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CASE PLEASE READ: Chief complaint: “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”. HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies. Denies associated symptoms of fever and chills. PMH: Diabetes Mellitus, type 2. Surgeries: None Allergies: Augmentin Medication: Metformin 500mg PO BID. Vaccination History: Immunization is up to date and she received her flu shot this year. Social history: College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago. Family history: Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN. ROS: Constitutional: Negative for fever. Negative for chills. Respiratory: No Shortness of breath. No Orthopnea Cardiovascular: Regular rhythm. Skin: Right great toe swollen, itchy, painful and discolored. Psychiatric : No anxiety. No depression. Physical examination: Vital Signs Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored HEENT : Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: Slow gait but steady. No Kyphosis. SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit. PSYCH: Normal affect. Cooperative. Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98. Assessment: Primary Diagnosis: Proximal subungual onychomycosis Differential Diagnosis: Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis Special Lab : Fu.
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Chief complaint My right great toe has been hurting for abou.docx
Chief complaint:
“ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.
HPI:
E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies. Denies associated symptoms of fever and chills.
PMH:
Diabetes Mellitus, type 2.
Surgeries: None
Allergies
:
Augmentin
Medication: Metformin 500mg PO BID.
Vaccination History:
Immunization is up to date and she received her flu shot this year.
Social history:
College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: Regular rhythm.
Skin: Right great toe swollen, itchy, painful and discolored.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: Slow gait but steady. No Kyphosis.
SKIN:
Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.
PSYCH
: Normal affect. Cooperative.
Labs
: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
A:
Primary Diagnosis:
Proximal subungual
onychomycosis
Differential Diagnosis:
Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis
Special Lab:
Fungal culture confirms fungal infec.
Chief complaint My right great toe has been hurting for ab.docx
Chief complaint:
“ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.
HPI:
E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies. Denies associated symptoms of fever and chills.
PMH:
Diabetes Mellitus, type 2.
Surgeries: None
Allergies
:
Augmentin
Medication: Metformin 500mg PO BID.
Vaccination History:
Immunization is up to date and she received her flu shot this year.
Social history:
College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: Regular rhythm.
Skin: Right great toe swollen, itchy, painful and discolored.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: Slow gait but steady. No Kyphosis.
SKIN:
Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.
PSYCH
: Normal affect. Cooperative.
Labs
: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
A:
Primary Diagnosis:
Proximal subungual onychomycosis
Differential Diagnosis:
Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis
Special Lab:
Fungal culture confirms fungal infect.
Chief complaint My right great toe has been hurting for ab.docx
Chief complaint:
“ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.
HPI:
E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies.
Denies associated symptoms of fever and chills.
PMH:
Diabetes Mellitus, type 2.
Surgeries:
None
Allergies:
Augmentin
Medication:
Metformin 500mg PO BID.
Vaccination History:
Immunization is up to date and she received her flu shot this year.
Social history:
College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.
ROS:
Constitutional:
Negative for fever. Negative for chills.
Respiratory:
No Shortness of breath. No Orthopnea
Cardiovascular:
Regular rhythm.
Skin:
Right great toe swollen, itchy, painful and discolored.
Psychiatric
: No anxiety. No depression.
Physical examination:
Vital Signs
Height:
5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK:
Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS:
No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART:
Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN:
No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY:
No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL:
Slow gait but steady. No Kyphosis.
SKIN:
Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.
PSYCH:
Normal affect. Cooperative.
Labs:
Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
Assessment:
Primary Diagnosis: Proximal subungual onychomycosis
Differential Diagnosis: Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis
Special Lab
:
Fungal culture confirms.
Chief complaint My right great toe has been hurting for ab.docx
Chief complaint:
“ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.
HPI:
E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies.
Denies associated symptoms of fever and chills.
PMH:
Diabetes Mellitus, type 2.
Surgeries:
None
Allergies:
Augmentin
Medication:
Metformin 500mg PO BID.
Vaccination History:
Immunization is up to date and she received her flu shot this year.
Social history:
College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.
ROS:
Constitutional:
Negative for fever. Negative for chills.
Respiratory:
No Shortness of breath. No Orthopnea
Cardiovascular:
Regular rhythm.
Skin:
Right great toe swollen, itchy, painful and discolored.
Psychiatric
: No anxiety. No depression.
Physical examination:
Vital Signs
Height:
5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK:
Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS:
No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART:
Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN:
No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY:
No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL:
Slow gait but steady. No Kyphosis.
SKIN:
Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.
PSYCH:
Normal affect. Cooperative.
Labs:
Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
Assessment:
Primary Diagnosis: Proximal subungual onychomycosis
Differential Diagnosis: Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis
Special Lab
:
Fungal culture confirms.
Please follow directions very carefully. Should you have any questio.docx
Please follow directions very carefully. Should you have any questions please don't hesitate to ask.
Read the case study and answer the questions as directed.
_________________________________________________________________________________________
Following Case Study Question: As an NP student, needs to determine the medications for Tinea Pedis.
According to the ACC/AHA Guidelines, what antifungal medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format.
WEEK 5: DISCUSSION QUESTION IN DISCUSSION BOARD
DERMATOLOGY CASE STUDY
ACC/AHA Guidelines
Chief complaint:
“ I have scaly crust in sole of feet and moist white crusts between my toes since I started using boots warm weather” for past 2 weeks.
HPI:
E.D a 45-year-old hispanic female presents to the clinic for complaint of itching in feet and scaly curst in sole of feet and moist white crusts between toes. She developed a red, itchy rash consistent with hypersensitivity reaction. She also indicates that she has noticed that her symptoms are worsening for past 2 weeks and it started after she started to use boots in warm weather. She has symptoms of red, itching rash consistent with a hypersensitivity reaction and tinea pedis. She wore about 2 weeks ago her mother’s shoes without socks and her mother has history of Tinea Pedis.
She has tried lotrimin AF cream for itching and it did not help relief her symptoms. She has not tried other remedies.
Denies associated symptoms of fever, chills, pain or any other symptoms.
PMH:
Diabetes Mellitus, type 2. Peripheral Vascular disease. Varicose Veins.
Surgeries: None
Allergies
:
Penicillin
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Social history:
High school graduate, married and no children. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis.
mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: + 1 pitting leg edema. + Varicose veins.
Skin: + rash crusted white in feet and inter-digit in feet.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0 po P 88 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN
: No abdominal distention ...
Recommended
Chief complaint My right great toe has been hurting for abou.docx
Chief complaint:
“ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.
HPI:
E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies. Denies associated symptoms of fever and chills.
PMH:
Diabetes Mellitus, type 2.
Surgeries: None
Allergies
:
Augmentin
Medication: Metformin 500mg PO BID.
Vaccination History:
Immunization is up to date and she received her flu shot this year.
Social history:
College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: Regular rhythm.
Skin: Right great toe swollen, itchy, painful and discolored.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: Slow gait but steady. No Kyphosis.
SKIN:
Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.
PSYCH
: Normal affect. Cooperative.
Labs
: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
A:
Primary Diagnosis:
Proximal subungual
onychomycosis
Differential Diagnosis:
Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis
Special Lab:
Fungal culture confirms fungal infec.
Chief complaint My right great toe has been hurting for ab.docx
Chief complaint:
“ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.
HPI:
E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies. Denies associated symptoms of fever and chills.
PMH:
Diabetes Mellitus, type 2.
Surgeries: None
Allergies
:
Augmentin
Medication: Metformin 500mg PO BID.
Vaccination History:
Immunization is up to date and she received her flu shot this year.
Social history:
College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: Regular rhythm.
Skin: Right great toe swollen, itchy, painful and discolored.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: Slow gait but steady. No Kyphosis.
SKIN:
Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.
PSYCH
: Normal affect. Cooperative.
Labs
: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
A:
Primary Diagnosis:
Proximal subungual onychomycosis
Differential Diagnosis:
Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis
Special Lab:
Fungal culture confirms fungal infect.
Chief complaint My right great toe has been hurting for ab.docx
Chief complaint:
“ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.
HPI:
E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies.
Denies associated symptoms of fever and chills.
PMH:
Diabetes Mellitus, type 2.
Surgeries:
None
Allergies:
Augmentin
Medication:
Metformin 500mg PO BID.
Vaccination History:
Immunization is up to date and she received her flu shot this year.
Social history:
College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.
ROS:
Constitutional:
Negative for fever. Negative for chills.
Respiratory:
No Shortness of breath. No Orthopnea
Cardiovascular:
Regular rhythm.
Skin:
Right great toe swollen, itchy, painful and discolored.
Psychiatric
: No anxiety. No depression.
Physical examination:
Vital Signs
Height:
5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK:
Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS:
No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART:
Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN:
No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY:
No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL:
Slow gait but steady. No Kyphosis.
SKIN:
Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.
PSYCH:
Normal affect. Cooperative.
Labs:
Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
Assessment:
Primary Diagnosis: Proximal subungual onychomycosis
Differential Diagnosis: Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis
Special Lab
:
Fungal culture confirms.
Chief complaint My right great toe has been hurting for ab.docx
Chief complaint:
“ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.
HPI:
E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies.
Denies associated symptoms of fever and chills.
PMH:
Diabetes Mellitus, type 2.
Surgeries:
None
Allergies:
Augmentin
Medication:
Metformin 500mg PO BID.
Vaccination History:
Immunization is up to date and she received her flu shot this year.
Social history:
College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.
ROS:
Constitutional:
Negative for fever. Negative for chills.
Respiratory:
No Shortness of breath. No Orthopnea
Cardiovascular:
Regular rhythm.
Skin:
Right great toe swollen, itchy, painful and discolored.
Psychiatric
: No anxiety. No depression.
Physical examination:
Vital Signs
Height:
5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK:
Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS:
No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART:
Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN:
No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY:
No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL:
Slow gait but steady. No Kyphosis.
SKIN:
Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.
PSYCH:
Normal affect. Cooperative.
Labs:
Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
Assessment:
Primary Diagnosis: Proximal subungual onychomycosis
Differential Diagnosis: Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis
Special Lab
:
Fungal culture confirms.
Please follow directions very carefully. Should you have any questio.docx
Please follow directions very carefully. Should you have any questions please don't hesitate to ask.
Read the case study and answer the questions as directed.
_________________________________________________________________________________________
Following Case Study Question: As an NP student, needs to determine the medications for Tinea Pedis.
According to the ACC/AHA Guidelines, what antifungal medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format.
WEEK 5: DISCUSSION QUESTION IN DISCUSSION BOARD
DERMATOLOGY CASE STUDY
ACC/AHA Guidelines
Chief complaint:
“ I have scaly crust in sole of feet and moist white crusts between my toes since I started using boots warm weather” for past 2 weeks.
HPI:
E.D a 45-year-old hispanic female presents to the clinic for complaint of itching in feet and scaly curst in sole of feet and moist white crusts between toes. She developed a red, itchy rash consistent with hypersensitivity reaction. She also indicates that she has noticed that her symptoms are worsening for past 2 weeks and it started after she started to use boots in warm weather. She has symptoms of red, itching rash consistent with a hypersensitivity reaction and tinea pedis. She wore about 2 weeks ago her mother’s shoes without socks and her mother has history of Tinea Pedis.
She has tried lotrimin AF cream for itching and it did not help relief her symptoms. She has not tried other remedies.
Denies associated symptoms of fever, chills, pain or any other symptoms.
PMH:
Diabetes Mellitus, type 2. Peripheral Vascular disease. Varicose Veins.
Surgeries: None
Allergies
:
Penicillin
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Social history:
High school graduate, married and no children. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis.
mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: + 1 pitting leg edema. + Varicose veins.
Skin: + rash crusted white in feet and inter-digit in feet.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0 po P 88 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN
: No abdominal distention ...
Discussion post reply to the following soap noted case scenario-Respon.docx
Discussion post reply to the following soap noted case scenario.
Respond by analyzing Analyze the possible conditions from your colleagues' differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.
APA format with intext citation
2 to 3 scholarly references with in the last 5 years
Plagiarism free with Turnitin report
250-300 minimum word count
Case scenario # 1
Week 8, Mpofu Sibongile C
1/18/2023
Review of Case Study # 2 Ankle Pain SOAP Note.
Patient Information: Name: MF
Initials, MF Age: 46-year-old Sex: Female, Caucasian.
S.
CC : “My Ankles Hurts, worse on the right ankleâ€.
HPI : MF is a 46-year-old Caucasian female who presents to the clinic this morning with bilateral ankle pain, worse on the right foot it hurts and very uncomfortable. She reports pain started two days ago after playing soccer over the weekend, she says she heard a “popâ€. It is a throbbing pain, that gets worse when she bears weight on it when standing or walking but gets better when she applies ice and rest with feet elevated. She states the pain as constant all day, associated with swelling. She rates her pain as 3/10 left ankle but right ankle is 7/10.
Current Medication:
1. Ibuprofen 400 mg x 2 PO 8 hrly prn for pain. Has been taking it for 2 days ago.
2. Tylenol 650 mg PO 6 hourly for pain. Since last night.
3. Ice packs, twice daily for pain.
4. Fish oil 1200 mg PO, HS for pain
Allergies: No Known allergies to drugs nor food allergies .
PMH: MF is up to date with her immunization, has covid-19 vaccine in June 2022. (Pfizer). Second dose on September 15th, 2022. Tetanus vaccine a year ago but cannot recall the date. Is getting flu vaccine end of the month. Made up history. Sprained her ankle 2 years ago,2020. No previous surgeries.
Soc History : Â She is a high school sports teacher. Married for 6 years, no children. She enjoys outdoor activities walking, camping, playing soccer and shopping. She lives with her husband in a 3-bedroom house, secure community. She does not smoke but drinks alcohol, a glass of wine during dinner and beer during weekends only if no sports. Denies drugs use. She drives herself to work, wears seat belts, she only answers the phone using her Bluetooth. She eats healthy diet and exercises 3 times a week on her treadmill and plays sports (soccer) every Friday afternoon and Saturday from 4 pm to 6pm. She gets support from her husband and is a member of teachers support group.
Fam Hx :
1. Mother: 72 years. Type 2 diabetes, on diet control, diagnosed 3 years ago alive.
2. Father: Father 78 years with gout, is alive.
3. Sister: 40 years with arthritis alive
4. Maternal grandmother: died at 80 years from hypertension.
5. Maternal grandfather: died at 68 years from COPD.
6. Paternal grandfather: Died from heart attack at 70 years.
7. Paternal grandmother: died at 80 years, unknown cause, but had arthritis.
ROS :
General: MF appears healthy, she wei.
SOAO NotePatient Initials S.MPt. Encounter Number 2 .docx
SOAO Note
Patient Initials: S.M
Pt. Encounter Number: 2
Date: 10/12/2020
Age: 61
Sex: Female
Allergies: NKA
Advanced Directives: No
SUBJECTIVE
Chief Complaint: "I have a lump on my right breast."
HPI: S.M is a 61-year-old, Hispanic, female who presents to the office alarmed by a painful lump in her right breast that she discovered while showering. S.M reports the pain started 2 days ago while in the shower. The pain is felt when touching the right breast, and it felt on light touch. Current pain level is now 5/10. She does not report any skin changes. Patient denies any history of herbal medicine use and is currently on no medication. Pain gets worse with movement and with lifting weight. Pain is relieved with rest and medication. S.M gets some short relief with pain reliever ibuprofen 200mg that she takes twice a day for the past two days.
Past Medical History
Medication Intolerances: No known drug intolerance
Chronic Illnesses/Major traumas: The patient denies any history of major trauma.
Screening Hx/Immunizations Hx: last mammogram, which was normal, was 2 years ago.
OBGYN: Menarche at 10; LMP 2 weeks ago; last PAP 2019/Normal; GTPAL: 11001 score; no previous history of STDs. S.M is sexually active, have had 2 sexual partners in the past. S.M used condoms with previous partners. No previous gyn diagnoses or procedures done in the past.
Hospitalizations/Surgeries: Hospitalized once for delivery
Family History: There is no history of malignancy in first-degree relatives. She has one sister, age 58, who is in good health. Mother died at age 70; father died at age 64, from unknown causes.
Social History: S.M is married with one child. No use of alcohol; drinks wine socially; drinks one cup of coffee sometime to start her day at work. Never uses drugs.
Review of System
Constitutional: No significant gain/loss weight, no chills, no malaise or fatigue; no night sweats, no exercise intolerance. She does not report any skin changes. She has not experienced fever, weight loss, headache, nausea, vomiting, dizziness, or bone pain.
Skin: Denies rashes, pigmentation changes, lesions, or hair or nail changes.
Eyes: denies vision changes, diplopia, blurred vision, reports wearing eyeglasses.
Ears: Denies loss of hearing, ear pain, drainage, sensation of ears feeling full, ringing in the ear, or ear trauma.
Nose/Mouth/Throat: Denies sore throat, hoarseness, difficulty swallowing, postnasal
drip. No report of mouth or lips sore, bleeding gums, ulcerations or lesions of tongue or
mucosa; no dentures or dental appliances, or missing teeth reported.
Breast: Refers to right breast pain, or discomfort to right breast. Reports some brownish nipple discharges when squeezing the nipple and denies any breast trauma.
Heme/Lymph/Endo: Denies history of anemia, no bruising, no abnormal bleeding, and no swollen glands.
Cardiovascular: Denies chest pain, palpitations, orthopnea, edema, claudicati.
SOAP NOTEName J.D.Date 03262020Time 200 pmAge 25 .docx
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.
Week 8GI Case Study H. Pylori infectionQuestions As an.docx
Week 8
GI Case Study: H. Pylori infection
Questions: As an NP student, needs to determine the medications for recurrent H. Pylori infection.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format.
ACC/AHA Guidelines
Chief complaint:
“ I have recurrent H. Pylori infection”.
HPI:
M.C. a 46-year-old hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has pmhx of dyspepsia, GERD.
She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods.
Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
H. Pylori infection gastritis
Diabetes Mellitus, type 2
Surgeries: None
Allergies
:
NKDA
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Social history:
High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis.
mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: No edema. No palpitations.
Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.
Skin: No lesions. No rash. No itching.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: Slow gait but steady. No Kyphosis.
SKIN:
Dry. Intact.
PSYCH
: Normal affect. Cooperative.
Labs day of visit
:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal
A:
Primary Diagnosis: Recurrent H. Pylori infection gastritis
Secondary Diagnoses:
Dyspepsia
Differential Diagnosis:
Peptic Ulcer Disease
Previous medication plan:
two months ago and failed.
Clarithromycin 500 m ...
Support with 1 journals no older than 5 years.Week 8GI Case .docx
Support with 1 journals no older than 5 years.
Week 8
GI Case Study: H. Pylori infection
Questions: As an NP student, needs to determine the medications for recurrent H. Pylori infection.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format.
ACC/AHA Guidelines
Chief complaint:
“ I have recurrent H. Pylori infection”.
HPI:
M.C. a 46-year-old hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has pmhx of dyspepsia, GERD.
She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods.
Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
H. Pylori infection gastritis
Diabetes Mellitus, type 2
Surgeries: None
Allergies
:
NKDA
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Social history:
High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis.
mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: No edema. No palpitations.
Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.
Skin: No lesions. No rash. No itching.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: Slow gait but steady. No Kyphosis.
SKIN:
Dry. Intact.
PSYCH
: Normal affect. Cooperative.
Labs day of visit
:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal
A:
Primary Diagnosis: Recurrent H. Pylori infection gastritis
Secondary Diagnoses:
Dyspepsia
Differential Diagnosis:
Peptic Ulcer Disease
Previous medic ...
Discussion QuestionSupport with 1 journals no older than 5 year.docx
Discussion Question:
Support with 1 journals no older than 5 years.
Week 8
GI Case Study: H. Pylori infection
Questions: As an NP student, needs to determine the medications for recurrent H. Pylori infection.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format.
ACC/AHA Guidelines
Chief complaint: “ I have recurrent H. Pylori infection”.
HPI: M.C. a 46-year-old hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has pmhx of dyspepsia, GERD.
She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods.
Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
H. Pylori infection gastritis
Diabetes Mellitus, type 2
Surgeries: None
Allergies: NKDA
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Social history:
High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis.
mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: No edema. No palpitations.
Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.
Skin: No lesions. No rash. No itching.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
HEENT: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema.
ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.
SKIN: Dry. Intact.
PSYCH: Normal affect. Cooperative.
Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal
A:
Primary Diagnosis: Recurrent H. Pylori infection gastritis
Secondary Diagnoses:
Dyspepsia
Differential Diagnosis:
Peptic Ulcer Disease
Previous medication plan:two months ago and failed.
Clar.
Support with 1 journals no older than 5 years. H. Pylori infect.docx
Support with 1 journals no older than 5 years.
H. Pylori infection
Questions: As an NP student, needs to determine the medications for recurrent H. Pylori infection. According to the ACC/AHA Guidelines, what medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format. ACC/AHA Guidelines Chief complaint: “ I have recurrent H. Pylori infection”. HPI: M.C. a 46-year-old hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has pmhx of dyspepsia, GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms. PMH: H. Pylori infection gastritis Diabetes Mellitus, type 2 Surgeries: None Allergies: NKDA Vaccination History: She receives an annual flu shot. Last flu shot was this year Social history: High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago. Family history: Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis. ROS: Constitutional: Negative for fever. Negative for chills. Respiratory: No Shortness of breath. No Orthopnea Cardiovascular: No edema. No palpitations. Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain. Skin: No lesions. No rash. No itching. Psychiatric: No anxiety. No depression. Physical examination: Vital Signs Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored HEENT: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: Slow gait but steady. No Kyphosis. SKIN: Dry. Intact. PSYCH: Normal affect. Cooperative. Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal A: Primary Diagnosis: Recurrent H. Pylori infection gastritis Secondary Diagnoses: Dyspepsia Differential Diagnosis: Peptic Ulcer Disease Previous medication plan: two month ...
SubjectiveChief complaint headaches and blurriness of visi.docx
Subjective:
Chief complaint: headaches and blurriness of vision on the right side
History of present illness: the patient is 67 years old Caucasian female, she complains of having had headaches for 2 weeks now. The pain is located in the right temporal area. She describes the pain as 8-10/10, sharp, constant, interferes with her sleep, she states that nothing aggravates it, not even the bright lights or high sounds, but she gets a little relief by taking Ibuprofen 800 mg. She stated that she has been having some blurriness in the right eye, while her left eye is fine. She also complains of pain in her jaw and tongue while chewing food. Her appetite has been low, and lost about 5 pounds in the last 2 weeks. She noticed low grade fever as well. She also reported ringing sounds in the right ear. She denies any nausea or vomiting. She denied having similar headaches in the past. The patient denies complaining of nasal or postnasal drainage.
PMH: past medical history is significant for Hypertension, type II diabetes mellitus, asthma, and degenerative arthritis of the knees.
PSH: hysterectomy
Medications: Lisinopril 10 mg PO QD
Metformin 500 mg PO BID.
Proair HFA 2 puffs PRN.
Ibuprofen 800 mg TID
Multivitamins
By comparing the medications that the patient is taking with Beers criteria, they all looked appropriate to be used in elderly patients.
Family Hx:
Father: HTN, diabetes, and stroke.
Mother: HTN, Diabetes, and breast cancer at the age of 72.
Social Hx: the patient never smoked tobacco products.
ETOH: social drinker
Illicit substances: denies ever using illicit drugs.
Allergies: penicillin.
Review of systems:
Constitutional: the patient complains of fever, fatigue, anorexia, and weight loss.
Head: the patient denies complaining dizziness or lightheadedness.
Eyes: blurriness in the right eye.
Ears: the patient reports tinnitus- right ear, but denies complaining of ear pain or ear discharge
Nose: the patient denies any nasal bleeding, discharge or obstruction
Mouth: the patient reports painful chewing, she denies gingival bleeding, having mouth sores, or having dental difficulties
Throat: no sore throat
Cardiovascular: the patient denies complaining of Chest pain, palpitations, or swelling in the legs.
Respiratory: the patient denies any wheezing, shortness of breath or coughing.
Gastrointestinal: the patient denies any nausea, vomiting, GERD, epigastric pain, diarrhea, constipation, having black stools, or blood in stool.
Genitourinary: the patient denies any dysuria, polyuria, or visible hematuria
Musculoskeletal: bilateral knee pain.
Integumentary (Skin): the patient denies having any skin rash or skin discolorations.
Neurological: the patient denies complaining of tingling or numbness in any extremity; there is no history of seizures, stroke, syncope, or memory changes.
Psychiatric: the patient denies complaining of depression, or anxiety, denies complaining of hallucinations.
Endocrine: the pat ...
Pharma Case Study week 8 Chief complaint I’m here for a medi.docx
Pharma Case Study week 8
Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.
HPI: Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH: Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies: Penicillin
Vaccination History: Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden's nodes at the DIP joints, hands. + Crepitus, bil ...
CASE STUDY #2 Chief Complaint I have pain in my belly”.docx
CASE STUDY #2
Chief Complaint:
“I have pain in my belly”
History of Present Illness (HPI):
A 25-year-old female presents to the emergency room (ER) with complaints of severe abdominal pain for 2 weeks . The pain is sharp and crampy It hurts if I run, sit down hard, or if I have sex
PMH:
Patient denies
Drug Hx:
Birth control
Allergies:
NKA
Subjective:
Nausea and vomiting, Last menstrual period 5 days ago, New sexual partner about 2 months ago, No condoms, he hates them No pain, blood or difficulty with urination
Objective Data:
PE:
B/P 138/90; temperature 99°F; (RR) 20; (HR) 110, regular; oxygen saturation (PO2) 96%; pain 5/10
General:
acute distress and severe pain
HEENT:
Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip.
Lungs:
CTA AP&L
Card:
S1S2 without rub or gallop
Abd:
INSPECTION: no masses or thrills noted; no discoloration and skin is warm to; no tattoos or piercings; abdomen is nondistended and round
• AUSCULTATION: bowel sounds (BS) are normal in all four quadrants, no bruits noted
• PALPATION: on palpation, abdomen is tender to touch in four quadrants; tenderness noted on light palpation, deep palpation reveals no masses, spleen and liver unremarkable
• PERCUSSION: tympany heard in all quadrants, no dullness noted in abdominal area
GU:
• EXTERNAL: mature hair distribution; no external lesions on labia
• INTROITUS: slight green-gray discharge, no lesions
• VAGINAL: normal rugae; moderate amount of green discharge on vaginal walls
• CERVIX: nulliparous os with small amount of purulent discharge from os with positive cervical motion tenderness (CMT)
• UTERUS: ante-flexed, normal size, shape, and position
• ADNEXA: bilateral tenderness with fullness; both ovaries without masses
• RECTAL: deferred
• VAGINAL DISCHARGE: green in color
Ext:
no cyanosis, clubbing or edema
Integument:
intact without lesions masses or rashes
Neuro:
No obvious deficits and CN grossly intact II-XII
Then answer the following questions:
What other subjective data would you obtain?
What other objective findings would you look for?
What diagnostic exams do you want to order?
Name 3 differential diagnoses based on this patient presenting symptoms?
Give rationales for your each differential diagnosis.
-
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
.
Chief complaint I’m here for a medication refill because I r.docx
Chief complaint:
“I’m here for a medication refill because I ran out of my medicines”.
HPI:
Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH:
Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies
:
Penicillin
Vaccination History:
Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs:
Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral .
Case Study 1 Applying Theory to PracticeSocial scientists hav.docx
Case Study 1: Applying Theory to Practice
Social scientists have proposed a number of theories to explain juvenile delinquency. Each has its own strengths and weaknesses. For this assignment, go to the following Website, located at http://listverse.com/2011/05/14/top-10-young-killers/ and select one of the juvenile case studies.
After reading the case, select one (1) of the psychological theories discussed in Chapter 4 of the text.
Write a two to three (2-3) page paper in which you:
1. Summarize three (3) key aspects of the juvenile case study that you selected.
2. Highlight at least three (3) factors that you believe are important for one to understand the origins of the juvenile’s delinquent behavior.
3. Apply at least two (2) concepts from the theory that you chose from the text that would help explain the juvenile’s behavior.
4. Identify one (1) appropriate strategy geared toward preventing delinquency that is consistent with the theory you chose.
5. Use at least three (3) quality references. Note: Wikipedia and other Websites do not qualify as academic resources.
Discussion-
"The Changing Family System"
Using what you’ve learned this week, respond to the following prompts in your post:
· Explain at least two (2) roles that different parenting styles play in shaping the overall behavior of children. Next, indicate the significant impacts that each role has in contributing to delinquent behavior among juveniles.
· Think about the following question: Should juvenile delinquents be removed from their home and parent(s) and placed in a foster home or group home if the child continues to commit criminal acts after repeated attempts at treatment and confinement? Based on this question, discuss your thoughts on this subject. Provide support for your response.
Discussion-
"Exploring Monopolies and Oligopolies"
Watch this video, Oligopolies and Monopolistic Competition, to help you prepare for this week’s discussion.
Reply to these prompts by using the company for which you currently work, a business with which your familiar, or a dream business you want to start:
· With your selected business in mind, determine if it is competitive, monopolistic competitive, an oligopoly, or pure monopoly. Explain how you drew your conclusion about its market structure.
· How does the business/firm in this industry determine the price it will charge for the products or services it sells?
Discussion-
"Considering Tradeoffs You Make Every Day"
Let's talk about two tradeoffs we face every day: how we spend our time and money.
We can only do two things with income: spend it or save it. Time is the ultimate resource. We can choose to spend time working to earn an income or we can do other things, broadly classified as leisure. Reply to these prompts to start your discussion:
· How does a change in interest rate affect your decision to spend or save? How would a change in the interest rate affect a firm's decision to invest or save?
· How might an increas.
Case Study - Option 3 BarbaraBarbara is a 22 year old woman who h.docx
Case Study - Option 3: Barbara
Barbara is a 22 year old woman who has recently graduated from college with a psychology degree. She is currently working as a waitress at a popular restaurant near campus, and says she has always planned to attend law school. Barbara was born in a New Orleans, Louisiana. Her mother is an African American who is an assistant manager at a grocery store. Her father is Caucasian and works at a department store. Barbara reports that she was a shy, unattractive child, but that in general her early childhood was "pretty happy." Barbara says that during elementary school, she was constantly harassed by classmates about being of mixed race. Still, she says that she felt very close to her family during this period. She now insists that "I am not black or white, I am me."
Barbara is sexually active and engages in sexual activity with different men at least 1 time a week. Barbara indicates that she does not need protection because she is on the pill. She says she is simply too young to settle down. During her junior year of high school, Barbara had her first serious boyfriend, Morris, who was a high school classmate. She describes the relationship as warm and supportive and they became sexually active during her senior year of high school. They broke up soon after the first sexual interaction. In college, Barbara has dated and she acknowledges some bisexual experimentation. Barbara says that she prefers heterosexual relationships, however.
Although Barbara appears to be a natural athlete, she leads a relatively sedentary lifestyle. She does not exercise regularly and indicates that it is just not enjoyable.
Barbara does not like her job at the restaurant, but seems unwilling to look for other employment. She says that she feels "very jittery" whenever she gets ready for work, and she uses any excuse to take days off. She also refuses to associate with fellow employees, and reports getting very anxious when she was given a surprise birthday party. Recently, she has lost interest in cleaning her house and seldom cooks for herself. She also attends less to her personal grooming.
Diagnosis – Social Anxiety Disorder/Minor Depression
DSM-5 – Diagnostic Criteria for Social Anxiety Disorder
1. Fear or anxiety specific to social settings, in which a person feels noticed, observed, or scrutinized.
2. Typically the individual will fear that they will display their anxiety and experience social rejection,
3. Social interaction will consistently provoke distress,
4. Social interactions are either avoided, or painfully and reluctantly endured,
5. The fear and anxiety will be grossly disproportionate to the actual situation,
6. The fear, anxiety or other distress around social situations will persist for six months or longer and
7. Cause personal distress and impairment of functioning in one or more domains, such as interpersonal or occupational functioning,
8. The fear or anxiety cannot be attributed to a medical disorder, s.
More Related Content
Similar to CASE PLEASE READChief complaint My right great toe has .docx
Discussion post reply to the following soap noted case scenario-Respon.docx
Discussion post reply to the following soap noted case scenario.
Respond by analyzing Analyze the possible conditions from your colleagues' differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.
APA format with intext citation
2 to 3 scholarly references with in the last 5 years
Plagiarism free with Turnitin report
250-300 minimum word count
Case scenario # 1
Week 8, Mpofu Sibongile C
1/18/2023
Review of Case Study # 2 Ankle Pain SOAP Note.
Patient Information: Name: MF
Initials, MF Age: 46-year-old Sex: Female, Caucasian.
S.
CC : “My Ankles Hurts, worse on the right ankleâ€.
HPI : MF is a 46-year-old Caucasian female who presents to the clinic this morning with bilateral ankle pain, worse on the right foot it hurts and very uncomfortable. She reports pain started two days ago after playing soccer over the weekend, she says she heard a “popâ€. It is a throbbing pain, that gets worse when she bears weight on it when standing or walking but gets better when she applies ice and rest with feet elevated. She states the pain as constant all day, associated with swelling. She rates her pain as 3/10 left ankle but right ankle is 7/10.
Current Medication:
1. Ibuprofen 400 mg x 2 PO 8 hrly prn for pain. Has been taking it for 2 days ago.
2. Tylenol 650 mg PO 6 hourly for pain. Since last night.
3. Ice packs, twice daily for pain.
4. Fish oil 1200 mg PO, HS for pain
Allergies: No Known allergies to drugs nor food allergies .
PMH: MF is up to date with her immunization, has covid-19 vaccine in June 2022. (Pfizer). Second dose on September 15th, 2022. Tetanus vaccine a year ago but cannot recall the date. Is getting flu vaccine end of the month. Made up history. Sprained her ankle 2 years ago,2020. No previous surgeries.
Soc History : Â She is a high school sports teacher. Married for 6 years, no children. She enjoys outdoor activities walking, camping, playing soccer and shopping. She lives with her husband in a 3-bedroom house, secure community. She does not smoke but drinks alcohol, a glass of wine during dinner and beer during weekends only if no sports. Denies drugs use. She drives herself to work, wears seat belts, she only answers the phone using her Bluetooth. She eats healthy diet and exercises 3 times a week on her treadmill and plays sports (soccer) every Friday afternoon and Saturday from 4 pm to 6pm. She gets support from her husband and is a member of teachers support group.
Fam Hx :
1. Mother: 72 years. Type 2 diabetes, on diet control, diagnosed 3 years ago alive.
2. Father: Father 78 years with gout, is alive.
3. Sister: 40 years with arthritis alive
4. Maternal grandmother: died at 80 years from hypertension.
5. Maternal grandfather: died at 68 years from COPD.
6. Paternal grandfather: Died from heart attack at 70 years.
7. Paternal grandmother: died at 80 years, unknown cause, but had arthritis.
ROS :
General: MF appears healthy, she wei.
SOAO NotePatient Initials S.MPt. Encounter Number 2 .docx
SOAO Note
Patient Initials: S.M
Pt. Encounter Number: 2
Date: 10/12/2020
Age: 61
Sex: Female
Allergies: NKA
Advanced Directives: No
SUBJECTIVE
Chief Complaint: "I have a lump on my right breast."
HPI: S.M is a 61-year-old, Hispanic, female who presents to the office alarmed by a painful lump in her right breast that she discovered while showering. S.M reports the pain started 2 days ago while in the shower. The pain is felt when touching the right breast, and it felt on light touch. Current pain level is now 5/10. She does not report any skin changes. Patient denies any history of herbal medicine use and is currently on no medication. Pain gets worse with movement and with lifting weight. Pain is relieved with rest and medication. S.M gets some short relief with pain reliever ibuprofen 200mg that she takes twice a day for the past two days.
Past Medical History
Medication Intolerances: No known drug intolerance
Chronic Illnesses/Major traumas: The patient denies any history of major trauma.
Screening Hx/Immunizations Hx: last mammogram, which was normal, was 2 years ago.
OBGYN: Menarche at 10; LMP 2 weeks ago; last PAP 2019/Normal; GTPAL: 11001 score; no previous history of STDs. S.M is sexually active, have had 2 sexual partners in the past. S.M used condoms with previous partners. No previous gyn diagnoses or procedures done in the past.
Hospitalizations/Surgeries: Hospitalized once for delivery
Family History: There is no history of malignancy in first-degree relatives. She has one sister, age 58, who is in good health. Mother died at age 70; father died at age 64, from unknown causes.
Social History: S.M is married with one child. No use of alcohol; drinks wine socially; drinks one cup of coffee sometime to start her day at work. Never uses drugs.
Review of System
Constitutional: No significant gain/loss weight, no chills, no malaise or fatigue; no night sweats, no exercise intolerance. She does not report any skin changes. She has not experienced fever, weight loss, headache, nausea, vomiting, dizziness, or bone pain.
Skin: Denies rashes, pigmentation changes, lesions, or hair or nail changes.
Eyes: denies vision changes, diplopia, blurred vision, reports wearing eyeglasses.
Ears: Denies loss of hearing, ear pain, drainage, sensation of ears feeling full, ringing in the ear, or ear trauma.
Nose/Mouth/Throat: Denies sore throat, hoarseness, difficulty swallowing, postnasal
drip. No report of mouth or lips sore, bleeding gums, ulcerations or lesions of tongue or
mucosa; no dentures or dental appliances, or missing teeth reported.
Breast: Refers to right breast pain, or discomfort to right breast. Reports some brownish nipple discharges when squeezing the nipple and denies any breast trauma.
Heme/Lymph/Endo: Denies history of anemia, no bruising, no abnormal bleeding, and no swollen glands.
Cardiovascular: Denies chest pain, palpitations, orthopnea, edema, claudicati.
SOAP NOTEName J.D.Date 03262020Time 200 pmAge 25 .docx
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.
Week 8GI Case Study H. Pylori infectionQuestions As an.docx
Week 8
GI Case Study: H. Pylori infection
Questions: As an NP student, needs to determine the medications for recurrent H. Pylori infection.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format.
ACC/AHA Guidelines
Chief complaint:
“ I have recurrent H. Pylori infection”.
HPI:
M.C. a 46-year-old hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has pmhx of dyspepsia, GERD.
She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods.
Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
H. Pylori infection gastritis
Diabetes Mellitus, type 2
Surgeries: None
Allergies
:
NKDA
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Social history:
High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis.
mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: No edema. No palpitations.
Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.
Skin: No lesions. No rash. No itching.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: Slow gait but steady. No Kyphosis.
SKIN:
Dry. Intact.
PSYCH
: Normal affect. Cooperative.
Labs day of visit
:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal
A:
Primary Diagnosis: Recurrent H. Pylori infection gastritis
Secondary Diagnoses:
Dyspepsia
Differential Diagnosis:
Peptic Ulcer Disease
Previous medication plan:
two months ago and failed.
Clarithromycin 500 m ...
Support with 1 journals no older than 5 years.Week 8GI Case .docx
Support with 1 journals no older than 5 years.
Week 8
GI Case Study: H. Pylori infection
Questions: As an NP student, needs to determine the medications for recurrent H. Pylori infection.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format.
ACC/AHA Guidelines
Chief complaint:
“ I have recurrent H. Pylori infection”.
HPI:
M.C. a 46-year-old hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has pmhx of dyspepsia, GERD.
She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods.
Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
H. Pylori infection gastritis
Diabetes Mellitus, type 2
Surgeries: None
Allergies
:
NKDA
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Social history:
High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis.
mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: No edema. No palpitations.
Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.
Skin: No lesions. No rash. No itching.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
HEENT
: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: Slow gait but steady. No Kyphosis.
SKIN:
Dry. Intact.
PSYCH
: Normal affect. Cooperative.
Labs day of visit
:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal
A:
Primary Diagnosis: Recurrent H. Pylori infection gastritis
Secondary Diagnoses:
Dyspepsia
Differential Diagnosis:
Peptic Ulcer Disease
Previous medic ...
Discussion QuestionSupport with 1 journals no older than 5 year.docx
Discussion Question:
Support with 1 journals no older than 5 years.
Week 8
GI Case Study: H. Pylori infection
Questions: As an NP student, needs to determine the medications for recurrent H. Pylori infection.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format.
ACC/AHA Guidelines
Chief complaint: “ I have recurrent H. Pylori infection”.
HPI: M.C. a 46-year-old hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has pmhx of dyspepsia, GERD.
She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods.
Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
H. Pylori infection gastritis
Diabetes Mellitus, type 2
Surgeries: None
Allergies: NKDA
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Social history:
High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis.
mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: No edema. No palpitations.
Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain.
Skin: No lesions. No rash. No itching.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored
HEENT: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema.
ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.
SKIN: Dry. Intact.
PSYCH: Normal affect. Cooperative.
Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal
A:
Primary Diagnosis: Recurrent H. Pylori infection gastritis
Secondary Diagnoses:
Dyspepsia
Differential Diagnosis:
Peptic Ulcer Disease
Previous medication plan:two months ago and failed.
Clar.
Support with 1 journals no older than 5 years. H. Pylori infect.docx
Support with 1 journals no older than 5 years.
H. Pylori infection
Questions: As an NP student, needs to determine the medications for recurrent H. Pylori infection. According to the ACC/AHA Guidelines, what medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format. ACC/AHA Guidelines Chief complaint: “ I have recurrent H. Pylori infection”. HPI: M.C. a 46-year-old hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has pmhx of dyspepsia, GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms. PMH: H. Pylori infection gastritis Diabetes Mellitus, type 2 Surgeries: None Allergies: NKDA Vaccination History: She receives an annual flu shot. Last flu shot was this year Social history: High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago. Family history: Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis. ROS: Constitutional: Negative for fever. Negative for chills. Respiratory: No Shortness of breath. No Orthopnea Cardiovascular: No edema. No palpitations. Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain. Skin: No lesions. No rash. No itching. Psychiatric: No anxiety. No depression. Physical examination: Vital Signs Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored HEENT: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: Slow gait but steady. No Kyphosis. SKIN: Dry. Intact. PSYCH: Normal affect. Cooperative. Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal A: Primary Diagnosis: Recurrent H. Pylori infection gastritis Secondary Diagnoses: Dyspepsia Differential Diagnosis: Peptic Ulcer Disease Previous medication plan: two month ...
SubjectiveChief complaint headaches and blurriness of visi.docx
Subjective:
Chief complaint: headaches and blurriness of vision on the right side
History of present illness: the patient is 67 years old Caucasian female, she complains of having had headaches for 2 weeks now. The pain is located in the right temporal area. She describes the pain as 8-10/10, sharp, constant, interferes with her sleep, she states that nothing aggravates it, not even the bright lights or high sounds, but she gets a little relief by taking Ibuprofen 800 mg. She stated that she has been having some blurriness in the right eye, while her left eye is fine. She also complains of pain in her jaw and tongue while chewing food. Her appetite has been low, and lost about 5 pounds in the last 2 weeks. She noticed low grade fever as well. She also reported ringing sounds in the right ear. She denies any nausea or vomiting. She denied having similar headaches in the past. The patient denies complaining of nasal or postnasal drainage.
PMH: past medical history is significant for Hypertension, type II diabetes mellitus, asthma, and degenerative arthritis of the knees.
PSH: hysterectomy
Medications: Lisinopril 10 mg PO QD
Metformin 500 mg PO BID.
Proair HFA 2 puffs PRN.
Ibuprofen 800 mg TID
Multivitamins
By comparing the medications that the patient is taking with Beers criteria, they all looked appropriate to be used in elderly patients.
Family Hx:
Father: HTN, diabetes, and stroke.
Mother: HTN, Diabetes, and breast cancer at the age of 72.
Social Hx: the patient never smoked tobacco products.
ETOH: social drinker
Illicit substances: denies ever using illicit drugs.
Allergies: penicillin.
Review of systems:
Constitutional: the patient complains of fever, fatigue, anorexia, and weight loss.
Head: the patient denies complaining dizziness or lightheadedness.
Eyes: blurriness in the right eye.
Ears: the patient reports tinnitus- right ear, but denies complaining of ear pain or ear discharge
Nose: the patient denies any nasal bleeding, discharge or obstruction
Mouth: the patient reports painful chewing, she denies gingival bleeding, having mouth sores, or having dental difficulties
Throat: no sore throat
Cardiovascular: the patient denies complaining of Chest pain, palpitations, or swelling in the legs.
Respiratory: the patient denies any wheezing, shortness of breath or coughing.
Gastrointestinal: the patient denies any nausea, vomiting, GERD, epigastric pain, diarrhea, constipation, having black stools, or blood in stool.
Genitourinary: the patient denies any dysuria, polyuria, or visible hematuria
Musculoskeletal: bilateral knee pain.
Integumentary (Skin): the patient denies having any skin rash or skin discolorations.
Neurological: the patient denies complaining of tingling or numbness in any extremity; there is no history of seizures, stroke, syncope, or memory changes.
Psychiatric: the patient denies complaining of depression, or anxiety, denies complaining of hallucinations.
Endocrine: the pat ...
Pharma Case Study week 8 Chief complaint I’m here for a medi.docx
Pharma Case Study week 8
Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.
HPI: Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH: Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies: Penicillin
Vaccination History: Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden's nodes at the DIP joints, hands. + Crepitus, bil ...
CASE STUDY #2 Chief Complaint I have pain in my belly”.docx
CASE STUDY #2
Chief Complaint:
“I have pain in my belly”
History of Present Illness (HPI):
A 25-year-old female presents to the emergency room (ER) with complaints of severe abdominal pain for 2 weeks . The pain is sharp and crampy It hurts if I run, sit down hard, or if I have sex
PMH:
Patient denies
Drug Hx:
Birth control
Allergies:
NKA
Subjective:
Nausea and vomiting, Last menstrual period 5 days ago, New sexual partner about 2 months ago, No condoms, he hates them No pain, blood or difficulty with urination
Objective Data:
PE:
B/P 138/90; temperature 99°F; (RR) 20; (HR) 110, regular; oxygen saturation (PO2) 96%; pain 5/10
General:
acute distress and severe pain
HEENT:
Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip.
Lungs:
CTA AP&L
Card:
S1S2 without rub or gallop
Abd:
INSPECTION: no masses or thrills noted; no discoloration and skin is warm to; no tattoos or piercings; abdomen is nondistended and round
• AUSCULTATION: bowel sounds (BS) are normal in all four quadrants, no bruits noted
• PALPATION: on palpation, abdomen is tender to touch in four quadrants; tenderness noted on light palpation, deep palpation reveals no masses, spleen and liver unremarkable
• PERCUSSION: tympany heard in all quadrants, no dullness noted in abdominal area
GU:
• EXTERNAL: mature hair distribution; no external lesions on labia
• INTROITUS: slight green-gray discharge, no lesions
• VAGINAL: normal rugae; moderate amount of green discharge on vaginal walls
• CERVIX: nulliparous os with small amount of purulent discharge from os with positive cervical motion tenderness (CMT)
• UTERUS: ante-flexed, normal size, shape, and position
• ADNEXA: bilateral tenderness with fullness; both ovaries without masses
• RECTAL: deferred
• VAGINAL DISCHARGE: green in color
Ext:
no cyanosis, clubbing or edema
Integument:
intact without lesions masses or rashes
Neuro:
No obvious deficits and CN grossly intact II-XII
Then answer the following questions:
What other subjective data would you obtain?
What other objective findings would you look for?
What diagnostic exams do you want to order?
Name 3 differential diagnoses based on this patient presenting symptoms?
Give rationales for your each differential diagnosis.
-
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
.
Chief complaint I’m here for a medication refill because I r.docx
Chief complaint:
“I’m here for a medication refill because I ran out of my medicines”.
HPI:
Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH:
Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies
:
Penicillin
Vaccination History:
Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs:
Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral .
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Case Study 1: Applying Theory to Practice
Social scientists have proposed a number of theories to explain juvenile delinquency. Each has its own strengths and weaknesses. For this assignment, go to the following Website, located at http://listverse.com/2011/05/14/top-10-young-killers/ and select one of the juvenile case studies.
After reading the case, select one (1) of the psychological theories discussed in Chapter 4 of the text.
Write a two to three (2-3) page paper in which you:
1. Summarize three (3) key aspects of the juvenile case study that you selected.
2. Highlight at least three (3) factors that you believe are important for one to understand the origins of the juvenile’s delinquent behavior.
3. Apply at least two (2) concepts from the theory that you chose from the text that would help explain the juvenile’s behavior.
4. Identify one (1) appropriate strategy geared toward preventing delinquency that is consistent with the theory you chose.
5. Use at least three (3) quality references. Note: Wikipedia and other Websites do not qualify as academic resources.
Discussion-
"The Changing Family System"
Using what you’ve learned this week, respond to the following prompts in your post:
· Explain at least two (2) roles that different parenting styles play in shaping the overall behavior of children. Next, indicate the significant impacts that each role has in contributing to delinquent behavior among juveniles.
· Think about the following question: Should juvenile delinquents be removed from their home and parent(s) and placed in a foster home or group home if the child continues to commit criminal acts after repeated attempts at treatment and confinement? Based on this question, discuss your thoughts on this subject. Provide support for your response.
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Watch this video, Oligopolies and Monopolistic Competition, to help you prepare for this week’s discussion.
Reply to these prompts by using the company for which you currently work, a business with which your familiar, or a dream business you want to start:
· With your selected business in mind, determine if it is competitive, monopolistic competitive, an oligopoly, or pure monopoly. Explain how you drew your conclusion about its market structure.
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Case Study - Option 3 BarbaraBarbara is a 22 year old woman who h.docx
Case Study - Option 3: Barbara
Barbara is a 22 year old woman who has recently graduated from college with a psychology degree. She is currently working as a waitress at a popular restaurant near campus, and says she has always planned to attend law school. Barbara was born in a New Orleans, Louisiana. Her mother is an African American who is an assistant manager at a grocery store. Her father is Caucasian and works at a department store. Barbara reports that she was a shy, unattractive child, but that in general her early childhood was "pretty happy." Barbara says that during elementary school, she was constantly harassed by classmates about being of mixed race. Still, she says that she felt very close to her family during this period. She now insists that "I am not black or white, I am me."
Barbara is sexually active and engages in sexual activity with different men at least 1 time a week. Barbara indicates that she does not need protection because she is on the pill. She says she is simply too young to settle down. During her junior year of high school, Barbara had her first serious boyfriend, Morris, who was a high school classmate. She describes the relationship as warm and supportive and they became sexually active during her senior year of high school. They broke up soon after the first sexual interaction. In college, Barbara has dated and she acknowledges some bisexual experimentation. Barbara says that she prefers heterosexual relationships, however.
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Diagnosis – Social Anxiety Disorder/Minor Depression
DSM-5 – Diagnostic Criteria for Social Anxiety Disorder
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7. Cause personal distress and impairment of functioning in one or more domains, such as interpersonal or occupational functioning,
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Case Study - Cyberterrorism—A New Reality:
When hackers claiming to support the Syrian regime of Bashar Al-Assad attacked and disabled the website of Al Jazeera, the Qatar-based satellite news channel, in September 2012, the act was another act of hacktivism, purporting to promote a specific political agenda over another. Hacktivism has become a very visible form of expressing dissent. Even though there have been numerous incidents reported by the media, the first case of hacktivism was documented in 1989 when a member of the Cult of the Dead Cow hacker collective named Omega coined the term in 1996. However, hacktivism is not the only form of cyber protest and conflict that has everyone from ICT professionals to governments scrambling for solutions. Individuals, enterprises, and governments alike rely in many instances almost completely on network computing technologies, including cloud computing. The international and ever-evolving nature of the Internet along with inadequate law enforcement and the anonymity the global architecture offers creates opportunities for hackers to attack vulnerable nodes for personal, financial, or political gain.
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Case Study - APA paper with min 4 page content Review the Blai.docx
Case Study - APA paper with min 4 page content
Review the
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I want you to, of course, show me that you understand the situation but then to add the
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Case Study - Global Mobile Corporation
“Damn it, he's done it again!”
Charlie Newburg had to get up and walk around his office, he was so frustrated. He had been
reviewing the most recent design, parts, and assembly specifications for Global Mobile's latest
smart phone (code named: Nonphixhun) that had been released for production the previous
Thursday. The files had just come back to Charlie's engineering services department with a
caustic note that began, “This one can't be produced, either…” It was the fourth time production
had returned the design.
Newburg, director of engineering for the Global Mobile Corporation, was normally a quiet
person. But the Nonphixhun project was stretching his patience; it was beginning to appear like
several other new products that had hit delays and problems in the transition from design to
production during the eight months Charlie had worked for Global Mobile. These problems were
nothing new at Global Mobile's Asian factory; Charlie's predecessor in the engineering job had
run afoul of them, too, and had finally been fired for protesting too vehemently about the other
departments. But the Nonphixhun phone should have been different. Charlie and the firm's
president, Hannah Hoover, had video-conferenced two months earlier (on July 3, 2006) with the
factory superintendent, Tyson Wang, to smooth the way for the new phone's design. He thought
back to the meeting …
• “Now, we all know there's a tight deadline on the Nonphixhun,” Hannah Hoover said, “and
Charlie's done well to ask us to talk about its introduction. I'm counting on both of you to find
any snags in the system, and to work together to get that first production run out by October
2. Can you do it?” “We can do it in production if we get a clean design two weeks from
now, as scheduled,” answered Tyson Wang, the factory manager. “Charlie and I have already
talked about that, of course. I've spoken with our circuit board and other parts suppliers and
scheduled assembly capacity, and we'll be ready. If the design goes over schedule, though, I'll
have to fill in with other runs, and it will cost us a bundle to break in for the Nonphixhun.
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any more last minute changes, we've got a shot. I've pulled my technical support people off of
three other overdue jobs to get this one out. But, Tyson, that means we can't spring engineers
loose to confer with your production people on other manufacturing problems.” “Well
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Case Study #3Apple Suppliers & Labor PracticesWith its h.docx
Case Study #3
Apple Suppliers & Labor Practices
With its highly coveted line of consumer electronics, Apple has a cult following among loyal consumers. During the 2014 holiday season, 74.5 million iPhones were sold. Demand like this meant that Apple was in line to make over $52 billion in profits in 2015, the largest annual profit ever generated from a company’s operations. Despite its consistent financial performance year over year, Apple’s robust profit margin hides a more complicated set of business ethics. Similar to many products sold in the U.S., Apple does not manufacture most its goods domestically. Most of the component sourcing and factory production is done overseas in conditions that critics have argued are dangerous to workers and harmful to the environment.
For example, tin is a major component in Apple’s products and much of it is sourced in Indonesia. Although there are mines that source tin ethically, there are also many that do not. One study found workers—many of them children—working in unsafe conditions, digging tin out by hand in mines prone to landslides that could bury workers alive. About 70% of the tin used in electronic devices such as smartphones and tablets comes from these more dangerous, small-scale mines. An investigation by the BBC revealed how perilous these working conditions can be. In interviews with miners, a 12-yearold working at the bottom of a 70-foot cliff of sand said: “I worry about landslides. The earth slipping from up there to the bottom. It could happen.”
Apple defends its practices by saying it only has so much control over monitoring and regulating its component sources. The company justifies its sourcing practices by saying that it is a complex process, with tens of thousands of miners selling tin, many of them through middle-men. In a statement to the BBC, Apple said “the simplest course of action would be for Apple to unilaterally refuse any tin from Indonesian mines. That would be easy for us to do and would certainly shield us from criticism. But that would also be the lazy and cowardly path, since it would do nothing to improve the situation. We have chosen to stay engaged and attempt to drive changes on the ground.”
In an effort for greater transparency, Apple has released annual reports detailing their work with suppliers and labor practices. While more recent investigations have shown some improvements to suppliers’ working conditions, Apple continues to face criticism as consumer demand for iPhones and other products continues to grow.
Essay directions –
Students will have to identify and analyze the above ethical dilemma. Write a 750 – 1000 word, double-spaced paper, and APA style.
Students are expected to identify the key stakeholders, discussion of the implications of the ethical dilemma, and answer the case study questions. Each paper should have the following sections: • Introduction of the case• The ethical dilemma • Stakeholders • Questions • Conclusions • References .
CASE STUDY (Individual) Scotland In terms of its physical l.docx
CASE STUDY (Individual): Scotland
* In terms of its physical landscape, where is the region that is experiencing a devolutionary process located and what type of climate is prevalent? (use Figure 2.5 and 2.4 of the textbook).
* According to the sources you have consulted, do these physical/natural characteristics have played any role in the historical background for this devolutionary process? How?
* How do the people that inhabit the region you are studying speak about their relationship to the land and the environment? Do they express any ideas on biodiversity conservation?
* Do they say anything about their homeland? If the region you are studying has a website (official or not), what role do maps play on their web site/s?
* Is this region located close to or far from the center of power of the country (the national capital city)?
* Does this condition have any impact on the reasons why they would like to gain at-least more autonomy to make their own decisions?
* According to the source/s you have consulted, what are the main reason/s why this population would like to break-up from the country in which they live in?
Do this/these source/s mention any explanation/s based on cultural or ethnic characteristics? For example, speaking a different language? Which one? Professing a different religion? Which one? Economic disparities
.
Case Study #2 T.D. enjoys caring for the children and young peop.docx
Case Study #2
T.D. enjoys caring for the children and young people in the schools where she works, but sometimes she is faced with tough situations such as suspected child abuse and neglect, teen pregnancy, and alcohol and drug use among teenagers. She works hard to ensure that the children in her schools receive the best care possible.
Question:
Several third graders reports having received no breakfast at home for more than a week. T.D. is exercising Advocacy for the students under her care. What type of actions she might be doing to exercise advocacy for the students?
Discuss this:
Moral distress is a frequent situation where health care providers should face. Please define and discuss a personal experience where you have faced Moral distress in your practice.
Discuss how health promotion relates to morality.
Discuss your insights about your own communication strengths and weaknesses. Identify situations in which it may be difficult for you to establish or terminate a therapeutic relationship.
*
formatted and cited in current APA style with support from at least 2 academic sources.
.
Case Study #1Jennifer is a 29-year-old administrative assistan.docx
Case Study #1
Jennifer is a 29-year-old administrative assistant married to Antonio, an Italian engineer, whom Jennifer met four years earlier while on a business trip for her marketing company. The couple now lives in Nebraska, where Antonio works for the county's transportation department and Jennifer commutes an hour each way to her marketing office. They have been trying to start a family for over a year. Eight months ago, Jennifer miscarried in her second month of pregnancy. Antonio's parents love Jennifer and often ask her if she is expecting again, hoping to encourage her to focus on her next baby. Jennifer's mother passed away two years ago and her father's health is rapidly deteriorating. Jennifer faces the probability of placing her father in a skilled nursing care facility within the next few months, against his wishes.
At work, Jennifer runs a tight ship. She is organized and prepares lists to assure that everything is done according to schedule. Everyone counts on Jennifer and she takes pride in never letting people down.
Jennifer has visited her physician numerous times in the last six months, complaining of headaches, backaches, and indigestion. Jennifer insists that she is happy and is not feeling stressed, yet she finds herself making more mistakes at work, unable to keep up with housework, and feeling tired and overwhelmed; she has begun to question her effectiveness as an employee, wife, daughter, and potential mother. Her pains seem to be increasing, but her doctor cannot find a physical cause for her discomfort.
Case Study #2
Michael is a 40-year-old airline pilot who has recently begun to experience chest pains. The chest pains began when Michael signed his final divorce papers, ending his 15-year marriage. He fought for joint custody of his two children, ages 12 and 10, but although he wants to be with them more frequently, he only sees them every two weeks. This schedule is, in great part, a result of his employer's announcement that budget constraints would result in layoffs. Michael worries that without his job he will be unable to support his children and lose the new townhouse that he purchased. Michael's chest pains are becoming more frequent and he fears that he may be dying.
Review case studies 1 and 2.
Choose one case study.
Complete the following questions in 150 to 200 words each. Be as detailed as possible and use the information you have learned throughout this course.
• What are the causes of stress in Michael’s or Jennifer’s life? How is stress affecting Michael’s or Jennifer’s health?
• How are these stressors affecting Michael’s or Jennifer’s self-concept and self-esteem?
• How might Michael’s or Jennifer’s situation illustrate adjustment? How might this situation become an opportunity for personal growth?
• What defensive coping methods is Michael or Jennifer using? What active coping methods might be healthier for Michael or Jennifer to use? Explain why you would recom.
Case Study # 2 –Danny’s Unhappy DutyEmployee ProfilesCaro.docx
Case Study # 2 –Danny’s Unhappy Duty
Employee Profiles
:
Carol Brown, Danny Winthrop, Thomas Fletcher
Carol, the Department Secretary for Purchasing and General Stores, has been
working at St. Louis Memorial Hospital for sixteen years, four of which have
been for the present Manager, Dan Winthrop. Carol likes her Boss, who gives
his employees more leeway than most. Carol’s main interests are her work and
her home—traits also typical of the other people who work in the Department.
Carol feels she is part of a close, cooperative group of employees.
Dan, or Danny, as he likes to be called, arrived at St. Louis Memorial four years
ago as a replacement for a Department manager who had been at the Hospital
for a number of years. Danny’s predecessor, Bill Taylor, was very strict in
everything from insisting that employees take exactly one-half hour for lunch
breaks to not having a coffee pot in the Department. When Danny came on
board as a Department Manager, his management style was much less strict.
The result was that Danny’s employees were much happier, and began to meet
and exceed expectations in getting their work done. St. Louis Memorial’s
previous CEO was a good friend and frequently complimented Danny on his
efficient and effective staff. Now a new CEO, Thomas Fletcher, has been hired
by the Hospital’s Board of Directors. Things are about to change.
Thomas Fletcher, new CEO and a recent graduate from a superior school of
hospital management, has always believed in “doing things by the book”.
Thomas originally had wanted to become a doctor, but decided two years into
the process that it was going to take him too long, and that he would be better
off becoming an administrator. He likes the idea of being an administrator,
and wants to be a good one. He has decided to start out his career at St. Louis
Memorial, of the smaller hospitals in the St. Louis area, but hopes to progress to a
a much larger facility in about four years, once he develops a track record at
St. Louis Memorial.
The Challenge: Communication, Criticism and Discipline, Leadership, Motivation,
Rules and Policies
Danny knows his employees quite well. They are generally a happy, cohesive, and cooperative group. They joke around a lot among themselves, but get the work done more than satisfactorily. All of them seem to give a
gr.
Case Study – Multicultural ParadeRead the Case below, and answe.docx
Case Study – Multicultural Parade
Read the Case below, and answer the following questions:
(No references needed, 2 pages double space, label the answer without copying the question in the paper)
1. What images come to mind when you hear the term “costume”? In what ways might it be considered demeaning?
2. Often people conflate “culture,” “ethnicity,” “heritage,” “race,” and “nationality,” or use them interchangeably. How are these concepts different from one another? Is a “Multicultural Day” different than an “International Day”?
3. How is Ms. Morrison’s definition of “cultural clothing” different from her definition of “ethnic heritage”? Did her explanation clarify things for Keisha and Emily?
4. How might activities that require students to share part of their ethnic heritage alienate students or contribute to students’ and teachers’ existing stereotypes and biases?
5. Connect to 3 of the core themes:
(Equity in Education/ Theories of Learning, Culture, and Identity/ Teaching and Learning in a Multicultural Society/ Research and Educational Knowledge )
-------------------------------------------------------------------------------------------------------------------------------
Case Study:
In an effort to celebrate the growing racial and ethnic diversity at Eastern School, the school’s Diversity Committee decided to sponsor Multicultural Day. Numerous performers were hired for assemblies and presentations. During the day’s feature event, the “Culture Parade,” students were asked to showcase cultural clothing as they walked through the hallways. Teachers were encouraged by the committee to discuss clothing from countries outside the United States and to invite students who had such clothing to bring it to school for the parade.
Ms. Morrison was excited about Multicultural Day because many of her students had parents who were immigrants. She imagined the day as an opportunity for those students to teach others about their cultures.
A week before the event, Ms. Morrison brought a kilt to class and explained its significance to the students. “This represents my Scottish heritage,” she said, “and I am proud to show it to you today.” She then asked whether students had “special costumes” at home that represented their cultures. Several students raised their hands, which prompted Ms. Morrison to discuss the events planned for Multicultural Day, including the parade.
During dismissal the day before the parade Ms. Morrison announced, “Don’t forget to bring your costumes to class tomorrow!”
The next day, Ms. Morrison was pleased to see several Hmong and Liberian students came with bags of clothing. She saw that two other students, Emily and Keisha, brought clothing, so she inquired about what was in their bags. Emily, a white student excitedly pulled out her soccer uniform, and Keisha, an African American student, pulled jeans and her favorite sweatshirt out of her bag. Ms. Morrison told the two girls she appreciated the.
Case Study THE INVISIBLE SPONSOR1BackgroundSome execut.docx
Case Study : THE INVISIBLE SPONSOR1
Background
Some executives prefer to micromanage projects whereas other executives
are fearful of making a decision because, if they were to make the wrong
decision, it could impact their career. In this case study, the president of the company assigned one of the vice presidents to act as the project sponsor on a project designed to build tooling for a client. The sponsor, however, was reluctant to make any decisions.
Assigning the VP
Moreland Company was well-respected as a tooling design-and-build
company. Moreland was project-driven because all of its income came
from projects. Moreland was also reasonably mature in project management.
When the previous VP for engineering retired, Moreland hired an executive from a manufacturing company to replace him. The new VP for engineering, Al Zink, had excellent engineering knowledge about tooling but had worked for companies that were not project-driven. Al had very little knowledge about project management and had never functioned as a project sponsor. Because of Al’s lack of experience as a sponsor, the president decided that Al should “get his feet wet” as quickly as possible and assigned him as the project sponsor on a mediumsized project. The project manager on this project was Fred Cutler. Fred was an engineer with more than twenty years of experience in tooling design and manufacturing. Fred reported directly to Al Zink administratively.
Fred's Dilemma
Fred understood the situation; he would have to train Al Zink on how to
function as a project sponsor. This was a new experience for Fred because subordinates usually do not train senior personnel on how to do their job. Would Al Zink be receptive?
Fred explained the role of the sponsor and how there are certain project documents that require the signatures of both the project manager and the project sponsor. Everything seemed to be going well until Fred informed Al that the project sponsor is the person that the president eventually holds accountable for the success or failure of the project. Fred could tell that Al was
quite upset over this statement.
Al realized that the failure of a project where he was the sponsor could damage his reputation and career. Al was now uncomfortable about having to act as a sponsor but knew that he might eventually be assigned as a sponsor on other projects. Al also knew that this project was somewhat of a high risk. If Al could function as an invisible sponsor, he could avoid making any critical decisions.
In the first meeting between Fred and Al where Al was the sponsor, Al asked Fred for a copy of the schedule for the project. Fred responded: I’m working on the schedule right now. I cannot finish the schedule until you tell me whether you want me to lay out the schedule based upon best time, least cost, or least risk.
Al stated that he would think about it and get back to Fred as soon as possible.
During the middle of the next week, Fred and Al m.
CASE STUDY Experiential training encourages changes in work beha.docx
CASE STUDY: Experiential training encourages changes in work behavior and growth in one’s abilities, which is accomplished through a multitude of methods. Experiential training has proven to be cost-effective while motivating employees as well as improving self-awareness, personal accountability, teamwork skills, and communication skills (Ritchie, 2011). Additionally, the training methods provide trainees with direct experience, the opportunity to reflect on that experience, and share models to help trainees to deduce using both present and past experience, while accommodating learning styles and strengths (Ritchie, 2011). Valkanos and Fragoulis identify several reasons why experiential training provides value:
1. Ongoing advances in technology requiring changes in knowledge, skills, and abilities
2. Divergence between theory and practice
3. Mergers and acquisitions of enterprises which tend to bring new jobs, organizational culture, and work content
4. Constant environment of change, from working conditions to processes and procedures relating to organizational issues, quality, and new products or services, and requiring new competencies, duties, or work content (Valkanos & Fragoulis, 2007, p. 22).
Method
Description
On-the-job Training
Receives instructions on the functions of their job in their assigned workplace.
Simulators
Teaches employees on how to operate equipment in a given context
Role Playing
Developing interpersonal and business skills, such as decision-making, communication, conflict resolution, and solving complex problems.
Case Study
Develops critical thinking skills to include analytical, higher-level skills, and exploring and resolving complex problems.
Games
Develops general business and organizational principles addressing application in a variety of situations.
Behavior Modeling
Used when learning goals are a rule and inflexible procedures. Provides skills and practice to modify and model behavior.
In-basket Techniques
A variety of items placed in an envelope that reflects what might be found in an inbox. This activity is used to assist trainees in developing and applying their strategic and operational skills.
(Blanchard & Thacker, 2013, pp. 222-223)
References:
· Blanchard, P. N., & Thacker, J. W. (2013). Effective training: Systems, strategies, and practices (5th ed.). Upper Saddle River, NJ: Pearson Education, Inc.
· Valkanos, E., & Fragoulis, I. (2007). Experiential learning – its place in in‐house education and training. Development and Learning in Organizations: An International Journal, 21(5), 21-23. doi:10.1108/14777280710779454
Discussion Question--Choose one perspective in which to respond.
Non-HR Perspective: Your department is not meeting performance expectations. What steps do you take to resolve the issue? Is training a possible solution; if so, which of the above training methods would be the most effective in addressing the issue? Would you, at any point, involve HR--if so, at what point and why?.
Case Study Hereditary AngioedemaAll responses must be in your .docx
Case Study: Hereditary Angioedema
All responses must be in your own words. Answers that have been copied and pasted will not receive credit.
1. Translate “angioedema”. [Note: I am not looking for a description of the disorder. Rather, I would like you to translate the medical term itself.]
2. The complement system is described as a ‘cascade system’. How does the system fit into this description of being a cascade? [Suggestion: Google the definition of cascade, then think about the complement system in light of the definition]
3. Is complement involved in the innate, or the adaptive immune system, or both? Please explain you answer.
4. What role does C1INH play in the complement system? Why is it so important?
5. What was the physiologic cause of Richard’s abdominal pain?
6. How can one distinguish the swelling of HAE from the swelling of allergic angioedema?
7. What is bradykinin’s role in HA?
8. Do you think Richard’s infancy colic was related to his HA? No need to research this. Just use your intuition. Explain your thinking.
9. What is typically used to treat attacks of HAE?
10. Swelling in the extremities is not dangerous. What other areas of the body are subject to swelling? What is the most dangerous location for swelling to occur and why is it the most dangerous?
2018
BUS 308 Week 2 Lecture 1
Examining Differences - overview
Expected Outcomes
After reading this lecture, the student should be familiar with:
1. The importance of random sampling.
2. The meaning of statistical significance.
3. The basic approach to determining statistical significance.
4. The meaning of the null and alternate hypothesis statements.
5. The hypothesis testing process.
6. The purpose of the F-test and the T-test.
Overview
Last week we collected clues and evidence to help us answer our case question about
males and females getting equal pay for equal work. As we looked at the clues presented by the
salary and comp-ratio measures of pay, things got a bit confusing with results that did not see to
be consistent. We found, among other things, that the male and female compa-ratios were fairly
close together with the female mean being slightly larger. The salary analysis showed a different
view; here we noticed that the averages were apparently quite different with the males, on
average, earning more. Contradictory findings such as this are not all that uncommon when
examining data in the “real world.”
One issue that we could not fully address last week was how meaningful were the
differences? That is, would a different sample have results that might be completely different, or
can we be fairly sure that the observed differences are real and show up in the population as
well? This issue, often referred to as sampling error, deals with the fact that random samples
taken from a population will generally be a bit different than the actual population parameters,
but will be “close” enough to the actual.
case studieson Gentrification and Displacement in the Sa.docx
case studies
on Gentrification and Displacement
in the San Francisco Bay Area
Authors:
Miriam Zuk and Karen Chapple
Chapter 3: Nicole Montojo
Chapter 4: Sydney Cespedes, Mitchell Crispell, Christina Blackston, Jonathan Plowman, and
Edward Graves
Chapter 5: Logan Rockefeller Harris, Mitchell Crispell, Fern Uennatornwaranggoon, and Hannah Clark
Chapter 6: Nicole Montojo and Beki McElvain
Chapter 7: Celina Chan, Viviana Lopez, Sydney Céspedes, and Nicole Montojo
Chapter 8: Alexander Kowalski, Julia Ehrman, Mitchell Crispell and Fern Uennatornwaranggoon
Chapter 9: Mitchell Crispell
Chapter 10: Logan Rockefeller Harris and Sydney Cespedes
Chapter 11: Mitchell Crispell
Partner Organizations:
Causa Justa :: Just Cause, Chinatown Community Development Center, Marin Grassroots, Monument
Impact, People Organizing to Demand Environmental & Economic Rights (PODER), San Francisco
Organizing Project / Peninsula Interfaith Action , Working Partnerships USA
Acknowledgements:
Research support was provided by Maura Baldiga, Julian Collins, Mitchell Crispell, Julia Ehrman, Alex
Kowalski, Jenn Liu, Beki McElvain, Carlos Recarte, Maira Sanchez, Mar Velez, David Von Stroh, and
Teo Wickland. Report layout and design was done by Somaya Abdelgany.
Additional advisory support was provided by Carlos Romero. This case study was funded in part by
the Regional Prosperity Plan1 of the Metropolitan Transportation Commission as part of the “Regional
Early Warning System for Displacement” project and from the California Air Resources Board2 as part
of the project “Developing a New Methodology for Analyzing Potential Displacement.”
The Center for Community Innovation (CCI) at UC-Berkeley nurtures effective solutions that expand
economic opportunity, diversify housing options, and strengthen connection to place. The Center
builds the capacity of nonprofits and government by convening practitioner leaders, providing techni-
cal assistance and student interns, interpreting academic research, and developing new research out
of practitioner needs.
communityinnovation.berkeley.edu
July 2015
Cover Photographs: Robert Campbell, Ricardo Sanchez, David Monniaux, sanmateorealestateonline.com/Redwood-City, marinretail-
buzz.blogspot.com, trulia.com/homes/California/Oakland , bloomingrock.com, sharks.nhl.com/club/gallery, panoramio.com
1 The work that provided the basis for this publication was supported by funding under an award with the U.S. Department of Hous-
ing and Urban Development. The substance and findings of the work are dedicated to the public. The author and publisher are solely
responsible for the accuracy of the statements and interpretations contained in this publication. Such interpretations do not neces-
sarily reflect the views of the Government.
2 The statements and conclusions in this report are those of the authors and not necessarily those of the California Air Resources
Board. The mention of commercial products, their source, or their u.
Case Studt on KFC Introduction1) Identify the type of .docx
Case Studt on KFC
Introduction
1) Identify the type of business organization and strategies
2) Key players
Body
1. Opportunities
2. Threats
Closing/Conclusion
1. Make recommendations
2. Offer a plan for implementation
.
Case Study Crocs Revolutionizing an Industry’s Supply Chain .docx
Case Study Crocs: Revolutionizing an Industry’s Supply Chain Model for
Competitive Advantage
If the products sell extremely well, we will
build more in season, and will be back on the
shelves in a few weeks. And we’ll build even
more, and even more, and even more, in that
same season. We’re not going to wait with a
hot new product until next year, when hope-
fully the same trend is alive.
—Ronald Snyder, CEO of Crocs, Inc.1
On May 3, 2007, Crocs, Inc. released its results for the
first quarter of the year. The footwear company,
which had sold its first shoes in 2003, reported reve-
nues of $142 million for the quarter, more than three
times its sales for the first quarter of 2006. Net in-
come, at $0.61 per share was more than 17 percent
of sales, nearly four times higher than the previous
year.2 These results far exceeded market expecta-
tions, which had been for earnings of $0.49 per share
on $114 million of revenue.3 As part of the earnings
release, the company announced a two-for-one stock
split. Immediately after the announcement, the stock
price jumped 15 percent.
The growth and profitability of Crocs, which made
funky, brightly colored shoes using an extremely com-
fortable plastic material, had been astounding. Much
of this growth had been made possible by a highly
flexible supply chain which enabled the company to
build additional product to fulfill new orders quickly
within the selling season, allowing it to respond to un-
expectedly high demand—a capability that was previ-
ously unheard of in the footwear industry. This ability
to fulfill the needs of retailers also made the company
a very popular supplier to shoe sellers.
This success also raised questions about how
the company should grow in the future. Should it
vertically integrate or grow through product line
extension? Should it grow organically or through ac-
quisition? Would potential growth paths exploit
Crocs’ core competencies or defocus them?
CROCS, INC.
In 2002, three friends from Boulder, Colorado went
sailing in the Caribbean. One brought a pair of foam
clog shoes that he had bought from a company in
Canada. The clogs were made from a special mate-
rial that did not slip on wet boat decks, was easy
to wash, prevented odor, and was extremely com-
fortable. The three, Lyndon “Duke” Hanson, Scott
Seamans, and George Boedecker, decided to start a
business selling these Canadian shoes to sailing en-
thusiasts out of a leased warehouse in Florida, as
Hanson said, “so we could work when we went on
sailing trips there.”4 The founders wanted to name
the shoes something that captured the amphibious
nature of the product. Since “Alligator” had already
been taken, they chose to name the shoes “Crocs.”
The shoes were an immediate success, and word
of mouth expanded the customer base to a wide
range of people who spent much of their days stand-
ing, such as doctors and gardeners. In October 2003,
as the business began to grow, th.
Case Studies Student must complete 5 case studies as instructed.docx
Case Studies: Student must
complete 5 case studies
as instructed by course
materials. Fill out form below for 5 different people (imaginary is okay).
Master Herbalist Questionnaire
Date: _____________________
Name: _________________________________ Age: ______ Birth date:_____________
Address: ________________________________________________________________
Home Phone: _________________________ Work Phone:________________________
Height: _________ Weight: _________ 1 year ago:__________ 5 years ago:_________
Occupation: _______________________________________ Full Time Part Time
Living situation: Alone Friends Partner Spouse Parents Children Pets
What are your major health concerns and intentions for your visit today?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please list any other health care providers or consultants you are currently working with:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please list any current health conditions diagnosed by a medical doctor:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please use this form
as a source of
reference when
conducting your
Case-Studies.
Treat this part as information only as you are not to treat or prescribe treatment for any specific diseases
It is important to know if the client is receiving treatment from other practitioners and what these entail
Since legally you are not allowed to diagnose disease, it is helpful to get one from an MD
When was your last physical exam?
________________________________________________________________________
Please list all herbs, vitamins, and dietary supplements you are currently taking, includingdosage and frequency:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
List all medication.
Case Studies in Telehealth AdoptionThe mission of The Comm.docx
Case Studies in Telehealth Adoption
The mission of The Commonwealth
Fund is to promote a high performance
health care system. The Fund carries
out this mandate by supporting
independent research on health care
issues and making grants to improve
health care practice and policy. Support
for this research was provided by
The Commonwealth Fund. The views
presented here are those of the author
and not necessarily those of The
Commonwealth Fund or its directors,
officers, or staff.
For more information about this study,
please contact:
Andrew Broderick, M.A., M.B.A.
Codirector, Center for Innovation
and Technology in Public Health
Public Health Institute
[email protected]
The Veterans Health Administration:
Taking Home Telehealth Services to
Scale Nationally
Andrew Broderick
ABSTRACT: Since the 1990s, the Veterans Health Administration (VHA) has used infor-
mation and communications technologies to provide high-quality, coordinated, and com-
prehensive primary and specialist care services to its veteran population. Within the VHA,
the Office of Telehealth Services offers veterans a program called Care Coordination/
Home Telehealth (CCHT) to provide routine noninstitutional care and targeted care man-
agement and case management services to veterans with diabetes, congestive heart fail-
ure, hypertension, post-traumatic stress disorder, and other conditions. The program uses
remote monitoring devices in veterans’ homes to communicate health status and to cap-
ture and transmit biometric data that are monitored remotely by care coordinators. CCHT
has shown promising results: fewer bed days of care, reduced hospital admissions, and
high rates of patient satisfaction. This issue brief highlights factors critical to the VHA’s
success—like the organization’s leadership, culture, and existing information technology
infrastructure—as well as opportunities and challenges.
OVERVIEW
Since the 1990s, information and communications technologies—including tele-
health—have been at the core of the Veterans Health Administration’s (VHA’s)
successful system-level transformation toward providing continuous, coordinated,
and comprehensive primary and specialist care services. The VHA’s leadership
and culture; underlying health information technology infrastructure; and strong
commitment to standardized work processes, policies, and training have all con-
tributed to the home telehealth program’s success in meeting the chronic care
needs of a population of aging veterans and reducing their use of institutional
care and its associated costs. The home teleheath model also encourages patient
activation, self-management, and helps in the early detection of complications.
To learn more about new publications
when they become available, visit the
Fund's website and register to receive
Fund email alerts.
Commonwealth Fund pub. 1657
Vol. 4
January 2013
www.commonwealthfund.org
www.commonwealthfund.org
mailto:[email pro.
Case Studies in Abnormal PsychologyYou Decide The Case of J.docx
Case Studies in Abnormal Psychology
You Decide: The Case of Julia
This case is presented in the voices of Julia and her roommate, Rebecca. Throughout the case, you are asked to consider a number of issues and to arrive at various decisions, including diagnostic and treatment decisions. Appendix A lists Julia’s probable diagnosis, the DSM-5 criteria, clinical information, and possible treatment directions.
Julia Measuring Up
I grew up in a northeastern suburban town, and I’ve lived in the same house for my entire life. My father is a lawyer, and my mother is the assistant principal at our town’s high school. My sister, Holly, is 4 years younger than I am.
My parents have been married for almost 20 years. Aside from the usual sort of disagreements, they get along well. In fact, I would say that my entire family gets along well. We’re not particularly touchy-feely: It’s always a little awkward when we have to hug our grandparents on holidays, because we just never do that sort of thing at home. That’s not to say that my parents are uninterested or don’t care about us. Far from it; even though they both have busy work schedules, one of them would almost always make it to my track and cross-country meets and to Holly’s soccer games. My mother, in particular, has always tried to keep on top of what’s going on in our lives.
In high school, I took advanced-level classes and earned good grades. I also got along quite well with my teachers, and ended up graduating in the top 10 percent of my class. I know this made my mother really proud, especially since she works at the school. She would get worried that I might not be doing my best and “working to my full potential.” All through high school, she tried to keep on top of my homework assignments and test schedules. She liked to look over my work before I turned it in, and would make sure that I left myself plenty of time to study for tests.
Describe the family dynamics and school pressures experienced by Julia. Under what circumstances might such family and school factors become problematic or set the stage for psychological problems?
In addition to schoolwork, the track and cross-country teams were a big part of high school for me. I started running in junior high school because my parents wanted me to do something athletic and I was never coordinated enough to be good at sports like soccer. I was always a little bit chubby when I was a kid. I don’t know if I was actually overweight, but everyone used to tease me about my baby fat. Running seemed like a good way to lose that extra weight; it was hard at first, but I gradually got better and by high school I was one of the best runners on the team. Schoolwork and running didn’t leave me much time for anything else. I got along fine with the other kids at school, but I basically hung out with just a few close friends. When I was younger, I used to get teased for being a Goody Two-Shoes, but that had died down by high school. I can’t remember anyone wi.
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