Chief complaint My right great toe has been hurting for ab.docx
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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.
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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.
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.
CASE PLEASE READChief complaint My right great toe has .docx
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.
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.
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.
CASE PLEASE READChief complaint My right great toe has .docx
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.
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 ...
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 .
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 ...
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 ...
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 ...
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.
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 ...
Week 7 Discussion Question Worth 5 pointsFor the following C.docx
Week 7 Discussion Question
Worth 5 points
For the following Case Study, as follow is Discussion Question: As an NP student, needs to determine the medications for constipation.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed for constipation? Write her complete prescriptions using the prescription writing format.
Support with 1 journal no older than 5 years.
Week 7: DISCUSSION QUESTION IN DISCUSSION BOARD
Gastroenterology-Motility Case Study
ACC/AHA Guidelines
Chief complaint: “ I have chronic constipation, incomplete defecation and abdominal bloating” for past 2 years.
HPI: M.C. a 46-year-old hispanic female presents to the GI-Motility clinic for complaint of chronic constipation, incomplete defecation and abdominal bloating. She has pmhx of DM-type 2, IBS-Constipation, Tubular Adenoma.
She also indicates that she has noticed that her symptoms are worsening for past 3 months. She has associated her symptoms with abdominal bloating, straining and incomplete defecation.
She has tried Miralax one packet po daily for at least 8 weeks and it has not relieved her symptoms.
Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
Diabetes Mellitus, type 2
Constipation, chronic-IBS
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 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: +Dryness, No open lesions. +Dry crusts in sole of feet. + moist crust in between toes.
PSYCH: Normal affect. Cooperative.
Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0 ...
Discussion # 13 Discuss the FDA approach for liver safety for .docx
Discussion # 13:
Discuss the FDA approach for liver safety for new drugs.
Support discussion with 1 journal no older than 5 years.
Discussion Question #14
Discuss an advantage and one disadvantage of one non-narcotic drug used for chronic pain syndrome.
Discussion week 15: (Worth 1 point)
Discuss a current issue on a pharmacological agent and your opinion.
Support with 1 peer reviewed journals no older than 5 years.
Discussion #12
CARDIOVASCULAR CASE STUDY
ACC/AHA Guidelines
Chief complaint: medication refill " I ran out of medicines"
HPI: E.D a 65-year-old AA male presents to the clinic for prescription refills. The patient also indicates that she has noticed shortness of breath which started about 4 months ago. The SOB gets worse with exertion, especially when she is walking fast and it is resolved when he is resting. He reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. His symptoms of shortness of breath resolve after sitting upright on 3 pillows. He also has lower leg edema pitting 1+ which started 2 weeks ago. He also indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight stairs, but it resolves after sitting down to rest. He has not tried any over the counter medications at home.
He never filled her prescriptions that he received at her checkup 6 months ago, she did not think it was important.
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:
He receives an annual flu shot. Last flu shot was this year
Has not had a Td in over 10 years
Has not had the herpes zoster vaccine
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 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: Pt sated not taking medications for 6 months - "ran out and did not get refills"
Physical examination:
Vital Signs
Height: 5 feet 1 inches Weight: 163 pounds BMI: 31 obesity, BP 157/87 T 98.0 po P 110 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: + Mild Crackles on inspiratory phase no 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 ra.
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.
For the following Case Study, as follow is Discussion Question
For the following Case Study, as follow is Discussion Question: As an NP student, needs to determine the medications for constipation.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed for constipation? Write her complete prescriptions using the prescription writing format.
Support with 1 journal no older than 5 years.
Week 7: DISCUSSION QUESTION IN DISCUSSION BOARD
Gastroenterology-Motility Case Study
ACC/AHA Guidelines
PLEASE USE THIS MEDICATION FOR THE CASE STUDY: LUBIPRISTONE 24 MCG TWO TIMES A DAY.
Case study sample:
Chief complaint:
“ I have chronic constipation, incomplete defecation and abdominal bloating” for past 2 years.
HPI:
M.C. a 46-year-old hispanic female presents to the GI-Motility clinic for complaint of chronic constipation, incomplete defecation and abdominal bloating. She has pmhx of DM-type 2, IBS-Constipation, Tubular Adenoma.
She also indicates that she has noticed that her symptoms are worsening for past 3 months. She has associated her symptoms with abdominal bloating, straining and incomplete defecation.
She has tried Miralax one packet po daily for at least 8 weeks and it has not relieved her symptoms.
Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
Diabetes Mellitus, type 2
Constipation, chronic-IBS
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 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: +Dryness, No open lesions. +Dry crusts in sole of feet. + moist crust in between toes.
PSYCH
: Normal affect. ...
Case StudyChief complaint I’m here for a medication refi.docx
Case Study
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 graduates 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 a history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has a 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. + Crep.
Case StudyChief complaint I’m here for a medication refill .docx
Case Study:
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. + Crepi.
SOAP NOTEName DL Date 9302022
SOAP NOTE
Name: DL
Date: 9/30/2022
Time: 10:00 am
Age: 28 years
Sex: Female
SUBJECTIVE
CC:
“I have my period for 22 days; I have pelvic pain and also noted some dark vaginal bleeding since yesterday.”
HPI: The patient states that she noted the darker bleeding yesterday. She has been having pelvic pain although she did not mention if it was severe, but some time she felt nauseous. She also states that she has been having her periods for the last 22 days although she noted the darker bleeding yesterday. She has been having pelvic pain. The patient took ibuprofen 400 mg to alleviate the pain.
Medications: Ibuprofen 400 mg PO Q6H as needed for pain
PMH:
Allergies: NKA
Medication Intolerances: Patient reports no known medical intolerance.
Immunizations: Immunization up to date
Chronic Illnesses/Major traumas: None reported
Hospitalizations/Surgeries no mention of any surgery or hospitalization.
Family History:
Both patents are alive. Only child. For the first-degree relatives there is no mention of malignancy.
Social History:
Patient was born in Cuba, came to US with her current boyfriend 2 years ago. Patient lives with her boyfriend. The patient denies any smoking, drinking, or any use of recreational drugs. The patient explains that she has been maintaining a regular diet and goes to the gym 2 or 3 times per week and usually sleep 7-8 hours daily. There is also no drug or tabaco use history in his family.
ROS
General- the patient states that her periods are 22 days, she has pelvic pain and that yesterday she noticed dark vaginal bleeding. From yesterday.
Cardiovascular
She denies any chest pains, palpitations nor pressure.
Skin
No changes on her skin
Respiratory
No coughing nor shortness of breath.
Eyes- she has no double vision, loss of vision, or blurred vision.
Gastrointestinal
The patient denies any nausea, vomiting or diarrhea, constipation but she states that she has pelvic pain.
Ears
No ear pain nor loss of hearing.
Genitourinary/Gynecological
She denies pain when urinating, she has vaginal discharge where she has noticed dark vaginal bleeding.
Nose/Mouth/Throat
No mouth pain, mouth discharge, throat pain nor having issues when swallowing.
Musculoskeletal
No bones, muscles, and joints pain and she deny constraint to a range motion, swelling of joints.
Breast
Denies any discomfort or lumps.
Neurological
She denies dizziness, headache, ataxia, or syncope.
Heme/Lymph/Endo
Denies any swollen gland, vaginal bleeding, and no sweats.
Psychiatric
No depression, insomnia, mood swings, or anxiety.
OBJECTIVE
Weight: 167.0lbs
...
Choose 1 focal point from each subcategory of practice, educatio.docx
Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management
Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.
Practice
1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families.
2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others.
3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death.
4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified.
Education
1. Those who practice in secondary or tertiary palliative care will have specialist education and certification.
2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula.
3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available.
4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families.
Research
1. Increase the integration of evidence-based care across the dimensions of end-of-life care.
2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal.
3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life.
4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments.
5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices.
Administration
1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families.
2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care.
3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or a.
CHOICE TOPIC Pick a philosophical topic of your own choosing and re.docx
CHOICE TOPIC: Pick a philosophical topic of your own choosing and relay your own perspective on that topic giving as much evidence and supporting reasoning as possible.
The assignment should be standard font, double spaced, at least a page and a half with proper citations when appropriate.
.
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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 .
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 ...
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 ...
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 ...
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.
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 ...
Week 7 Discussion Question Worth 5 pointsFor the following C.docx
Week 7 Discussion Question
Worth 5 points
For the following Case Study, as follow is Discussion Question: As an NP student, needs to determine the medications for constipation.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed for constipation? Write her complete prescriptions using the prescription writing format.
Support with 1 journal no older than 5 years.
Week 7: DISCUSSION QUESTION IN DISCUSSION BOARD
Gastroenterology-Motility Case Study
ACC/AHA Guidelines
Chief complaint: “ I have chronic constipation, incomplete defecation and abdominal bloating” for past 2 years.
HPI: M.C. a 46-year-old hispanic female presents to the GI-Motility clinic for complaint of chronic constipation, incomplete defecation and abdominal bloating. She has pmhx of DM-type 2, IBS-Constipation, Tubular Adenoma.
She also indicates that she has noticed that her symptoms are worsening for past 3 months. She has associated her symptoms with abdominal bloating, straining and incomplete defecation.
She has tried Miralax one packet po daily for at least 8 weeks and it has not relieved her symptoms.
Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
Diabetes Mellitus, type 2
Constipation, chronic-IBS
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 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: +Dryness, No open lesions. +Dry crusts in sole of feet. + moist crust in between toes.
PSYCH: Normal affect. Cooperative.
Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0 ...
Discussion # 13 Discuss the FDA approach for liver safety for .docx
Discussion # 13:
Discuss the FDA approach for liver safety for new drugs.
Support discussion with 1 journal no older than 5 years.
Discussion Question #14
Discuss an advantage and one disadvantage of one non-narcotic drug used for chronic pain syndrome.
Discussion week 15: (Worth 1 point)
Discuss a current issue on a pharmacological agent and your opinion.
Support with 1 peer reviewed journals no older than 5 years.
Discussion #12
CARDIOVASCULAR CASE STUDY
ACC/AHA Guidelines
Chief complaint: medication refill " I ran out of medicines"
HPI: E.D a 65-year-old AA male presents to the clinic for prescription refills. The patient also indicates that she has noticed shortness of breath which started about 4 months ago. The SOB gets worse with exertion, especially when she is walking fast and it is resolved when he is resting. He reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. His symptoms of shortness of breath resolve after sitting upright on 3 pillows. He also has lower leg edema pitting 1+ which started 2 weeks ago. He also indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight stairs, but it resolves after sitting down to rest. He has not tried any over the counter medications at home.
He never filled her prescriptions that he received at her checkup 6 months ago, she did not think it was important.
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:
He receives an annual flu shot. Last flu shot was this year
Has not had a Td in over 10 years
Has not had the herpes zoster vaccine
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 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: Pt sated not taking medications for 6 months - "ran out and did not get refills"
Physical examination:
Vital Signs
Height: 5 feet 1 inches Weight: 163 pounds BMI: 31 obesity, BP 157/87 T 98.0 po P 110 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: + Mild Crackles on inspiratory phase no 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 ra.
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.
For the following Case Study, as follow is Discussion Question
For the following Case Study, as follow is Discussion Question: As an NP student, needs to determine the medications for constipation.
According to the ACC/AHA Guidelines, what medication should this patient be prescribed for constipation? Write her complete prescriptions using the prescription writing format.
Support with 1 journal no older than 5 years.
Week 7: DISCUSSION QUESTION IN DISCUSSION BOARD
Gastroenterology-Motility Case Study
ACC/AHA Guidelines
PLEASE USE THIS MEDICATION FOR THE CASE STUDY: LUBIPRISTONE 24 MCG TWO TIMES A DAY.
Case study sample:
Chief complaint:
“ I have chronic constipation, incomplete defecation and abdominal bloating” for past 2 years.
HPI:
M.C. a 46-year-old hispanic female presents to the GI-Motility clinic for complaint of chronic constipation, incomplete defecation and abdominal bloating. She has pmhx of DM-type 2, IBS-Constipation, Tubular Adenoma.
She also indicates that she has noticed that her symptoms are worsening for past 3 months. She has associated her symptoms with abdominal bloating, straining and incomplete defecation.
She has tried Miralax one packet po daily for at least 8 weeks and it has not relieved her symptoms.
Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms.
PMH:
Diabetes Mellitus, type 2
Constipation, chronic-IBS
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 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: +Dryness, No open lesions. +Dry crusts in sole of feet. + moist crust in between toes.
PSYCH
: Normal affect. ...
Case StudyChief complaint I’m here for a medication refi.docx
Case Study
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 graduates 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 a history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has a 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. + Crep.
Case StudyChief complaint I’m here for a medication refill .docx
Case Study:
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. + Crepi.
SOAP NOTEName DL Date 9302022
SOAP NOTE
Name: DL
Date: 9/30/2022
Time: 10:00 am
Age: 28 years
Sex: Female
SUBJECTIVE
CC:
“I have my period for 22 days; I have pelvic pain and also noted some dark vaginal bleeding since yesterday.”
HPI: The patient states that she noted the darker bleeding yesterday. She has been having pelvic pain although she did not mention if it was severe, but some time she felt nauseous. She also states that she has been having her periods for the last 22 days although she noted the darker bleeding yesterday. She has been having pelvic pain. The patient took ibuprofen 400 mg to alleviate the pain.
Medications: Ibuprofen 400 mg PO Q6H as needed for pain
PMH:
Allergies: NKA
Medication Intolerances: Patient reports no known medical intolerance.
Immunizations: Immunization up to date
Chronic Illnesses/Major traumas: None reported
Hospitalizations/Surgeries no mention of any surgery or hospitalization.
Family History:
Both patents are alive. Only child. For the first-degree relatives there is no mention of malignancy.
Social History:
Patient was born in Cuba, came to US with her current boyfriend 2 years ago. Patient lives with her boyfriend. The patient denies any smoking, drinking, or any use of recreational drugs. The patient explains that she has been maintaining a regular diet and goes to the gym 2 or 3 times per week and usually sleep 7-8 hours daily. There is also no drug or tabaco use history in his family.
ROS
General- the patient states that her periods are 22 days, she has pelvic pain and that yesterday she noticed dark vaginal bleeding. From yesterday.
Cardiovascular
She denies any chest pains, palpitations nor pressure.
Skin
No changes on her skin
Respiratory
No coughing nor shortness of breath.
Eyes- she has no double vision, loss of vision, or blurred vision.
Gastrointestinal
The patient denies any nausea, vomiting or diarrhea, constipation but she states that she has pelvic pain.
Ears
No ear pain nor loss of hearing.
Genitourinary/Gynecological
She denies pain when urinating, she has vaginal discharge where she has noticed dark vaginal bleeding.
Nose/Mouth/Throat
No mouth pain, mouth discharge, throat pain nor having issues when swallowing.
Musculoskeletal
No bones, muscles, and joints pain and she deny constraint to a range motion, swelling of joints.
Breast
Denies any discomfort or lumps.
Neurological
She denies dizziness, headache, ataxia, or syncope.
Heme/Lymph/Endo
Denies any swollen gland, vaginal bleeding, and no sweats.
Psychiatric
No depression, insomnia, mood swings, or anxiety.
OBJECTIVE
Weight: 167.0lbs
...
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Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice.
Practice
1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families.
2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others.
3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death.
4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified.
Education
1. Those who practice in secondary or tertiary palliative care will have specialist education and certification.
2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula.
3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available.
4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families.
Research
1. Increase the integration of evidence-based care across the dimensions of end-of-life care.
2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal.
3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life.
4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments.
5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices.
Administration
1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families.
2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care.
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CHOICE TOPIC Pick a philosophical topic of your own choosing and re.docx
CHOICE TOPIC: Pick a philosophical topic of your own choosing and relay your own perspective on that topic giving as much evidence and supporting reasoning as possible.
The assignment should be standard font, double spaced, at least a page and a half with proper citations when appropriate.
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Choice to documentcritique 10-12 Pages APA Formation .docx
Choice to document/critique
10-12 Pages
APA Formation (10 points)
Breakdown of Project Stages:
Project Initiation (18 points)
Project Planning (18 points)
Project Execution (18 points)
Project Monitoring and Controls (18 points)
Project Closing (18 points)
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Choice Hotels InternationalOverviewRead the case study, .docx
Choice Hotels International
Overview
Read the case study,
Choice Hotels International
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Instructions
Write a fully developed paper in which you: DO NOT WRITE IN 1ST PERSON
Assess the two distinct networking functions.
Analyze the issues Choice is likely to experience as it expands its network to full global reach. Provide a rationale for your answer.
Critique Choice implementing free high-speed Internet access for all guests in its Clarion Hotels and Comfort Suites from the security point of view.
Use at least three quality resources in this assignment. Note: Wikipedia and similar websites do not qualify as quality resources.
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Choice Theory- Is to choose to engage in delinquent and criminal behavior after weighing the consequences and benefits of their actions
Classical Criminology
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1. In 1764, criminologist Cesare Beccaria wrote An Essay on Crimes and Punishments, which set forth classical criminological theory. He argued that the only justified rationale for laws and punishments was the principle of utility.
2. Beccaria believed the basis of society, as well as the origin of punishments and the right to punish, is the social contract. The only legitimate purpose of punishment is special deterrence and general deterrence.
3. Beccaria believed the best way to prevent and deter crime was to: • Enact laws that are clear, simple, and unbiased, and that reflect the consensus of the population. • Educate the public. • Eliminate corruption from the administration of justice. • Reward virtue.
4. Real-world drawbacks of Beccaria’s theory are: • Not all offenders are alike, juveniles are treated the same as adults. • Similar crimes are not always as similar as they might appear,first-time offenders are treated the same as repeat offenders.
I don't pay for cover pages
1 APA style page
12 pt font
I gave a breakdown of what the teacher is looking for
.
CHM130LLLab 2Measurements Accuracy and PrecisionName __.docx
CHM130LL
Lab 2
Measurements: Accuracy and Precision
Name : _____________________________
A. Data Tables
Data Table 1 (12 points)
Measurement
Data
(1) Length of aluminum plastic packet
(2) Height of aluminum plastic packet
(3) Temperature of faucet water
(3) Temperature of ice water
(5) Volume of water in 10-mL
graduated cylinder
(6) Volume of water in 50-mL
graduated cylinder
Data Table 2 (10 points)
Measurement
Data
(1) Inside diameter of 50-mL
graduated cylinder
(2) Height of 50-mL graduated cylinder
(3) Water temperature
(4) Initial volume of water in 50-mL
graduated cylinder
10.0 mL
(5) Mass of water in the 50-mL
graduated cylinder
10.0 g
(6) Volume of water and aluminum shot in 50-mL graduated cylinder
(7) Mass of aluminum shot (given on outside of packet)
B. Insert the picture of the plastic packet containing aluminum shots with student’s name and MEID (25 points)
C. Follow-Up Questions (Show all calculations for full credits)
Part I
1. Convert the length and height measurements for the packet that contains the aluminum shot from units of cm to units of mm using the unit-factor method. (10 points)
2. Convert the temperature measurements for the faucet water and the ice water from oC to oF, using the following equation: oF =1.8(oC) + 32. (10 points)
3. Convert the volumes of the water in the 10-mL and 50-mL graduated cylinders from mL to L, using the unit-factor method. (10 points)
4. Looking at your measurements for the volumes of water in the 10-mL and 50-mL graduated cylinders, are your values identical? Discuss at least two reasons why the measurements were not identical. (5 points)
Part II
5. Calculate the volume of the 50mL graduated cylinder using your measurements of diameter and height, using the formula V= πr2h (r=½ diameter). This is your experimental value. (10 points)
6. Assuming the accepted value of the volume of the graduated cylinder is 50.00 mL, calculate the percent error of your volume calculation, using the following formula and the experimental value calculated in question 5: (10 points)
Percent Error
=
|
accepted value - experimental value
accepted value
|
x
100
7. Calculate the mass of 10ml of water in the graduated cylinder using 1/5 the volume calculated in question 5, the density of water of 1.00 g/mL and this given the formula: (10 points)
Density
=
mass
volume
8. Using 10.0 g as the accepted value for the mass of the water, and the mass calculated in #7 above as the experimental value, calculate the percent error of your mass calculation, using the same formula as in #6 above. (10 points)
9. Calculate the volume of aluminum shot added to the graduated cylinder, using the information from Data Table 2 in the following formula: (10 points)
Volume of water and aluminum shot in 50-mL graduated cylinder(#6) – Initial volume of water in 50-mL graduated cylinder (#4) = volume of aluminum shot
10. Calculate the experimental value for density of the aluminum shot based on its mass (given on.
Chocolates by Jacki has provided information relating to its curre.docx
Chocolates by Jacki has provided information relating to its current year. The Controller has asked you to complete a First-Stage Allocation to Activity Cost Pools. Use the information included in the Excel Simulation and the Excel functions described below to complete the task.
· Cell Reference: Allows you to refer to data from another cell in the worksheet. From the Excel Simulation below, if in a blank cell, “=B7” was entered, the formula would output the result from cell B7, or 400,000 in this example.
· Absolute Reference: Allows you to maintain the original cell reference when a formula is copied to another cell. The cell reference is “locked” by putting a dollar sign ($) before the column and row references. By default a cell reference is relative, so when you copy a formula to another cell the values update based on a relative reference. For example, if you copy the formula “=B8+B9” from cell C1 to cell C2, the formula in cell C2 will relatively update to be “=B9+B10” since the copied formula moved down one cell, the formula cell references also moved down one cell. Conversely, by adding the absolute cell reference “locks” to the equation, the formula will not change when copied to any other cell. For example, “=$B$8+$B$9” written in cell C1 is copied to cell C2, the formula in cell C2 will remain “=$B$8+$B$9”. You can also use a mixed cell reference by only “locking” the column or row only ($B8 or B$8) which locks that specific column or row and the other reference becomes a relative reference and “moves” with the formula as its copied to another cell. For example, if you copy the formula “=B$8+B9” from cell C1 to cell C2, the formula in cell C2 will update to be “=B$8+B10” since the copied formula moved down one cell, the formula cell relative references also moved down one cell, but the absolute “locked” reference remained the same.
· Basic Math functions: Allows you to use the basic math symbols to perform mathematical functions. You can use the following keys: + (plus sign to add), - (minus sign to subtract), * (asterisk sign to multiply), and / (forward slash to divide). From the Excel Simulation below, if in a blank cell “=B18+B19” was entered, the formula would add the values from those cells and output the result, or 250,000 in this example. If using the other math symbols the result would output an appropriate answer for its function.
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Quest.
Chloe1a. This study uses qualitative meta-synthesis to take a.docx
Chloe
1a. This study uses qualitative meta-synthesis to take a holistic approach to innovation in information systems companies. The article stated that the researchers used qualitative meta-synthesis that analyzed over 370 different articles, journals or other written forums, which required a severe amount of time to read a review and correlate to each other to show a holistic approach. Some of the artifacts used were, “Fear of technological complexity”, “Data collection and processing tools”, and others in Table 1 (Lawrence, 2013).
1b. Information systems innovation is difficult. Not only just systems such as Facebook and Google but the backbone of systems that run corporations such as FedEx and UPS. Changing the users’ experience where it is not just easy to use, but functional has always been difficult such as when we think back to how clunky MySpace and AOL were. This article is about how cultures in information systems companies need mediation to generate innovation, which is directly applicable to how to generate innovative environments.
2a. This research focused on how social media could or could not enhance innovation. The researcher’s hypothesis was that a new connection + novel idea = innovation. In order to connect people, the researcher’s used social media due to its proclivity in today’s world. There were 31 owner-managers from the United Kingdom that signed up and 42 interviews that were conducted. The result of those interviews were over 500 pages of transcripts that required combing through, but first as binned by coding into nine different categories. Overall there was an extensive amount of qualitative research conducted is considerably larger than most qualitative studies.
2b. This article specifically applies to my topic of how to generate innovative environments because it takes a 21st-century approach to innovation, which is ironic, and assess how to use social media to generate innovative ideas. Though overall the discovery is that social media is a difficult platform to meet strangers, there is an avenue such as like type communities on social media that would work better.
References:
Lawrence, C. (2013). A Holistic Narrative of Culture’s Mediation of Information Systems Innovation: A
Qualitative Meta-Synthesis. Journal of Global Information Technology Management, 31–52.
Berne, D. F., Coda, R., Krakauer, P., & Donaire, D. (2019). The innovation challenge in micro and small enterprises
(MSE): An exploratory study at São Paulo metropolitan region. Studii de Ştiintă Şi Cultură, 15(4), 235–252. https://doi.org/10.1108/INMR-03-2019-0031
PAUL:
Part one:
Article one: The article chosen discusses how sales professionals perceive leadership. Interviews were conducted with both sales leaders and salespeople. What was found was that the salespeople overwhelmingly supported specific leadership traits that contributed to their overall performance. The four areas covered were coaching, collaborat.
Chinese railroad workers began to contribute to the Canadian railr.docx
Chinese railroad workers began to contribute to the Canadian railroad in 1800, but they paid a lot of labour and even life with low wages. Now, many bronze men in the Roger's Centre in Toronto are reminding people that many Chinese workers died while building the railroad, they were overworked and their salaries were low (China town concern group, 2016, para.1). However, these hard and lovely people have not received the respect they deserve in such a difficult situation. After they built the Canadian Pacific Railway, one of Canada's outstanding engineering projects, they were discriminatorily levied a head tax on Chinese workers. As the Frey (2017) suggests, the racist law imposed a "head tax" on Chinese immigrants from 1885 to 1923, acknowledging that the abuse of Chinese immigrants is a long process, and it is necessary to fight against historical inertia and racist laws (para.18). Over time, people's awareness of racism has increased, and they have begun to reflect on previous mistakes and modify some wrong regulations and measures. The websites show the unequal treatment and compensation of many Chinese railroad workers.
Reference
China town concern group. (2016, April 28). “Now and Then: Chinese Railroad Workers Memorial”. https://chinatownconcerngroup.wordpress.com/2016/05/13/now-and-then-chinese-railroad-workers-memorial/
Frey, W. (2017). Chinese workers integral in building Canada's first megaproject. Construct Connect. https://canada.constructconnect.com/Leaders2017/chinese-workers.html
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CHIROPRACTIC & MANUAL THERAPIESClar et al. Chiropractic & .docx
CHIROPRACTIC & MANUAL THERAPIES
Clar et al. Chiropractic & Manual Therapies 2014, 22:12
http://www.chiromt.com/content/22/1/12
SYSTEMATIC REVIEW Open Access
Clinical effectiveness of manual therapy for the
management of musculoskeletal and non-
musculoskeletal conditions: systematic review
and update of UK evidence report
Christine Clar1, Alexander Tsertsvadze1, Rachel Court1, Gillian Lewando Hundt2, Aileen Clarke1 and Paul Sutcliffe1*
Abstract
Background: This systematic review updated and extended the “UK evidence report” by Bronfort et al. (Chiropr
Osteopath 18:3, 2010) with respect to conditions/interventions that received an ‘inconclusive’ or ‘negative’ evidence
rating or were not covered in the report.
Methods: A literature search of more than 10 general medical and specialised databases was conducted in August
2011 and updated in March 2013. Systematic reviews, primary comparative studies and qualitative studies of
patients with musculoskeletal or non-musculoskeletal conditions treated with manual therapy and reporting clinical
outcomes were included. Study quality was assessed using standardised instruments, studies were summarised, and
the results were compared against the evidence ratings of Bronfort. These were either confirmed, updated, or new
categories not assessed by Bronfort were added.
Results: 25,539 records were found; 178 new and additional studies were identified, of which 72 were systematic
reviews, 96 were randomised controlled trials, and 10 were non-randomised primary studies. Most ‘inconclusive’ or
‘moderate’ evidence ratings of the UK evidence report were confirmed. Evidence ratings changed in a positive
direction from inconclusive to moderate evidence ratings in only three cases (manipulation/mobilisation [with
exercise] for rotator cuff disorder; spinal mobilisation for cervicogenic headache; and mobilisation for
miscellaneous headache). In addition, evidence was identified on a large number of non-musculoskeletal conditions
not previously considered; most of this evidence was rated as inconclusive.
Conclusions: Overall, there was limited high quality evidence for the effectiveness of manual therapy. Most reviewed
evidence was of low to moderate quality and inconsistent due to substantial methodological and clinical diversity.
Areas requiring further research are highlighted.
Keywords: Clinical effectiveness, Manual therapy, Systematic review, Musculoskeletal, Bronfort
Background
Manual therapy is a non-surgical type of conservative
management that includes different skilled hands/fingers-
on techniques directed to the patient’s body (spine and
extremities) for the purpose of assessing, diagnosing,
and treating a variety of symptoms and conditions [1-4].
Manual therapy constitutes a wide variety of different
* Correspondence: [email protected]
1Populations, Evidence and Technologies, Division of Health Sciences,
Warwick Medical School, University of Warwick, Coventry CV4 7AL, England
Full list of author info.
Chinese Society 中国社会What are the social voices in China.docx
Chinese Society
中国社会
What are the social voices in China?
Tradition
Confucianism
Revolution
Communism, Maoism
Reform (Current)
Socialism with Chinese Characteristics?
Capitalism?
Deng Xiaoping Thought?
Harmonious Society (since 2005)
What are the components in Chinese society?
Danwei
Work unit
Guanxi
Connections
Family
One child, two childe
How has Chinese society changed?
Time
Space
Money
Commodification
Landscape
Self
Sex
What are the paths to success?
Mao’s China
Red- politics, White - education
Army, marriage
Deng’s China
Golden - business
To get rich is glorious
Redefining China’s Families
http://www.washingtonpost.com/wp-srv/world/interactives/chinafamilies/
How has the family in China changed?
Young and Restless in China
http://www.pbs.org/wgbh/pages/frontline/youngchina/
What are the lives of people like ?
Hutong Old Beijing
10
PSY 345: Social Psychology
McAuliff
Personal Application Paper
PERSONAL APPLICATION PAPER
In addition to reading and thinking about the concepts covered in the text, an important part of the
learning process includes applying these concepts to your own life and experiences. To facilitate
this process, a personal application paper must be uploaded on Moodle no later than 10am on
Monday, May 11. The paper should be typed (12 characters/inch font), three to five pages in
length, and double-spaced with one inch margins. Late papers will not be accepted and
students not turning in papers will receive a 0. The personal application paper will count
for 25% of your final grade.
For the paper, students should select one or two central topics discussed during the semester and
write about how the topic(s) is relevant to you and your life. For example, for the chapter on
prejudice, you might write about a time you directly or indirectly experienced some form of
prejudice. Alternatively, you could analyze a television commercial with an eye toward the material
covering the use of persuasion to increase compliance. Remember, this assignment is intended to
help you recognize how the material covered in class is personally relevant, as well as to
encourage you to think critically about the concepts presented instead of passively accepting them
as truths. Thus it is acceptable (and commendable) to include in your paper a discussion of the
reasons why you agree/disagree with what the author is saying. To reiterate, each paper must
have the following two components: a review (including proper citation) of the concept from the text
to be discussed; and second, your thoughts/feelings on this topic and a discussion of how it applies
to your life including whether you agree/disagree with what the author has said.
PSY 345: Social Psychology
McAuliff
Personal Application Paper Grading Form
_____ Introduction (2)
_____ Statement of interest (1)
_____ Explained (1)
_____ Description of Social Psychological Concept, Theory, or Research (.
China’s geography中国地理China’s physiographyRegion.docx
China’s geography
中国地理
China’s physiography
Regional Geography
The same area as the U.S.
1.39 Billion People, 0.3% growth
90 percent live in the Eastern half
NORTHMandarinCoal; wheat;
Heavy industrySOUTHCantonesecotton; rice;
light industryWESTMinoritiesOil;
Agriculture
4
Figure 11-12
Title:
Landscape Regions of China
Caption:
The term China proper denotes the densely populated, culturally Han Chinese areas to the east of the blue line. The Yangtze Valley divides China proper into two general areas. Immediately to the north is the large fertile area of the North China Plain, bisected by the Huang He (or Yellow) River. To the west is the Loess Plateau, an upland area of soil derived from wind-deposited silt after the prehistoric glacial period, about 15,000 years ago.
China/USA
What are the characteristics of China’s territory?
Size of US 9,600,000 sq km
1.39 billion people
mid latitude
Continental
West dry, mountainous
East coastal humid
Vast in territory, rich in resources
Land is scarce, people are many
How do the mountains, rivers and basins combine in China?
Three tiers
SW mountains Tibetan Plateau >3000m
Himalayas, Kun Lun, Karakoram, Tian Shan
Basins and Plateaus 1000-3000m
Tarim Basin, Junggar Basin, Mongolian Plateau (Ordos),
Great Xingan, Chang Bai
Loess Plateau, Sichuan Basin, Yunnan Plateau
South China Hills (Wuyi)
Lowlands <500m
North China Plain, Northeast Plain, Deltas
Karakoram mountains
Tibetan plateau
Everest Chomolongma
Sichuan
Loess plateau
Guangdong
North China
South China
SW - Yunnan
Yellow River - West
Yellow River - East
Yangzi Basin
Yangzi River
Three Gorges Dam
Electrical power
Flood control?
Earthquake
Silt in lake
Aquatic habitat
2 million people moved
Physical environment
Climate
11_04.JPG
18
Figure 11-04
Title:
Flooding on the North China Plain
Caption:
Major flooding, sometimes inundating large sections of the North China Plain, has been a historical problem with the Huang He River. Severe droughts can also plague the same region. Extensive dikes have been built along much of the river to protect the countryside from flooding, as seen in this photo taken near the historical city of Kaifeng. (Yang Xiuyun/ChinaStock Photo Library)
11_05.JPG
19
Figure 11-05
Title:
Denuded Hillslopes in China
Caption:
Because of the need to clear forests for wood products and agricultural lands, China's mountain slopes have long been deforested. Without forest cover, soil erosion is a serious issue. (Bob Sacha/Corbis)
11_07.JPG
20
Figure 11-07
Title:
Coal-Fired Power Plant in China
Caption:
A coal-fired power plant emits large quantities of pollution in northwestern China. As China industrializes, it is building many such plants, damaging local air quality and contributing to global warming. (Natalie Behring/OnAsia.com)
Environmental Challenges
21
China’s population
中国人口
Current stats
http://www.prb.org/
Population Reference Bureau.
China’s reliance on coal epitomizes the central single energy .docx
China’s reliance on coal epitomizes the central “single energy dilemma” by being dependent upon oil heavily over the last decade. China became a net coal importer in 2009. They have multiple sources that supplies the country in proximity; specifically, Australia, Russia, and Indonesia to name a couple. China is the “second largest economy and destination of foreign direct investment” (Sarah Ladislaw, 2014). China due to the heavy growth must use more energy in order to support the growth. Another source stated that China also imported 5.4 million barrels per day of crude and 706 billion cubic feet of natural gas in 2012 alone. This contributes to the “single energy dilemma” because China seemingly is dependent on imported oils due to the amount of growth that they are experiencing.
In my personal assessment it is likely that China can move away from and off goal due to the development and interest in shale gas which is an alternative to coal. China used 10.7 million barrels of oil per day in 2013 which accounted for one third of global oil demand. Due to shale gas being developed China is rethinking their relationships with the Middle East and North Africa. Their dependence on Middle East supplies continues to grow so there needs to be another option for a country who grows ten percent per decade. There are other avenues other than the Middle East. For example, China has been looking into resources closer to home such as central Asian countries for oil. In conclusion China can move away from and off coal with the development of great relationships closer to home.
Sarah Ladislaw, M. L. (2014).
New Energy, New Geopolitics.
Bradshaw, M. (2013).
Global Energy Dilemmas.
.
chinese civilization essay question text 2-3 pages Cours.docx
chinese civilization essay question text
2-3 pages
Course Syllabus
Jump to Today
Chinese 10: Chinese Civilization
Instructor:
Dr. Jingyu Xue
Email:
[email protected]
Class Hours:
W 3:45-6:55 pm, Room R219
Office Hours:
before and after class, or by appointment
COURSE DESCRIPTION:
This course traces the development of Chinese civilization, one of the world’s oldest continuous civilizations, from Neolithic times down to the present. It covers the study of Chinese geography, philosophy, religion, political environment, social relations, family and gender roles, literature, art and drama. Classes will be a combination of lecture and discussion, and students are expected to participate in classroom discussion in order to better understand the rich heritage and full complexity of Chinese culture.
This class will be taught entirely in English. No prior knowledge of Chinese language or culture is required.
TEXTBOOK:
All required readings will be posted on Canvas.
Recommended textbook:
Ebrey, Patricia.
The Cambridge Illustrated History of China, 2nd
edition.
Cambridge: Cambridge University Press, 2010.
STUDENT LEARNING OUTCOMES:
After the completion of this course, students will be able to perform the following tasks:
Describe the major geographic features of China.
Describe the historical contributions of important people in Chinese history.
Explain at least two aspects of Chinese culture and aesthetic tradition.
Analyze various religious influences in China.
Compare/ contrast the differences between the Western and Chinese cultures in family, artistic, and philosophical values.
REQUIREMENTS:
Attendance is mandatory and factored into your participation grade. A student who arrives more than 10 minutes late or leaves more than 10 minutes early will be marked as half-absence. More than 1 unexcused absence will adversely affect your participation grade (10 points out of 100 will be subtracted for each absence). Any student who is absent 3 times in a row will be dropped from the class. An appropriate document is required for all excused absences.
All required readings will be posted on Canvas
. Students are expected to complete reading the assigned texts before coming to each class. It is very important to keep up with the weekly reading assignments and come to class with your textbooks and notes. By doing so, you will be better prepared to participate in class discussion
Active and informed participation in class discussion is required. The final grade can be raised or lowered a few points based on participation. Also, answers to all the exam questions will be addressed during class lectures and discussion. Please be sure to pay close attention and take careful notes. Please turn off all cell phones, pagers and other electronic devices during our class sessions.
Academic Honesty
. All written assignments must be original work put in an individual student’s own words. They can never be copied from another student,.
ChinaThe Third RevolutionXi Jinping and the New Chinese Sta.docx
China:
The Third Revolution
Xi Jinping and the New Chinese State
Elizabeth Economy
Elizabeth Economy, PhD
Council on Foreign Relations:
C. V. Starr senior fellow
Director for Asia studies
Hoover Institution of Stanford University
Visiting Fellow
She is an acclaimed author and expert on Chinese domestic and foreign policy, writing on topics ranging from China's environmental challenges to its role in global governance.
BA – Swarthmore; MA – Stanford; PhD – University of Michigan
Primary Theses
1. Xi Jinping has steered politics and economics towards repression, state control, and confrontation
Xi Jinping has used his power to reassert dominance of the Communist Party and of his own position within it
As part of the campaign against corruption, he has purged potential rivals
He has executed sweeping reorganization of the People’s Liberation Army to ensure loyalty of the military to the party and to him personally
Mr. Xi has imprisoned supporters of Western liberal reform and stamped out criticism of the party and government in the media and online
He has created a surveillance state to monitor discontent and deviance.
China increasingly controls business as an arm of state power
Made in China 2025 plan uses subsidies and protection to create world leadership in ten industries including aviation, tech & energy
Belt and Road Initiative subsidizes infrastructure development in Asia and Africa in return for Chinese trade agreements
c. Regional production chains or production networks are the mechanism by which China influences Asian economies and integrates itself with the global economy.
Enables higher degree of specialization and integration
Facilitates exploitation of scale and scope economies
Ideologically, Chinese path is captured in the “Chinese Dream”
The Third Revolution
The Rejuvenation of the Great Chinese Nation
Common Factors that Explain Takeoff
Openness to trade and investment – higher than rest of world
Strong Export Demand in advanced industrial economy
Increasing intra-regional trade
High Domestic Savings & Investment Rates
Strengthened physical and digital infrastructure
Improved quality of human capital
Active Government Involvement in Economy
Openness to trade
Share of Asian trade as % total world trade increasing at expense of European and Russian trade
North American trade relatively stable.
China: export partners in 2016, by export value
(in billion yuan)
United States
“…other than trade and FDI (foreign direct investment), regional production chains or production networks became a mechanism by which Asian economies tangibly influenced each other as well as integrated in a market-led manner. As barriers to the movement of goods, services and factors of production are dropped further, Asian economies would integrate more with each other as well as with the global economy.” Das, p. 13
Enables higher degree of specialization and integration
Facilitates .
Chinas first emperor, Qin, unified the different territories and st.docx
China's first emperor, Qin, unified the different territories and states into one empire. Discuss the importance of "standardization" (coins, stamps, language, etc.) in that unification.
Need at least two sources minimum and all sources need to be cited.
Minimum 300 words, maximum 500 words.
.
Chinas Great Wall Please respond to the following, using sources.docx
China's Great Wall" Please respond to the following, using sources under the Explore heading as the basis of your response:
Describe two (2) specific aspects about the Great Wall of China, such as facts about its size, length, purposes, varied materials, labor force, and its phases of construction. Consider the various purposes of such a wall and its impact for good or bad, and compare the Chinese wall in this respect to some specific wall of more modern times.
Compare and contrast the Great Wall of China with The Tomb and Terra Cotta Warriors of Qin Shihuangdi. Which is his greatest legacy?
Or, take the opposite approach and present the case that neither was Qin Shihuangdi’s greatest legacy.
Explore
China and Its Great Wall
•Chapter 7 (pp. 212-213, 220), early phases, (p. 605) later phase
•Explore wall interactively at http://www.panoramas.dk/7-wonders/great-wall.html
•Video at http://www.discovery.com/tv-shows/other-shows/videos/discovery-atlas-china-revealed-the-great-wall.htm
•UNESCO article at http://whc.unesco.org/en/list/438
•“China’s Wall Less Great in View from Space” article at http://www.nasa.gov/vision/space/workinginspace/great_wall.html
.
China1. Assess and include transcultural beliefs including l.docx
China
1. Assess and include transcultural beliefs including language, religious practices, socioeconomic status, end-of-life practices, dietary preferences, risky behaviors
2. Identify healthcare behaviors (i.e. nontraditional therapies)
3. Identify challenges and barriers to healthcare and outcomes related to these challenges
4. Develop an evidence-based plan that can be used to improve healthcare outcomes and access to healthcare (including use of IT systems, interdisciplinary members, etc.) for your selected culture. Provide supporting data from peer-reviewed articles
.
APA formatted, 2-page paper
Minimum of 3 references within 5 years
.
China, also known as the Peoples Republic of China or PRC, is a cou.docx
China, also known as the People's Republic of China or PRC, is a country located in the east of Asia. It is the largest Asian country and has the biggest population in the world at around 1.4 billion. Its ruling and founding political party is called the
Communist Party
wherein the head of state is the President, elected by the National People's Congress. He supervises the state council which consists of four vice premiers and the heads of ministries and commissions.
Although Human rights are exercised in this country, a sample of which is the freedom of speech, it is not freely implemented, since it is limited and firmly restricted by specific regulations and laws. This essay will tackle the restriction of freedom of speech in China.
Limited Freedom of Expression
Freedom of expression is the right to convey one’s opinions and thoughts without fear of being punished by the country's government. And although a lot of countries are exercising freedom of speech, some countries like China don't have this as one of their basic human rights.
As a sample, during the 2008 Summer Olympics, the Chinese government agreed to release permits allowing the people to protest in specific areas designed as protest parks in Beijing, but most of the applications sent to the government were either refused, banned or withheld and the police authorities even apprehended the people who applied for permits. If you are looking for essay examples, for example, a
freedom of speech persuasive essay
, it would impossible to find an essay that cites controversial issues. This is because access to web pages considered by the authorities of China as "threatening" or "risky" to the Communist Party are blocked on the internet.
On the brighter side, The Chinese government is spending huge amounts of money on catching and blocking not only web pages that advertise political change within the country, but also websites which may have violence and pornography. According to the Constitution of the People's Republic of China, Chinese citizens can enjoy the freedom of the press and freedom of speech.
However, these kinds of freedom are not institutionally protected. Public speeches that consist of forbidden subjects that can have a huge impact on the people could result in a penalty by the government, and that can include criminal sentences.
As a country ruled by
communism
, it does not accept any disapproval or protest from its people, and other parties defying the government and criticizing them are at risk of persecution. As a Chinese citizen, you are not allowed to freely use social media and have access to western news since it is also controlled by the government.
Other Restrictions
Aside from the government's restriction on freedom of speech, there are other limitations and regulations as well, such as on the administration of publishing and radio and television administration. According to the constitution regarding the administration of publication, .
china & USA ----Food curlture1 follow news story, and related curr.docx
china & USA ----Food curlture
1 follow news story, and related current events, for the entire semester, using diverse global news sources.
2 utilize diverse reference materials and peer reviewed academic journal articles across disciplines
3 present and explanation of research three times during the semester news report days.
NEWS report presentation rubric
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completion
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detail
source list
cotent
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connection to texts&class discussions
questions raised for further research
significant contribution to group
diverse sources
slant/bias considered or acknowledged
quality of sources
style
pace&volume
clarity
creativity
enthusiasm
.
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