort is
4/10 now after eating breakfast and 8/10 at worse.
W.S has a past medical history of HTN. She takes lisinpril 10
mg PO daily for hypertension. She has no past surgical history.
No allergies. She is married with 2 grown kids and works full
time. She states she is not very active and does not engage in
much physical activity or daily exercise due to her busy
schedule. She states she occasionally smokes cigarettes but is
trying to quit completely and drinks alcohol occasionally.
She is 5’6” and weights 180 lbs which considers her overweight
with a BMI of 29.05. BP 135/65, HR 70, T 36.5, R 18. Abdomen
soft, nontender, BS active. Otherwise, normal physical exam.
The patient was diagnosed based on the presenting symptom of
heartburn, weight, lifestyle, and aggravating factors. The patient
was prescribed to take omeprazole 20 mg PO daily and follow
up in 2 weeks. Treatment was based on familiarity and it being
an over the counter medication. Comparing these actions to the
CPG guidelines, Proton pump inhibitors (PPI’s) are considered
the most effective medical treatment for GERD. There are seven
proton pump inhibitors (PPI’s). Four are over the counter,
omeprazole, lansoprazole, esomeprazole, and omeprazole-
sodium bicarbonate. Rabeprazole, pantoprazole, and
dexlansoprazole are available only by prescription (Dalbir, &
Fass, 2018). Esomeprazole showed an 8% increase in
probability of GERD symptom relief at 4 weeks of taking (Katz,
Gerson, & Vela, 2013). A meta-analysis of these concluded that
the newer PPI’s were similar in efficacy in terms of heartburn
control, healing esophageal erosions and the relapse rates of
GERD (Dalbir, & Fass, 2018).
The patient was educated on importance of healthy diet, daily
exercise, and weight management. According to the CPG
guidelines, weight loss is recommended for GERD patients who
are overweight or have had recent weight gain in order to
reduce the symptoms of GERD (Katz, Gerson, & Vela, 2013).
Reference
Dalbir, S. S., & Fass, R. (2018). Current trends in the
management of gastroesophageal reflux disease. Gut and Liver
12(1), 7-16.
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas,
D. J. (2011). Primary care: The art and science of advanced
practice nursing (3rd ed.). Philadelphia, PA: F.A. Davis
Company.
El-Serag, H. B., Sweet, S., Winchester, C. C., & Dent, J.
(2014). Update on the epidemiology of gastro-oesophageal
reflux disease: A systemic review. Gut 63(6), 871-880.
Katz, P. O., Gerson, L. B., & Vela, M. F. (2013). Guidelines for
the diagnosis and management of gastroesophageal reflux
disease. American Journal of Gastroenterology, 108(3), 308-
328.
MUST HAVES THIS ALL
Reference not older than 5 years
you must have your oral CPG presentation posted by 11:59 PM
ALONG WITH a copy of the article and your written transcript.
Cystitis
Jessica Ruiz – Presenter
Gupta, K., Hooton, T., Naber, K., Wullt, B., Colgan, R., et al.
(2011). International Clinical Practice Guidelines for the
Treatment of Acute Uncomplicated Cystitis and Pyelonephritis
in Women: A 2010 Update by the Infectious Diseases Society
of America and the European Society for Microbiology and
Infectious Diseases. Clinical Infectious Diseases, 52(5), e103-
e120.
NR511 Clinical Practice Guideline Assignment
NR511 Clinical Practice Guideline Assignment
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomeDisease &
Background Student: 1) Identifies the disease condition 2)
Gives a brief statement of incidence and prevalence in the US 3)
The student briefly summarizes the disease pathophysiology and
4) Identifies the typical clinical presentation seen in a patient
with the disease (4 critical elements).
15.0 pts
Exceptional- Student identifies the disease topic AND Student
states the incidence and prevalence in the US AND Student
provides a pathophysiology statement AND Student states the
typical clinical presentation seen in a patient with the disease.
13.0 pts
Exceeds- All four (4) critical elements are present but some
information may be only partially addressed or inaccurate.
12.0 pts
Meets- One to two (1-2) critical elements are missing.
6.0 pts
Needs Improvement- Three (3) critical elements are missing.
0.0 pts
Developing- All four (4) critical elements are missing.
15.0 pts
This criterion is linked to a Learning OutcomePublication &
Applicability in Primary Care The student: 1) Identifies the
author, organization or group that developed the CPG, 2)
Student denotes the year of the original guideline publication,
3) Student identifies any subsequent revisions (student’s
reference should be the most recent version), and 4) Student
discusses the applicability for use of this CPG in the primary
care setting (4 critical elements).
30.0 pts
Exceptional- Student correctly identifies the author(s),
organization(s), or group(s) that developed the CPG AND
Student states the year of the original CPG guideline AND
Student notes all subsequent revisions of the guideline (with the
student’s version being the most recent) AND Student discusses
how this CPG is applicable to primary care.
26.0 pts
Exceeds- All four (4) critical elements are present but some
information may be only partially addressed or inaccurate.
24.0 pts
Meets- Two (2) critical elements are missing.
12.0 pts
Needs Improvement- Three (3) critical elements are missing.
0.0 pts
Developing-All four (4) critical elements are missing.
30.0 pts
This criterion is linked to a Learning OutcomeKey Action
Statements & Body of Evidence The student: 1)Provides each of
the CPG’s “Key Action” or “Guideline Statements” up to a
maximum of 5 relevant recommendations, 2) Provides the body
of evidence strength for each, and 3) If the statement has
applicability to other groups, only discuss the relevant primary
care ones (3 critical elements).
45.0 pts
Exceptional- Student presents a maximum of 5 relevant
recommendations AND Student denotes the evidence strength
for EACH recommendation AND Student discusses ONLY the
ones applicable to primary care
39.0 pts
Exceeds- All three (3) critical elements are addressed but some
information may be only partially addressed, or not completely
accurate
37.0 pts
Meets- One (1) critical element is missing.
18.0 pts
Needs Improvement- Two (2) critical elements are missing.
0.0 pts
Developing- All three (3) critical elements are missing
45.0 pts
This criterion is linked to a Learning OutcomeApplication in
Clinical 1) Using an example of a patient from their clinical
rotation with the same condition, 2) Student discusses how the
diagnosis and treatment of their patient compared to the
recommendations given in the guidelines, and 3). Specific
examples of what was done well or what could have been done
better is noted (3 critical elements).
45.0 pts
Exceptional- The student uses a patient example from their
clinical setting with the same condition AND The student
discusses how the diagnosis & treatment of their patient
compared to those recommended in the guideline AND Specific
examples are given on what was done well or what could have
been done better
39.0 pts
Exceeds- All three (3) critical elements are addressed but some
information may only be partially addressed
37.0 pts
Meets- One (1) critical element is missing.
18.0 pts
Needs Improvement- Two (2) critical elements are missing.
0.0 pts
Developing- All three (3) critical elements are missing
45.0 pts
This criterion is linked to a Learning OutcomePresentation 1)
The student used PowerPoint and Kaltura and presentation was
professional in quality, 2) Slides were well organized and
aesthetically pleasing, 3) Student’s narration was
understandable and well-paced, 4) References were noted, 5)
Presentation was under 15min in length. (5 critical elements).
15.0 pts
Exceptional- Student uses Power Point and Kaltura which
demonstrates a professional quality AND Student’s slides were
well organized AND Student’s narration was understandable
and well-paced AND References were noted AND Presentation
was <15 minutes
13.0 pts
Exceeds- Two (2) critical elements were missing.
12.0 pts
Meets- Three (3) critical elements were missing.
6.0 pts
Needs Improvement-Four (4) critical elements were missing.
0.0 pts
Developing- Five (5) critical elements were missing
15.0 pts
Total Points: 150.0

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  • 1. Excel 2016 Chapter 6 Exploring the Function Library Last Updated: 3/27/19 Page 1 USING MICROSOFT EXCEL 2016 Independent Project 6-5 (Mac 2016) Independent Project 6-5 (Mac 2016 Version) Classic Gardens and Landscapes counts responses to mail promotions to determine effectiveness. You use SUMIFS and a nested IF formula to complete the summary. You also calculate insurance statistics and convert birth dates from text to dates. Skills Covered in This Project • Nest MATCH and INDEX functions. • Create DSUM formulas. • Build an IFS function. • Build SUMIFS formulas. • Use DATEVALUE to convert text to dates. 1. Open the ClassicGardens-06 start file. Click the Enable Editing button. The file will be renamed
  • 2. automatically to include your name. Change the project file name if directed to do so by your instructor, and save it. 2. Create a nested INDEX and MATCH function to display the number of responses from a city. a. Click the Mailings sheet tab and select and name cells A3:D28 as Responses b. Click the Mailing Stats sheet tab. c. Click cell B21 and type Carthage. d. Click cell C21, start an INDEX function, and select the first argument list option. e. Choose the Responses range for the Array argument. f. Click the Row_num box and nest a MATCH function. Select cell B21 for the Lookup_value and cells A3:A28 on the Mailings sheet for the Lookup_array. Click the Match_type argument box and type 0. g. Click INDEX in the Formula bar. Click the Column_num box and nest a second MATCH function to look up cell D3 on the Mailings sheet in the lookup array A3:D3. h. Click the Match_type box and type 0 (Figure 6-105).
  • 3. Important: There is a known bug in Excel for Mac that places plus signs ( + ) instead of commas ( , ) between the arguments when using the Formula Builder. If this is the case in your Excel for Mac version, replace the plus signs with commas. Step 1 Download start file Excel 2016 Chapter 6 Exploring the Function Library Last Updated: 3/27/19 Page 2 USING MICROSOFT EXCEL 2016 Independent Project 6-5 (Mac 2016) i. Format the results to show zero decimal places. j. Type Smyrna in cell B21. 3. Use DSUM to summarize mailing data. a. On the Mailings sheet, note that number sent is located in the third column and response data is in the fourth column. b. Click the Criteria sheet tab. Select cell B2 and type lan* to
  • 4. select data for the Landscape Design department. c. Click the Mailing Stats sheet tab and select cell B7. d. Use DSUM with the range name Responses as the Database argument. Type 3 for the Field argument, and use an absolute reference to cells B1:B2 on the Criteria sheet as the Criteria argument. e. Copy the formula to cell C7 and edit the Field argument to use the fourth column. f. Complete criteria for the two remaining departments on the Criteria sheet. g. Click the Mailing Stats sheet tab and select cell B8. h. Use DSUM in cells B8:C9 to calculate results for the two departments. 4. Use SUM in cells B10:C10. 5. Format all values as Comma Style with no decimal places. 6. Create an IFS function to display a response rating. IMPORTANT: If you are using a version of Excel that does not include the IFS function, create a formula using nested IF functions instead where each Value_if_false argument is the next IF
  • 5. statement. The innermost nested IF statement should have a Logical_test argument of C7/B7<10%, Value_if_true argument of $C$18, and Value_if_false argument of 0. a. Click cell D7. The response rate and ratings are shown in rows 14:18. b. Start an IFS function and select C7 for the Logical_test1 argument. Type / for division and select cell B7. Type >= 20% to complete the test. c. Click the Value_if_true1 box, select C15, and press F4 (FN+F4) (Figure 6-106). Excel 2016 Chapter 6 Exploring the Function Library Last Updated: 3/27/19 Page 3 USING MICROSOFT EXCEL 2016 Independent Project 6-5 (Mac 2016) d. Click the Logical_test2 box, select C7, type /, select cell B7, and type >=15% e. Click the Value_if_true2 box, click cell C16, and press F4 (FN+F4). f. Complete the third and fourth logical tests and value_if_true
  • 6. arguments (Figure 6-107). g. Copy the formula in cell D7 to cells D8:D10. 7. Use SUMIFS to total insurance claims and dependents by city and department. a. Click the Employee Insurance sheet tab and select cell E25. b. Use SUMIFS with an absolute reference to cells F4:F23 as the Sum_range argument. c. The Criteria_range1 argument is an absolute reference to cells E4:E23 with Criteria1 that will select the city of Brentwood. d. The Criteria_range2 argument is an absolute reference to the department column with criteria that will select the Landscape
  • 7. Design department. e. Complete SUMIFS formulas for cells E26:E28. f. Format borders to remove inconsistencies, if any, and adjust column widths to display data. 8. Use DATEVALUE to convert text data to dates. a. Click the Birth Dates sheet tab and select cell D4. The dates were imported as text and cannot be used in date arithmetic. b. Select cells D4:D23 and cut/paste them to cells G4:G23. c. Select cell H4 and use DATEVALUE to convert the date in cell G4 to a serial number. d. Copy the formula to cells H5:H23. e. Select cells H4:H23 and copy them to the Clipboard. f. Select cell D4, click the arrow with the Paste button [Home tab, Clipboard group], and choose Values (Figure 6-108). g. Format the values in column D to use the Short Date format. h. Hide columns G:H. i. Apply All Borders to the data
  • 8. and make columns B:D each 13.57 wide. NOTE: Some versions of Excel 2016 for Mac use inches for row height and column width. When viewing the column width, if double quotes appear when displaying the value, enter 1.17” instead of 13.57. Excel 2016 Chapter 6 Exploring the Function Library Last Updated: 3/27/19 Page 4 USING MICROSOFT EXCEL 2016 Independent Project 6-5 (Mac 2016) 9. Save and close the workbook (Figure 6-109). 10. Upload and save your project file. 11. Submit project for grading.
  • 9. Step 2 Upload & Save Step 3 Grade my Project Hypothyroidism · Hypothyroidism entails an underactive thyroid. · The thyroid gland produces insufficient hormones. · Women above 60 years are more affected by the condition (Alexander et al., 2017). · Signs and symptoms depend on the severity of hormone deficiency. Untreated hypothyroidism has severe impacts including goiter and memory loss. Incidence and Prevalence · Presently, incidence and prevalence are conducted in small community cohorts. · Prevalence and incidence are reported as 2-4 per 1000 individuals per year. · Prevalence is 0.2%-0.4% for undiagnosed cases (Seo & Chung, 2015). · Prevalence is 1%-2% for previously diagnosed cases. · Women above 60 years are more easily affected by hypothyroidism In 2002, NHANES III (United States National Health and Nutrition Examination Survey) reported the detection of overt hypothyroidism is 0.3% in general population while 0.7% had
  • 10. the subclinical hypothyroidism Pathophysiology · The thyroid gland is responsible for producing triiodothyronine (T3) and thyroxine (T4). · TSH is responsible for regulating the hormone synthesis and release by thyroid glands. · TSH is influenced by the TRH from the hypothalamus (Donzelli et al., 2016). · Both TRH and TSH are regulated by negative feedback from thyroid hormone (T3) · Increase in circulating thyroid hormone result in blunting of both secretion and synthesis of serum TSH. Low T3 and T4 increase TSH levels as a compensatory function. Clinical Presentations · Hypothyroidism symptoms vary with hormone deficiency. · Initially, noticing the symptoms may be challenging · One may relate fatigue and weight gain to old age (Seo & Chung, 2015) · Main signs and symptoms include fatigue, cold intolerance, constipation, dry skin, puffy face, hoarseness, muscle weakness, elevated blood cholesterol, muscle stiffness and tenderness, joint pains, irregular or heavier menstrual periods, slowed heart rate, impaired memory, and depression. Untreated symptoms result in severe conditions such as goiter and memory loss. CPG Authors and Publication · The clinical practice guideline (CPG) entails hypothyroidism in adults. · The CPG was developed by the American Association of Clinical Endocrinologists and American Thyroid Association · The CPG was developed by 9 authors including Garber, Cobin, Gharib, Hennessey, Klein, Mechanick, Pessah-Pollack, Singer, and Woeber. · The most recent publication of the CPG article was 2012.
  • 11. Updates to CPG was 2008 and 2010, with revisions which are seen in the 2012 CPG. Applicability in Primary Care Setting · Hypothyroidism is characterized by various manifestations and etiologies · Effective management requires proper diagnosis and is influenced by coexisting medical conditions (Garber et al., 2012) · This CPG aids in profoundly understanding the condition and its presentation The CPG develops recommendations which can be applied in the diagnosis and treatment of the condition. Clinical Applications · The CPG enhances awareness on epidemiology, associated hypothyroidism disorders, signs and symptoms, and measurement approaches of T4 and T3 · In managing recommendations, key aspects included are when antithyroid antibodies should be measured, the importance of clinical scoring approach in performing diagnosis, and use of diagnostic tests (Garber et al., 2012). · CPG also focuses on pregnant women with hypothyroidism and effective approaches that should be implemented such as monitoring them. Areas of future research are identified including cardiac and cognitive benefits from managing subclinical hypothyroidism and screening for pregnancy. Key Actions · Recommendation 1: Anti-thyroid peroxidase antibody (TPOAb) evaluations are essential to consider when examining patients with subclinical hypothyroidism: Grade B evidence. · Grade B is considered for the recommendation since the evidence is only predictive in nature. · In case there are positive thyroid antibodies, the condition occurs at 4.3% and 2.6 annually in negative thyroid antibodies. Recommendation 7: Besides pregnancy, serum free T4 assessment should be conducted rather than total T4 in
  • 12. evaluating hypothyroidism. Grade A evidence · Recommendation 13: Patients being treated for hypothyroidism should have TSH serum measured at 4-8 weeks after first treatment of dose change. Grade B · Consistent valuation aims at examining the effectiveness of the treatment · Recommendation 16: Treatment centered on personal factors for individuals with TSH levels between 10 mIU/L and laboratory reference range should be considered if the patient demonstrates positive findings for hypothyroidism. Grade B Recommendation 20.2: Hypothyroidism screening for aged patients above 60 years should be considered. Grade B Application to Clinical · Mrs. J.R, a 62-year-old African American presents to the clinic · Her chief complaint was fatigue, feeling the cold, and low energy. · Physical assessment reveals a high BMI of 31.2, dry skin, and hoarseness. · Patient has diabetes and hypertension. Patient’s husband is 72 year and suffering from HTN, and Dementia. Diagnosis and Management · Primary evaluation entails evaluating the physical symptoms. · Diagnosis entails measuring TSH where high level reveals underactive thyroid. · Other diagnoses as outlined in the CPG include BMR(Basic Metabolic Rate) and total cholesterol. · Patient’s TSH was 11.2 mlU/L which revealed hypothyroidism. · L-thyroxine at a strength of 50 mcg PO qDay was prescribed as suggested by the CPG (Garber et al., 2012). Follow-up was scheduled after 30 days of the first dosage. Conclusion · Hypothyroidism is described by the underactive thyroid gland
  • 13. · Key symptoms are fatigue, cold sensitivity, increase in weight, dry skin, and pain in the joints · CPG outlines key recommendations including diagnosis and management approaches · These guidelines can profoundly be applied to the primary care setting · Hypothyroidism evaluation entails TSH levels, total cholesterol, and BMR Management involves L-thyroxine and a follow-up after 4 weeks. Hello my name is Blah blah blah and I will be presenting the clinical practice guideline on the diagnosis and management of Gastroesophageal reflux disease also known as GERD. Disease and Background Incidence: GERD can occur at any age, but the incidence increases after age 50 and common in older adults (Dunphy, Winland-Brown, Porter, & Thomas, 2011). In 2005, the incidence of GERD was approximately 5 per 1000 persons-years in the overall US populations (El-Serag, Sweet, Winchester & Dent, 2014). Prevalence: Epidemiologic estimates of the prevalence of GERD are based primarily on the typical symptoms of heartburn and regurgitation (Katz, Gerson, & Vela, 2013). The prevalence is increasing worldwide and it is the most prevalent gastrointestinal disorder in the United States. The prevalence of GERD ranged from 18.1-27.8% of the population of North America. Research suggests that Caucasians patients tend to have more severe manifestations and complications (Dalbir, & Fass, 2018). Pathophysiology: Esophageal reflux occurs when the gastric
  • 14. volume or the intra-abdominal pressure is elevated. It can also occur when the sphincter tone of the lower esophageal sphincter (LES) is decreased or when the LES undergoes inappropriate relaxation. Gravity, saliva, and peristalsis work together to return refluxed content back to the stomach (Dunphy, Winland- Brown, Porter, & Thomas, 2011). With repeated exposure to gastric acid, the esophagus and esophageal mucosa becomes inflamed and irritated causing an inflammatory response. The esophagus then cannot eliminate the refluxed material causing a prolonged exposure of gastric content to the esophageal mucosa (Dunphy, Winland-Brown, Porter, & Thomas, 2011). Clinical Presentation: Subjective: The most typical symptom of GERD is heartburn, ranging from mild to severe and regurgitation. Other associated symptoms include water brash (reflux salivation), dysphagia, sour taste in the mouth in the morning, odynophagia, belching, coughing, hoarseness, and wheezing that usually occurs at night (Dunphy, Winland-Brown, Porter, & Thomas, 2011). Chest pain in the retrosternal or substernal area may also occur, which will then need further evaluation to rule out cardiac origin. Factors that usually make symptoms worse include reclining after eating, eating a large meal, alcohol, chocolate caffeine, nicotine, fatty food, and spicy food ingestion, wearing constrictive clothing, heavy lifting, straining, or working in a bent over position is involved to help determine a diagnosis of GERD (Dunphy, Winland-Brown, Porter, & Thomas, 2011). Objective: The physical exam is usually normal for patients with GERD. The only sign may be a stool positive for occult blood on a rectal exam resulting from microhemmorrhages in the irritated esophageal epithelium (Dunphy, Winland-Brown, Porter, & Thomas, 2011). Publication and Applicability in Primary Care The evidenced based clinical practice guidelines for the Diagnosis and Management of Gastroesophageal Reflux Disease
  • 15. from the American Journal of Gastroenterology was developed by the American College of Gastroenterology and released in March of 2013 with no revisions. The authors are Katz, P. O., Gerson, L. B., and Vela, M. F. The organization or group that developed the clinical practice guidelines is the Nature Publishing Group. These clinical practice guidelines is applicable to primary care in order to properly diagnosis and manage GERD and reduce related complications such as erosive esophagitis, stricture, and Barrett’s esophagus (Katz, Gerson, & Vela, 2013). Key Action Statements & Body of Evidence 5 recommendations applicable in primary care are: 1. A presumptive diagnosis of GERD can be established in the setting of typical symptoms of heartburn and regurgitation and are the most reliable for making a presumptive diagnosis based on history alone. Empiric medical therapy with a PPI is the recommended approach to confirm GERD when it is suspected in patients with typical symptoms. This is a strong recommendation, moderate level of evidence (Katz, Gerson, & Vela, 2013). 2. A cardiac cause should be excluded in patients with chest pain before the commencement of a gastrointestinal evaluation. Non-cardiac chest pain is and associated symptom with the presence of GERD, therefore, cardiac etiology should be ruled out. This is a strong recommendation, moderate level of evidence (Katz, Gerson, & Vela, 2013). 3. Weight loss is recommended for GERD patients who are overweight or have had recent weight gain. This is a conditional recommendation, moderate level of evidence. GERD and obesity have a definite correlation with body mass index, waist circumference, and weight gain (Katz, Gerson, & Vela, 2013). Weight gain with a normal BMI has been associated with new onset of GERD symptoms. It has been shown that there has been a reduction in GERD symptoms with weight loss (Katz, Gerson, & Vela, 2013).
  • 16. 4. Barium radiographs should not be preformed to diagnose GERD. Although barium radiographs detect esophagitis, the sensitivity of this test is very low and is not recommended as a diagnostic test without dysphagia. This is a strong recommendation, high level of evidence (Katz, Gerson, & Vela, 2013). 5. Upper endoscopy is not required in the presence of typical GERD symptoms. Endoscopy is recommended in the presence of alarm symptoms and for screening of patients at high risk for complications (Katz, Gerson, & Vela, 2013). The vast majority of patients with heartburn and regurgitation will not have erosions limiting upper endoscopy as an initial diagnosis test for patients with suspected GERD. (Katz, Gerson, & Vela, 2013). This is a strong recommendation, moderate level of evidence. These statements are applicable to primary care in which present key evidence supporting the recommendations. Application in Clinical Rotation W.S. is a 57-year-old Caucasian obese female who came in on 10/11/18 with chief complaint of intermittent epigastric pain and heartburn x 2 weeks. It progressively worsens after eating, smoking, and drinking coffee. Standing up helps. She tried OTC Tums, which temporarily relieved the discomfort. Discomfort is 4/10 now after eating breakfast and 8/10 at worse. W.S has a past medical history of HTN. She takes lisinpril 10 mg PO daily for hypertension. She has no past surgical history. No allergies. She is married with 2 grown kids and works full time. She states she is not very active and does not engage in much physical activity or daily exercise due to her busy schedule. She states she occasionally smokes cigarettes but is trying to quit completely and drinks alcohol occasionally. She is 5’6” and weights 180 lbs which considers her overweight with a BMI of 29.05. BP 135/65, HR 70, T 36.5, R 18. Abdomen soft, nontender, BS active. Otherwise, normal physical exam.
  • 17. The patient was diagnosed based on the presenting symptom of heartburn, weight, lifestyle, and aggravating factors. The patient was prescribed to take omeprazole 20 mg PO daily and follow up in 2 weeks. Treatment was based on familiarity and it being an over the counter medication. Comparing these actions to the CPG guidelines, Proton pump inhibitors (PPI’s) are considered the most effective medical treatment for GERD. There are seven proton pump inhibitors (PPI’s). Four are over the counter, omeprazole, lansoprazole, esomeprazole, and omeprazole- sodium bicarbonate. Rabeprazole, pantoprazole, and dexlansoprazole are available only by prescription (Dalbir, & Fass, 2018). Esomeprazole showed an 8% increase in probability of GERD symptom relief at 4 weeks of taking (Katz, Gerson, & Vela, 2013). A meta-analysis of these concluded that the newer PPI’s were similar in efficacy in terms of heartburn control, healing esophageal erosions and the relapse rates of GERD (Dalbir, & Fass, 2018). The patient was educated on importance of healthy diet, daily exercise, and weight management. According to the CPG guidelines, weight loss is recommended for GERD patients who are overweight or have had recent weight gain in order to reduce the symptoms of GERD (Katz, Gerson, & Vela, 2013). Reference Dalbir, S. S., & Fass, R. (2018). Current trends in the management of gastroesophageal reflux disease. Gut and Liver 12(1), 7-16. Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2011). Primary care: The art and science of advanced practice nursing (3rd ed.). Philadelphia, PA: F.A. Davis Company. El-Serag, H. B., Sweet, S., Winchester, C. C., & Dent, J. (2014). Update on the epidemiology of gastro-oesophageal reflux disease: A systemic review. Gut 63(6), 871-880.
  • 18. Katz, P. O., Gerson, L. B., & Vela, M. F. (2013). Guidelines for the diagnosis and management of gastroesophageal reflux disease. American Journal of Gastroenterology, 108(3), 308- 328. MUST HAVES THIS ALL Reference not older than 5 years you must have your oral CPG presentation posted by 11:59 PM ALONG WITH a copy of the article and your written transcript. Cystitis Jessica Ruiz – Presenter Gupta, K., Hooton, T., Naber, K., Wullt, B., Colgan, R., et al. (2011). International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases, 52(5), e103- e120. NR511 Clinical Practice Guideline Assignment NR511 Clinical Practice Guideline Assignment Criteria Ratings Pts This criterion is linked to a Learning OutcomeDisease & Background Student: 1) Identifies the disease condition 2) Gives a brief statement of incidence and prevalence in the US 3) The student briefly summarizes the disease pathophysiology and
  • 19. 4) Identifies the typical clinical presentation seen in a patient with the disease (4 critical elements). 15.0 pts Exceptional- Student identifies the disease topic AND Student states the incidence and prevalence in the US AND Student provides a pathophysiology statement AND Student states the typical clinical presentation seen in a patient with the disease. 13.0 pts Exceeds- All four (4) critical elements are present but some information may be only partially addressed or inaccurate. 12.0 pts Meets- One to two (1-2) critical elements are missing. 6.0 pts Needs Improvement- Three (3) critical elements are missing. 0.0 pts Developing- All four (4) critical elements are missing. 15.0 pts This criterion is linked to a Learning OutcomePublication & Applicability in Primary Care The student: 1) Identifies the author, organization or group that developed the CPG, 2) Student denotes the year of the original guideline publication, 3) Student identifies any subsequent revisions (student’s reference should be the most recent version), and 4) Student discusses the applicability for use of this CPG in the primary care setting (4 critical elements). 30.0 pts Exceptional- Student correctly identifies the author(s), organization(s), or group(s) that developed the CPG AND Student states the year of the original CPG guideline AND Student notes all subsequent revisions of the guideline (with the student’s version being the most recent) AND Student discusses how this CPG is applicable to primary care. 26.0 pts Exceeds- All four (4) critical elements are present but some information may be only partially addressed or inaccurate.
  • 20. 24.0 pts Meets- Two (2) critical elements are missing. 12.0 pts Needs Improvement- Three (3) critical elements are missing. 0.0 pts Developing-All four (4) critical elements are missing. 30.0 pts This criterion is linked to a Learning OutcomeKey Action Statements & Body of Evidence The student: 1)Provides each of the CPG’s “Key Action” or “Guideline Statements” up to a maximum of 5 relevant recommendations, 2) Provides the body of evidence strength for each, and 3) If the statement has applicability to other groups, only discuss the relevant primary care ones (3 critical elements). 45.0 pts Exceptional- Student presents a maximum of 5 relevant recommendations AND Student denotes the evidence strength for EACH recommendation AND Student discusses ONLY the ones applicable to primary care 39.0 pts Exceeds- All three (3) critical elements are addressed but some information may be only partially addressed, or not completely accurate 37.0 pts Meets- One (1) critical element is missing. 18.0 pts Needs Improvement- Two (2) critical elements are missing. 0.0 pts Developing- All three (3) critical elements are missing 45.0 pts This criterion is linked to a Learning OutcomeApplication in Clinical 1) Using an example of a patient from their clinical rotation with the same condition, 2) Student discusses how the diagnosis and treatment of their patient compared to the
  • 21. recommendations given in the guidelines, and 3). Specific examples of what was done well or what could have been done better is noted (3 critical elements). 45.0 pts Exceptional- The student uses a patient example from their clinical setting with the same condition AND The student discusses how the diagnosis & treatment of their patient compared to those recommended in the guideline AND Specific examples are given on what was done well or what could have been done better 39.0 pts Exceeds- All three (3) critical elements are addressed but some information may only be partially addressed 37.0 pts Meets- One (1) critical element is missing. 18.0 pts Needs Improvement- Two (2) critical elements are missing. 0.0 pts Developing- All three (3) critical elements are missing 45.0 pts This criterion is linked to a Learning OutcomePresentation 1) The student used PowerPoint and Kaltura and presentation was professional in quality, 2) Slides were well organized and aesthetically pleasing, 3) Student’s narration was understandable and well-paced, 4) References were noted, 5) Presentation was under 15min in length. (5 critical elements). 15.0 pts Exceptional- Student uses Power Point and Kaltura which demonstrates a professional quality AND Student’s slides were well organized AND Student’s narration was understandable and well-paced AND References were noted AND Presentation was <15 minutes 13.0 pts Exceeds- Two (2) critical elements were missing. 12.0 pts
  • 22. Meets- Three (3) critical elements were missing. 6.0 pts Needs Improvement-Four (4) critical elements were missing. 0.0 pts Developing- Five (5) critical elements were missing 15.0 pts Total Points: 150.0