1
[Shortened Title up to 50 Characters] 16Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.
Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.
Duration: 5 to7 days d ...
12SOAP Note Patient with UTIUnited StateEttaBenton28
1
2
SOAP Note Patient with UTI
United State University
FNP xxx: Common Illness Across the Lifespan -Clinical Practicum
Dr. xxxx
SOAP Note Patient with UTI
ID: L.U. a female patient presented to the clinic accompany by self, patient is a reliable historian.
Client’s Initials: L.U
Age :65 years.
Race: African American
Gender: Female
Date of Birth: 08
Insurance: BlueCross BlueShield .
Marital Status: Married
Subjective: “ I have been having pain and burning during urination for two weeks now and the pain goes to my lower abdomen, and I have been unable to hold urine, I now urinate on myself because I can no longer hold it until I get to the bathroom”.
CC: Pain and burning during urination.
HPI:
Patient stated symptoms began within the past two weeks and have worsened over the past seven days. The patient complains of severe pain and burning sensation during urination that radiates to lower abdomen, with urgency. The urine is cloudy and has a foul smell odor. After attempting to pass urine, the pain subsides for a little while, yet it reoccurs. Patient states that she has been sexually active only with the same partner for the past 15 years. On assessment patient reports pain of 8 /10 on pain scale. Patient denies having blood in urine, fever, headache, shortness of breath or chest pain at the moment.
ROS
Constitutional: Patient states she is in good state of health she denies headache , chest pain weakness fever chills, weight loss or gain.
Eyes: Denies double vision, change in vision factors, or blurry vision.
Ears/Nose/Mouth/Throat: denies sore throat, hearing issues, or nose congestion.
Cardiovascular: denies any kind of orthopnea, rapid heart rate, palpitations, or chest pain.
Pulmonary: Denies
Gastrointestinal: c/o moderate to severe pain in the abdominal area.
Genitourinary: acknowledged presence of increase in urgency and frequency of urination. Major pain while urinating for the past ten days.
Musculoskeletal: Denies any kind of pain
Integumentary & breast: Denies issues
Neurological: Denies issues
Psychiatric: Denies any kind of depression or mood swing
Endocrine: Denies having any problem
Hematologic/Lymphatic: Denies
Allergic/Immunologic: No Known allergy
Past Medical History:
· Medical problem list: patient denies having any major illnesses and only reports headaches and sometimes common seasonal allergy or cold.
· Denies history of chronic medical problems with father or mother.
· Preventative care: None indicated
· Surgeries: Denies
· Hospitalizations: Denies
· LMP: Patient states she do have a 28 days menstrual cycle and the last cycle was 2 weeks ago. She has had three pregnancies and three cesarean section.
Allergies: No known food or drug allergy
· Medications: Patient takes only Centrum vitamins and sometimes Tylenol for headache. Family History: Patient’s mother has hypertension that she manages by taking daily medication and exercising. The patient’s father has hypertension too a ...
1
2
SOAP Note Patient with UTI
United State University
FNP xxx: Common Illness Across the Lifespan -Clinical Practicum
Dr. xxxx
SOAP Note Patient with UTI
ID: L.U. a female patient presented to the clinic accompany by self, patient is a reliable historian.
Client’s Initials: L.U
Age :65 years.
Race: African American
Gender: Female
Date of Birth: 08
Insurance: BlueCross BlueShield .
Marital Status: Married
Subjective: “ I have been having pain and burning during urination for two weeks now and the pain goes to my lower abdomen, and I have been unable to hold urine, I now urinate on myself because I can no longer hold it until I get to the bathroom”.
CC: Pain and burning during urination.
HPI:
Patient stated symptoms began within the past two weeks and have worsened over the past seven days. The patient complains of severe pain and burning sensation during urination that radiates to lower abdomen, with urgency. The urine is cloudy and has a foul smell odor. After attempting to pass urine, the pain subsides for a little while, yet it reoccurs. Patient states that she has been sexually active only with the same partner for the past 15 years. On assessment patient reports pain of 8 /10 on pain scale. Patient denies having blood in urine, fever, headache, shortness of breath or chest pain at the moment.
ROS
Constitutional: Patient states she is in good state of health she denies headache , chest pain weakness fever chills, weight loss or gain.
Eyes: Denies double vision, change in vision factors, or blurry vision.
Ears/Nose/Mouth/Throat: denies sore throat, hearing issues, or nose congestion.
Cardiovascular: denies any kind of orthopnea, rapid heart rate, palpitations, or chest pain.
Pulmonary: Denies
Gastrointestinal: c/o moderate to severe pain in the abdominal area.
Genitourinary: acknowledged presence of increase in urgency and frequency of urination. Major pain while urinating for the past ten days.
Musculoskeletal: Denies any kind of pain
Integumentary & breast: Denies issues
Neurological: Denies issues
Psychiatric: Denies any kind of depression or mood swing
Endocrine: Denies having any problem
Hematologic/Lymphatic: Denies
Allergic/Immunologic: No Known allergy
Past Medical History:
· Medical problem list: patient denies having any major illnesses and only reports headaches and sometimes common seasonal allergy or cold.
· Denies history of chronic medical problems with father or mother.
· Preventative care: None indicated
· Surgeries: Denies
· Hospitalizations: Denies
· LMP: Patient states she do have a 28 days menstrual cycle and the last cycle was 2 weeks ago. She has had three pregnancies and three cesarean section.
Allergies: No known food or drug allergy
· Medications: Patient takes only Centrum vitamins and sometimes Tylenol for headache. Family History: Patient’s mother has hypertension that she manages by taking daily medication and exercising. The patient’s father has hypertension too a ...
Nursing Process – SAMPLE Nursing DiagnosisNANDA (North American .docxkendalfarrier
Nursing Process – SAMPLE Nursing Diagnosis
NANDA (North American Nursing Diagnosis)
Chronic Painrelated to unknown etiology
as evidenced by self-reports of pain “I feel pain when sitting or lying down mostly at night” using a standardized pain scale, 4/10 on a 0 to 10 numeric rating scale. The patient reports an altered sleep-wake cycle.
Patient Goal/Outcome
Interventions
Rationale for Interventions
Evaluation of Each Goal/Intervention
1)The Patient’s pain will reduce and her sleep will promote by using nonpharmacological methods such as supplements or enhance pharmacological interventions within the next three months.
1a) RN will in addition to administering analgesics, support the client's use of nonpharmacological methods to help
control pain, such as distraction, imagery, relaxation, and application of heat and cold.
1b) RN will ask the client to describe prior experiences with pain, effectiveness of pain management interventions,
responses to analgesic medications (including occurrence of side effects), and concerns about pain and
its treatment (e.g., fear about addiction, worries, anxiety) and informational needs.
1a) Evidence
suggested efficacy and satisfaction when complementary therapies are integrated into pain treatment plans of
older adults (Bruckenthal, 2016 as cited in Ackley et al., 2022, p. 723).
1b) Sleep disturbance and decreased physical activity are adverse
effects of people with chronic pain. In a study of clients with chronic pain, those who participated in a 4 week
multiprofessional program that included psychoeducation and training related to pain, sleep, exercise, and
activity training had improvement in sleep quality and pain intensity (de la Vega, 2019, as cited in Ackley et al., 2022, p. 721).
1a) Goal partially met. Patient’s pain decreased to level 2/10, with relaxation therapy such as meditation and usage of heat pads.
1b) Goal met. Patients starts to drink Valerian root tea and states “It reduced the amount of time takes me to fall asleep and helped me sleep better.”
Health history assignment part 1
Section 1: Biographic Data
N.V is a 46-year-old married Iranian woman, who currently is a full-time financial manager at BMW company. She speaks fluent English and does not require an interpreter.
Section 2: Source of History
The patient provides the information herself. The patient seems reliable, as she is alert and oriented.
Section 3: Reason for Seeking Care
The patient states, “I am really exhausted and want to get rid of my leg pain. I have severe pain in my thighs and legs and it started six years ago.”
Section 4: History of Present Illness (HPI)
The patient’s thigh and leg pain began six years prior to the interview. Her pain started following the birth of her second child. The patient has frequent episodes, the last being three days ago. It has never been resolved. It is specially located in the thighs and .
Soap Note 2 Chronic Conditions
Soap Note Chronic Conditions (15 Points)
Pick any Chronic Disease from Weeks 6-10
Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)
Follow the MRU Soap Note Rubric as a guide
Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement
SOAP NOTE SAMPLE FORMAT FOR MRC
Name:
LP
Date:
Time:
1315
Age:
30
Sex:
F
SUBJECTIVE
CC:
“I am having vaginal itching and pain in my lower abdomen.”
HPI:
Pt is a 30y/o AA female, who is a new patient that has recently moved to Miami. She seeks treatment today after unsuccessful self-treatment of vaginal itching, burning upon urination, and lower abdominal pain. She is concerned for the presence of a vaginal or bladder infection, or an STD. Pt denies fever. She reports the itching and burning with urination has been present for 3 weeks, and the abdominal pain has been intermittent since months ago. Pt has tried OTC products for the itching, including Monistat and Vagisil. She denies any other urinary symptoms, including urgency or frequency. She describes the abdominal pain as either sharp or dull. The pain level goes as high as 8 out of 10 at times. 200mg of PO Advil PRN reduces the pain to a 7/10. Pt denies any aggravating factors for the pain. Pt reports that she did start her menstrual cycle this morning, but denies any other discharge other that light bleeding beginning today. Pt denies douching or the use of any vaginal irritants. She reports that she is in a stable sexual relationship, and denies any new sexual partners in the last 90 days. She denies any recent or historic known exposure to STDs. She reports the use of condoms with every coital experience, as well as this being her only form of contraceptive. She reports normal monthly menstrual cycles that last 3-4 days. She reports dysmenorrhea, which she also takes Advil for. She reports her last PAP smear was in 7/2016, was normal, and reports never having an abnormal PAP smear result. Pt denies any hx of pregnancies. Other medical hx includes GERD. She reports that she has an Rx for Protonix, but she does not take it every day. Her family hx includes the presence of DM and HTN.
Current Medications:
Protonix 40mg PO Daily for GERD
MTV OTC PO Daily
Advil 200mg OTC PO PRN for pain
PMHx:
Allergies:
NKA & NKDA
Medication Intolerances:
Denies
Chronic Illnesses/Major traumas
GERD
Hospitalizations/Surgeries
Denies
Family History
Father- DM & HTN; Mother- HTN; Older sister- DM & HTN; Maternal and paternal grandparents without known medical issues; 1 brother and 3 other sisters without known med ...
SOAP NOTE
Name: J.D.
Date: 03/26/2020
Time: 2:00 pm
Age: 25 y/o
Sex: F
SUBJECTIVE
CC:
” I have a lot of pain on my left side, in my lower belly”
HPI: J.D. is a 25-year-old white female that came to the office today complaining of pain in her lower abdomen. The patient has always had painful cramps with her periods but this time it is much worse being described as a 6 out of 10 and lasting up to 5 hours. The pain started 2 days ago. The pain is described as more painful cramps. It is debilitating and prevents the patient from performing most daily activities. It is localized in the lower abdominal area, and sometimes radiates down her legs, and to her lower back. The patient uses hot compresses to relieve the pain as Tylenol does not work. The patient also states that she has been feeling nauseous ever since the pain started. She also urinates more frequently and pain on urination. Denies fever, vomiting, or chills.
Medications:
2 Tylenol as needed for her pain
PMH (include-immunization status including Gardisil, GTPLA).
Current or past illnesses: No current or past illnesses
Immunizations: All vaccines updated including flu vaccine and Gardasil.
Allergies: NKDA
Medication Intolerances: None.
Chronic Illnesses/Major traumas: None.
Hospitalizations/Surgeries (include delivery of pregnancies here)
No hospitalizations.
G0P0
Family History
Mother: 49 years old, no significant health problems
Maternal Side: No significant health problems
Father: 50 years old, hypertensive
Paternal Side: no significant health problems
Social History
Patient works full-time as a research assistant at a local university. A full-time student seeking a master’s degree in biochemistry at a local university. Married. Sexually active only with husband. Always uses male condoms as contraceptive device. Does not use recreational drugs, tobacco, or electronic cigarettes. Devout follower of Christianity. Denomination: catholic.
ROS
General Patient denies fever or chills, no weight changes.
Cardiovascular Denies chest pain, or discomfort. Denies palpitations, dyspnea, or orthopnea.
Skin: Denies presences of moles, rash, or itching.
Respiratory: Denies dyspnea, cough, hemoptysis, or pleuritic pains.
Eyes Denies problems or changes in her vision; denies double or blurred vision.
Gastrointestinal Positive for nausea.Denies hemorrhoids, constipation, or diarrhea. No variation in bowel habits. Denies vomiting.
Ears Denies difficulty or changes in his hearing. Denies tinnitus, or discharges.
Genitourinary/Gynecological Menarche 11 years old. Regular menstrual periods starting around the 3rd week of every month. LMP: 03.
12SOAP Note Patient with UTIUnited StateEttaBenton28
1
2
SOAP Note Patient with UTI
United State University
FNP xxx: Common Illness Across the Lifespan -Clinical Practicum
Dr. xxxx
SOAP Note Patient with UTI
ID: L.U. a female patient presented to the clinic accompany by self, patient is a reliable historian.
Client’s Initials: L.U
Age :65 years.
Race: African American
Gender: Female
Date of Birth: 08
Insurance: BlueCross BlueShield .
Marital Status: Married
Subjective: “ I have been having pain and burning during urination for two weeks now and the pain goes to my lower abdomen, and I have been unable to hold urine, I now urinate on myself because I can no longer hold it until I get to the bathroom”.
CC: Pain and burning during urination.
HPI:
Patient stated symptoms began within the past two weeks and have worsened over the past seven days. The patient complains of severe pain and burning sensation during urination that radiates to lower abdomen, with urgency. The urine is cloudy and has a foul smell odor. After attempting to pass urine, the pain subsides for a little while, yet it reoccurs. Patient states that she has been sexually active only with the same partner for the past 15 years. On assessment patient reports pain of 8 /10 on pain scale. Patient denies having blood in urine, fever, headache, shortness of breath or chest pain at the moment.
ROS
Constitutional: Patient states she is in good state of health she denies headache , chest pain weakness fever chills, weight loss or gain.
Eyes: Denies double vision, change in vision factors, or blurry vision.
Ears/Nose/Mouth/Throat: denies sore throat, hearing issues, or nose congestion.
Cardiovascular: denies any kind of orthopnea, rapid heart rate, palpitations, or chest pain.
Pulmonary: Denies
Gastrointestinal: c/o moderate to severe pain in the abdominal area.
Genitourinary: acknowledged presence of increase in urgency and frequency of urination. Major pain while urinating for the past ten days.
Musculoskeletal: Denies any kind of pain
Integumentary & breast: Denies issues
Neurological: Denies issues
Psychiatric: Denies any kind of depression or mood swing
Endocrine: Denies having any problem
Hematologic/Lymphatic: Denies
Allergic/Immunologic: No Known allergy
Past Medical History:
· Medical problem list: patient denies having any major illnesses and only reports headaches and sometimes common seasonal allergy or cold.
· Denies history of chronic medical problems with father or mother.
· Preventative care: None indicated
· Surgeries: Denies
· Hospitalizations: Denies
· LMP: Patient states she do have a 28 days menstrual cycle and the last cycle was 2 weeks ago. She has had three pregnancies and three cesarean section.
Allergies: No known food or drug allergy
· Medications: Patient takes only Centrum vitamins and sometimes Tylenol for headache. Family History: Patient’s mother has hypertension that she manages by taking daily medication and exercising. The patient’s father has hypertension too a ...
1
2
SOAP Note Patient with UTI
United State University
FNP xxx: Common Illness Across the Lifespan -Clinical Practicum
Dr. xxxx
SOAP Note Patient with UTI
ID: L.U. a female patient presented to the clinic accompany by self, patient is a reliable historian.
Client’s Initials: L.U
Age :65 years.
Race: African American
Gender: Female
Date of Birth: 08
Insurance: BlueCross BlueShield .
Marital Status: Married
Subjective: “ I have been having pain and burning during urination for two weeks now and the pain goes to my lower abdomen, and I have been unable to hold urine, I now urinate on myself because I can no longer hold it until I get to the bathroom”.
CC: Pain and burning during urination.
HPI:
Patient stated symptoms began within the past two weeks and have worsened over the past seven days. The patient complains of severe pain and burning sensation during urination that radiates to lower abdomen, with urgency. The urine is cloudy and has a foul smell odor. After attempting to pass urine, the pain subsides for a little while, yet it reoccurs. Patient states that she has been sexually active only with the same partner for the past 15 years. On assessment patient reports pain of 8 /10 on pain scale. Patient denies having blood in urine, fever, headache, shortness of breath or chest pain at the moment.
ROS
Constitutional: Patient states she is in good state of health she denies headache , chest pain weakness fever chills, weight loss or gain.
Eyes: Denies double vision, change in vision factors, or blurry vision.
Ears/Nose/Mouth/Throat: denies sore throat, hearing issues, or nose congestion.
Cardiovascular: denies any kind of orthopnea, rapid heart rate, palpitations, or chest pain.
Pulmonary: Denies
Gastrointestinal: c/o moderate to severe pain in the abdominal area.
Genitourinary: acknowledged presence of increase in urgency and frequency of urination. Major pain while urinating for the past ten days.
Musculoskeletal: Denies any kind of pain
Integumentary & breast: Denies issues
Neurological: Denies issues
Psychiatric: Denies any kind of depression or mood swing
Endocrine: Denies having any problem
Hematologic/Lymphatic: Denies
Allergic/Immunologic: No Known allergy
Past Medical History:
· Medical problem list: patient denies having any major illnesses and only reports headaches and sometimes common seasonal allergy or cold.
· Denies history of chronic medical problems with father or mother.
· Preventative care: None indicated
· Surgeries: Denies
· Hospitalizations: Denies
· LMP: Patient states she do have a 28 days menstrual cycle and the last cycle was 2 weeks ago. She has had three pregnancies and three cesarean section.
Allergies: No known food or drug allergy
· Medications: Patient takes only Centrum vitamins and sometimes Tylenol for headache. Family History: Patient’s mother has hypertension that she manages by taking daily medication and exercising. The patient’s father has hypertension too a ...
Nursing Process – SAMPLE Nursing DiagnosisNANDA (North American .docxkendalfarrier
Nursing Process – SAMPLE Nursing Diagnosis
NANDA (North American Nursing Diagnosis)
Chronic Painrelated to unknown etiology
as evidenced by self-reports of pain “I feel pain when sitting or lying down mostly at night” using a standardized pain scale, 4/10 on a 0 to 10 numeric rating scale. The patient reports an altered sleep-wake cycle.
Patient Goal/Outcome
Interventions
Rationale for Interventions
Evaluation of Each Goal/Intervention
1)The Patient’s pain will reduce and her sleep will promote by using nonpharmacological methods such as supplements or enhance pharmacological interventions within the next three months.
1a) RN will in addition to administering analgesics, support the client's use of nonpharmacological methods to help
control pain, such as distraction, imagery, relaxation, and application of heat and cold.
1b) RN will ask the client to describe prior experiences with pain, effectiveness of pain management interventions,
responses to analgesic medications (including occurrence of side effects), and concerns about pain and
its treatment (e.g., fear about addiction, worries, anxiety) and informational needs.
1a) Evidence
suggested efficacy and satisfaction when complementary therapies are integrated into pain treatment plans of
older adults (Bruckenthal, 2016 as cited in Ackley et al., 2022, p. 723).
1b) Sleep disturbance and decreased physical activity are adverse
effects of people with chronic pain. In a study of clients with chronic pain, those who participated in a 4 week
multiprofessional program that included psychoeducation and training related to pain, sleep, exercise, and
activity training had improvement in sleep quality and pain intensity (de la Vega, 2019, as cited in Ackley et al., 2022, p. 721).
1a) Goal partially met. Patient’s pain decreased to level 2/10, with relaxation therapy such as meditation and usage of heat pads.
1b) Goal met. Patients starts to drink Valerian root tea and states “It reduced the amount of time takes me to fall asleep and helped me sleep better.”
Health history assignment part 1
Section 1: Biographic Data
N.V is a 46-year-old married Iranian woman, who currently is a full-time financial manager at BMW company. She speaks fluent English and does not require an interpreter.
Section 2: Source of History
The patient provides the information herself. The patient seems reliable, as she is alert and oriented.
Section 3: Reason for Seeking Care
The patient states, “I am really exhausted and want to get rid of my leg pain. I have severe pain in my thighs and legs and it started six years ago.”
Section 4: History of Present Illness (HPI)
The patient’s thigh and leg pain began six years prior to the interview. Her pain started following the birth of her second child. The patient has frequent episodes, the last being three days ago. It has never been resolved. It is specially located in the thighs and .
Soap Note 2 Chronic Conditions
Soap Note Chronic Conditions (15 Points)
Pick any Chronic Disease from Weeks 6-10
Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)
Follow the MRU Soap Note Rubric as a guide
Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement
SOAP NOTE SAMPLE FORMAT FOR MRC
Name:
LP
Date:
Time:
1315
Age:
30
Sex:
F
SUBJECTIVE
CC:
“I am having vaginal itching and pain in my lower abdomen.”
HPI:
Pt is a 30y/o AA female, who is a new patient that has recently moved to Miami. She seeks treatment today after unsuccessful self-treatment of vaginal itching, burning upon urination, and lower abdominal pain. She is concerned for the presence of a vaginal or bladder infection, or an STD. Pt denies fever. She reports the itching and burning with urination has been present for 3 weeks, and the abdominal pain has been intermittent since months ago. Pt has tried OTC products for the itching, including Monistat and Vagisil. She denies any other urinary symptoms, including urgency or frequency. She describes the abdominal pain as either sharp or dull. The pain level goes as high as 8 out of 10 at times. 200mg of PO Advil PRN reduces the pain to a 7/10. Pt denies any aggravating factors for the pain. Pt reports that she did start her menstrual cycle this morning, but denies any other discharge other that light bleeding beginning today. Pt denies douching or the use of any vaginal irritants. She reports that she is in a stable sexual relationship, and denies any new sexual partners in the last 90 days. She denies any recent or historic known exposure to STDs. She reports the use of condoms with every coital experience, as well as this being her only form of contraceptive. She reports normal monthly menstrual cycles that last 3-4 days. She reports dysmenorrhea, which she also takes Advil for. She reports her last PAP smear was in 7/2016, was normal, and reports never having an abnormal PAP smear result. Pt denies any hx of pregnancies. Other medical hx includes GERD. She reports that she has an Rx for Protonix, but she does not take it every day. Her family hx includes the presence of DM and HTN.
Current Medications:
Protonix 40mg PO Daily for GERD
MTV OTC PO Daily
Advil 200mg OTC PO PRN for pain
PMHx:
Allergies:
NKA & NKDA
Medication Intolerances:
Denies
Chronic Illnesses/Major traumas
GERD
Hospitalizations/Surgeries
Denies
Family History
Father- DM & HTN; Mother- HTN; Older sister- DM & HTN; Maternal and paternal grandparents without known medical issues; 1 brother and 3 other sisters without known med ...
SOAP NOTE
Name: J.D.
Date: 03/26/2020
Time: 2:00 pm
Age: 25 y/o
Sex: F
SUBJECTIVE
CC:
” I have a lot of pain on my left side, in my lower belly”
HPI: J.D. is a 25-year-old white female that came to the office today complaining of pain in her lower abdomen. The patient has always had painful cramps with her periods but this time it is much worse being described as a 6 out of 10 and lasting up to 5 hours. The pain started 2 days ago. The pain is described as more painful cramps. It is debilitating and prevents the patient from performing most daily activities. It is localized in the lower abdominal area, and sometimes radiates down her legs, and to her lower back. The patient uses hot compresses to relieve the pain as Tylenol does not work. The patient also states that she has been feeling nauseous ever since the pain started. She also urinates more frequently and pain on urination. Denies fever, vomiting, or chills.
Medications:
2 Tylenol as needed for her pain
PMH (include-immunization status including Gardisil, GTPLA).
Current or past illnesses: No current or past illnesses
Immunizations: All vaccines updated including flu vaccine and Gardasil.
Allergies: NKDA
Medication Intolerances: None.
Chronic Illnesses/Major traumas: None.
Hospitalizations/Surgeries (include delivery of pregnancies here)
No hospitalizations.
G0P0
Family History
Mother: 49 years old, no significant health problems
Maternal Side: No significant health problems
Father: 50 years old, hypertensive
Paternal Side: no significant health problems
Social History
Patient works full-time as a research assistant at a local university. A full-time student seeking a master’s degree in biochemistry at a local university. Married. Sexually active only with husband. Always uses male condoms as contraceptive device. Does not use recreational drugs, tobacco, or electronic cigarettes. Devout follower of Christianity. Denomination: catholic.
ROS
General Patient denies fever or chills, no weight changes.
Cardiovascular Denies chest pain, or discomfort. Denies palpitations, dyspnea, or orthopnea.
Skin: Denies presences of moles, rash, or itching.
Respiratory: Denies dyspnea, cough, hemoptysis, or pleuritic pains.
Eyes Denies problems or changes in her vision; denies double or blurred vision.
Gastrointestinal Positive for nausea.Denies hemorrhoids, constipation, or diarrhea. No variation in bowel habits. Denies vomiting.
Ears Denies difficulty or changes in his hearing. Denies tinnitus, or discharges.
Genitourinary/Gynecological Menarche 11 years old. Regular menstrual periods starting around the 3rd week of every month. LMP: 03.
1) Naïve T cells have the potential to differentiate into several MartineMccracken314
1) Naïve T cells have the potential to differentiate into several types of effector cells. In the space below, describe the roles and activities of each of these cells:
TH1 cells
TH2 cells
TH17 cells
TFH cells
2) Use the following diagram to compare and contrast systemic immunity and mucosal immunity.
Systemic
Both Systemic and Mucosal
Mucosal
ordinary surface epithelia
Why is there a need for these differences in the first place?
CDC Sexually Transmitted Diseases Case Study.
Read the patient case study below
General:
The patient is a young seventeen-year-old female who came to the clinic with complaint of abdominal pain.
Chief Complaint:
Kim reports "I've been having pain in my stomach for several weeks." She describes the pain as being sharp and being constant. She stated the pain often occurs on both sides of her lower abdominal. She has been experiencing the pain for the past two weeks. The pain has gotten worse since then.
Reliability and Source of History:
The patient is alert and oriented and able to answer most of the questions.
Source & Reliability of History:
O – "I have been having pain in my stomach for several weeks now.” she stated that the pain has lasted for two weeks without any relief.
L – Both sides of her lower stomach
D – The patient reported that she has been having this bilateral lower stomach pain for the last two weeks, However, the symptoms got worse since the pain started ago.
C – She stated that since the onset of the pain, her pain has remained constant without any relieve and aggravating factor. The pain is firm regardless of the time or day or event. She further stated that her symptoms get worse. The patient states that she is unaware of what caused the pain or how the pain started; however, she stated that taking pills could relieve her stomach pain and stop her bleeding
A – She stated that the pain remains constant. She also stated that she is unaware of what caused the pain or how the pain started.
R – She stated that the pain remains steady and does not go away or radiate to other areas.
T- she reported feeling uncomfortable doing her regular shores due to the pain.
Past Medical history:
Patient is asthmatic; however, her asthma is under control. She knows known history of any other condition or never been hospitalized.
Family History:
She is the second in a family of four who are all alive and healthy. There is no history of any chronic condition in the family.
Social History:
Patient is a regularly active young woman; she is single and does moderately active exercise. However, she stated that her daily activity and chores has recently reduced due to her recent symptoms of pain. She also stated to have no appetite secondary to her recent pain. She also stated that her stress level may be related with her college. She has no history of alcohol, smoking, or had never smoked in her life. She has not used any ...
1) Naïve T cells have the potential to differentiate into several AbbyWhyte974
1) Naïve T cells have the potential to differentiate into several types of effector cells. In the space below, describe the roles and activities of each of these cells:
TH1 cells
TH2 cells
TH17 cells
TFH cells
2) Use the following diagram to compare and contrast systemic immunity and mucosal immunity.
Systemic
Both Systemic and Mucosal
Mucosal
ordinary surface epithelia
Why is there a need for these differences in the first place?
CDC Sexually Transmitted Diseases Case Study.
Read the patient case study below
General:
The patient is a young seventeen-year-old female who came to the clinic with complaint of abdominal pain.
Chief Complaint:
Kim reports "I've been having pain in my stomach for several weeks." She describes the pain as being sharp and being constant. She stated the pain often occurs on both sides of her lower abdominal. She has been experiencing the pain for the past two weeks. The pain has gotten worse since then.
Reliability and Source of History:
The patient is alert and oriented and able to answer most of the questions.
Source & Reliability of History:
O – "I have been having pain in my stomach for several weeks now.” she stated that the pain has lasted for two weeks without any relief.
L – Both sides of her lower stomach
D – The patient reported that she has been having this bilateral lower stomach pain for the last two weeks, However, the symptoms got worse since the pain started ago.
C – She stated that since the onset of the pain, her pain has remained constant without any relieve and aggravating factor. The pain is firm regardless of the time or day or event. She further stated that her symptoms get worse. The patient states that she is unaware of what caused the pain or how the pain started; however, she stated that taking pills could relieve her stomach pain and stop her bleeding
A – She stated that the pain remains constant. She also stated that she is unaware of what caused the pain or how the pain started.
R – She stated that the pain remains steady and does not go away or radiate to other areas.
T- she reported feeling uncomfortable doing her regular shores due to the pain.
Past Medical history:
Patient is asthmatic; however, her asthma is under control. She knows known history of any other condition or never been hospitalized.
Family History:
She is the second in a family of four who are all alive and healthy. There is no history of any chronic condition in the family.
Social History:
Patient is a regularly active young woman; she is single and does moderately active exercise. However, she stated that her daily activity and chores has recently reduced due to her recent symptoms of pain. She also stated to have no appetite secondary to her recent pain. She also stated that her stress level may be related with her college. She has no history of alcohol, smoking, or had never smoked in her life. She has not used any ...
Except in association with molar or hydropic degeneration of the placenta, with or without a coexistent fetus, eclampsia before 20 weeks of gestation is rare and only few cases have been described. The case reported was that of a 24 year old primipara who had tonic-clonic seizures at 19 weeks gestation without prior Preeclampsia. She remained stable and was managed closely up to 36 weeks gestation. She had spontaneous vaginal delivery of a live baby at 38 weeks with good outcome. Atypical eclampsia may develop before 20 weeks of gestation and could pose serious management challenges. Such patients if carefully selected and closely monitored may have satisfactory outcome. This case deserves reporting because of its rare nature as several literature search did not reveal any reported case of eclampsia before 20 weeks that was successfully managed to term.
Case Study Report on PIH and Severe Pre eclampsiaRashmi Regmi
it is a case study report on PIH and Severe Pre eclampsia
I did when I was posted on Kist Medical TEaching Hospital for Midwifery Practicum
Prepared by:
Rashmi Regmi
B Sc Nursing
Manmohan Memorial Institute Of health Sciences
CC I have itchy white discharge”HPI Patient is a 32 African.docxtroutmanboris
CC: "I have itchy white discharge”
HPI: Patient is a 32 African American female who reports having increased vaginal itching and discharge times 2 days. She states that her vagina feels irritated and that the itch is progressively getting worst. She reports a thick white cottage cheese discharge is present. She reports that she used a Monistat 3 day 6 days ago but hasn't had any relief. She states that the pain is worst after sex.
PMH: Patient denies having any past medical history. She denies any past traumas or hospitalizations.
PSH: Patient denies having a history of trauma. Patient denies having any surgical history.
Allergies: Patient denies having allergies to latex, food or any medications.
Medications: Patient reports she is currently on no medications.
Social history: Patient reports that her entire family lives nearby. She states that she lives in a two-bedroom apartment alone. States that she drinks 3 glasses of 8oz glasses of wine with friends twice a week. Denies recreational drug use. Denies tobacco use. Reports that she is single. She denies having any new sex partners during the last 3 years. She states that she drinks 1 8oz cups of coffee daily. She reports that she has worked as a real estate agent for the last 2years. Reports no job-related stressors.
Family History: Patient reports that her mother is a live and has a medical history of that she was diagnosed with anxiety and depression at the age of 35. She states her father has a medical history of depression which he was diagnosed with at age 45. She reports her maternal grandmother had a history of COPD and CHF. She reports her maternal grandmother died from complications of chronic kidney disease at the age of 80. She reports that her maternal grandfather had a medical history of hypertension, she reports he is still alive at 88. Patient reports her paternal grandmother has a medical history of CHF and diabetes mellitus type 2. She reports her paternal grandmother is still alive at 85 but has dementia She states paternal grandfather had a medical history of COPD and CHF, she reports he died at age 85 from complications of diabetes mellitus type 2. She has two older sister who both have no medical history.
Health Promotion/Maintenace: Patient reports she had a flu shot in September 2017 in a private doctor's office. Reports she had a TDAP booster in 2014. Based on the patients age USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. Reports she had a std screen 2 years ago. She reports that she has never had an abnormal pap smear. She states STD screen was negative. Reports she had a pap 4 years ago. She reports she does monthly self-breast exams at home. She reports that she eats 2 times daily. Reports she eats well balanced nutritious meals for each meal. She reportedly drinks approximately 30oz of water a day.
General: Patient reports having, fever, chills, and malaise
Skin: Pat.
1
Health History
2
Health History
Health History
Name
Global Health College
Health Assessment
10/16/2015
Date __10/5/2015___
Examiner M. A.
1. Biographical Data
Initials __AM__ Phone __3017934596____
Address ___7001 96 Avenue, Lanham MD 20706
Birth date 07/28/1980 Birthplace Limbe, Cameroon___
Age __35__ Gender __Female__ Marital Status _Married__ Occupation _Nurse__
Race/ethnic origin __Black/Cameroon__ Employer __Karen For Kids Inc.__
2. Source and Reliability: The source of information is reliable because it is provided by the patient herself.
3. Reason for Seeking Care: Patient is seeking help because she has been having persistent diarrhea and abdominal cramps for two days.
4. Present Health or Health of Present Illness: Diarrhea and abdominal cramps.
Patient AM, came to the hospital at 4pm on 10/5/2015, complaining of persistent diarrhea and generalized abdominal cramps. She states that her illness started after she came back from a family swimming picnic on 10/2/2015 at 7pm. She states that her illness started with generalized abdominal cramping that was followed with her passing watery non-tarry stool with no foul smell. She says she has been having 5 episodes of diarrhea each day for two days. Patient also states that her illness is triggered when she eats any food or when she wants to do her daily exercise. Patient states she feels a little weak. Patient added that she has also taken Over The Counter (OTC) Imodium 4mg twice a day for two days but doesn’t feel any better. That is why she came to the hospital today for help.
5. Past Health
Ms AM says she has been healthy over the past years, except for today when she complains of diarrhea and abdominal cramps. She denies having any past history of childhood illnesses: measles, chicken pox, mumps, meningitis, impetigo. Patient confirms haven had pink eye at age 10years old, which was treated with some home remedies (soaked clean compress and OTC eye drop called artificial tears). Patient says she had a minor nose injury at age 12 years that was treated by her pediatrician with pain medication. Patient denies having history of any chronic illness: diabetes, hypertension, asthma, cancer, Congestive Heart Failure (CHF), Coronary Artery Disease (CAD), or stroke.
Patient denies haven been hospitalized before except during delivery. She also denies having any surgical procedures. Patient states that she has been pregnant three times, and she has three babies, two boys and one girl. She went ahead to say she had no premature procedures, delivery, abortion, or miscarriage. She added that all of her babies were carried full term and delivered after 9 months. of pregnancy. She labored for 4 hours for her first baby who was a boy, and 3 hours each for both second and third babies, a boy and a girl consecutively. She said her first baby weighed 7lbs and the other two weighed 8lbs each. All her three babies were delivered .
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Guidelines for assignment
This is an individual assignment
Ground your answer in relevant theory
Plagiarism and reproduction of someone else’s work as your own will be penalized
Make use of references, where appropriate – Use Harvard or APA referencing method.
Late submission are not accepted
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Structural elements should include an introduction, main body, and a conclusion
Weight – 50%
Word count guidance : part 1 – N/A. Business report wordage should be 2000 +/-10%
Type of assignment: Excel Assessed Work Folder and Business Report
Start / Finish : Week 3 – 4
Learning Outcome Assessed: 1,2,3,4
Submit one single document and not lots of different files.
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November ...
Nonclassified DataIn order to maintain transparency and et.docxhallettfaustina
Nonclassified Data
In order to maintain transparency and ethical standards of research, researchers may file a Freedom of Information Act (FOIA) request to obtain all nonclassified data on a subject. Why is this legislation important? Do you think it is working? Why or why not.
Crime Mapping
Crime mapping has been used for
intelligence-led policing
: using data, analysis, and criminal theory to guide police allocation and decision making. Give some examples of ways this is used in your community. Explain if it is working. What are some other ways that you think it should be used in your Community? Give examples and how it would be effective in policing.
Importance of Reviewing Communications
Describe a situation when you may have sent something electronically (email) or turned something in when the lack of review or proofreading was brought to your attention by yourself or others. Discuss any repercussions you faced due to the communication not being reviewed. Explain the importance of reviewing any form of communication prior to disseminating it.
Who Reviews Your Work?
In our everyday life (school, work, or home) we use some form of communication. Who reviews your communication before it is sent, or do you review the communication of others and your own? Describe how you would ensure the communication is “good to go” or ready to disseminate to others.
.
More Related Content
Similar to 1[Shortened Title up to 50 Characters]16Week 9 Assignment.docx
1) Naïve T cells have the potential to differentiate into several MartineMccracken314
1) Naïve T cells have the potential to differentiate into several types of effector cells. In the space below, describe the roles and activities of each of these cells:
TH1 cells
TH2 cells
TH17 cells
TFH cells
2) Use the following diagram to compare and contrast systemic immunity and mucosal immunity.
Systemic
Both Systemic and Mucosal
Mucosal
ordinary surface epithelia
Why is there a need for these differences in the first place?
CDC Sexually Transmitted Diseases Case Study.
Read the patient case study below
General:
The patient is a young seventeen-year-old female who came to the clinic with complaint of abdominal pain.
Chief Complaint:
Kim reports "I've been having pain in my stomach for several weeks." She describes the pain as being sharp and being constant. She stated the pain often occurs on both sides of her lower abdominal. She has been experiencing the pain for the past two weeks. The pain has gotten worse since then.
Reliability and Source of History:
The patient is alert and oriented and able to answer most of the questions.
Source & Reliability of History:
O – "I have been having pain in my stomach for several weeks now.” she stated that the pain has lasted for two weeks without any relief.
L – Both sides of her lower stomach
D – The patient reported that she has been having this bilateral lower stomach pain for the last two weeks, However, the symptoms got worse since the pain started ago.
C – She stated that since the onset of the pain, her pain has remained constant without any relieve and aggravating factor. The pain is firm regardless of the time or day or event. She further stated that her symptoms get worse. The patient states that she is unaware of what caused the pain or how the pain started; however, she stated that taking pills could relieve her stomach pain and stop her bleeding
A – She stated that the pain remains constant. She also stated that she is unaware of what caused the pain or how the pain started.
R – She stated that the pain remains steady and does not go away or radiate to other areas.
T- she reported feeling uncomfortable doing her regular shores due to the pain.
Past Medical history:
Patient is asthmatic; however, her asthma is under control. She knows known history of any other condition or never been hospitalized.
Family History:
She is the second in a family of four who are all alive and healthy. There is no history of any chronic condition in the family.
Social History:
Patient is a regularly active young woman; she is single and does moderately active exercise. However, she stated that her daily activity and chores has recently reduced due to her recent symptoms of pain. She also stated to have no appetite secondary to her recent pain. She also stated that her stress level may be related with her college. She has no history of alcohol, smoking, or had never smoked in her life. She has not used any ...
1) Naïve T cells have the potential to differentiate into several AbbyWhyte974
1) Naïve T cells have the potential to differentiate into several types of effector cells. In the space below, describe the roles and activities of each of these cells:
TH1 cells
TH2 cells
TH17 cells
TFH cells
2) Use the following diagram to compare and contrast systemic immunity and mucosal immunity.
Systemic
Both Systemic and Mucosal
Mucosal
ordinary surface epithelia
Why is there a need for these differences in the first place?
CDC Sexually Transmitted Diseases Case Study.
Read the patient case study below
General:
The patient is a young seventeen-year-old female who came to the clinic with complaint of abdominal pain.
Chief Complaint:
Kim reports "I've been having pain in my stomach for several weeks." She describes the pain as being sharp and being constant. She stated the pain often occurs on both sides of her lower abdominal. She has been experiencing the pain for the past two weeks. The pain has gotten worse since then.
Reliability and Source of History:
The patient is alert and oriented and able to answer most of the questions.
Source & Reliability of History:
O – "I have been having pain in my stomach for several weeks now.” she stated that the pain has lasted for two weeks without any relief.
L – Both sides of her lower stomach
D – The patient reported that she has been having this bilateral lower stomach pain for the last two weeks, However, the symptoms got worse since the pain started ago.
C – She stated that since the onset of the pain, her pain has remained constant without any relieve and aggravating factor. The pain is firm regardless of the time or day or event. She further stated that her symptoms get worse. The patient states that she is unaware of what caused the pain or how the pain started; however, she stated that taking pills could relieve her stomach pain and stop her bleeding
A – She stated that the pain remains constant. She also stated that she is unaware of what caused the pain or how the pain started.
R – She stated that the pain remains steady and does not go away or radiate to other areas.
T- she reported feeling uncomfortable doing her regular shores due to the pain.
Past Medical history:
Patient is asthmatic; however, her asthma is under control. She knows known history of any other condition or never been hospitalized.
Family History:
She is the second in a family of four who are all alive and healthy. There is no history of any chronic condition in the family.
Social History:
Patient is a regularly active young woman; she is single and does moderately active exercise. However, she stated that her daily activity and chores has recently reduced due to her recent symptoms of pain. She also stated to have no appetite secondary to her recent pain. She also stated that her stress level may be related with her college. She has no history of alcohol, smoking, or had never smoked in her life. She has not used any ...
Except in association with molar or hydropic degeneration of the placenta, with or without a coexistent fetus, eclampsia before 20 weeks of gestation is rare and only few cases have been described. The case reported was that of a 24 year old primipara who had tonic-clonic seizures at 19 weeks gestation without prior Preeclampsia. She remained stable and was managed closely up to 36 weeks gestation. She had spontaneous vaginal delivery of a live baby at 38 weeks with good outcome. Atypical eclampsia may develop before 20 weeks of gestation and could pose serious management challenges. Such patients if carefully selected and closely monitored may have satisfactory outcome. This case deserves reporting because of its rare nature as several literature search did not reveal any reported case of eclampsia before 20 weeks that was successfully managed to term.
Case Study Report on PIH and Severe Pre eclampsiaRashmi Regmi
it is a case study report on PIH and Severe Pre eclampsia
I did when I was posted on Kist Medical TEaching Hospital for Midwifery Practicum
Prepared by:
Rashmi Regmi
B Sc Nursing
Manmohan Memorial Institute Of health Sciences
CC I have itchy white discharge”HPI Patient is a 32 African.docxtroutmanboris
CC: "I have itchy white discharge”
HPI: Patient is a 32 African American female who reports having increased vaginal itching and discharge times 2 days. She states that her vagina feels irritated and that the itch is progressively getting worst. She reports a thick white cottage cheese discharge is present. She reports that she used a Monistat 3 day 6 days ago but hasn't had any relief. She states that the pain is worst after sex.
PMH: Patient denies having any past medical history. She denies any past traumas or hospitalizations.
PSH: Patient denies having a history of trauma. Patient denies having any surgical history.
Allergies: Patient denies having allergies to latex, food or any medications.
Medications: Patient reports she is currently on no medications.
Social history: Patient reports that her entire family lives nearby. She states that she lives in a two-bedroom apartment alone. States that she drinks 3 glasses of 8oz glasses of wine with friends twice a week. Denies recreational drug use. Denies tobacco use. Reports that she is single. She denies having any new sex partners during the last 3 years. She states that she drinks 1 8oz cups of coffee daily. She reports that she has worked as a real estate agent for the last 2years. Reports no job-related stressors.
Family History: Patient reports that her mother is a live and has a medical history of that she was diagnosed with anxiety and depression at the age of 35. She states her father has a medical history of depression which he was diagnosed with at age 45. She reports her maternal grandmother had a history of COPD and CHF. She reports her maternal grandmother died from complications of chronic kidney disease at the age of 80. She reports that her maternal grandfather had a medical history of hypertension, she reports he is still alive at 88. Patient reports her paternal grandmother has a medical history of CHF and diabetes mellitus type 2. She reports her paternal grandmother is still alive at 85 but has dementia She states paternal grandfather had a medical history of COPD and CHF, she reports he died at age 85 from complications of diabetes mellitus type 2. She has two older sister who both have no medical history.
Health Promotion/Maintenace: Patient reports she had a flu shot in September 2017 in a private doctor's office. Reports she had a TDAP booster in 2014. Based on the patients age USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. Reports she had a std screen 2 years ago. She reports that she has never had an abnormal pap smear. She states STD screen was negative. Reports she had a pap 4 years ago. She reports she does monthly self-breast exams at home. She reports that she eats 2 times daily. Reports she eats well balanced nutritious meals for each meal. She reportedly drinks approximately 30oz of water a day.
General: Patient reports having, fever, chills, and malaise
Skin: Pat.
1
Health History
2
Health History
Health History
Name
Global Health College
Health Assessment
10/16/2015
Date __10/5/2015___
Examiner M. A.
1. Biographical Data
Initials __AM__ Phone __3017934596____
Address ___7001 96 Avenue, Lanham MD 20706
Birth date 07/28/1980 Birthplace Limbe, Cameroon___
Age __35__ Gender __Female__ Marital Status _Married__ Occupation _Nurse__
Race/ethnic origin __Black/Cameroon__ Employer __Karen For Kids Inc.__
2. Source and Reliability: The source of information is reliable because it is provided by the patient herself.
3. Reason for Seeking Care: Patient is seeking help because she has been having persistent diarrhea and abdominal cramps for two days.
4. Present Health or Health of Present Illness: Diarrhea and abdominal cramps.
Patient AM, came to the hospital at 4pm on 10/5/2015, complaining of persistent diarrhea and generalized abdominal cramps. She states that her illness started after she came back from a family swimming picnic on 10/2/2015 at 7pm. She states that her illness started with generalized abdominal cramping that was followed with her passing watery non-tarry stool with no foul smell. She says she has been having 5 episodes of diarrhea each day for two days. Patient also states that her illness is triggered when she eats any food or when she wants to do her daily exercise. Patient states she feels a little weak. Patient added that she has also taken Over The Counter (OTC) Imodium 4mg twice a day for two days but doesn’t feel any better. That is why she came to the hospital today for help.
5. Past Health
Ms AM says she has been healthy over the past years, except for today when she complains of diarrhea and abdominal cramps. She denies having any past history of childhood illnesses: measles, chicken pox, mumps, meningitis, impetigo. Patient confirms haven had pink eye at age 10years old, which was treated with some home remedies (soaked clean compress and OTC eye drop called artificial tears). Patient says she had a minor nose injury at age 12 years that was treated by her pediatrician with pain medication. Patient denies having history of any chronic illness: diabetes, hypertension, asthma, cancer, Congestive Heart Failure (CHF), Coronary Artery Disease (CAD), or stroke.
Patient denies haven been hospitalized before except during delivery. She also denies having any surgical procedures. Patient states that she has been pregnant three times, and she has three babies, two boys and one girl. She went ahead to say she had no premature procedures, delivery, abortion, or miscarriage. She added that all of her babies were carried full term and delivered after 9 months. of pregnancy. She labored for 4 hours for her first baby who was a boy, and 3 hours each for both second and third babies, a boy and a girl consecutively. She said her first baby weighed 7lbs and the other two weighed 8lbs each. All her three babies were delivered .
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Guidelines for assignment
This is an individual assignment
Ground your answer in relevant theory
Plagiarism and reproduction of someone else’s work as your own will be penalized
Make use of references, where appropriate – Use Harvard or APA referencing method.
Late submission are not accepted
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Structural elements should include an introduction, main body, and a conclusion
Weight – 50%
Word count guidance : part 1 – N/A. Business report wordage should be 2000 +/-10%
Type of assignment: Excel Assessed Work Folder and Business Report
Start / Finish : Week 3 – 4
Learning Outcome Assessed: 1,2,3,4
Submit one single document and not lots of different files.
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November ...
Similar to 1[Shortened Title up to 50 Characters]16Week 9 Assignment.docx (20)
Nonclassified DataIn order to maintain transparency and et.docxhallettfaustina
Nonclassified Data
In order to maintain transparency and ethical standards of research, researchers may file a Freedom of Information Act (FOIA) request to obtain all nonclassified data on a subject. Why is this legislation important? Do you think it is working? Why or why not.
Crime Mapping
Crime mapping has been used for
intelligence-led policing
: using data, analysis, and criminal theory to guide police allocation and decision making. Give some examples of ways this is used in your community. Explain if it is working. What are some other ways that you think it should be used in your Community? Give examples and how it would be effective in policing.
Importance of Reviewing Communications
Describe a situation when you may have sent something electronically (email) or turned something in when the lack of review or proofreading was brought to your attention by yourself or others. Discuss any repercussions you faced due to the communication not being reviewed. Explain the importance of reviewing any form of communication prior to disseminating it.
Who Reviews Your Work?
In our everyday life (school, work, or home) we use some form of communication. Who reviews your communication before it is sent, or do you review the communication of others and your own? Describe how you would ensure the communication is “good to go” or ready to disseminate to others.
.
No plaigarism!!! Due Saturday @ 12pm!Example included and worksh.docxhallettfaustina
No plaigarism!!! Due Saturday @ 12pm!
Example included and worksheet attached.
Use the
Source Evaluation Worksheet
to submit an annotated bibliography of 5 sources that you intend to use in your paper. Prepare a citation, annotation, and evaluation for each source.
You may collect the worksheets together as one document or you may submit a separate worksheet for each source.
.
Not all EBP projects result in statistically significant results. De.docxhallettfaustina
Not all EBP projects result in statistically significant results. Define clinical significance, and explain the difference between clinical and statistical significance. How can you use clinical significance to support positive outcomes in your project?
the project topic is after discharge follow up
.
Nonprofit v Criminal JusticeCriminal justice organizations and.docxhallettfaustina
Nonprofit v Criminal Justice
Criminal justice organizations and nonprofit organizations have a lot of factors and/or characteristics that are similar as well as different. These types of organizations are out there for members of society to help those who are in need as well as gain that experience necessary to fulfill that spot they need within themselves and their life.
To start off, “nonprofit organizations occupy a unique third sector with diverse resource dependencies, arising mainly from private donations and labor, but subsidized by government exemption of certain public tax obligations to encourage charitable activity (Oelbrger, 2016)”. With that being said, a non profit organization, such as the Masonic family, which is a very controversial idea, raises money for those charities such as Shriners Hospital as well as military troops who are actively deployed. Not only this, but they also award their members with scholarships for doing good deeds around their community. I know this personally as my dad is an active Mason.
Criminal justice organizations have many goals as well. Their goals consist of helping those around their community and the country. One of the goals mentioned by the Department of Justice (2018) is to “prevent Crime, Protect the Rights of the American People, and Enforce Federal Law”. As criminal justice employees, they are putting their life on the line whereas daily to help serve their people. Whereas, nonprofit organizations are helping those in their community by serving them with needs that they have, that do not require putting their life on the line.
Both organizations however, are doing what they need to do to help support those around their community. They are both helping their community and those in need when it is needed. Between protection, or fundraisers, or support financially, these organizations do what they have to do to ensure that they are getting their name out there in a positive manner, of course.
.
Noah DeWaalTuesday16 Jun at 1538Manage discussion entryFou.docxhallettfaustina
Noah DeWaal
Tuesday16 Jun at 15:38
Manage discussion entry
"Four Horsemen" describes the ways in which our world is slowly folding on itself. It categorizes the four horsemen as a wrongful banking system, escalating violence, an abundance of poverty, and deletion of the world's resources. All these topics are the signs that we have truly doomed ourselves as a nation and as a planet. The underlying kingpin here is money. Everyone, including the government, lives, and works to earn and spend money. There are a variety of different paths to obtain that currency and the banks are at the heart, banks that create this money out of thin air. The film starts by speaking of empires and power. Nations want to be in positions to be on top as a means of security and credibility. Top nations control our world and those who are not, strive to become one. From historic times to now, people and groups want to become the most powerful, and when they do, they obtain all the resources they can do benefit their empires and the leaders become wealthy and untouchable. There is usually one common factor within one's rise to power, and that is money. It earns resources and credibility which makes others become submissive to you. We are supposed to be living within a free market system where everyone has a fair piece of the pie, but that is rarely true today. The way the banks function and government spending only amasses debt that will in turn be paid by the American people. Some of these people live in poverty, meaning they cannot even live anymore. People are expected to pay more for items as the price level rises while many incomes are not following suit. This system leaves those who are poor behind making it nearly impossible for them to catch up. As stated before, government spending can leave a budget deficit that needs to be repaid. Most of these expenditures, however, are on war and violence. International affairs, terrorism, and national crime are all credible threats, and a lot of money goes into limiting it. The resources used to support these organization makes them more powerful and it has transitioned peacekeeping into utter force and violence. Here at home and abroad, war rages daily. From small to large scale conflict is being solved in horrific ways and many innocent people are dying along the way. At the root of all of it, is money and power. A lot of this is also politically inclined. We live in a society in which people are paid just to influence politicians to pass acts that will in turn create more money for people who already have a lot of it. Wealth drives our nation, without it, one is just swept under the carpet. People have worked way too hard to obtain wealth while those in control can create it like none other. This exponential growth has depleted Earth's resources and we are running out fast. With no resources, what is there to gain anymore. The Four Horsemen are the warning signs that our systems are heavily flawed and need to be chan.
No Plagiarism4-6 slides (excluding Title and Reference slides).docxhallettfaustina
No Plagiarism
4-6 slides (excluding Title and Reference slides) with notes that are a minimum of 150 words per slide.
Leaders face many hurdles when leading in multiple countries. There are several examples of disastrous public relations fallout that have occurred when companies have outsourced work to other nations. When determining where to move offshore as a company, the leaders of the organization must make several decisions.
Using course theories and current multinational organizations that have locations in several countries, convey your own thoughts on the subject and address the following:
What leadership considerations must an organization weigh in selecting another country to open a location such as a manufacturing plant?
How might leaders need to change leadership styles to manage multinational locations?
What public relations issues might arise from such a decision?
How would you recommend such a company to demonstrate their social responsibility to their headquarters country as well as any offshore locations?
.
North American Philosophical Publications Prejudice i.docxhallettfaustina
North American Philosophical Publications
Prejudice in Jest: When Racial and Gender Humor Harms
Author(s): David Benatar
Source: Public Affairs Quarterly, Vol. 13, No. 2 (Apr., 1999), pp. 191-203
Published by: University of Illinois Press on behalf of North American Philosophical
Publications
Stable URL: http://www.jstor.org/stable/40441225
Accessed: 18-05-2017 00:16 UTC
JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted
digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about
JSTOR, please contact [email protected]
Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at
http://about.jstor.org/terms
University of Illinois Press, North American Philosophical Publications are collaborating
with JSTOR to digitize, preserve and extend access to Public Affairs Quarterly
This content downloaded from 132.174.250.5 on Thu, 18 May 2017 00:16:08 UTC
All use subject to http://about.jstor.org/terms
Public Affairs Quarterly
Volume 13, Number 2, April 1999
PREJUDICE IN JEST: WHEN RACIAL AND
GENDER HUMOR HARMS
David Benatar
central questions in the sparse literature on the ethics of humor
are: 1) What makes a piece of humor racist or sexist? 2) Are jokes
that embody negative racial and gender stereotypes necessarily racist
and sexist? Because these issues have tended to be discussed separately
it has not been noted that some answers to the first question render the
second question moot. My answer to the first question does not have this
effect. It will draw on an account of humor ethics that I provide and
defend against rival views of racist (and sexist) humor. I shall then
proceed to answering the second question.
An Account of Humor Ethics
How can humor be immoral? Briefly, the answer is that it is immoral
where it is intended to harm people or where there are good grounds for
expecting it to harm people, and where the harm in question is wrong-
fully inflicted. Following Joel Feinberg, I understand harm in terms of
negative effects on people's interests. However, my understanding of
harm is, in two ways, broader than the one for which he opts in his work
about the moral limits of the criminal law.1 Firstly, because in the cur-
rent context I have a more expansive interpretation of what interests
are, my understanding of harm includes what he calls hurts, offenses
and other disliked states which are insufficiently severe to warrant be-
ing termed harms for his purposes. Because I am concerned with the
morality of humor rather than with the moral limits of legally restrict-
ing it, the inclusion of less severe though nonetheless disliked states is
more appropriate. Secondly, for Professor Feinberg, a harm is some-
thing that is wrongfully inflicted. That definition is th.
Non-governmental Organizations (NGOs) are essential as they fulfill .docxhallettfaustina
Non-governmental Organizations (NGOs) are essential as they fulfill a purpose that is traditionally addressed by a government (Balteanu & Marcu, 2014). In order for an NGO to be impactful and serve its purpose, it will require support and involvement from those it has been organized to help, as well as maintain financial and management autonomy, devoid of the governmental influence (Johnson & Stoskopf, 2010). Political and social instability has made it difficult for NGO's to fulfill their purpose to meet the needs of the communities they have pin pointed as their focus (Balteanu & Marcu). During unrest experienced by many countries, residents who need shelter, food, and medical care, benefit from what NGO's to provide (Balteanu & Marcu). Without the government, military, or religious backing of the NGO's purpose, the NGO will not be able to fulfill it's intent (Balteanu & Marcu).
Resident of unstable regions through out the world, are without food, shelter, and medical care due to the preoccupation with control, whether through the government, military, or religious factions. The unstable governments within these regions are either unwilling or unable to care for the needs of their citizens or have taken away their ability to care for themselves. NGO's have the ability to provide for the needs of the people and help them sustain, if allowed.
In general, what is the impact of political and social instability on non-government organizations?
.
Nonverbal CommunicationCOLLAPSEDescribe a scenario in which a .docxhallettfaustina
Nonverbal Communication
COLLAPSE
Describe a scenario in which a person's nonverbal language says something quite different from the same person's verbal language. In doing so, be sure to address how non-verbal communication differs from verbal communication. Describe how the speaker's message differs depending on the following elements of delivery: voice, volume, pitch, rate, pauses, variety, pronunciation, articulation, and dialect.
When replying to peers in this forum, comment on their ideas, and offer additional suggestions for consideration using your assigned readings.
NOTE: You may conduct research to complete any of these discussions (if you are still waiting on the book), using the Internet or other resources. Be certain to properly cite your sources and provide a bibliography in appropriate format. This information is also addressed in this week's audio lessons.
Remember that your discussion response must include the following:
A reflection on the concept we are discussing. Give us a summary of things you learned about this concept from your assigned chapter readings.
A thorough example/discussion to support your reflection.
A final statement that tells us what you take away from this week's lesson.
Properly formatted in-text citations and references.
Strong grammar, spelling, and mechanics.
In total your discussion should be at least 250 words.
.
No plagiarism Research paper should contains following content.docxhallettfaustina
No plagiarism
Research paper should contains following content
1) Abstract - Summarize the major elements of the paper
2) Introduction- provide context and rationale for the study
3)Materials- Describe the experimental design so it is reproducible
4) Methods -Describe the experimental procedures
5) Results-summarize the findings without interpretation
6)Discussion- interpret the findings of the study
7)Summary- summarize the findings
8)Acknowledge- give credits to those
9) References- list all scientific papers books and website that you cited
Paper should be in API Style
Requirements: 20 pages
.
NO PLAGIARISM MEET REQUIREMENTSCOMPLETE BY DEADLINE Wr.docxhallettfaustina
NO PLAGIARISM
MEET REQUIREMENTS
COMPLETE BY DEADLINE
Write 650 words (Questions NOT included in word count) answering the following questions in the case study. please format APA style.
3 SCHOLARLY REFERENCES.
Shell Oil in Nigeria
1. What are some of the factors explaining why corrup- tion and bribery are so high in Nigeria?
2. Was Shell involved in the execution of the poet Ken Saro-Wiwa?Whatimpactdidthepoet’sdeathhave CASE CREDIT
on Shell?
3. Was Shell taking advantage of weak local regulation?
4. What can a company do to ensure that it operates
ethically in societies with weak institutions?
case study is provided below
.
No plagiarism very important In a few short paragraphs, explain .docxhallettfaustina
No plagiarism very important
In a few short paragraphs, explain which cloud services you use (Google, Amazon, iCloud, Verizon, Microsoft One, Dropbox, etc) and what type of information you store (docs, photos, music, other files?). How much space do you have and what does this cost per month?
Need in word document with apa format with citations
.
No plagiarism very important Do you feel the benefits of cloud c.docxhallettfaustina
No plagiarism very important
Do you feel the benefits of cloud computing are worth the threats and vulnerabilities? Have we arrived at a point where we can trust external agencies to secure our most precious data? Please explain your answer.
Need responses to reply my teamates discusions
.
No plagiarism very important 5-CEHv9 Module 03 Scanning Networ.docxhallettfaustina
No plagiarism very important
5-CEHv9 Module 03 Scanning Networks.pdf
Select one network scanning software tool (there is a list in your required reading slides) and explain in detail how it works and how detects network vulnerabilities. Provide the site where you obtained your information and include that in your assignment write-up. (in word document).
Need citations
.
No plagiarism very importantNeed responses to my teamates discus.docxhallettfaustina
No plagiarism very important
Need responses to my teamates discussions
question:Social engineering is the art of manipulating people so they give up confidential information. The types of information these criminals are seeking can vary, but when individuals are targeted the criminals are usually trying to trick you into giving them your passwords or bank information, or access your computer to secretly install malicious software - that will give them access to your passwords and bank information as well as giving them control over your computer.
Explain a scenario where you or someone you know may have unknowingly given too much personal information to a stranger. How could this situation been avoided?
Reference Article Link:
https://www.webroot.com/us/en/resources/tips-articles/what-is-social-engineering
.
No More Backstabbing... A Faithful Scheduling Policy for Multi.docxhallettfaustina
No More Backstabbing... A Faithful Scheduling Policy for Multithreaded Programs
Kishore Kumar Pusukuri, Rajiv Gupta, Laxmi N. Bhuyan
Department of Computer Science and Engineering
University of California, Riverside
Riverside, USA 92521
[email protected], [email protected], [email protected]
Abstract—Efficient contention management is the key to
achieving scalable performance for multithreaded applications
running on multicore systems. However, contention manage-
ment policies provided by modern operating systems increase
context-switches and lead to performance degradation for
multithreaded applications under high loads. Moreover, this
problem is exacerbated by the interaction between contention
management policies and OS scheduling polices. Time Share
(TS) is the default scheduling policy in a modern OS such as
OpenSolaris and with TS policy, priorities of threads change
very frequently for balancing load and providing fairness in
scheduling. Due to the frequent ping-ponging of priorities,
threads of an application are often preempted by the threads
of the same application. This increases the frequency of
involuntary context-switches as wells as lock-holder thread
preemptions and leads to poor performance. This problem
becomes very serious under high loads.
To alleviate this problem, in this paper, we present a
scheduling policy called Faithful Scheduling (FF), which dra-
matically reduces context-switches as well as lock-holder thread
preemptions. We implemented FF on a 24-core Dell PowerEdge
R905 server running OpenSolaris.2009.06 and evaluated it
using 22 programs including the TATP database application,
SPECjbb2005, programs from PARSEC, SPEC OMP, and
some microbenchmarks. The experimental results show that FF
policy achieves high performance for both lightly and heavily
loaded systems. Moreover it does not require any changes to
the application source code or the OS kernel.
Keywords-Scheduling; priorities; contention; context-
switches
I. INTRODUCTION
The advent of multicore architectures provides an attractive
opportunity for achieving high performance for a wide
variety of multithreaded applications. However, exploiting
the system density, and the parallelism they offer, to improve
performance of multithreaded applications is a challenging
task. This is because multithreaded application performance is
sensitive to the implementations of synchronization primitives
and contention management policies. Therefore the key
to achieving high performance for multithreaded applica-
tions running on multicore systems is to use appropriate
synchronization primitives along with efficient contention
management policies. Contention management policies are
either based on spinning, or blocking, or a combination
of both. Spinning resolves contention by busy waiting,
therefore waiting threads respond to lock handoffs very
quickly. However, spinning threads can wastes CPU resources
and prevent the lock-holder thread from runnin.
No plagiarism very importantThere are many mobile platform vulne.docxhallettfaustina
No plagiarism very important
There are many mobile platform vulnerabilities listed in the readings from this week (slides 8, 9, and 10). Which do you feel is the greatest threat to users? Do you agree that people generally are not aware of the threats to their mobile devices?
Need responses to reply my teamattes and need references for all of them
.
No more than 10 slides, including title slide, providing executive s.docxhallettfaustina
No more than 10 slides, including title slide, providing executive summary of emergency response plan, actions taken prior to, during and post event.
This presentation is intended for high level executives of the company and should be brief but comprehensive.
See attachment for more information.
.
NO PLAGIARISM !Write 3 pages of descriptive essay about why you .docxhallettfaustina
NO PLAGIARISM !
Write 3 pages of descriptive essay about why you should visit and spend time in Denali National Park which is located in Alaska, USA.
Outline
1. Introduction
2. Reason 1 and explain, example
3. Reason 2 and explain, example
4. Reason 3 and explain, example
5. Reason 4 and explain, example
6. Reason 5 and explain, example
7. Conclusion
.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
1[Shortened Title up to 50 Characters]16Week 9 Assignment.docx
1. 1
[Shortened Title up to 50 Characters] 16Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI,
2012) described abnormal uterine bleeding as bleeding that
differs in quality and quantity from normal menstrual bleeding,
such as women spotting or bleeding between the women’s
menstrual periods; bleeding after sex; bleeding heavier or last
more days than normal; and bleeding post menopause.
According to SREI (2012), factors that can cause abnormal
bleeding include structural abnormalities of the reproductive
system, such as uterine polyps, fibroids, and adenomyosis.
Furthermore, SREI (2012) explained that vaginal, uterine or
cervical lesions, miscarriage, ectopic pregnancy, endometritis,
adhesions in the endometrium, and use of an intrauterine device
(IUD) can also cause abnormal bleeding. Johns Hopkins
2. Medicine (2016) specified that early recognition of abnormal
bleeding, and seeing a health care provider immediately for
appropriate diagnosis and treatment increase the chance of
successful treatment. Therefore, the author will focus on a
single patient comprehensive evaluation, which includes the
patient’s personal/health history; physical examination;
laboratory/diagnostic tests; diagnosis; treatment/management
plan; education strategies; and follow-up care. Comment by
DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender:
This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding
with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic
American female who presented to the clinic with complaint of
heavy prolonged menstrual bleeding with severe cramping for
the past one year. Patient reported sharp pelvic pain during
menstruation, bleeding between periods, pain with intercourse,
blood clots during periods. Abdominal pain/pressure and
bloating. Patient suggested that these symptoms started after her
second caesarean section surgery one year ago. Patient also
reported that she takes over-the counter medication, such as
ibuprofen to relieve the pain. she also suggested that she uses
heating pad on her abdomen/pelvic for pain relief, and she
stated that she soaks in a warm sitz bath to ease pelvic pain and
cramping. Patient also reported fatigue and weakness. Patient
further stated that she decided to see an obstetrician and
gynecologist (OB/GYN) because the heavy prolonged bleeding
with severe menstrual cramp interfere with her regular
activities. Patient denied nausea, vomiting, diarrhea, fever, and
chills.
3. Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is
pelvic/uterus/vaginal.
Duration: 5 to7 days during periods for the past one year.
Quality/Characteristic: Patient reported heavy prolonged
menstrual pain; severe, sharp lower abdominal/pelvic
cramping/pain, and blood clots during periods.
Aggravating Factors: Monthly periods as stated by the patient.
Relieving/Alleviating Factors: Patient stated that ibuprofen pain
medication, heating pad, and/or warm sitz bath help the
pain/cramping.
Severity: The severity of the pain/cramping on a pain scale is
10/10 reported by the patient.
Treatments/Therapies: Patient stated that she had not undergone
any treatment for the reported problems.
Last Menstrual Period: The last menstrual period reported by
patient was 7/5/2016.
Sexual Activity Status: Patient reported being sexually active.
Barrier Prevention: Patient stated she uses natural barrier
methods.
Sexual Preference: Patient sexual preference is
monogamous/heterogeneous relationship.
Satisfaction with Sexual Activity: Patient reported that she is
sexually satisfied with her partner.
Contraception Method: Patient denied using any contraception
method.
Patient History
Past medical History (PMH): Anemia and C-section. Patient was
delivered full term through vaginal delivery without
complications. The birth weight was 8 pounds 10 oz.
Psychological/Mental Health: Patient denied depression, mood
swings, anxiety, or mental health problem.
Medications: RG reported that she takes over the counter Motrin
200-400 mg orally every 4-6 hours as needed for pain and
cramping.
4. Allergies: Patient reported no known allergies (NKA).
Past Surgical/Hospitalization History: Patient reported history
of C-section twice, and she was hospitalized for 3 days post the
C-sections.
Preventive Screening: Patient reported that she had flu shot on
11/20/2015; last mammogram was 2/12/2015 and mammogram
was normal; Pap smear was on 2/20/2015, which was also
normal; patient also reported that she was up to date with her
childhood immunization, but denied pneumococcal vaccination.
Family History: Both father and mother have history of diabetes
mellitus type 2 and hypertension. Both parents are still living,
and two siblings are still living and well.
Gynecological History: Patient is multipara with 2 pregnancy
resulting in two viable offsprings. Patient had her first child at
the age of 33 years. Menarche at age 13; periods last between 5
to 7 days. Patient reported heavy prolonged menstrual bleeding
with severe cramping; sharp pelvic pain during menstruation;
and bleeding between periods for the past one year. Denied
vaginal discharge or sexually transmitted infection/disease.
Obstetric History: Gravida 2, Para 2, term 2, preterm 0,
spontaneous abortion 0, and living 2 (G2T2P2A0L2). Gravida 1:
Delivered at 39 weeks by C-section on 4/20/08 male; Gravida 2:
Delivered at 40 weeks by C-section on 2/18/15 female. Patient
denied therapeutic abortion (TAB) or spontaneous abortion
(SAB); Patient denied preterm or low birth weight baby with no
delivery complications. Patient also denied having sexual
transmitted disease.
Personal/Social History: Patient is married with 2 children, and
lives at home with the husband. Patient is a college graduate;
works outside the house as a nurse at a nearby hospital.
Patient’s husband works for a computer company. Patient
family is a middle income family. Also, patient denied any
physical or psychological abuse. Patient denied being exposed
to any environmental or occupational health hazards. Patient
5. also denied alcohol consumption, tobacco, or recreational drug
use. Patient denied participating in any exercise or physical
activity because she is tired after work, and prefers to rest.
Patient reported that she eats healthy; she eats low fat, low
carbohydrate meals, and she eats fruits and vegetable at least 3
to 4 times a week. Patient stated
that she sleeps well at night, and she usually goes to bed at 9
pm and wakes up at 6 am. Patient drinks a cup of coffee
occasional, especially when she is at work to be awake.
Review of System (ROS)
General: RG admitted fatigue and weakness; denied fever
/chills; and no weight loss.
Head and Neck: Patient denied headache or dizziness. Patient
also denied lumps, neck injury, pain/tenderness or jugular vein
distention.
Chest: Patient denied chest pain, cough or shortness of breath.
Heart: RG denied irregular heartbeats, heart attack, or heart
murmur.
Breasts: Patient denied nipple discharge, tenderness or swelling.
Gastrointestinal: Patient admitted lower abdominal pain,
pressure, and bloating; denied constipation, nausea, vomiting,
and diarrhea.
Genitourinary: RG denied urinary tract infection, urinary
frequency or burning on urination.
Genital: Patient admitted heavy prolonged menstrual bleeding
with severe cramping for one year. Patient admitted sharp
pelvic pain during menstruation, bleeding between periods, pain
with intercourse, and blood clots during periods. Patient denied
vaginal discharge.
Musculoskeletal: RG denied varicosities or extremities problem.
Psychiatric: RGdenied depression, anxiety, or any psychiatric
problems.
Neurological: Patient admitted fatigue and weakness; denied
confusion, seizures, or tingling.
Hematologic: Patient admitted history of anemia; denied blood
6. transfusion or easily bruise or bleeding.
Physical Examination
General exam: Patient appeared well developed and pleasant
with good hygiene. Patient also appeared pale and weak. Vital
signs: Blood pressure 118/76, heart rate 80, respiration 18,
temperature 98.8, pulse ox 100% on room air. Weight 78.2 kg,
height 67 inches, and body mass index (BMI) 27.
HEENT: The head is normaceplalic, atraumatic. The pupils are
equal, round, and reactive to light and accommodation.
Extraocular movements are intact. Tympanic membrane is gray
bilaterally. Oral mucosa is dry. Oropharynx is clear. Nares are
patient, no nasal or septal deviation noted. No pharyngeal
erythema.
Neck: Noted to be supple without jugular vein distention (JVD),
thyromegaly or lymphadenopathy.
Lungs: Noted to be clear to auscultation throughout the lobes;
no wheezes or rhonchi noted.
Cardiovascular: Regular rate and rhythm on auscultation, S1 S2
present without murmurs. Palpable pulses noted without
peripheral edema.
Gastrointestinal: Bowel sounds are active in all quadrant.
Abdomen is soft and tender on palpation.
Breast: The size of the breasts, areolas, and nipples are round
and symmetrical with no discoloration, rash, lesions, dimpling,
or retraction bilaterally; no masses, lumps, or tenderness noted
on palpation bilaterally; and axillary lymph nodes non-palpable.
Pelvic Examination:
Vulva: The hair distribution is normal; no lesion noted.
Vagina: Vaginal walls are pink, and pubic hair is shaven; no
lesions, masses, inflammation or discharge noted.
Cervix: Intact cervix with closed os.
Uterus: Enlarged, asymmetrical, soft, boggy and tender.
7. Laboratory and Diagnostic Tests
Laboratory Test and Results: Pregnancy test: Result is negative.
Hemoglobin and Hematocrit (H/H): Result showed H/H
8.7/26.7, which is positive for anemia.
Diagnostic:
Transvaginal ultrasonography of the uterus: Revealed uterine
enlargement measuring 12 cm with no leiomyomata; uterine
wall thickening; cystic anechoic spaces in the myometrium;
heterogeneous echo texture; obscured endometrial/myometrial
border; sub endometrial echogenic linear striations; and
thickening of the transition zone measuring 12.8 millimeter.
The transvaginal sonography is used to rule out possible uterine
tumor (Sakhel & Abuhamad, 2012).
Magnetic Resonance Imaging (MRI): MRI is ordered to obtain a
high resolution image of the uterus as well as
verifying/confirming the suspected diagnosis. The MRI result
revealed that the junctional zone of the uterus is thickened and
measures 12.8 millimeter. Also, MRI revealed an ill-defined
ovoid and diffuse region of thickening with striated appearance
(Sakhel & Abuhamad, 2012).
Differential Diagnoses
The differential diagnoses of the patient clinical presentation as
described by Schuiling and Likis (2013) include: Adenomyosis,
uterine fibroids and endometrial hyperplasia. However, the
primary diagnosis for the patient is Adenomyosis.
Adenomyosis: Schuiling and Likis (2013) described
adenomyosis as a benign, common condition that involves the
movement of endometrial tissue into the uterine muscles. The
definitive cause of the adenomyosis is unknown, but the
condition is common among women with elevated levels of
estrogen; the condition usually ceases post menopause when
estrogen levels are reduced. Risk factors explained by Taran,
Stewart, and Brucker (2013) include multiparity; previous
uterine surgery, such as C-section, dilatation/curettage, or
fibroids
removal surgery; and women at reproductive age, especially
8. between the age of 40s or 50s. furthermore, Taran et al. (2013)
specified that the clinical presentation entails chronic pelvic
pain, prolonged menstrual cramps, heavy menstrual bleeding,
spotting between periods, abdominal tenderness, painful
intercourse, longer periods than normal, blood clots during
periods. Taran et al. (2013) also explained that finding during
physical examination include enlarged, tender, soft and boggy
uterus. According to Taran et al. (2013) diagnosis is made based
on sonographic or MRI results, and treatment is not
recommended for women with mild form of adenomyosis,
except when the symptoms interfere with daily activities. Taran
et al. (2013) further explained that treatment options include
anti-inflammatory medications; hormonal treatments;
endometrial ablation; uterine artery embolization, MRI-guided
focused ultrasound surged or hysterectomy, which is the
definitive treatment for adenomyosis.
Adenomyosis is selected as the primary diagnosis because
the aforementioned patient’s clinical presentation, physical
examination findings, and diagnostic tests results are
synonymous with adenomyosis aforementioned associated signs
and symptoms; risk factors; physical examination findings; and
diagnostic test results.
Uterine Fibroids: Women’s Health (WH, 2015) described
uterine fibroid to be muscular tumors that develop in the uterine
wall, which can also be referred to as leiomyoma or myoma.
Uterine fibroids are usually non-cancerous, and can be single or
multiple tumors in the uterus. According to WH (2015), women
risk for developing uterine fibroid are increased by age, such as
women in their 30s and 40s until menopause when the fibroids
commonly shrink. Other risk factors include family history,
ethnic origin, obesity and eating habits. Symptoms of fibroids
as explained by WH (2015) involve lower back pain; pain
during sex; heavy bleeding; painful menses, enlarged lower
abdominal, frequent urination; and lower abdominal/pelvic
feeling of fullness. Physical examination shows reveal painless,
firm, irregular pelvic mass. According to WH (2015),
9. diagnosis is done using transvaginal ultrasound, MRI,
hysteroslpingography, hysteroscopy, and endometrial biopsy.
Fibroid is not selected as the primary diagnosis because there is
no visualization of the fibroid during pelvic examination or on
sonography test. Moreover, severe pain is noted during pelvic
exam. Furthermore, sonographic result is more consistent with
adenomyosis rather than fibroids.
Endometrial Hyperplasia: Cancer Research of United Kingdom
(CRUK, 2014) described endometrial hyperplasia as thickening
of the covering of the uterus due to excessive growth of the
cells that covers the uterus, and endometrial hyperplasia can
lead to womb cancer. Risk factors according to CRUK (2014)
include- age over 35 years; white race; nulliparity; older age at
menopause; obesity; cigarette smoking; family history of
ovarian, colon, or uterine cancer; early menarche; and history of
diabetes, polycystic ovary syndrome, thyroid disease and
gallbladder disease. The CRUK (2014), explained that the
condition is caused by imbalance of to the estrogen and
progesterone. According to CRUK (2014), signs and symptoms
of endometrial hyperplasia includes abnormal, prolonged, heavy
periods; bleeding between periods; shorter than 21 days’
menstrual cycles; and bleeding after menopause. Also, diagnosis
is established by vaginal ultrasound scan, dilatation and
curettage, or hysteroscopy.
23rd ed. Philadelphia, PA: Lippincott Williams &.Wilkins;
2014presentation, physical findings during examination; and
diagnostic results are not synonymous with the signs and
symptoms; physical examination finding, risk factors and
diagnostic
results associated with endometrial hyperplasia (American
College of Obstetricians and Gynecologist, 2016).
Management Plan
Diagnosis: The only definitivediagnosis of adenomyosis is
established after uterus is examined post hysterectomy.
However, clinical findings that helped in the diagnosis of the
patient includes enlarged, asymmetrical, soft, boggy and tender
10. uterus during pelvic examination and aforementioned
sonographic and MRI findings, which synonymous with the
diagnosis of adenomyosis (Sakhel & Abuhamad, 2012).
Treatment: Treatment was considered based on the patient
clinical presentations, and collaborative agreement with the
patient, the author, and the preceptor for total hysterectomy
after explanation of the treatment options to the patient. Patient
selected hysterectomy because patient does not want to have
another child. According to Schuiling and Likis (2013)
explanations, patient was advised to continue with the over-the
counter anti-inflammatory drug: Motrin 200-400 mg orally
every 4-6 hours as needed for pain and cramping until
hysterectomy is performed. Also, Ferrous sulfate 325 mg orally
three times a day for anemia was prescribed. Patient was
educated to take the medication on an empty stomach one hour
before meal or 2 hours after meal for optimum absorption.
Patient Education: Patient was educated on the risk factors for
adenomyosis, the causes, symptoms, diagnosis, and treatment
options. Patient was educated that most women with
adenomyosis does not have any symptoms, but adenomyosis is
usually found after the tissue obtained from the uterus has been
biopsied after pelvic surgery. Patient was also informed that the
C-section she had twice during child birth may have put her at
risk for adenomyosis. Patient was informed that the symptoms
of adenomyosis goes away after menopause or after
hysterectomy. Patient was educated that all options of treatment
must be tried before hysterectomy, but patient opted for
hysterectomy without trying all options of treatment.
furthermore, patient was educated to continue the home remedy,
such as continuation of the use of the heating pad, warm soak
bath, and continuing with the over the counter Motrin to
alleviate the pain associate with the condition. Finally, patient
was educated on the psychological and emotional effects of
adenomyosis and hysterectomy surgery because some women
grieve on the loss of their womb, which may put them into
depression as a result of that; the patient has to be completely
11. sure that she really wants to do the surgery at her age now or
wait and do the surgery in the future (University of Maryland
Medical Center, 2016).
Follow Up Care: In consideration of the Schuiling and Likis
(2013) discussion, patient was schedule to follow-up in 6 weeks
for follow-up on the patient’s anemia and surgical work up labs,
such as complete blood count, complete metabolic panel,
prothrombin time and international normalized ratio(PT/INR).
Also, an electrocardiogram (EKG) and chest x-ray was ordered
to rule out any cardiac problem that would complicate the
hysterectomy surgery. The patient’s H/H came up to 11.5/38.9
and all the other laboratory and diagnostic result was normal.
The Total hysterectomy surgery was performed on 7/27/2016.
Surgery was successful, and patient was schedule to follow up
in six eek post-surgery.
Conclusion Comment by DeAllen B Millender:
Level 1 headings are centered, in bold print, and in 'Title Case'
(Chapter 3, 3.03, pp. 62-63; see Table 3.1 and Figure 2.1).
The author selected a patient at the author’s clinical site, and
obtained a complete health history following the patient care
from the beginning of the clinical up to 9 weeks of clinical. The
author also used the patient health information and clinical
presentation to come up with a diagnosis of adenomyosis. The
author developed an appropriate treatment plan with the patient
in collaboration with the author’s preceptor incorporating the
author’s classroom knowledge with the author’s chosen nursing
theorist. Finally, the patient was educated on the condition and
follow up care.
12. References
American College of Obstetricians and Gynecologist. (2016).
Endometrial Comment by DeAllen B Millender:
Paper and poster titles presented at meetings that are not a part
of a symposium should be in italics (Chapter 7, 7.04, p. 206).
Hyperplasia. Retrieved from http://www.acog.org/Patients/
FAQs/Endometrial-Hyperplasia
Cancer Research of United Kingdom. (2014). Endometrial
hyperplasia. Retrieved from
http://www.cancerresearchuk.org/about-cancer/cancers-in-
general/cancer-questions/endometrial-hyperplasia
John Hopkins Medicine. (2016). Recognizing gynecologic
problems. Retrieved from
http://www.hopkinsmedicine.org/healthlibrary/
conditions/adult/gynecological_health/recognizing_gyneco
logic_ problems_85,P00584/
Sakhel, k., & Abuhamad, A. (2012). Sonography of
adenomyosis. Journal of Ultrasound in Medicine, 31(12), 805-
808.
Schuiling, K. D., & Likis, F. E. (2013). Women’s gynecologic
health (2rd ed.). Burlington, MA: Jones and Bartlett Publishers.
Society for Reporoductive Endocrinology and Infertility.
(2012). Abnormal uterine bleeding. Retrieved from
13. http://www.socrei.org/BOOKLET_abnormal_uteine_bleeding/
Taran, F. A., Stewart, E. A., & Brucker, S. (2013).
Adenomyosis: Epidemiology, risk factors, clinical phenotype
and surgical and interventional alternative to hysterectomy.
Geburtshilfe Frauenheilkunde, 73(9), 924-931.
University of Maryland Medical Center. (2016). Adenomyosis.
Retrieved from
http://umm.edu/health/medical/ency/articles/adenomyosis
Women’s Health. (2015). Uterine fibroids fact sheet. Retrieved
from
http://www.womenshealth.gov/publications/our-
publications/fact-sheet/uterine-fibroids.html#c
1. Comprehensive Write-up Guide Assignment: Comprehensive
Patient Assessment
2. When completing practicum requirements in clinical settings,
you and your Preceptor might complete several patient
assessments in the course of a day or even just a few hours.
This schedule does not always allow for a thorough discussion
or reflection on every patient you have seen. As a future
advanced practice nurse, it is important that you take the time to
reflect on a comprehensive patient assessment that includes
everything from patient medical history to evaluations and
follow-up care. For this Assignment, you begin to plan and
write a comprehensive assessment paper that focuses on one
female patient from your current practicum setting.
To complete:
Write an 8- to 10-page comprehensive paper that addresses the
following:
1. General patient information a. Age b. Race/ethnicity c.
Partner status
2. Current health status a. Chief concern/complaint and history