Chief complaint My right great toe has been hurting for abou.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 infec.

Education

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 infection.
Treatment: terbinafine 250 mg daily x 12 weeks or
Itraconazole 200 mg daily x 12 weeks
For follow up and baseline therapy the labs ordered were:
liver blood test and blood count to determine the ALT and the
AST levels
Please address the following:
Specify when to refer the patient after therapy and why?
Provide rationale.
According to the recommended guidelines, what are the non-
pharmacological approaches to Onychomycosis?
Provide patient education. Keep in mind the past medical
history of this patient
.

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Discussion QuestionSupport with 1 journals no older than 5 year.docx

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Discussion post reply to the following soap noted case scenario-Respon.docx

estefana2345678

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.

SOAO NotePatient Initials S.MPt. Encounter Number 2 .docx

pbilly1

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 # 13 Discuss the FDA approach for liver safety for .docx

lynettearnold46882

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. ...

For the following Case Study, as follow is Discussion Question

shantayjewison

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.

SOAP NOTEName J.D.Date 03262020Time 200 pmAge 25 .docx

pbilly1

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 refi.docx

troutmanboris

Soap Note Acute.docx

write5

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 ...

SOAP NOTEName DL Date 9302022

pearlenehodge

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.

Case StudyChief complaint I’m here for a medication refill .docx

troutmanboris

Ibd by dr qasim

West Medicine Ward

Mrs. Jones is a 32 year old Caucasian female who presents for follow up on her gestational diabetes. She is 3 months postpartum and was diagnosed with gestational diabetes. This was her first pregnancy. She has a strong family history of diabetes and was told to get it checked out once she stopped breastfeeding. She has not checked her glucose since she came home from the hospital, stating she has been too busy. Allergies: Sulfa Current medications: Multivitamin PMH: Gestational Diabetes PSH: Tonsillectomy, Wisdom teeth extraction Social: Denies tobacco, Alcohol, or illegal drug use. She is married and lives with her husband and new baby. She works as an elementary teacher. She follows a regular diet and walks 2 days a week when she has recess duty. Immunizations: flu: 2019 Family: Father: alive, +DM, CAD, Hyperlipidemia, Mother: alive, +DM, CKD ROS: Constitutional: Complains of increase fatigue HEENT: Denies any headache, nasal congestion, ear pain Cardiovascular: Denies chest pain Respiratory: Denies any SOB or DOE GI: Denies any issues, last BM 1 day ago. GU: Denies any painful urination, urgency, hesitancy Musculoskeletal: denies. Neurological: Denies Psychiatric: Denies suicidal ideations, depression. Does report difficulty falling asleep Endocrine: Denies any weight changes, intolerance to heat/cold Hematologic/ Lymphatic: Denies any bruising OBJECTIVE: Vital signs: Ht: 66, Wt: 185, BP 130/78, HR 76, Resp: 16, SaO2: 98% Constitutional: Well developed, overweight female HEENT: Oropharynx pink, moist, no lesions or exudate. Tonsils 1+ bilaterally. Teeth in good repair, no cavities noted. Tongue smooth, pink, no lesions, protrudes in midline. Neck supple. No cervical lymphadenopathy or tenderness noted. Thyroid midline, small and firm without palpable masses Cardiovascular: RRR, No murmurs or rubs noted. Respiratory: Clear all fields GI: Abdomen round, soft, with bowel sounds noted in all four quadrants. GU: Deferred Musculoskeletal: Crepitus noted bilateral knees, fluid wave noted to Rt knee Integumentary: Skin warm and dry, No rashes noted Neuro: Follows commands without difficulty Working with your group, utilize the above case study a, develop a Voice Over PowerPoint presentation for your patient covering the problems identified in the case study and content in Unit 3 of Edelman, Kudzama, & Mandle (2018). Include the following: Nutrition Counseling for Health Promotion Exercise Stress Management .

Mrs. Jones is a 32 year old Caucasian female who presents for fo.docx

griffinruthie22

Osteomyelitis Case Presentation

Redzwan Abdullah

0125orthopaedicom-140626070019-phpapp02 (1).pdf

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SOAP NOTEName J.D.Date 03262020Time 200 pmAge 25 .docx

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SOAP NOTEName DL Date 9302022

Case StudyChief complaint I’m here for a medication refill .docx

Ibd by dr qasim

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0125orthopaedicom-140626070019-phpapp02 (1).pdf

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Choose 3 or 4 poems from Elizabeth Bishop. You may choose any poems .docx

spoonerneddy

Choose 1 topic to write an essay. Don't restate all the time. Write your own thoughts. 800 words. 1. Jesus was both a person of his times and a figure whose teachings have obviously transcended his specific context. How did Jesus’s life and teachings better fit the first century? How do Jesus’s life and teachings seem to apply today? Which do you think better characterizes Jesus’s actual life and teachings? Is it more convincing to you that the first century Jesus resists our expectations, or that he anticipates them? 2. Jesus and the early Christians were a part of the larger Jewish context. At the same time, they also brought a number of innovations and new combinations. Compare Jesus’s life and message to that of the Pharisees, Essenes, followers of John the Baptist, Sadducees, priests, and/or the temple. How did Jesus and the early Christians fit with these other Jewish groups? How did they challenge them? Is it more convincing to you that Jesus and the early Christians were part of first century Judaism, or that they pushed to create a new religion? 3. Jesus avoided political attention for most of his life and work. Whatever he taught, he taught it skillfully and carefully enough that political figures allowed him to continue when many others were crucified. And yet, at the end, he too was crucified, but alone. Describe both the ways in which the historical Jesus avoided political confrontation and the ways in which he touched on politically sensitive ideas. Which gives us a better portrait of Jesus—the one who was politically cautious, or the rebel? .

Choose 1 topic to write an essay. Dont restate all the time. Write .docx

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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 an injury. 4. Suppo.

Choose 1 focal point from each subcategory of practice, educatio.docx

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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 an injury. 4. Sup.

Choose 1 focal point from each subcategory of practice, education, r.docx

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Chinese History Based on the lecture on Chinese History and Marxist Historiography that we can observe that women’s values for love and marriage have changed dramatically. China entered different periods from the feudal system to the opening of China. In the feudal period, people attached importance to family ethics took the land as the main interest and lived a life according to family rules. However, after China entered the capitalist era, capitalism encouraged people to pursue money and material life. Marriage and love are very important to a woman. However, at different times, a woman has a completely different way of life. For example, Yulian lived in a feudal period dominated by family so she put her husband's family first. In my opinion, Yulian sacrificed her love and happiness for putting family first, which is a great thing but not worth it. However, Jia Jia from the beginning of the gold digger because of a series of events and become a brave pursuit of their own love and life woman is very worthy of praise. With the passage of time, people's concept has changed gradually, from the old conservative value of family to the priority of their own ideas, from the pursuit of land as the interest standard to the pursuit of money and material life as the most important goal, which is an important symbol of the changing times. Jia Jia and Julian have something in common. They all focus on who can give them a stable and good life. However, the difference is that Yulian follows the traditional idea of giving priority to her family but Jia Jia is based on their own ideas to live out their own life. Marxist Historiography 1. Marxist Historiography has five different stages. The first stage is Primitive Communism, People at this stage use hunting as raw meat, which is the most important asset. The second stage is Oriental Slavery, the agricultural development began, and people willing to fight elsewhere and take slaves to cultivate for themselves. The most valuable is the slave. The third stage is Feudalism, serfs or peasants serve for their king and pay the rent or tax. Capitalism is the four-stage, the most important asset is money. The five-stage is Communism, for this stage that no more private ownership and it will be a world of peace and no war. 2. Base on Marxist Historiography lecture, the era of Yulian's life is very important to the family. She listens to her family's arrangements to get married and takes care of her husband's family after marriage. So I think Yulian is in the third stage of the Marxism Feudalism stage because people at this stage serve the king, they obedient and obey the rules. Yulian's life all follow her husband’s family and obey her family. Jia Jia emphasized that she has money from the beginning of the film. Anything she wants that she just use money to get it. All Jia Jia thinks that she can buy it with money. Therefore, Jia Jia is the fourth stage Capitalism stage in Marxism. 3. On the stage of Yulian so be .

Chinese HistoryBased on the lecture on Chinese History and Marxi.docx

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Children need an Aesthetics Experience from the teacher and in the classroom. The above document is a brief summary of Aesthetic and some key terms. Do the following: 1. Read the document completely 2. Study the Key Terms 3. Use the key terms and determine which words can be used in a Early Childhood Classroom and which words can be used with an An Art Conversation with a child. Give a brief explanation of your reasoning .

Children need an Aesthetics Experience from the teacher and in the c.docx

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China’s economy 中国经济 http://worldmap.harvard.edu/chinamap/ How has China’s economy changed 1949-present? What is the structure of PR China’s economy? What are some major agricultural issues in China? What are some industrial issues in China? What is the Belt and Road Initiative? What are the economic forces at work in China? How has the economic reform policy progressed in China? How has China’s economy changed 1949-present? Economy Timeline Mao 1950s Land reform, Collectivization, Great Leap Forward, 1960s Cultural Revolution 1976 Four Modernizations Deng Reforms 1980s Agricultural Responsibility System Socialist Economy with Chinese Characteristics Exports 1992 Deng’s Southern tour Regional Development, Coast, Interior 2000 Develop the West 2010 Moderate Prosperity, Technology, Green 2013 Third Plenum - China Dream http://www.bbc.co.uk/news/business-25033622 http://www.bbc.com/news/world-asia-china-31744373 Videos China in the Red http://www.pbs.org/wgbh/pages/frontline/shows/red/ http://www.dailymotion.com/video/xen5f7_pbs-china-in-the-red-9-11_news What are the lives of people like? Form of Economy Mixed Economy Market-Leninism Transition: Elements of Socialism, Market & Capitalism What is the structure of PR China’s economy? Ownership types: State, Collective, Private and individual, Foreign Economic Indicators GDP Trillion $25.36 GDP per capita $18, 200 GDP growth 6.9% GDP Composition Agriculture 8%, Industry 40% Service 52% Labor Composition Agriculture 28%, Industry 29% Service 43% Poverty 3.3%, <RMB2300 ( US$400) Trade Exports (number 1): US 19, Hong Kong 12, Japan 6, South Korea 5 Electrical, computers, apparel, furniture, textiles Imports ( number 2): South Korea 10, Japan 9, US 9, Germany 5, Australia 5 Electrical, oil, medical, ore, vehicle, soybean Structure of China’s Transitional Economy 1 Structure of China’s Transitional Economy Industrial structure (compare to Japan and S. Korea) Enterprise groups – SOE State Operated Enterprise state support/control, losing money, 25% industry Collective enterprises – independent of state manager bought company from state 40% industry TVE Enterprises – Township and Village Enterprises (former collective) Owned operated by rural - Dynamic element of economy Structure of China’s Transitional Economy 2 Private Entrepreneurs - small business, 20% industry services/manufactures Difficult taxes, legality, politics Foreign Ventures – partnerships, 10% industry – commerce, industry Agriculture - backbone of economy 8% econ employment / food supply Responsibility system, state out of agriculture have right to work land Food price control and some subsidies still exist Economic Dualism Industrial v. non-industrial : worker - peasant Coastal & open cities v. hinterland “backward” City v. country urban v. rural China Inc? Simplified form CCP Business Bureaucracy (SOE, Coll., TVE) (State Council) Rural .

China’s economy中国经济httpworldmap.harvard.educhinamap.docx

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Children's Health Insurance Program CHIP. Respond to the 5 questions in 200 words per question using at least 4 source. 1. What is the CHIP program? When and how was it established? how does it benefit children’s health and wellbeing and that of the overall population? 2. How could the CHIP program continue to be successfully funded? 3. Who do you feel should be covered in the program? 4. How should the qualifications be set for being accepted? 5. Revise one evidence-based article regarding this program and the impact it has. .

Childrens Health Insurance Program CHIP. Respond to the 5 questions.docx

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