Comprehensive SOAP ExemplarPurpose To demonstrate what each sec.docx
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Comprehensive SOAP Exemplar Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise. Patient Initials: _______ Age: _______ Gender: _______ SUBJECTIVE DATA: Chief Complaint (CC): Coughing up phlegm and fever History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10. Medications: 1.) Lisinopril 10mg daily 2.) Combivent 2 puffs every 6 hours as needed 3.) Serovent daily 4.) Salmeterol daily 5.) Over-the-counter Ibuprofen 200mg -2 PO as needed 6.) Over-the-counter Benefiber 7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms Allergies: Sulfa drugs - rash Past Medical History (PMH): 1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments. 2.) Hypertension – well controlled 3.) Gastroesophageal reflux (GERD) – quiet, on no medication 4.) Osteopenia 5.) Allergic rhinitis Past Surgical History (PSH): 1.) Cholecystectomy 1994 2.) Total abdominal hysterectomy (TAH) 1998 Sexual/Reproductive History: Heterosexual G1P1A0 Non-menstruating – TAH 1998 Personal/Social History: She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use. Immunization History: Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time. Significant Family History: Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood. Lifestyle: She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable. She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends. Review of Systems: General: + fatigue .
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Comprehensive SOAP ExemplarPurpose To demonstrate what each s
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP note should include. Remember that Nurse Practitioners treat patients in a holistic manner and your SOAP note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65 year old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last three days. She reported that the “cold feels like it is descending into her chest”. The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4, last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over the counter Ibuprofen 200mg -2 PO as needed
6.) Over the counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and an hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstrating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65 and the other with prostate CA, dx at age 62. She has 1 daughter, in her 50’s, healthy, living in nearby neighborhood.
Lifestyle:
She is a retired; widowed x 8 years; lives in the city, moderate crime area, with good public transportation. She college graduate, owns her home and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center and she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue since the illness starte ...
Comprehensive SOAP ExemplarPurpose To demonstrate what each s.docx
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue sinc.
Comprehensive SOAP ExemplarPurpose To demonstrate what each s.docx
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue sinc.
Give an example from your own experience or research an article or.docx
Give an example from your own experience or research an article or the media in which a business executive did something of significance that is morally right. Use APA format to cite your material from your sources.
Is there a relationship between obesity and socio-economic status? Should obese people be considered a protected class under Title VII of the Civil Rights Act?
1:
2:
3.
4.
5.
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and r ...
Comprehensive SOAP ExemplarPurpose To demonstrate what each sec.docx
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue .
Comprehensive SOAP TemplateThis template is for a full history.docx
Comprehensive SOAP Template
This template is for a full history and physical. For this course include only areas that are related to the case.
Patient Initials: _______
Age: _______
Gender: _______
Note: The mnemonic below is included for your reference and should be removed before the submission of your final note.
O = onset of symptom (acute/gradual)
L= location
D= duration (recent/chronic)
C= character
A= associated symptoms/aggravating factors
R= relieving factors
T= treatments previously tried – response? Why discontinued?
S= severity
SUBJECTIVE DATA: Include what the patient tells you, but organize the information.
Chief Complaint (CC): In just a few words, explain why the patient came to the clinic.
History of Present Illness (HPI): This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes ofeach principal symptom in paragraph form not a list:
1. Location
2. Quality
3. Quantity or severity
4. Timing, including onset, duration, and frequency
5. Setting in which it occurs
6. Factors that have aggravated or relieved the symptom
7. Associated manifestations
Medications: Include over-the-counter, vitamin, and herbal supplements. List each one by name with dosage and frequency.
Allergies: Include specific reactions to medications, foods, insects, and environmental factors. Identify if it is an allergy or intolerance.
Past Medical History (PMH): Include illnesses (also childhood illnesses), hospitalizations.
Past Surgical History (PSH): Include dates, indications, and types of operations.
Sexual/Reproductive History: If applicable, include obstetric history, menstrual history, methods of contraception, sexual function, and risky sexual behaviors.
Personal/Social History: Include tobacco use, alcohol use, drug use, patient’s interests, ADL’s and IADL’s if applicable, and exercise and eating habits.
Immunization History: Includelast Tdap, Flu, pneumonia, etc.
Significant Family History: Include history of parents, grandparents, siblings, and children.
Lifestyle: Include cultural factors, economic factors, safety, and support systems and sexual preference.
Review of Systems: From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History (this includes the systems that address any previous diagnoses).Remember that the information you include in this section is based on what the patient tells you so ensure that you include all essentials in your case (refer to Chapter 2 of the Sullivan text).
General: Include any recent weight changes, weakness, fatigue, or fever, but do not restate HPI data here.
HEENT:
Neck:
Breasts:
Respiratory:
Cardiovascular/Peripheral Vascular:
Gastrointestinal:
Genitourinary:
Mu.
Differential Diagnosis for Skin Conditions Case Study.pdf
The document provides instructions for a case study assignment on differential diagnosis for skin conditions. Students will examine visual representations of various skin conditions and use differential diagnosis techniques to determine the most likely diagnosis. They will choose one skin condition to document in a SOAP note format, describing observations and formulating a differential diagnosis list of 3-5 possible conditions. The most likely diagnosis must be explained using references.
Financial & Managerial Accounting Assignment 1 – Financial S.docx
This document provides guidelines and instructions for an assignment on financial statement analysis. It states that the assignment is individual work, must be grounded in relevant theory, and plagiarism will be penalized. It provides word count guidance and states the assignment is an Excel assessed work folder and business report to be submitted as one document between weeks 3-4. The learning outcomes assessed are also listed.
The second part of the document is a sample SOAP note for a patient presenting with cough and fever. It provides an exemplar of all the required sections of the SOAP note, including subjective information like the patient's history and complaints, objective physical exam findings, assessments and diagnoses, and a plan section.
Recommended
Comprehensive SOAP ExemplarPurpose To demonstrate what each s
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP note should include. Remember that Nurse Practitioners treat patients in a holistic manner and your SOAP note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65 year old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last three days. She reported that the “cold feels like it is descending into her chest”. The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4, last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over the counter Ibuprofen 200mg -2 PO as needed
6.) Over the counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and an hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstrating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65 and the other with prostate CA, dx at age 62. She has 1 daughter, in her 50’s, healthy, living in nearby neighborhood.
Lifestyle:
She is a retired; widowed x 8 years; lives in the city, moderate crime area, with good public transportation. She college graduate, owns her home and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center and she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue since the illness starte ...
Comprehensive SOAP ExemplarPurpose To demonstrate what each s.docx
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue sinc.
Comprehensive SOAP ExemplarPurpose To demonstrate what each s.docx
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue sinc.
Give an example from your own experience or research an article or.docx
Give an example from your own experience or research an article or the media in which a business executive did something of significance that is morally right. Use APA format to cite your material from your sources.
Is there a relationship between obesity and socio-economic status? Should obese people be considered a protected class under Title VII of the Civil Rights Act?
1:
2:
3.
4.
5.
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and r ...
Comprehensive SOAP ExemplarPurpose To demonstrate what each sec.docx
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue .
Comprehensive SOAP TemplateThis template is for a full history.docx
Comprehensive SOAP Template
This template is for a full history and physical. For this course include only areas that are related to the case.
Patient Initials: _______
Age: _______
Gender: _______
Note: The mnemonic below is included for your reference and should be removed before the submission of your final note.
O = onset of symptom (acute/gradual)
L= location
D= duration (recent/chronic)
C= character
A= associated symptoms/aggravating factors
R= relieving factors
T= treatments previously tried – response? Why discontinued?
S= severity
SUBJECTIVE DATA: Include what the patient tells you, but organize the information.
Chief Complaint (CC): In just a few words, explain why the patient came to the clinic.
History of Present Illness (HPI): This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes ofeach principal symptom in paragraph form not a list:
1. Location
2. Quality
3. Quantity or severity
4. Timing, including onset, duration, and frequency
5. Setting in which it occurs
6. Factors that have aggravated or relieved the symptom
7. Associated manifestations
Medications: Include over-the-counter, vitamin, and herbal supplements. List each one by name with dosage and frequency.
Allergies: Include specific reactions to medications, foods, insects, and environmental factors. Identify if it is an allergy or intolerance.
Past Medical History (PMH): Include illnesses (also childhood illnesses), hospitalizations.
Past Surgical History (PSH): Include dates, indications, and types of operations.
Sexual/Reproductive History: If applicable, include obstetric history, menstrual history, methods of contraception, sexual function, and risky sexual behaviors.
Personal/Social History: Include tobacco use, alcohol use, drug use, patient’s interests, ADL’s and IADL’s if applicable, and exercise and eating habits.
Immunization History: Includelast Tdap, Flu, pneumonia, etc.
Significant Family History: Include history of parents, grandparents, siblings, and children.
Lifestyle: Include cultural factors, economic factors, safety, and support systems and sexual preference.
Review of Systems: From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History (this includes the systems that address any previous diagnoses).Remember that the information you include in this section is based on what the patient tells you so ensure that you include all essentials in your case (refer to Chapter 2 of the Sullivan text).
General: Include any recent weight changes, weakness, fatigue, or fever, but do not restate HPI data here.
HEENT:
Neck:
Breasts:
Respiratory:
Cardiovascular/Peripheral Vascular:
Gastrointestinal:
Genitourinary:
Mu.
Differential Diagnosis for Skin Conditions Case Study.pdf
The document provides instructions for a case study assignment on differential diagnosis for skin conditions. Students will examine visual representations of various skin conditions and use differential diagnosis techniques to determine the most likely diagnosis. They will choose one skin condition to document in a SOAP note format, describing observations and formulating a differential diagnosis list of 3-5 possible conditions. The most likely diagnosis must be explained using references.
Financial & Managerial Accounting Assignment 1 – Financial S.docx
This document provides guidelines and instructions for an assignment on financial statement analysis. It states that the assignment is individual work, must be grounded in relevant theory, and plagiarism will be penalized. It provides word count guidance and states the assignment is an Excel assessed work folder and business report to be submitted as one document between weeks 3-4. The learning outcomes assessed are also listed.
The second part of the document is a sample SOAP note for a patient presenting with cough and fever. It provides an exemplar of all the required sections of the SOAP note, including subjective information like the patient's history and complaints, objective physical exam findings, assessments and diagnoses, and a plan section.
Below is an example to follow ThanksComprehensive
Below is an example to follow :
Thanks
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP note should include. Remember that Nurse Practitioners treat patients in a holistic manner and your SOAP note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Eddie Myers is a 58 year old African American male who presents today with a productive cough x 3 days, fever, muscle aches, loss of taste and smell for the last three days. He reported that the “cold feels like it is descending into his chest and he can’t eat much”. The cough is nagging and productive. He brought in a few paper towels with expectorated phlegm – yellow/green in color. He has associated symptoms of dyspnea of exertion and fatigue. His Tmax was reported to be 100.3, last night. He has been taking Tylenol 325mg about every 6 hours and the fever breaks, but returns after the medication wears off. He rated the severity of her symptom discomfort at 8/10.
Medications:
1.) Norvasc 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Advair 500/50 daily
4.) Singulair 10mg daily
5.) Over the counter Tylenol 325mg as needed
6.) Over the counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Cipro-headache
Past Medical History (PMH):
1.) Asthma
2.) Hypertension
3.) Osteopenia
4.) Allergic rhinitis
5.) Prostate Cancer
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Prostatectomy 1986
Sexual/Reproductive History:
Heterosexual
Personal/Social History:
He has never smoked
Dipped tobacco for 25 years, no longer dipping
Denied ETOH or illicit drug use.
Immunization History:
Covid Vaccine #1 3/2/2021 #2 4/2/2021 Moderna
Influenza Vaccination 10/3/2020
PNV 9/18/2018
Tdap 8/22/2017
Shingles 3/22/2016
Significant Family History:
One sister – with diabetes, dx at age 65
One brother--with prostate CA, dx at age 62. He has 2 daughters, both in 30’s, healthy, living in nearby neighborhood.
Lifestyle:
He works FT as Xray Tech; widowed x 8 years; lives in the city, moderate crime area, with good public transportation. He is a college grad, owns his home and financially stable.
He has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. He has medical insurance but often asks for drug samples for cost savings. He has a healthy diet and eating pattern. There are resources and community groups in his area at the senior center but he does not attend. He enjoys golf and walking. He has a good support system composed of family and friends.
Review of Systems:
General: + fatigue since the illness started; + fever, no chills or night sweats; no recent weight gains of losses of significance.
HEENT: no changes in vision or hearing; he does wear glasses and his last ...
NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLISTThe fo.docx
NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLIST
The following list will be used to determine the grade for the physical examination demonstration. It does not constitute a
complete list of everything that could be included in a physical examination but rather a list of those things that should be done at a
minimum for every individual having a “complete physical examination”.
Possible
Points
Score
Skin
2
Inspects all areas of body esp. feet
2
Head & Neck
6
Inspect & Palpates skull
1
Palpates lymph nodes for adenopathy
2
Palpates thyroid (with H2O/swallowing)
2
Palpates tracheal placement
1
Eyes
12
Checks visual acuity
1
Checks peripheral fields
2
Checks EOMs
2
Checks conjunctiva for pallor
1
Checks pupillary reaction
1
Opthalmoscopic exam
5
describes discs, checks for microaneurysms,
hemorrhages, neovascularization
Ears, Nose,
Sinuses, Mouth
Determines gross hearing/whisper test
2
8
Otoscopic exam (describes landmarks)
2
Inspect & Assess Nares
1
Palpate & percuss sinuses
2
Examines mouth including blind pouch
1
Chest and Lungs
8
Inspect & Observes respiratory movements/rate
1
Posterior chest
5
Palpates & percuss respiratory excursion. Assess tactile fremitus
Auscultates breath sounds
Anterior chest
2
Palpate & percuss ant chest. Auscultate breath sounds
Breasts
Explanation only –do not demonstrate
1
1
Palpates axillae, inspects breasts
Palpates axillary lymph nodes
Cardiovascular
8
Inspect & Observes neck veins and measures
1
Palpates PMI and precordium
2
Auscultates cardiac sounds
5
With diaphragm and bell sitting
then diaphragm supine/left lateral decubitis
Peripheral Vascular
5
Inspect & Palpates pulses: carotids, radials, tibialis, pedals
2
Palpates for lower extremity edema
1
Auscultates carotids
2
Abdomen
10
Inspect & Auscultates bowel sounds
1
Auscultates renal arteries
2
Palpates abdomen for tenderness/McBurney’s pt
2
(rebound tenderness)
Check for splenic & liver enlargement
3
Percuss liver to determine span
2
Neurological
30
Mental status—MMSE or clock drawing
1
Cranial nerves:
12
Olfactory: smell
Optic: visual acuity, fields
Oculomotor, trochlear, abducens: EOMs
Trigeminal: sensation & jaw strength
Facial: frown, smile, corneal reflex
Acoustic: gross hearing
Glossopharyngeal, vagus: gag reflex
Spinal accessory: shrug shoulders
Hypoglossal: moves tongue
Reflexes: all DTRs and Babinski
5
Sensory:
light touch/monofilament on feet
1
Vibration
1
Stereognosis or graphesthesia
1
Motor:
Strength—upper and lower extremities
2
Muscle tone during active ROM
2
Gait
1
Cerebellar:
Test for coordination—finger/nose
1
One test for balance
1
One test for meningeal irritation
1
One test for nerve root irritation
1
Musculoskeletal
10
Inspect & Inspects spine
1
Palpates spine
2
Palpates major joint.
1) Naïve T cells have the potential to differentiate into several
1) Naïve T cells have the potential to differentiate into several types of effector cells. In the space below, describe the roles and activities of each of these cells:
TH1 cells
TH2 cells
TH17 cells
TFH cells
2) Use the following diagram to compare and contrast systemic immunity and mucosal immunity.
Systemic
Both Systemic and Mucosal
Mucosal
ordinary surface epithelia
Why is there a need for these differences in the first place?
CDC Sexually Transmitted Diseases Case Study.
Read the patient case study below
General:
The patient is a young seventeen-year-old female who came to the clinic with complaint of abdominal pain.
Chief Complaint:
Kim reports "I've been having pain in my stomach for several weeks." She describes the pain as being sharp and being constant. She stated the pain often occurs on both sides of her lower abdominal. She has been experiencing the pain for the past two weeks. The pain has gotten worse since then.
Reliability and Source of History:
The patient is alert and oriented and able to answer most of the questions.
Source & Reliability of History:
O – "I have been having pain in my stomach for several weeks now.” she stated that the pain has lasted for two weeks without any relief.
L – Both sides of her lower stomach
D – The patient reported that she has been having this bilateral lower stomach pain for the last two weeks, However, the symptoms got worse since the pain started ago.
C – She stated that since the onset of the pain, her pain has remained constant without any relieve and aggravating factor. The pain is firm regardless of the time or day or event. She further stated that her symptoms get worse. The patient states that she is unaware of what caused the pain or how the pain started; however, she stated that taking pills could relieve her stomach pain and stop her bleeding
A – She stated that the pain remains constant. She also stated that she is unaware of what caused the pain or how the pain started.
R – She stated that the pain remains steady and does not go away or radiate to other areas.
T- she reported feeling uncomfortable doing her regular shores due to the pain.
Past Medical history:
Patient is asthmatic; however, her asthma is under control. She knows known history of any other condition or never been hospitalized.
Family History:
She is the second in a family of four who are all alive and healthy. There is no history of any chronic condition in the family.
Social History:
Patient is a regularly active young woman; she is single and does moderately active exercise. However, she stated that her daily activity and chores has recently reduced due to her recent symptoms of pain. She also stated to have no appetite secondary to her recent pain. She also stated that her stress level may be related with her college. She has no history of alcohol, smoking, or had never smoked in her life. She has not used any ...
1) Naïve T cells have the potential to differentiate into several
1) Naïve T cells have the potential to differentiate into several types of effector cells. In the space below, describe the roles and activities of each of these cells:
TH1 cells
TH2 cells
TH17 cells
TFH cells
2) Use the following diagram to compare and contrast systemic immunity and mucosal immunity.
Systemic
Both Systemic and Mucosal
Mucosal
ordinary surface epithelia
Why is there a need for these differences in the first place?
CDC Sexually Transmitted Diseases Case Study.
Read the patient case study below
General:
The patient is a young seventeen-year-old female who came to the clinic with complaint of abdominal pain.
Chief Complaint:
Kim reports "I've been having pain in my stomach for several weeks." She describes the pain as being sharp and being constant. She stated the pain often occurs on both sides of her lower abdominal. She has been experiencing the pain for the past two weeks. The pain has gotten worse since then.
Reliability and Source of History:
The patient is alert and oriented and able to answer most of the questions.
Source & Reliability of History:
O – "I have been having pain in my stomach for several weeks now.” she stated that the pain has lasted for two weeks without any relief.
L – Both sides of her lower stomach
D – The patient reported that she has been having this bilateral lower stomach pain for the last two weeks, However, the symptoms got worse since the pain started ago.
C – She stated that since the onset of the pain, her pain has remained constant without any relieve and aggravating factor. The pain is firm regardless of the time or day or event. She further stated that her symptoms get worse. The patient states that she is unaware of what caused the pain or how the pain started; however, she stated that taking pills could relieve her stomach pain and stop her bleeding
A – She stated that the pain remains constant. She also stated that she is unaware of what caused the pain or how the pain started.
R – She stated that the pain remains steady and does not go away or radiate to other areas.
T- she reported feeling uncomfortable doing her regular shores due to the pain.
Past Medical history:
Patient is asthmatic; however, her asthma is under control. She knows known history of any other condition or never been hospitalized.
Family History:
She is the second in a family of four who are all alive and healthy. There is no history of any chronic condition in the family.
Social History:
Patient is a regularly active young woman; she is single and does moderately active exercise. However, she stated that her daily activity and chores has recently reduced due to her recent symptoms of pain. She also stated to have no appetite secondary to her recent pain. She also stated that her stress level may be related with her college. She has no history of alcohol, smoking, or had never smoked in her life. She has not used any ...
Soap Note 2 Chronic ConditionsSoap Note Chronic Conditions (
Soap Note 2 Chronic Conditions
Soap Note Chronic Conditions (15 Points)
Pick any Chronic Disease from Weeks 6-10
Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)
Follow the MRU Soap Note Rubric as a guide
Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement
SOAP NOTE SAMPLE FORMAT FOR MRC
Name:
LP
Date:
Time:
1315
Age:
30
Sex:
F
SUBJECTIVE
CC:
“I am having vaginal itching and pain in my lower abdomen.”
HPI:
Pt is a 30y/o AA female, who is a new patient that has recently moved to Miami. She seeks treatment today after unsuccessful self-treatment of vaginal itching, burning upon urination, and lower abdominal pain. She is concerned for the presence of a vaginal or bladder infection, or an STD. Pt denies fever. She reports the itching and burning with urination has been present for 3 weeks, and the abdominal pain has been intermittent since months ago. Pt has tried OTC products for the itching, including Monistat and Vagisil. She denies any other urinary symptoms, including urgency or frequency. She describes the abdominal pain as either sharp or dull. The pain level goes as high as 8 out of 10 at times. 200mg of PO Advil PRN reduces the pain to a 7/10. Pt denies any aggravating factors for the pain. Pt reports that she did start her menstrual cycle this morning, but denies any other discharge other that light bleeding beginning today. Pt denies douching or the use of any vaginal irritants. She reports that she is in a stable sexual relationship, and denies any new sexual partners in the last 90 days. She denies any recent or historic known exposure to STDs. She reports the use of condoms with every coital experience, as well as this being her only form of contraceptive. She reports normal monthly menstrual cycles that last 3-4 days. She reports dysmenorrhea, which she also takes Advil for. She reports her last PAP smear was in 7/2016, was normal, and reports never having an abnormal PAP smear result. Pt denies any hx of pregnancies. Other medical hx includes GERD. She reports that she has an Rx for Protonix, but she does not take it every day. Her family hx includes the presence of DM and HTN.
Current Medications:
Protonix 40mg PO Daily for GERD
MTV OTC PO Daily
Advil 200mg OTC PO PRN for pain
PMHx:
Allergies:
NKA & NKDA
Medication Intolerances:
Denies
Chronic Illnesses/Major traumas
GERD
Hospitalizations/Surgeries
Denies
Family History
Father- DM & HTN; Mother- HTN; Older sister- DM & HTN; Maternal and paternal grandparents without known medical issues; 1 brother and 3 other sisters without known med ...
NR 601 Inspiring Innovation/tutorialrank.com
For more course tutorials visit
www.tutorialrank.com
Discussion Part One (graded)
You meet your first patient of the morning. A.K. is a 65-year-old Caucasian male who you are seeing for the first time. Both wife and daughter are present.
SampleWriteUp.pdf history and physical examination
1. This 83-year-old woman presented to the emergency room with substernal chest pain and was diagnosed with an acute anterolateral myocardial infarction based on EKG changes and elevated cardiac enzymes. She has a history of hypertension and congestive heart failure.
2. On examination, she was tachycardic with bibasilar rales and edema suggestive of congestive heart failure. Laboratory results showed evidence of a heart attack and mild left ventricular dysfunction.
3. The plan is to continue medical management for the heart attack and congestive heart failure while also treating her for a suspected urinary tract infection based on dysuria and pyuria.
SOAP NOTENameDateTime AgeSexSUBJECTIVECC .docx
SOAP NOTE
Name:
Date:
Time:
Age:
Sex:
SUBJECTIVE
CC:
Reason given by the patient for seeking medical care “in quotes”
HPI: Use OLDCART acronym
Describe the course of the patient’s illness, including when it began, character of symptoms, location where the symptoms began, aggravating or alleviating factors; pertinent positives and negatives, other related diseases, past illnesses, surgeries or past diagnostic testing related to present illness.
Medications: (list with reason for med ) write medicine the same way you write a Rx
PMH (list approximate year of Dx of the disease or when surgical procedure performed)
Allergies:
Medication Intolerances:
Chronic Illnesses/Major traumas
Hospitalizations/Surgeries
Family History (list immediate family, age, disease, and whether is dead or alive)
Does your mother, father or siblings have any medical or psychiatric illnesses? Anyone diagnosed with: lung disease, heart disease, htn, cancer, TB, DM, or kidney disease.
Social History
Education level, occupational history, current living situation/partner/marital status, substance use/abuse, ETOH, tobacco, marijuana. Safety status
ROS (Start each sentence with words such as “Denies, admits, complains, reports”, do not use the words “No, positive for, negative for”. Do NOT list physical exam findings here. If the body system not assess write “Non-Contributory”
General
Cardiovascular
Skin
Respiratory
Eyes
Gastrointestinal
Ears
Genitourinary/Gynecological
Nose/Mouth/Throat
Musculoskeletal
Breast
Neurological
Heme/Lymph/Endo
Psychiatric
OBJECTIVE- this is where you document physical exam findings, do NOT use the word NORMAL to document a finding, and instead explain what normal is. For example, the gait is not normal, the gait is steady. If the body part not assessed then type “Deferred”.
Weight BMI
Temp
BP
Height
Pulse
Resp
General Appearance
Skin
HEENT
Cardiovascular
Respiratory
Gastrointestinal
Breast
Genitourinary
Musculoskeletal
Neurological
Psychiatric
Lab Tests (lists any tests ordered and status of the test, if a rapid test was done at the office, list the results)
Special Tests (List any imaging study or special test ordered and status of the test, if the result is available, write the result)
Diagnosis
Differential Diagnoses with ICD 10 codes (these are Dx you considered, but then ruled out)
· 1-
· 2-
· 3-
Diagnosis with ICD 10 Code
CPT Code/Office visit code:
Plan/Therapeutics
· Plan:
· Further testing
· Medication
· Education
· Non-medication treatments
· Follow Up
· Referral
· When to seek emergency care
Evaluation of patient encounter
Document your level of interaction with the patient.
Weaknesses:
Strengths:
Reflection:
References:
Week 2: Respiratory Clinical Case
Patient Setting:
65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle
accident presents to the clinic today. States she is having severe wheezing, shortness of b.
SubjectiveChief complaint headaches and blurriness of visi.docx
Subjective:
Chief complaint: headaches and blurriness of vision on the right side
History of present illness: the patient is 67 years old Caucasian female, she complains of having had headaches for 2 weeks now. The pain is located in the right temporal area. She describes the pain as 8-10/10, sharp, constant, interferes with her sleep, she states that nothing aggravates it, not even the bright lights or high sounds, but she gets a little relief by taking Ibuprofen 800 mg. She stated that she has been having some blurriness in the right eye, while her left eye is fine. She also complains of pain in her jaw and tongue while chewing food. Her appetite has been low, and lost about 5 pounds in the last 2 weeks. She noticed low grade fever as well. She also reported ringing sounds in the right ear. She denies any nausea or vomiting. She denied having similar headaches in the past. The patient denies complaining of nasal or postnasal drainage.
PMH: past medical history is significant for Hypertension, type II diabetes mellitus, asthma, and degenerative arthritis of the knees.
PSH: hysterectomy
Medications: Lisinopril 10 mg PO QD
Metformin 500 mg PO BID.
Proair HFA 2 puffs PRN.
Ibuprofen 800 mg TID
Multivitamins
By comparing the medications that the patient is taking with Beers criteria, they all looked appropriate to be used in elderly patients.
Family Hx:
Father: HTN, diabetes, and stroke.
Mother: HTN, Diabetes, and breast cancer at the age of 72.
Social Hx: the patient never smoked tobacco products.
ETOH: social drinker
Illicit substances: denies ever using illicit drugs.
Allergies: penicillin.
Review of systems:
Constitutional: the patient complains of fever, fatigue, anorexia, and weight loss.
Head: the patient denies complaining dizziness or lightheadedness.
Eyes: blurriness in the right eye.
Ears: the patient reports tinnitus- right ear, but denies complaining of ear pain or ear discharge
Nose: the patient denies any nasal bleeding, discharge or obstruction
Mouth: the patient reports painful chewing, she denies gingival bleeding, having mouth sores, or having dental difficulties
Throat: no sore throat
Cardiovascular: the patient denies complaining of Chest pain, palpitations, or swelling in the legs.
Respiratory: the patient denies any wheezing, shortness of breath or coughing.
Gastrointestinal: the patient denies any nausea, vomiting, GERD, epigastric pain, diarrhea, constipation, having black stools, or blood in stool.
Genitourinary: the patient denies any dysuria, polyuria, or visible hematuria
Musculoskeletal: bilateral knee pain.
Integumentary (Skin): the patient denies having any skin rash or skin discolorations.
Neurological: the patient denies complaining of tingling or numbness in any extremity; there is no history of seizures, stroke, syncope, or memory changes.
Psychiatric: the patient denies complaining of depression, or anxiety, denies complaining of hallucinations.
Endocrine: the pat ...
Example Focused SOAP Note for a patient with chest painS..docx
Example
Focused SOAP Note for a patient with chest pain
S.
CC: “Chest pain”
HPI: The patient is a 65 year old AA male who developed sudden onset of chest pain, which began early this morning. The pain is described as “crushing” and is rated nine out of 10 in terms of intensity. The pain is located in the middle of the chest and is accompanied by shortness of breath. The patient reports feeling nauseous. The patient tried an antacid with minimal relief of his symptoms.
PMH: Positive history of GERD and hypertension is controlled
FH: Mother died at 78 of breast cancer; Father at 75 of CVA. No history of premature cardiovascular disease in first degree relatives.
SH : Negative for tobacco abuse, currently or previously; consumes moderate alcohol; married for 39 years
ROS
General--Negative for fevers, chills, fatigue
Cardiovascular--Negative for orthopnea, PND, positive for intermittent lower extremity edema
Gastrointestinal--Positive for nausea without vomiting; negative for diarrhea, abdominal pain
Pulmonary--Positive for intermittent dyspnea on exertion, negative for cough or hemoptysis
O.
VS: BP 186/102; P 94; R 22; T 97.8; 02 96% Wt 235lbs; Ht 70”
General--Pt appears diaphoretic and anxious
Cardiovascular--PMI is in the 5th inter-costal space at the mid clavicular line. A grade 2/6 systolic decrescendo murmur is heard best at the
second right inter-costal space which radiates to the neck.
A third heard sound is heard at the apex. No fourth heart sound or rub are heard. No cyanosis, clubbing, noted, positive for bilateral 2+ LE edema is noted.
Gastrointestinal--The abdomen is symmetrical without distention; bowel
sounds are normal in quality and intensity in all areas; a
bruit is heard in the right para-umbilical area. No masses or
splenomegaly are noted. Positive for mid-epigastric tenderness with deep palpation.
Pulmonary-- Lungs are clear to auscultation and percussion bilaterally
Diagnostic results: EKG, CXR, CK-MB (support with evidenced and guidelines)
A.
Differential Diagnosis:
1) Myocardial Infarction (provide supportive documentation with evidence based guidelines).
2) Angina (provide supportive documentation with evidence based guidelines).
3) Costochondritis (provide supportive documentation with evidence based guidelines).
Primary Diagnosis/Presumptive Diagnosis: Myocardial Infarction
P. This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
© 2014 Laureate Education, Inc.
Page 2 of 2
© 2014 Laureate Education, Inc.
Page 1 of 2
Episodic/Focused SOAP Note Template
Patient Information:
Initials, Age, Sex, Race
S.
CC (chief complaint) a BRIEF statement identifying why the patient is here - in the patient’s own words - for instance "headache", NOT "bad headache for 3 days”.
HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, a.
CC I have itchy white discharge”HPI Patient is a 32 African.docx
A 32-year-old African American female presented with increased vaginal itching and thick white discharge for 2 days. She reported using Monistat 3 days ago without relief and increased pain after sex. On examination, the patient had a fever and curdy white vaginal discharge with inflamed mucosa. A diagnosis of vulvovaginal candidiasis was made and a KOH smear was ordered to confirm. The patient was prescribed a single dose of oral fluconazole or topical antifungal and educated on maintaining a dry environment and use of probiotics to prevent recurrence.
EpisodicFocused SOAP Note Exemplar Focused SOAP Note for a pati.docx
Episodic/Focused SOAP Note Exemplar
Focused SOAP Note for a patient with chest pain
S.
CC: “Chest pain”
HPI: The patient is a 65 year old AA male who developed sudden onset of chest pain, which began early this morning. The pain is described as “crushing” and is rated nine out of 10 in terms of intensity. The pain is located in the middle of the chest and is accompanied by shortness of breath. The patient reports feeling nauseous. The patient tried an antacid with minimal relief of his symptoms.
PMH: Positive history of GERD and hypertension is controlled
FH: Mother died at 78 of breast cancer; Father at 75 of CVA. No history of premature cardiovascular disease in first degree relatives.
SH : Negative for tobacco abuse, currently or previously; consumes moderate alcohol; married for 39 years
ROS
General--Negative for fevers, chills, fatigue
Cardiovascular--Negative for orthopnea, PND, positive for intermittent lower extremity edema
Gastrointestinal--Positive for nausea without vomiting; negative for diarrhea, abdominal pain
Pulmonary--Positive for intermittent dyspnea on exertion, negative for cough or hemoptysis
O.
VS: BP 186/102; P 94; R 22; T 97.8; 02 96% Wt 235lbs; Ht 70”
General--Pt appears diaphoretic and anxious
Cardiovascular--PMI is in the 5th inter-costal space at the mid clavicular line. A grade 2/6 systolic decrescendo murmur is heard best at the
second right inter-costal space which radiates to the neck.
A third heard sound is heard at the apex. No fourth heart sound or rub are heard. No cyanosis, clubbing, noted, positive for bilateral 2+ LE edema is noted.
Gastrointestinal--The abdomen is symmetrical without distention; bowel
sounds are normal in quality and intensity in all areas; a
bruit is heard in the right para-umbilical area. No masses or
splenomegaly are noted. Positive for mid-epigastric tenderness with deep palpation.
Pulmonary-- Lungs are clear to auscultation and percussion bilaterally
Diagnostic results: EKG, CXR, CK-MB (support with evidenced and guidelines)
A.
Differential Diagnosis:
1) Myocardial Infarction (provide supportive documentation with evidence based guidelines).
2) Angina (provide supportive documentation with evidence based guidelines).
3) Costochondritis (provide supportive documentation with evidence based guidelines).
Primary Diagnosis/Presumptive Diagnosis: Myocardial Infarction
P. This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
© 2019 Walden University
Page 2 of 2
© 2019 Walden University
Page 1 of 2
Episodic/Focused SOAP Note Template
Patient Information:
Initials, Age, Sex, Race
S.
CC (chief complaint) a BRIEF statement identifying why the patient is here - in the patient’s own words - for instance "headache", NOT "bad headache for 3 days”.
HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care ...
Running head SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS 1SKIN.docx
Running head: SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS 1
SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS 7
Skin Conditions and Differential Diagnosis
Adesola Turner
Walden University
NURS-6512N-17
Advanced Health Assessment.
December 22, 2019.
Introduction
The number 2 graphic (figure below) is characterized as Cherry angiomas that appear in older adults. With time cherry angiomas turn dark, though after infection it is identified by round tiny bright ruby red papules. As age numerically increase Dunphy et al (2015) argues that the disease virtually occurs to everyone above the age of 30 years. One of the ways in which I would perform differential diagnosis is by observing the skin of a patient who is 70 years of age.
Graphic #2
Patient Initials: AB Age: 70 Gender: male
SUBJECTIVE DATA:
Chief Complaint (CC): AB comes in clinic complaining about development of hard red bumps on the chest
History of Present Illness (HPI): Patient AB who is 70 years old comes in the hospital with complaints of having red bumps on his chest that appeared 2 weeks ago. He states that he wants to be done aa physical examination to be performed. AB says that last year he developed at least 4 new bumps on his chest that formed gradually. He is filled with anxiety because upon doing a Google search about his condition, he found that it could some tumors that are developing on his chest. He deniesrefutes any bleeding, painful and itchy bumps, exudation, or any climate variations. The bumps are located around the chest and the abdomen. AB says he has not come into contact with an irritant, denies having a fever, or does he take medications. Also, he reports he is neither under stress nor lifestyle changes. He claims, no one in his family lineage has ever been diagnosed with skin cancer.
Medications: none
Allergies: NKDA
Past Medical History (PMH): identified with stage 4 blood pressure Hypertension and the age of 60 which was well managed.
Past Surgical History (PSH): At age 40, his left shoulder was repaired from a torn rotator cuff.
Sexual/Reproductive History: Married and not sexually active.
Personal/Social History: denies smoking, taking alcohol, substance abuse, or under any influence of ETOH
Immunization History: His immunizations are current. In 2017, he got immunized of Pneumococcal vaccines and influenza vaccine
Significant Family History: Living with no parents who perished from a car accident. Living with his healthy daughter whom he got at his 30s
Social History: Live with her daughter and his 3 grandchildren. Being a widow for 8 years, he has been working as an engineer before he retired. In his free time, he does light exercises. Every day he attends catholic mass and then joins his 6 friends for breakfast at the local diner.
Review of Systems (ROS):
General: Mr. AB is a well-organized and neat man. He is alert and corporate during the discussion. He responds t ...
Contraception Essays.docx
This document discusses contraceptive options for a 38-year-old woman. It provides her medical history including asthma, migraines, IBS, and family history of various medical conditions. It notes her physical exam findings and asks additional questions needed to determine the best contraceptive method for her given her medical history and symptoms.
NR 601 Education Specialist / snaptutorial.com
This document provides background information on a 65-year-old male patient presenting with an 18-pound unintentional weight loss over 2 months, along with increased fatigue and difficulty sleeping. His past medical history includes hypertension, cataracts, osteoarthritis, and obstructive sleep apnea. A physical exam is requested to develop differential diagnoses and formulate a treatment plan.
Knowledge of anatomy.docx
A 42-year-old African American male presents with lower back pain radiating to his left leg for the past month. Based on the patient's medical history and description of symptoms, the nerve roots involved could be L4, L5, or S1, which can be tested via straight leg raise test. Differential diagnoses include herniated disc, spinal stenosis, or sciatica. A physical exam and special maneuvers like straight leg raise test are needed to determine the cause and guide treatment.
Myxedema & hypothyroid
This document presents a case of a 47-year-old male who presented with symptoms of falls, leg edema and pain, fatigue, headaches, shortness of breath, and weight gain. Laboratory tests found very high TSH levels consistent with severe hypothyroidism. The patient was diagnosed with myxedema coma, a life-threatening complication of longstanding, untreated hypothyroidism. Treatment for myxedema coma involves intensive care admission, parenteral thyroxine replacement, electrolyte management, and avoiding sedation to prevent further deterioration.
Week 4Problem Assignment Time Value of Money1If you deposit $15,0.docx
Week 4Problem Assignment: Time Value of Money1If you deposit $15,000 today and earn 8% annual interest, how much will you have in 9 years?Answer:$29,985.072Tiffany will receive a graduation gift of $10,000 from her parents in 3 years. If the discount rateis 7%, what is this gift worth today?Answer:$8,162.983What is the present value of a 20-year ordinary annuity of $30,000 using a 6% discount rate?Answer:$344,097.644You deposit $5,000 in an account that pays 8% interest per annum. How long will it take to double your money?Answer:9 years5The Johnsons have $60,000 to use as a down-payment on a house, and they want to borrow $240,000from the bank. The current mortgage interest rate is 5%. If they make equal monthly payments for 30 years,how much will the monthly payment be?Answer:$1,288.376Tim paid $250 per month into his 401K retirement plan. After 30 years, he had accumulated $500,000. Whataverage annual rate of interest had he earned over the 30 years?Answer:9.42%7Charlotte's firm had sales of $525,000 in the year 2001. By 2012, sales had increased to $1,200,000. What wasthe average annual rate of increase?Answer:7.80%8Alan had saved up $500,000. How much more must he save each year over the next 10 years in order to have atotal of $2 million? Alan earns 5% interest, compounded annually.Answer:$94,257
Instructions
· This week’s case study will introduce concepts related to the pulmonary system and shock states. Read the scenario and thoroughly complete the questions. Some of the answers will be short answers and may not require a lot of details. For example: what is the most common organism to cause a hospital acquired infection? The answer is pseudomonas aeruginosa. Answers to questions that relate to the pathogenesis of a disease must include specific details on the process. For example: How does hypoxia lead to cellular injury? Simply writing that a lack of blood flow, causes a lack of oxygen available to the cell and the cell cannot function without oxygen is not sufficient. This type of response is NOT reflective of an advanced understanding of the concept or graduate level work. This answer should discuss the cascade of events leading to the lack of oxygen and how it specifically impairs cellular function. All answers to these type of questions should address the effects at the cellular level, then the effects on the organ and then the body as a whole. Additionally describing the normal anatomical and/or physiologic processes underlying the pathogenesis will be necessary to thoroughly answer the question.
It is very likely that you will need to reference multiple sources to answer the questions thoroughly. Your text book will not necessarily have all the answers. Only professional sources may be used to complete the assignment. These include text books, primary and secondary journal articles from peer reviewed journals, government and university websites, and publications from professional societies who establish disease management g.
Week 2 Respiratory Clinical CasePatient Setting65 year old C.docx
Week 2: Respiratory Clinical Case
Patient Setting:
65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle accident presents to the clinic today. States she is having severe wheezing, shortness of breath and coughing at least once daily. She can barely get her words out without taking breaks to catch her breath and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10 weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no seizure activity since initiation of therapy.
PMH
History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago; placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to worsening CHF; symptoms well controlled the last year.
Past Surgical History
None
Family/Social History
Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF
Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.
Medication History
Theophylline SR Capsules 300 mg PO BID
Albuterol inhaler, PRN
Phenytoin SR capsules 300 mg PO QHS
HTCZ 50 mg PO BID
Enalapril 5 mg PO BID
Allergies
NKDA
ROS
Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache, swelling in the extremities and seizures.
Physical exam
BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”
VS after Albuterol breathing treatment - BP 134/79, HR 80, RR 18
Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2. Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU: Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses. NEURO: A&O X3, cranial nerves intact.
Laboratory and Diagnostic Testing
Na - 134
K - 4.9
Cl - 100
BUN - 21
Cr - 1.2
Glu – 110
ALT – 24
AST - 27
Total Chol – 190
CBC - WNL
Theophylline - 6.2
Phenytoin - 17
Chest Xray – Blunting of the right and left costophrenic angles
Peak Flow – 75/min; after albuterol – 102/min
FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%
Week
2
:
Respiratory
Clinical Case
Patient Setting:
65
year old
Caucasian female
that was
discharged from the
hospital
10 weeks ago
after
a
motor vehicle
accident presents to the clinic today.
States she is having severe wheezing, shortness of breath and
coughing at least once daily. She can barely get her words out
without taking breaks to catch her breath
and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months
(more than 4 times per week
average
)
, serious MVA 10
weeks ago; post traumatic seizure 2 w
eeks after the accident; anticonvulsant phenytoin started
–
no
seizure activ.
Nursing Care Plan and Diagnosis for Chronic Pain.pdf
This nursing care plan addresses chronic pain in a 56-year-old male patient presenting with lower back pain lasting one year. The nursing diagnosis is inflammation of the lumbar spine causing back pain and related symptoms including disrupted relationships, depression, fatigue, and pain rubbing. Outcomes include improved back pain/function and pain management education. Interventions include evaluating pain/function at follow-up, discussing treatment expectations, teaching noninvasive pain techniques, and instructing on pain medication use.
You have been chosen to present in front of your local governing boa.docx
You have been chosen to present in front of your local governing board (county commission, city council, etc.) to outline the prevention and preparedness programs that should be implemented in your community.
Create a PowerPoint presentation consisting of 8−10 slides (excluding the title slide, table of contents slide, and references slide) that covers the following:
Evaluation of the threats specific to your community (man-made and natural)
Threat mitigation techniques that should be incorporated
Important partnerships that should be maintained with both public and private entities
Cost effectiveness of mitigation versus the expense of response to an incident
Business continuity considerations for returning government services to normal operations
.
You have been charged with overseeing the implementation of cybersec.docx
You have been charged with overseeing the implementation of cybersecurity best practices for EnergyA. In this course, you examined 10 design and security principles (Deception, Separation, Diversity, Commanlity, Depth, Discretion, Collection, Correlation, Awareness, Response) in the context of national and critical infrastructure protection
.
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Similar to Comprehensive SOAP ExemplarPurpose To demonstrate what each sec.docx
Below is an example to follow ThanksComprehensive
Below is an example to follow :
Thanks
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP note should include. Remember that Nurse Practitioners treat patients in a holistic manner and your SOAP note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Eddie Myers is a 58 year old African American male who presents today with a productive cough x 3 days, fever, muscle aches, loss of taste and smell for the last three days. He reported that the “cold feels like it is descending into his chest and he can’t eat much”. The cough is nagging and productive. He brought in a few paper towels with expectorated phlegm – yellow/green in color. He has associated symptoms of dyspnea of exertion and fatigue. His Tmax was reported to be 100.3, last night. He has been taking Tylenol 325mg about every 6 hours and the fever breaks, but returns after the medication wears off. He rated the severity of her symptom discomfort at 8/10.
Medications:
1.) Norvasc 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Advair 500/50 daily
4.) Singulair 10mg daily
5.) Over the counter Tylenol 325mg as needed
6.) Over the counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Cipro-headache
Past Medical History (PMH):
1.) Asthma
2.) Hypertension
3.) Osteopenia
4.) Allergic rhinitis
5.) Prostate Cancer
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Prostatectomy 1986
Sexual/Reproductive History:
Heterosexual
Personal/Social History:
He has never smoked
Dipped tobacco for 25 years, no longer dipping
Denied ETOH or illicit drug use.
Immunization History:
Covid Vaccine #1 3/2/2021 #2 4/2/2021 Moderna
Influenza Vaccination 10/3/2020
PNV 9/18/2018
Tdap 8/22/2017
Shingles 3/22/2016
Significant Family History:
One sister – with diabetes, dx at age 65
One brother--with prostate CA, dx at age 62. He has 2 daughters, both in 30’s, healthy, living in nearby neighborhood.
Lifestyle:
He works FT as Xray Tech; widowed x 8 years; lives in the city, moderate crime area, with good public transportation. He is a college grad, owns his home and financially stable.
He has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. He has medical insurance but often asks for drug samples for cost savings. He has a healthy diet and eating pattern. There are resources and community groups in his area at the senior center but he does not attend. He enjoys golf and walking. He has a good support system composed of family and friends.
Review of Systems:
General: + fatigue since the illness started; + fever, no chills or night sweats; no recent weight gains of losses of significance.
HEENT: no changes in vision or hearing; he does wear glasses and his last ...
NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLISTThe fo.docx
NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLIST
The following list will be used to determine the grade for the physical examination demonstration. It does not constitute a
complete list of everything that could be included in a physical examination but rather a list of those things that should be done at a
minimum for every individual having a “complete physical examination”.
Possible
Points
Score
Skin
2
Inspects all areas of body esp. feet
2
Head & Neck
6
Inspect & Palpates skull
1
Palpates lymph nodes for adenopathy
2
Palpates thyroid (with H2O/swallowing)
2
Palpates tracheal placement
1
Eyes
12
Checks visual acuity
1
Checks peripheral fields
2
Checks EOMs
2
Checks conjunctiva for pallor
1
Checks pupillary reaction
1
Opthalmoscopic exam
5
describes discs, checks for microaneurysms,
hemorrhages, neovascularization
Ears, Nose,
Sinuses, Mouth
Determines gross hearing/whisper test
2
8
Otoscopic exam (describes landmarks)
2
Inspect & Assess Nares
1
Palpate & percuss sinuses
2
Examines mouth including blind pouch
1
Chest and Lungs
8
Inspect & Observes respiratory movements/rate
1
Posterior chest
5
Palpates & percuss respiratory excursion. Assess tactile fremitus
Auscultates breath sounds
Anterior chest
2
Palpate & percuss ant chest. Auscultate breath sounds
Breasts
Explanation only –do not demonstrate
1
1
Palpates axillae, inspects breasts
Palpates axillary lymph nodes
Cardiovascular
8
Inspect & Observes neck veins and measures
1
Palpates PMI and precordium
2
Auscultates cardiac sounds
5
With diaphragm and bell sitting
then diaphragm supine/left lateral decubitis
Peripheral Vascular
5
Inspect & Palpates pulses: carotids, radials, tibialis, pedals
2
Palpates for lower extremity edema
1
Auscultates carotids
2
Abdomen
10
Inspect & Auscultates bowel sounds
1
Auscultates renal arteries
2
Palpates abdomen for tenderness/McBurney’s pt
2
(rebound tenderness)
Check for splenic & liver enlargement
3
Percuss liver to determine span
2
Neurological
30
Mental status—MMSE or clock drawing
1
Cranial nerves:
12
Olfactory: smell
Optic: visual acuity, fields
Oculomotor, trochlear, abducens: EOMs
Trigeminal: sensation & jaw strength
Facial: frown, smile, corneal reflex
Acoustic: gross hearing
Glossopharyngeal, vagus: gag reflex
Spinal accessory: shrug shoulders
Hypoglossal: moves tongue
Reflexes: all DTRs and Babinski
5
Sensory:
light touch/monofilament on feet
1
Vibration
1
Stereognosis or graphesthesia
1
Motor:
Strength—upper and lower extremities
2
Muscle tone during active ROM
2
Gait
1
Cerebellar:
Test for coordination—finger/nose
1
One test for balance
1
One test for meningeal irritation
1
One test for nerve root irritation
1
Musculoskeletal
10
Inspect & Inspects spine
1
Palpates spine
2
Palpates major joint.
1) Naïve T cells have the potential to differentiate into several
1) Naïve T cells have the potential to differentiate into several types of effector cells. In the space below, describe the roles and activities of each of these cells:
TH1 cells
TH2 cells
TH17 cells
TFH cells
2) Use the following diagram to compare and contrast systemic immunity and mucosal immunity.
Systemic
Both Systemic and Mucosal
Mucosal
ordinary surface epithelia
Why is there a need for these differences in the first place?
CDC Sexually Transmitted Diseases Case Study.
Read the patient case study below
General:
The patient is a young seventeen-year-old female who came to the clinic with complaint of abdominal pain.
Chief Complaint:
Kim reports "I've been having pain in my stomach for several weeks." She describes the pain as being sharp and being constant. She stated the pain often occurs on both sides of her lower abdominal. She has been experiencing the pain for the past two weeks. The pain has gotten worse since then.
Reliability and Source of History:
The patient is alert and oriented and able to answer most of the questions.
Source & Reliability of History:
O – "I have been having pain in my stomach for several weeks now.” she stated that the pain has lasted for two weeks without any relief.
L – Both sides of her lower stomach
D – The patient reported that she has been having this bilateral lower stomach pain for the last two weeks, However, the symptoms got worse since the pain started ago.
C – She stated that since the onset of the pain, her pain has remained constant without any relieve and aggravating factor. The pain is firm regardless of the time or day or event. She further stated that her symptoms get worse. The patient states that she is unaware of what caused the pain or how the pain started; however, she stated that taking pills could relieve her stomach pain and stop her bleeding
A – She stated that the pain remains constant. She also stated that she is unaware of what caused the pain or how the pain started.
R – She stated that the pain remains steady and does not go away or radiate to other areas.
T- she reported feeling uncomfortable doing her regular shores due to the pain.
Past Medical history:
Patient is asthmatic; however, her asthma is under control. She knows known history of any other condition or never been hospitalized.
Family History:
She is the second in a family of four who are all alive and healthy. There is no history of any chronic condition in the family.
Social History:
Patient is a regularly active young woman; she is single and does moderately active exercise. However, she stated that her daily activity and chores has recently reduced due to her recent symptoms of pain. She also stated to have no appetite secondary to her recent pain. She also stated that her stress level may be related with her college. She has no history of alcohol, smoking, or had never smoked in her life. She has not used any ...
1) Naïve T cells have the potential to differentiate into several
1) Naïve T cells have the potential to differentiate into several types of effector cells. In the space below, describe the roles and activities of each of these cells:
TH1 cells
TH2 cells
TH17 cells
TFH cells
2) Use the following diagram to compare and contrast systemic immunity and mucosal immunity.
Systemic
Both Systemic and Mucosal
Mucosal
ordinary surface epithelia
Why is there a need for these differences in the first place?
CDC Sexually Transmitted Diseases Case Study.
Read the patient case study below
General:
The patient is a young seventeen-year-old female who came to the clinic with complaint of abdominal pain.
Chief Complaint:
Kim reports "I've been having pain in my stomach for several weeks." She describes the pain as being sharp and being constant. She stated the pain often occurs on both sides of her lower abdominal. She has been experiencing the pain for the past two weeks. The pain has gotten worse since then.
Reliability and Source of History:
The patient is alert and oriented and able to answer most of the questions.
Source & Reliability of History:
O – "I have been having pain in my stomach for several weeks now.” she stated that the pain has lasted for two weeks without any relief.
L – Both sides of her lower stomach
D – The patient reported that she has been having this bilateral lower stomach pain for the last two weeks, However, the symptoms got worse since the pain started ago.
C – She stated that since the onset of the pain, her pain has remained constant without any relieve and aggravating factor. The pain is firm regardless of the time or day or event. She further stated that her symptoms get worse. The patient states that she is unaware of what caused the pain or how the pain started; however, she stated that taking pills could relieve her stomach pain and stop her bleeding
A – She stated that the pain remains constant. She also stated that she is unaware of what caused the pain or how the pain started.
R – She stated that the pain remains steady and does not go away or radiate to other areas.
T- she reported feeling uncomfortable doing her regular shores due to the pain.
Past Medical history:
Patient is asthmatic; however, her asthma is under control. She knows known history of any other condition or never been hospitalized.
Family History:
She is the second in a family of four who are all alive and healthy. There is no history of any chronic condition in the family.
Social History:
Patient is a regularly active young woman; she is single and does moderately active exercise. However, she stated that her daily activity and chores has recently reduced due to her recent symptoms of pain. She also stated to have no appetite secondary to her recent pain. She also stated that her stress level may be related with her college. She has no history of alcohol, smoking, or had never smoked in her life. She has not used any ...
Soap Note 2 Chronic ConditionsSoap Note Chronic Conditions (
Soap Note 2 Chronic Conditions
Soap Note Chronic Conditions (15 Points)
Pick any Chronic Disease from Weeks 6-10
Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)
Follow the MRU Soap Note Rubric as a guide
Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement
SOAP NOTE SAMPLE FORMAT FOR MRC
Name:
LP
Date:
Time:
1315
Age:
30
Sex:
F
SUBJECTIVE
CC:
“I am having vaginal itching and pain in my lower abdomen.”
HPI:
Pt is a 30y/o AA female, who is a new patient that has recently moved to Miami. She seeks treatment today after unsuccessful self-treatment of vaginal itching, burning upon urination, and lower abdominal pain. She is concerned for the presence of a vaginal or bladder infection, or an STD. Pt denies fever. She reports the itching and burning with urination has been present for 3 weeks, and the abdominal pain has been intermittent since months ago. Pt has tried OTC products for the itching, including Monistat and Vagisil. She denies any other urinary symptoms, including urgency or frequency. She describes the abdominal pain as either sharp or dull. The pain level goes as high as 8 out of 10 at times. 200mg of PO Advil PRN reduces the pain to a 7/10. Pt denies any aggravating factors for the pain. Pt reports that she did start her menstrual cycle this morning, but denies any other discharge other that light bleeding beginning today. Pt denies douching or the use of any vaginal irritants. She reports that she is in a stable sexual relationship, and denies any new sexual partners in the last 90 days. She denies any recent or historic known exposure to STDs. She reports the use of condoms with every coital experience, as well as this being her only form of contraceptive. She reports normal monthly menstrual cycles that last 3-4 days. She reports dysmenorrhea, which she also takes Advil for. She reports her last PAP smear was in 7/2016, was normal, and reports never having an abnormal PAP smear result. Pt denies any hx of pregnancies. Other medical hx includes GERD. She reports that she has an Rx for Protonix, but she does not take it every day. Her family hx includes the presence of DM and HTN.
Current Medications:
Protonix 40mg PO Daily for GERD
MTV OTC PO Daily
Advil 200mg OTC PO PRN for pain
PMHx:
Allergies:
NKA & NKDA
Medication Intolerances:
Denies
Chronic Illnesses/Major traumas
GERD
Hospitalizations/Surgeries
Denies
Family History
Father- DM & HTN; Mother- HTN; Older sister- DM & HTN; Maternal and paternal grandparents without known medical issues; 1 brother and 3 other sisters without known med ...
NR 601 Inspiring Innovation/tutorialrank.com
For more course tutorials visit
www.tutorialrank.com
Discussion Part One (graded)
You meet your first patient of the morning. A.K. is a 65-year-old Caucasian male who you are seeing for the first time. Both wife and daughter are present.
SampleWriteUp.pdf history and physical examination
1. This 83-year-old woman presented to the emergency room with substernal chest pain and was diagnosed with an acute anterolateral myocardial infarction based on EKG changes and elevated cardiac enzymes. She has a history of hypertension and congestive heart failure.
2. On examination, she was tachycardic with bibasilar rales and edema suggestive of congestive heart failure. Laboratory results showed evidence of a heart attack and mild left ventricular dysfunction.
3. The plan is to continue medical management for the heart attack and congestive heart failure while also treating her for a suspected urinary tract infection based on dysuria and pyuria.
SOAP NOTENameDateTime AgeSexSUBJECTIVECC .docx
SOAP NOTE
Name:
Date:
Time:
Age:
Sex:
SUBJECTIVE
CC:
Reason given by the patient for seeking medical care “in quotes”
HPI: Use OLDCART acronym
Describe the course of the patient’s illness, including when it began, character of symptoms, location where the symptoms began, aggravating or alleviating factors; pertinent positives and negatives, other related diseases, past illnesses, surgeries or past diagnostic testing related to present illness.
Medications: (list with reason for med ) write medicine the same way you write a Rx
PMH (list approximate year of Dx of the disease or when surgical procedure performed)
Allergies:
Medication Intolerances:
Chronic Illnesses/Major traumas
Hospitalizations/Surgeries
Family History (list immediate family, age, disease, and whether is dead or alive)
Does your mother, father or siblings have any medical or psychiatric illnesses? Anyone diagnosed with: lung disease, heart disease, htn, cancer, TB, DM, or kidney disease.
Social History
Education level, occupational history, current living situation/partner/marital status, substance use/abuse, ETOH, tobacco, marijuana. Safety status
ROS (Start each sentence with words such as “Denies, admits, complains, reports”, do not use the words “No, positive for, negative for”. Do NOT list physical exam findings here. If the body system not assess write “Non-Contributory”
General
Cardiovascular
Skin
Respiratory
Eyes
Gastrointestinal
Ears
Genitourinary/Gynecological
Nose/Mouth/Throat
Musculoskeletal
Breast
Neurological
Heme/Lymph/Endo
Psychiatric
OBJECTIVE- this is where you document physical exam findings, do NOT use the word NORMAL to document a finding, and instead explain what normal is. For example, the gait is not normal, the gait is steady. If the body part not assessed then type “Deferred”.
Weight BMI
Temp
BP
Height
Pulse
Resp
General Appearance
Skin
HEENT
Cardiovascular
Respiratory
Gastrointestinal
Breast
Genitourinary
Musculoskeletal
Neurological
Psychiatric
Lab Tests (lists any tests ordered and status of the test, if a rapid test was done at the office, list the results)
Special Tests (List any imaging study or special test ordered and status of the test, if the result is available, write the result)
Diagnosis
Differential Diagnoses with ICD 10 codes (these are Dx you considered, but then ruled out)
· 1-
· 2-
· 3-
Diagnosis with ICD 10 Code
CPT Code/Office visit code:
Plan/Therapeutics
· Plan:
· Further testing
· Medication
· Education
· Non-medication treatments
· Follow Up
· Referral
· When to seek emergency care
Evaluation of patient encounter
Document your level of interaction with the patient.
Weaknesses:
Strengths:
Reflection:
References:
Week 2: Respiratory Clinical Case
Patient Setting:
65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle
accident presents to the clinic today. States she is having severe wheezing, shortness of b.
SubjectiveChief complaint headaches and blurriness of visi.docx
Subjective:
Chief complaint: headaches and blurriness of vision on the right side
History of present illness: the patient is 67 years old Caucasian female, she complains of having had headaches for 2 weeks now. The pain is located in the right temporal area. She describes the pain as 8-10/10, sharp, constant, interferes with her sleep, she states that nothing aggravates it, not even the bright lights or high sounds, but she gets a little relief by taking Ibuprofen 800 mg. She stated that she has been having some blurriness in the right eye, while her left eye is fine. She also complains of pain in her jaw and tongue while chewing food. Her appetite has been low, and lost about 5 pounds in the last 2 weeks. She noticed low grade fever as well. She also reported ringing sounds in the right ear. She denies any nausea or vomiting. She denied having similar headaches in the past. The patient denies complaining of nasal or postnasal drainage.
PMH: past medical history is significant for Hypertension, type II diabetes mellitus, asthma, and degenerative arthritis of the knees.
PSH: hysterectomy
Medications: Lisinopril 10 mg PO QD
Metformin 500 mg PO BID.
Proair HFA 2 puffs PRN.
Ibuprofen 800 mg TID
Multivitamins
By comparing the medications that the patient is taking with Beers criteria, they all looked appropriate to be used in elderly patients.
Family Hx:
Father: HTN, diabetes, and stroke.
Mother: HTN, Diabetes, and breast cancer at the age of 72.
Social Hx: the patient never smoked tobacco products.
ETOH: social drinker
Illicit substances: denies ever using illicit drugs.
Allergies: penicillin.
Review of systems:
Constitutional: the patient complains of fever, fatigue, anorexia, and weight loss.
Head: the patient denies complaining dizziness or lightheadedness.
Eyes: blurriness in the right eye.
Ears: the patient reports tinnitus- right ear, but denies complaining of ear pain or ear discharge
Nose: the patient denies any nasal bleeding, discharge or obstruction
Mouth: the patient reports painful chewing, she denies gingival bleeding, having mouth sores, or having dental difficulties
Throat: no sore throat
Cardiovascular: the patient denies complaining of Chest pain, palpitations, or swelling in the legs.
Respiratory: the patient denies any wheezing, shortness of breath or coughing.
Gastrointestinal: the patient denies any nausea, vomiting, GERD, epigastric pain, diarrhea, constipation, having black stools, or blood in stool.
Genitourinary: the patient denies any dysuria, polyuria, or visible hematuria
Musculoskeletal: bilateral knee pain.
Integumentary (Skin): the patient denies having any skin rash or skin discolorations.
Neurological: the patient denies complaining of tingling or numbness in any extremity; there is no history of seizures, stroke, syncope, or memory changes.
Psychiatric: the patient denies complaining of depression, or anxiety, denies complaining of hallucinations.
Endocrine: the pat ...
Example Focused SOAP Note for a patient with chest painS..docx
Example
Focused SOAP Note for a patient with chest pain
S.
CC: “Chest pain”
HPI: The patient is a 65 year old AA male who developed sudden onset of chest pain, which began early this morning. The pain is described as “crushing” and is rated nine out of 10 in terms of intensity. The pain is located in the middle of the chest and is accompanied by shortness of breath. The patient reports feeling nauseous. The patient tried an antacid with minimal relief of his symptoms.
PMH: Positive history of GERD and hypertension is controlled
FH: Mother died at 78 of breast cancer; Father at 75 of CVA. No history of premature cardiovascular disease in first degree relatives.
SH : Negative for tobacco abuse, currently or previously; consumes moderate alcohol; married for 39 years
ROS
General--Negative for fevers, chills, fatigue
Cardiovascular--Negative for orthopnea, PND, positive for intermittent lower extremity edema
Gastrointestinal--Positive for nausea without vomiting; negative for diarrhea, abdominal pain
Pulmonary--Positive for intermittent dyspnea on exertion, negative for cough or hemoptysis
O.
VS: BP 186/102; P 94; R 22; T 97.8; 02 96% Wt 235lbs; Ht 70”
General--Pt appears diaphoretic and anxious
Cardiovascular--PMI is in the 5th inter-costal space at the mid clavicular line. A grade 2/6 systolic decrescendo murmur is heard best at the
second right inter-costal space which radiates to the neck.
A third heard sound is heard at the apex. No fourth heart sound or rub are heard. No cyanosis, clubbing, noted, positive for bilateral 2+ LE edema is noted.
Gastrointestinal--The abdomen is symmetrical without distention; bowel
sounds are normal in quality and intensity in all areas; a
bruit is heard in the right para-umbilical area. No masses or
splenomegaly are noted. Positive for mid-epigastric tenderness with deep palpation.
Pulmonary-- Lungs are clear to auscultation and percussion bilaterally
Diagnostic results: EKG, CXR, CK-MB (support with evidenced and guidelines)
A.
Differential Diagnosis:
1) Myocardial Infarction (provide supportive documentation with evidence based guidelines).
2) Angina (provide supportive documentation with evidence based guidelines).
3) Costochondritis (provide supportive documentation with evidence based guidelines).
Primary Diagnosis/Presumptive Diagnosis: Myocardial Infarction
P. This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
© 2014 Laureate Education, Inc.
Page 2 of 2
© 2014 Laureate Education, Inc.
Page 1 of 2
Episodic/Focused SOAP Note Template
Patient Information:
Initials, Age, Sex, Race
S.
CC (chief complaint) a BRIEF statement identifying why the patient is here - in the patient’s own words - for instance "headache", NOT "bad headache for 3 days”.
HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, a.
CC I have itchy white discharge”HPI Patient is a 32 African.docx
A 32-year-old African American female presented with increased vaginal itching and thick white discharge for 2 days. She reported using Monistat 3 days ago without relief and increased pain after sex. On examination, the patient had a fever and curdy white vaginal discharge with inflamed mucosa. A diagnosis of vulvovaginal candidiasis was made and a KOH smear was ordered to confirm. The patient was prescribed a single dose of oral fluconazole or topical antifungal and educated on maintaining a dry environment and use of probiotics to prevent recurrence.
EpisodicFocused SOAP Note Exemplar Focused SOAP Note for a pati.docx
Episodic/Focused SOAP Note Exemplar
Focused SOAP Note for a patient with chest pain
S.
CC: “Chest pain”
HPI: The patient is a 65 year old AA male who developed sudden onset of chest pain, which began early this morning. The pain is described as “crushing” and is rated nine out of 10 in terms of intensity. The pain is located in the middle of the chest and is accompanied by shortness of breath. The patient reports feeling nauseous. The patient tried an antacid with minimal relief of his symptoms.
PMH: Positive history of GERD and hypertension is controlled
FH: Mother died at 78 of breast cancer; Father at 75 of CVA. No history of premature cardiovascular disease in first degree relatives.
SH : Negative for tobacco abuse, currently or previously; consumes moderate alcohol; married for 39 years
ROS
General--Negative for fevers, chills, fatigue
Cardiovascular--Negative for orthopnea, PND, positive for intermittent lower extremity edema
Gastrointestinal--Positive for nausea without vomiting; negative for diarrhea, abdominal pain
Pulmonary--Positive for intermittent dyspnea on exertion, negative for cough or hemoptysis
O.
VS: BP 186/102; P 94; R 22; T 97.8; 02 96% Wt 235lbs; Ht 70”
General--Pt appears diaphoretic and anxious
Cardiovascular--PMI is in the 5th inter-costal space at the mid clavicular line. A grade 2/6 systolic decrescendo murmur is heard best at the
second right inter-costal space which radiates to the neck.
A third heard sound is heard at the apex. No fourth heart sound or rub are heard. No cyanosis, clubbing, noted, positive for bilateral 2+ LE edema is noted.
Gastrointestinal--The abdomen is symmetrical without distention; bowel
sounds are normal in quality and intensity in all areas; a
bruit is heard in the right para-umbilical area. No masses or
splenomegaly are noted. Positive for mid-epigastric tenderness with deep palpation.
Pulmonary-- Lungs are clear to auscultation and percussion bilaterally
Diagnostic results: EKG, CXR, CK-MB (support with evidenced and guidelines)
A.
Differential Diagnosis:
1) Myocardial Infarction (provide supportive documentation with evidence based guidelines).
2) Angina (provide supportive documentation with evidence based guidelines).
3) Costochondritis (provide supportive documentation with evidence based guidelines).
Primary Diagnosis/Presumptive Diagnosis: Myocardial Infarction
P. This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
© 2019 Walden University
Page 2 of 2
© 2019 Walden University
Page 1 of 2
Episodic/Focused SOAP Note Template
Patient Information:
Initials, Age, Sex, Race
S.
CC (chief complaint) a BRIEF statement identifying why the patient is here - in the patient’s own words - for instance "headache", NOT "bad headache for 3 days”.
HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care ...
Running head SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS 1SKIN.docx
Running head: SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS 1
SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS 7
Skin Conditions and Differential Diagnosis
Adesola Turner
Walden University
NURS-6512N-17
Advanced Health Assessment.
December 22, 2019.
Introduction
The number 2 graphic (figure below) is characterized as Cherry angiomas that appear in older adults. With time cherry angiomas turn dark, though after infection it is identified by round tiny bright ruby red papules. As age numerically increase Dunphy et al (2015) argues that the disease virtually occurs to everyone above the age of 30 years. One of the ways in which I would perform differential diagnosis is by observing the skin of a patient who is 70 years of age.
Graphic #2
Patient Initials: AB Age: 70 Gender: male
SUBJECTIVE DATA:
Chief Complaint (CC): AB comes in clinic complaining about development of hard red bumps on the chest
History of Present Illness (HPI): Patient AB who is 70 years old comes in the hospital with complaints of having red bumps on his chest that appeared 2 weeks ago. He states that he wants to be done aa physical examination to be performed. AB says that last year he developed at least 4 new bumps on his chest that formed gradually. He is filled with anxiety because upon doing a Google search about his condition, he found that it could some tumors that are developing on his chest. He deniesrefutes any bleeding, painful and itchy bumps, exudation, or any climate variations. The bumps are located around the chest and the abdomen. AB says he has not come into contact with an irritant, denies having a fever, or does he take medications. Also, he reports he is neither under stress nor lifestyle changes. He claims, no one in his family lineage has ever been diagnosed with skin cancer.
Medications: none
Allergies: NKDA
Past Medical History (PMH): identified with stage 4 blood pressure Hypertension and the age of 60 which was well managed.
Past Surgical History (PSH): At age 40, his left shoulder was repaired from a torn rotator cuff.
Sexual/Reproductive History: Married and not sexually active.
Personal/Social History: denies smoking, taking alcohol, substance abuse, or under any influence of ETOH
Immunization History: His immunizations are current. In 2017, he got immunized of Pneumococcal vaccines and influenza vaccine
Significant Family History: Living with no parents who perished from a car accident. Living with his healthy daughter whom he got at his 30s
Social History: Live with her daughter and his 3 grandchildren. Being a widow for 8 years, he has been working as an engineer before he retired. In his free time, he does light exercises. Every day he attends catholic mass and then joins his 6 friends for breakfast at the local diner.
Review of Systems (ROS):
General: Mr. AB is a well-organized and neat man. He is alert and corporate during the discussion. He responds t ...
Contraception Essays.docx
This document discusses contraceptive options for a 38-year-old woman. It provides her medical history including asthma, migraines, IBS, and family history of various medical conditions. It notes her physical exam findings and asks additional questions needed to determine the best contraceptive method for her given her medical history and symptoms.
NR 601 Education Specialist / snaptutorial.com
This document provides background information on a 65-year-old male patient presenting with an 18-pound unintentional weight loss over 2 months, along with increased fatigue and difficulty sleeping. His past medical history includes hypertension, cataracts, osteoarthritis, and obstructive sleep apnea. A physical exam is requested to develop differential diagnoses and formulate a treatment plan.
Knowledge of anatomy.docx
A 42-year-old African American male presents with lower back pain radiating to his left leg for the past month. Based on the patient's medical history and description of symptoms, the nerve roots involved could be L4, L5, or S1, which can be tested via straight leg raise test. Differential diagnoses include herniated disc, spinal stenosis, or sciatica. A physical exam and special maneuvers like straight leg raise test are needed to determine the cause and guide treatment.
Myxedema & hypothyroid
This document presents a case of a 47-year-old male who presented with symptoms of falls, leg edema and pain, fatigue, headaches, shortness of breath, and weight gain. Laboratory tests found very high TSH levels consistent with severe hypothyroidism. The patient was diagnosed with myxedema coma, a life-threatening complication of longstanding, untreated hypothyroidism. Treatment for myxedema coma involves intensive care admission, parenteral thyroxine replacement, electrolyte management, and avoiding sedation to prevent further deterioration.
Week 4Problem Assignment Time Value of Money1If you deposit $15,0.docx
Week 4Problem Assignment: Time Value of Money1If you deposit $15,000 today and earn 8% annual interest, how much will you have in 9 years?Answer:$29,985.072Tiffany will receive a graduation gift of $10,000 from her parents in 3 years. If the discount rateis 7%, what is this gift worth today?Answer:$8,162.983What is the present value of a 20-year ordinary annuity of $30,000 using a 6% discount rate?Answer:$344,097.644You deposit $5,000 in an account that pays 8% interest per annum. How long will it take to double your money?Answer:9 years5The Johnsons have $60,000 to use as a down-payment on a house, and they want to borrow $240,000from the bank. The current mortgage interest rate is 5%. If they make equal monthly payments for 30 years,how much will the monthly payment be?Answer:$1,288.376Tim paid $250 per month into his 401K retirement plan. After 30 years, he had accumulated $500,000. Whataverage annual rate of interest had he earned over the 30 years?Answer:9.42%7Charlotte's firm had sales of $525,000 in the year 2001. By 2012, sales had increased to $1,200,000. What wasthe average annual rate of increase?Answer:7.80%8Alan had saved up $500,000. How much more must he save each year over the next 10 years in order to have atotal of $2 million? Alan earns 5% interest, compounded annually.Answer:$94,257
Instructions
· This week’s case study will introduce concepts related to the pulmonary system and shock states. Read the scenario and thoroughly complete the questions. Some of the answers will be short answers and may not require a lot of details. For example: what is the most common organism to cause a hospital acquired infection? The answer is pseudomonas aeruginosa. Answers to questions that relate to the pathogenesis of a disease must include specific details on the process. For example: How does hypoxia lead to cellular injury? Simply writing that a lack of blood flow, causes a lack of oxygen available to the cell and the cell cannot function without oxygen is not sufficient. This type of response is NOT reflective of an advanced understanding of the concept or graduate level work. This answer should discuss the cascade of events leading to the lack of oxygen and how it specifically impairs cellular function. All answers to these type of questions should address the effects at the cellular level, then the effects on the organ and then the body as a whole. Additionally describing the normal anatomical and/or physiologic processes underlying the pathogenesis will be necessary to thoroughly answer the question.
It is very likely that you will need to reference multiple sources to answer the questions thoroughly. Your text book will not necessarily have all the answers. Only professional sources may be used to complete the assignment. These include text books, primary and secondary journal articles from peer reviewed journals, government and university websites, and publications from professional societies who establish disease management g.
Week 2 Respiratory Clinical CasePatient Setting65 year old C.docx
Week 2: Respiratory Clinical Case
Patient Setting:
65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle accident presents to the clinic today. States she is having severe wheezing, shortness of breath and coughing at least once daily. She can barely get her words out without taking breaks to catch her breath and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10 weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no seizure activity since initiation of therapy.
PMH
History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago; placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to worsening CHF; symptoms well controlled the last year.
Past Surgical History
None
Family/Social History
Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF
Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.
Medication History
Theophylline SR Capsules 300 mg PO BID
Albuterol inhaler, PRN
Phenytoin SR capsules 300 mg PO QHS
HTCZ 50 mg PO BID
Enalapril 5 mg PO BID
Allergies
NKDA
ROS
Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache, swelling in the extremities and seizures.
Physical exam
BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”
VS after Albuterol breathing treatment - BP 134/79, HR 80, RR 18
Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2. Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU: Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses. NEURO: A&O X3, cranial nerves intact.
Laboratory and Diagnostic Testing
Na - 134
K - 4.9
Cl - 100
BUN - 21
Cr - 1.2
Glu – 110
ALT – 24
AST - 27
Total Chol – 190
CBC - WNL
Theophylline - 6.2
Phenytoin - 17
Chest Xray – Blunting of the right and left costophrenic angles
Peak Flow – 75/min; after albuterol – 102/min
FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%
Week
2
:
Respiratory
Clinical Case
Patient Setting:
65
year old
Caucasian female
that was
discharged from the
hospital
10 weeks ago
after
a
motor vehicle
accident presents to the clinic today.
States she is having severe wheezing, shortness of breath and
coughing at least once daily. She can barely get her words out
without taking breaks to catch her breath
and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months
(more than 4 times per week
average
)
, serious MVA 10
weeks ago; post traumatic seizure 2 w
eeks after the accident; anticonvulsant phenytoin started
–
no
seizure activ.
Nursing Care Plan and Diagnosis for Chronic Pain.pdf
This nursing care plan addresses chronic pain in a 56-year-old male patient presenting with lower back pain lasting one year. The nursing diagnosis is inflammation of the lumbar spine causing back pain and related symptoms including disrupted relationships, depression, fatigue, and pain rubbing. Outcomes include improved back pain/function and pain management education. Interventions include evaluating pain/function at follow-up, discussing treatment expectations, teaching noninvasive pain techniques, and instructing on pain medication use.
Similar to Comprehensive SOAP ExemplarPurpose To demonstrate what each sec.docx (20)
NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLISTThe fo.docx
NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLISTThe fo.docx
1) Naïve T cells have the potential to differentiate into several
1) Naïve T cells have the potential to differentiate into several
1) Naïve T cells have the potential to differentiate into several
1) Naïve T cells have the potential to differentiate into several
Soap Note 2 Chronic ConditionsSoap Note Chronic Conditions (
Soap Note 2 Chronic ConditionsSoap Note Chronic Conditions (
SampleWriteUp.pdf history and physical examination
SampleWriteUp.pdf history and physical examination
SubjectiveChief complaint headaches and blurriness of visi.docx
SubjectiveChief complaint headaches and blurriness of visi.docx
Example Focused SOAP Note for a patient with chest painS..docx
Example Focused SOAP Note for a patient with chest painS..docx
CC I have itchy white discharge”HPI Patient is a 32 African.docx
CC I have itchy white discharge”HPI Patient is a 32 African.docx
EpisodicFocused SOAP Note Exemplar Focused SOAP Note for a pati.docx
EpisodicFocused SOAP Note Exemplar Focused SOAP Note for a pati.docx
Running head SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS 1SKIN.docx
Running head SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS 1SKIN.docx
Week 4Problem Assignment Time Value of Money1If you deposit $15,0.docx
Week 4Problem Assignment Time Value of Money1If you deposit $15,0.docx
Week 2 Respiratory Clinical CasePatient Setting65 year old C.docx
Week 2 Respiratory Clinical CasePatient Setting65 year old C.docx
Nursing Care Plan and Diagnosis for Chronic Pain.pdf
Nursing Care Plan and Diagnosis for Chronic Pain.pdf
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Thanks!
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You have been assigned a reading by WMF Petrie; Diospolis Parva (.docx
You have been assigned a reading by WMF Petrie; Diospolis Parva (posted as a pdf folder).
You needn’t read the whole volume; I would like you to concentrate on pp.(4-12) which outlines Petrie’s method.
Further information about Petrie’s method can be found in Bard in box 5-A, pp. 100-102.
For this discussion, answer the following questions;
1. Why does Petrie invent sequence dating? What kinds of artifacts does Petrie use to construct his relative sequence?
2. Why is the following statement important for “anchoring” Petrie’s method in time?
“The most clear series of derived forms is that of the wavy handled vases (Class W)…side by side with this (Class) W pottery… we have seen to be later than the rest, as it links to the historic age… lettered L,” (Petrie 1901:5).
3. Why do you think Petrie’s method reflects the passage of time?
Your answer should be 3-4 paragraphs.
This is a digital copy of a book that was preserved for generations on library shelves before it was carefully scanned by Google as part of a project
to make the world’s books discoverable online.
It has survived long enough for the copyright to expire and the book to enter the public domain. A public domain book is one that was never subject
to copyright or whose legal copyright term has expired. Whether a book is in the public domain may vary country to country. Public domain books
are our gateways to the past, representing a wealth of history, culture and knowledge that’s often difficult to discover.
Marks, notations and other marginalia present in the original volume will appear in this file - a reminder of this book’s long journey from the
publisher to a library and finally to you.
Usage guidelines
Google is proud to partner with libraries to digitize public domain materials and make them widely accessible. Public domain books belong to the
public and we are merely their custodians. Nevertheless, this work is expensive, so in order to keep providing this resource, we have taken steps to
prevent abuse by commercial parties, including placing technical restrictions on automated querying.
We also ask that you:
+ Make non-commercial use of the filesWe designed Google Book Search for use by individuals, and we request that you use these files for
personal, non-commercial purposes.
+ Refrain from automated queryingDo not send automated queries of any sort to Google’s system: If you are conducting research on machine
translation, optical character recognition or other areas where access to a large amount of text is helpful, please contact us. We encourage the
use of public domain materials for these purposes and may be able to help.
+ Maintain attributionThe Google “watermark” you see on each file is essential for informing people about this project and helping them find
additional materials through Google Book Search. Please do not remove it.
+ Keep it legalWhatever your use, remember that you are responsible for ensuring that what you are doing is legal. Do n.
You have been asked to speak to city, municipal, and state elected a.docx
You have been asked to speak to city, municipal, and state elected and appointed officials who investigate disaster management at the next governmental meeting. Your main task is to recommend policy actors who could be involved in disaster management planning after a catastrophic event. These individuals will be involved during the entire process.
Develop a PowerPoint presentation to guide your presentation. Be sure to address the following:
Identify key local, state, and federal partners as policy actors.
Provide rationale for the selection of each policy actor.
Determine how these specific people will aid the community amid the devastation.
As you develop your PowerPoint, you may wish to interview someone in your community that is involved in disaster planning. Interviews can be conducted in-person, via telephone, or by email. However, this is not required. Incorporate appropriate animations, transitions, and graphics as well as speaker notes for each slide. The speaker notes may be comprised of brief paragraphs or bulleted lists.
Support your presentation with at least five scholarly resources. In addition to these specified resources, other appropriate scholarly resources may be included.
Length: 12 slides (with a separate reference slide)
Notes Length: 200 words for each slide
Be sure to include citations for quotations and paraphrases with references in APA format and style.
.
You have been asked to provide a presentation, covering the history .docx
You have been asked to provide a presentation, covering the history of the juvenile court system in the United States. In your history, be sure to address the following issues:
10-12 slides
When was the first juvenile court established?
What was the child-saver movement during the 1800s? How did this social movement lead to the creation establishment of the juvenile justice
system?
What is
parens patriae
, and how has this concept influenced juvenile courts in the United States?
Identify and describe 2 significant changes in the legal rights of juvenile offenders since the establishment of the juvenile justice
system.
3-4 paragraphs
Peter is a 14-year-old boy living in New York in the year 1870. Peter has stolen a horse and has been arrested by local law enforcement.
Discuss what life may have been like for Peter as a young person in the United States at this time.
How were young people treated in everyday life?
How were their criminal actions handled?
How would Peter's punishment be different as compared to an adult who was arrested for the same crime?
.
You have been asked to organize a community health fair at a loc.docx
You have been asked to organize a community health fair at a local public school. The health fair will provide information and education on the following topics related to health promotion:
*Immunizations
*Importance of healthy diet and exercise
*Avoidance of tobacco, drugs, and alcohol
*Responsible sexual behaviors (use of condoms, risk of sexually transmitted infections including HIV, and concerns related to unintended pregnancies)
*Injury and violence prevention (motor vehicle crashes, firearms, poisonings, suffocation, falls, fires, and drowning)
The volunteers who will be manning the stations are from the health care community (i.e., doctors, nurses, dietitians, and social workers). You want to ensure that the team members take into consideration the familial health traditions, personal beliefs, and the values of the people who will be attending the health fair. In a three- to four-page paper (excluding title and reference pages), address the following points:
-Identify potential areas where health care providers’ culture may influence the treatment approach/recommendations, which may be in conflict with the health belief of a community member’s culture and practices.
-Describe the differences.
-Describe the role, if any, social control will play in the development of the educational materials presented by differentiating health and wellness rituals among people of different cultures.
-Recommend potential strategies that the health care team can use when faced with a cultural practice that conflicts with the medical model.
-Recommend strategies to increase community participation and enhance the relationships/partnerships between the medical community and members of the culturally diverse community.
The Critical Thinking Paper
^Must be three to four double-spaced pages in length (not including title and references pages) and formatted according to APA style.
^Must use at least two scholarly sources in addition to the course text.
^Must document all sources in APA style.
^Must include a separate references page that is formatted according to APA style.
.
You have been asked to explain the differences between certain categ.docx
You have been asked to explain the differences between certain categories of crimes. For each of the following categories of crime, provide a general definition of the category of crime and give at least 2 detailed examples of specific crimes that fall into each category:
Violent crimes
Crimes against persons
Crimes against property
Crimes of public morality
White-collar crime
Cyber crime
Then, for the following scenarios, discuss the categories of crimes involved in each scenario, and explain the specific criminal charges that you would apply to each scenario. You can utilize the Library, Internet, and other resources to research the criminal statutes of a state of your choice to help you determine which criminal charges should be applied:
David S. was running around a public park at 3 AM without his clothes on, singing and shouting loudly. Police arrived after neighbors called to complain. They saw David S. tipping over a garbage can and when they shouted for him to stop, he threw the garbage can into a car, breaking one of its side windows. The police arrested David S. His blood alcohol level was twice the legal limit.
Gary M. was arrested by the FBI when he showed up at a local mall to meet a 14-year-old girl for a date, which he arranged over the Internet. He didn't know that the “14-year-old girl" was actually a 35-year-old male FBI agent.
Elaine R. was an accountant working for a large corporation. She had been falsifying the accounting records and sending some of the corporate funds to her own bank accounts in an offshore bank. The corporation found out what she had been doing and reported her to the police.
Your complete answer to this assignment should be 1–3 pages.
.
You have been asked to evaluate a 3-year-old child in your clinic. .docx
You have been asked to evaluate a 3-year-old child in your clinic. Riley’s mother is concerned that “her speech has sounded “bumpy” over the last two weeks. She also reports that Riley has a cousin who stutters. During the evaluation, Riley demonstrated occasional whole word repetitions and hesitations in her speech. She did not appear to notice these disfluencies.
.
You have been asked to develop UML diagrams to graphically depict .docx
You have been asked to develop UML diagrams to graphically depict and describe the architecture of two (2) unrelated software systems. The first system is for an automated ticket-issuing system used by passengers at a railway station. The second system is for a computer-controlled video conferencing system, located in a corporate office and accessible to senior management that allows video, audio, and computer data to be visible to several participants at the same time.
Write a three to five (3-5) page paper in which you:
Create two (2) UML diagrams, one (1) showing a conceptual view and one (1) showing a process view of the architectures for each of the two (2) following systems (for a total of four [4] diagrams) through the use of Microsoft Visio or its open source alternative, Dia.
Note:
The graphically depicted solution is not included in the required page length.
An automated ticket-issuing system used by passengers at a railway station.
A computer-controlled, video-conferencing system that allows video, audio, and computer data to be visible to several participants at the same time.
Describe how you created the conceptual and process view for all four (4) diagrams. In the description, be sure to provide a justification for each key decision in the design.
Explain how you arrived at your final solution for the four (4) conceptual and process view diagrams that you have created.
Your assignment must follow these formatting requirements:
Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.
Include charts or diagrams created in Visio or an equivalent such as Dia. The completed diagrams / charts must be imported into the Word document before the paper is submitted.
.
You have been asked to develop UML diagrams to graphically depict an.docx
You have been asked to create UML diagrams depicting the conceptual and process views of two unrelated software systems: 1) an automated ticket-issuing system for a railway station, and 2) a computer-controlled video conferencing system for a corporate office. You must create two diagrams for each system (one conceptual view diagram and one process view diagram), for a total of four diagrams. You then need to write a 3-5 page paper describing how you created the diagrams and justifying the key design decisions.
You have been asked to develop a quality improvement (QI) process fo.docx
You have been asked to develop a quality improvement (QI) process for your medical facility employer. You have previously established the skill sets required for QI team members. The chief information officer has asked you what areas you will be analyzing and how you will determine if your project was successful or not. Complete the following:
Write a paper that details the method that you will use to quantitatively and qualitatively measure your QI process for various QI areas in your health care facility.
.
You have been asked to design and deliver a Microsoft PowerPoint pre.docx
You have been asked to design and deliver a Microsoft PowerPoint presentation to your team regarding the upgrade and the integration of the WATCH network into SHG's Active Directory forest. Since your team is geographically dispersed, you must create the slides and record the presentation so that when you distribute it to your team, they can watch and listen to the recording to understand the upgrade and integration.
You will need to do the following:
Explain how to integrate the existing WATCH networking standards, protocols, and access methods.
Select which is the most appropriate protocols and access standard to use without any loss of existing functionality to the billing department, the intranet, or the existing Internet site.
These functionalities will be migrated later, but for now your team needs only the migration plans for the administrative and bookkeeping functions.
.
You have been asked to be the project manager for the development of.docx
You have been asked to be the project manager for the development of an information technology (IT) project. The system to be developed will allow a large company to coordinate and maintain records of the professional development of its employees. The company has over 30,000 employees who are located in four sites: Florida, Colorado, Illinois, and Texas. The system needs to allow employees to locate and schedule professional development activities that are relevant to their positions. Sophisticated search capabilities are required, and the ability to add scheduled events to the employees’ calendars is desired. The system needs to support social networking to allow employees to determine who is attending conferences and events. This will promote fostering relationships and ensure coverage of conferences that are considered of high importance.
Once an activity has been completed, employees will use the system to submit the documentation. The system should support notifications to management personnel whenever their direct reports have submitted documentation. The system should also notify employees if their deadline to complete professional-development requirements is approaching and is not yet satisfied.
There are several types of architectural views. For the given scenario, develop 2 architectural views.
There must be enough detail for the design to be handed off to an implementation team.
.
You have been asked to conduct research on a past forensic case to a.docx
You have been asked to conduct research on a past forensic case to analyze how digital data was used to solve the case. Choose one of the following digital forensic cases:
S. v. Doe (1983), Doe U.S. (1988), People Sanchez (1994), Michelle Theer (2000), Scott Tyree (2002), Dennis Rader (2005), Corey Beantee Melton (2005), James Kent (2007), Brad Cooper (2008)
Using the Stayer Library or the Internet, search for the case notes and reports for the case and answer the following:
Summarize the case, the pertinent actors, evidence, and facts.
Outline the specific digital evidence that was used in the case.
Describe how the investigators found and documented the evidence, if any.
Describe the procedures and tool(s) used for acquiring potential evidence.
Describe the obstacles faced in the investigation.
Outline the most significant improvement to digital forensic investigations/tools that assisted with efficiency and reliability.
Provide the links to two modern tools that could have assisted with the collection of evidence.
Use at least five (5) quality resources in this assignment.
Note:
Wikipedia and similar websites do not qualify as quality resources.
Your assignment must follow these formatting requirements:
Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.
Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date.
.
You have been asked for the summary to include the following compone.docx
Telehealth is defined as the use of telecommunications technologies to provide clinical health care at a distance. It allows nurses to assess, diagnose, and treat patients using telecommunications technology. Telehealth has expanded access to care for rural communities by enabling virtual visits and remote patient monitoring. The evidence shows that telehealth improves health outcomes for patients in remote areas by overcoming barriers to accessing specialists. A recommended strategy is for healthcare organizations to implement telehealth programs that use remote patient monitoring for chronic disease management in rural communities, as studies have found it reduces hospitalizations and healthcare costs while improving patient outcomes and satisfaction.
You have been asked to be the project manager for the developmen.docx
You have been asked to be the project manager for the development of an information technology (IT) project. The system to be developed will allow a large company to coordinate and maintain its records of the professional development of its employees. The company has over 30,000 employees, who are located in four sites: Florida, Colorado, Illinois, and Texas. The system must allow employees to locate and schedule professional-development activities that are relevant to their positions. Sophisticated search capabilities are required, and the ability to add scheduled events to the employees' calendars is desired. The system needs to support social networking, which will allow employees to determine who is attending various conferences and events. This will promote the fostering of relationships and ensure that the company has representation at important conferences.
Once an activity has been completed, employees will use the system to submit the documentation. The system should support notifications, which will allow managers to receive notice whenever their direct reports have submitted documentation. The system should also notify employees if their deadline to complete a professional-development requirement is approaching and it has not yet been completed. Because the expenditure has been approved for the project, it is now time to justify the start-up of the project with a business case.
Using the above scenario, develop a business case and project charter (2–3 pages each). Include the following:
Section 1: Business Case (Unit 1)
Description of the problem or opportunity being presented to the business
Costs and benefits of each alternative solution
Recommended solution needed for approval
List of alternative solutions, feasibility of each in a table, and the selected solution
Section 2: Project Charter and WBS (Unit 1)
Identify project vision
Define scope of project
List project deliverables
List roles and responsibilities
List risks, issues, and assumptions
.
You have been asked by management, as a senior member of your co.docx
You have been asked by management, as a senior member of your corporate IT team, to provide insight into the meaning of IoT wireless services and foundational concepts. You want to discuss the foundational IoT wireless concepts and influence IoT will have on the organization’s wireless and mobile connectivity and services. Provide a response to the following:
Discuss the real meaning of Internet of Things and its impact everything that has the ability to communicate.
What types of “Things” communicate within the IoT concept?
How do these types of “Things” communicate?
How do “mobile technologies” relate to IoT?
Provide definitions for the following concepts within the IoT sphere:
RFID, Sensors, Smart technology and Nano technology
.
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- 2. 5.) Over-the-counter Ibuprofen 200mg -2 PO as needed 6.) Over-the-counter Benefiber 7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms Allergies: Sulfa drugs - rash Past Medical History (PMH): 1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments. 2.) Hypertension – well controlled 3.) Gastroesophageal reflux (GERD) – quiet, on no medication 4.) Osteopenia 5.) Allergic rhinitis Past Surgical History (PSH): 1.) Cholecystectomy 1994 2.) Total abdominal hysterectomy (TAH) 1998 Sexual/Reproductive History: Heterosexual G1P1A0 Non-menstruating – TAH 1998 Personal/Social History: She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
- 3. Immunization History: Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time. Significant Family History: Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood. Lifestyle: She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable. She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends. Review of Systems: General: + fatigue since the illness started; + fever, no chills or night sweats; no recent weight gains of losses of significance HEENT: No changes in vision or hearing; she does wear glasses, and her last eye exam was 1 ½ years ago. She reported no history of glaucoma, diplopia, floaters, excessive tearing, or photophobia. She does have bilateral small cataracts that are being followed by her ophthalmologist. She has had no recent ear infections, tinnitus, or discharge from the ears. She reported her sense of smell is intact. She has not had any episodes of epistaxis. She does not have a history of nasal polyps or recent
- 4. sinus infection. She has a history of allergic rhinitis that is seasonal. Her last dental exam was 3/2014. She denied ulceration, lesions, gingivitis, gum bleeding, and has no dental appliances. She has had no difficulty chewing or swallowing. Neck: No pain, injury, or history of disc disease or compression. Her last Bone Mineral density (BMD) test was 2013 and showed mild osteopenia, she said. Breasts: No reports of breast changes. No history of lesions, masses, or rashes. No history of abnormal mammograms. Respiratory: + cough and sputum production (see HPI); denied hemoptysis, no difficulty breathing at rest; + dyspnea on exertion; she has history of COPD and community acquired pneumonia 2012. Last PPD was 2013. Last CXR – 1 month ago. CV: No chest discomfort, palpitations, history of murmur; no history of arrhythmias, orthopnea, paroxysmal nocturnal dyspnea, edema, or claudication. Date of last ECG/cardiac work up is unknown by patient. GI: No nausea or vomiting, reflux controlled. No abd pain, no changes in bowel/bladder pattern. She uses fiber as a daily laxative to prevent constipation. GU: No change in her urinary pattern, dysuria, or incontinence. She is heterosexual. She has had a total abd hysterectomy. No history of STDs or HPV. She has not been sexually active since the death of her husband. MS: She has no arthralgia/myalgia, no arthritis, gout or limitation in her range of motion by report. No history of trauma or fractures. Psych: No history of anxiety or depression. No sleep disturbance, delusions, or mental health history. She denied suicidal/homicidal history. Neuro: No syncopal episodes or dizziness, no paresthesia, headaches. No change in memory or thinking patterns; no twitches or abnormal movements; no history of gait disturbance
- 5. or problems with coordination. No falls or seizure history. Integument/Heme/Lymph: No rashes, itching, or bruising. She uses lotion to prevent dry skin. She has no history of skin cancer or lesion removal. She has no bleeding disorders, clotting difficulties, or history of transfusions. Endocrine: No endocrine symptoms or hormone therapies. Allergic/Immunologic: Has hx of allergic rhinitis, but no known immune deficiencies. Her last HIV test was 10 years ago. OBJECTIVE DATA Physical Exam: Vital signs: B/P 110/72, left arm, sitting, regular cuff; P 70 and regular; T 98.3 orally; RR 16; non-labored; Wt: 115 lbs; Ht: 5’2; BMI 21 General: A&O x3, NAD, appears mildly uncomfortable HEENT: PERRLA, EOMI, oronasopharynx is clear Neck: Carotids no bruit, jvd or tmegally Chest/Lungs: CTA AP&L Heart/Peripheral Vascular: RRR without murmur, rub, or gallop; pulses+2 bilat pedal and +2 radial ABD: benign, nabs x 4, no organomegaly; mild suprapubic tenderness – diffuse – no rebound Genital/Rectal: external genitalia intact, no cervical motion tenderness, no adnexal masses. Musculoskeletal: symmetric muscle development - some age- related atrophy; muscle strengths 5/5 all groups Neuro: CN II – XII grossly intact, DTR’s intact
- 6. Skin/Lymph Nodes: No edema, clubbing, or cyanosis; no palpable nodes ASSESSMENT: Lab Tests and Results: CBC – WBC 15,000 with + left shift SAO2 – 98% Diagnostics: Lab: Radiology: CXR – cardiomegaly with air trapping and increased AP diameter ECG Normal sinus rhythm Differential Diagnosis (DDx): 1.) Acute Bronchitis 2.) Pulmonary Embolis 3.) Lung Cancer Diagnoses/Client Problems: 1.) COPD 2.) HTN, controlled
- 7. 3.) Tobacco abuse – 40-pack-a-year history 4.) Allergy to sulfa drugs – rash 5.) GERD – quiet, on no current medication PLAN: [This section is not required for the assignments in this course but will be required for future courses.] © 2014 Laureate Education, Inc. Page 4 of 4 © 2014 Laureate Education, Inc. Page 3 of 4 Advanced Digital Design Module 4: Flip-Flops Problems on Flip-Flops MUST PROVIDE FILES AND CODES : SEND TO [email protected] Flip-Flops, Registers, and Counters Provide detailed answers to the following: 1. Explain the differences among a truth table, a state table, a
- 8. characteristic table, and an excitation table. Also, explain the differences among a Boolean equation, a state equation, a characteristic equation, and a flip-flop input equation. 2. Given a 100-MHz clock signal, derive a circuit using D flip- flops to generate 50-MHz and 25-MHz clock signals. Draw a timing diagram for all three clock signals, assuming reasonable delays. 3. Write Verilog behavioral code modules for D FF, J-K FF and T FF. Use the American Psychological Association (APA) style (6th edition) for writing your assignment. Compose your work using a word processor