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For this homework assignment, you will continue coding for Reports 2-5, which are located on pages 182-184 of the Step-by-Step Workbook. Using Encoder Pro, create codes for information from Reports 2-5. Additionally, explain how you arrived at that code. Report 2: Discharge Summary Diagnoses include: 1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma of unknown primary location. 2. Vena Cava syndrome post placement of Hickman catheter. 3. Anemia due to chronic disease. 4. Hypertension. HOSPITAL COURSE: The patient is a 78 year old female whom we have been following in our clinic for hypertension and also chronic pudendal nerve pain. She had been recently diagnosed with pelvic metastatic clear cell carcinoma, which her primary location is unknown at this time. She will be discussing this further after the pathology reports are read. During her hospital stay a Hickman catheter was placed in order to have IV access for pain medication or future cancer therapy. She was also admitted for chronic pain. She did develop swelling of her arms and neck. She was brought to interventional radiology and she did have venography and the Hickman catheter was removed. Her swelling to her arms and neck have decreased greatly. She denies any shortness of breath. No choking sensation as previously noted. Her pain has been managed well with fentanyl patch at 175mcg. She has also been on IV heparin therapy for anticoagulation following the vena cava syndrome. Today, the patient has been having complaints of nausea. She did get some dexamethasone IV for her nausea, which did improve later this morning. Her blood pressure has been under good control. Her labs today include a WBC of 5.18, hemoglobin 7.8, hematocrit 23.7, protime 14.4, INR 1.5, PTT 39.6, BUN 6, sodium 139, potassium 4.2, and CO2 27.2. DISCHARGE MEDICATIONS: 1. Will continue home medications. 2. Phenergan 12.5 1-2 tabs p.o. p.r.n. every 6 hours for nausea. 3. Lovenox 1 mg/kg subcutaneously every 24 hours. 4. Fentanyl patch 175 mcg to be changed every 3 days. 5. Epogen 40,000 units subcutaneously weekly at the Cancer Center. REPORT 3. CLINIC CHART NOTE HISTORY: This 16 year old female is seen today after falling off a curb and twisting her right ankle. She is normally a patient of Dr. Anderson, who is out of town this week. She states that she has pain surrounding the entire foot and ankle. Seems unable or unwilling to bear weight.(Problem focused history) PHYSICAL EXAM: Ankle and foot examined. Foot is warm to the touch. Some swelling and bruising noted around the lateral aspect of the ankle. X-ray is negative for fracture. (problem focused examination) IMPRESSION: Sprained right ankle. (MDM complexity straightforward) PLAN: Elevation; ice to affected area. Weight bearing only as tolerated. Return for follow-up p.r.n. REPORT 4: ADMIT INPATIENT This is a 19 year old with a living-related donor kidney transplant as of last month and admitted to hospital fo ...
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Yan 2Yichao YanKara WilliamsESL 10696 April 2019 Rough.docx
Yan 2
Yichao Yan
Kara Williams
ESL 1069
6 April 2019
Rough Draft Analysis of Argument Essay
In the article “What Else Can I Do to Get the School Supplies My Student Need?” the author discusses that, textbook still plays an important role in today’s class. There are so many debates about weather using online text book or physical textbook in school nowadays. The author as a college teacher claims that physical textbook helps her students have better understanding of knowledges. Also, she thinks physical textbook reduced the financial burden on students. However, online source or online textbook should have more benefit then the physical textbook.
First of all, the author claims that physical textbook could helps student read and understand better of new knowledges. The resources that teachers need for their teaching are so differently. It depended on student’s grade and their teaching style. Even people nowadays assume textbooks are outdated, inefficient and biased, author still think using textbook is very important for students to know about some academic basic information, which could help students master the course better.
APPENDIX I r Reports
DIAGNOSES include:
1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma
of unknown PrimarY location.
2. Yeta cava sy.rdromi post placement of Hickman catheter'
3. Anemia due to chronic disease.
4. Hypertension.
HOSPITAL COURSE: The patient is a 78-year-old female whom we have
been following in our clinic ior hypertension and also chronic pudendal
nerve pain. Shie had been recently biagnosed with pelvic me,tastatic clear
cell caicinoma, which her primaiy location is unknown at this time' She
will be discussing this further after the pathology reports are, read. During
her hospital stalia Hickman catheter was placed in order to have IV access
for pain medication or future cancer therapy. She was also admitted for
chronic pain. she did develop swelling of her arms and neck. She was
broughtio interventional radiology and she did have venography and the
Hickman catheter was removed. Her swelling to her arms and neck have
decreased greatly. She denies any shortness of breath. No choking sensation
as previouily noted. Her pain has been managed well with fentanyl patch at
175 mcg. She has also been on IV heparin therapy for anticoagulation
followitig the vena cava syndrome. Today, the patient hasbeen having
complaiits of nausea. She did get some dexamethasone IV for her nausea,
which did improve later this morning. Her blood plessure has been under
good control. Her labs today include a wBC of 5.18, hemoglobin 7.8,
f,ematocrit 23.7, protime 74.4,INR 1'5, PTT 39'6, BUN 6, sodium 139'
potassium 4.2, CO2 27.2.
DISCHARGE, PLANS:
1. IV heparin is discontinued. She will be switched ovel to Lovenox
r mg/kg subcutaneously daily. The patient will have Home Health to
help her set uP these iniections.
2. She will continue with the fentanyl patch 175 mcg for the pain..
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.
1.The APRN is giving a pathophysiology lecture to APRN students on .docx
1. The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, glomerular filtration rate, autoregulation, and related hormone factors regulating renal blood flow
Question:
What would be the most important concept of hormonal regulation that the APRN should address?
2. The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, related hormones, and glomerular filtration rate.
Question:
What would be the most important concept of glomerular filtration rate that the APRN should address?
A 46-year-old Caucasian female presents to the PCP’s office with a chief complaint of severe, intermittent right upper quadrant pain for the last 3 days. The pain is described as sharp and has occurred after eating french fries and cheeseburgers and radiates to her right shoulder. She has had a few episodes of vomiting “green stuff”. States had fever and chills last night which precipitated her trip to the office. She also had some dark orange urine, but she thought she was dehydrated.
Physical exam: slightly obese female with icteric sclera as well as generalized jaundice. Temp 101˚F, pulse 108, respirations 18. Abdominal exam revealed rounded abdomen with slightly hypoactive bowel sounds. + rebound tenderness on palpation of right upper quadrant. No tenderness or rebound in epigastrium or other quadrants. Labs demonstrate elevated WBC, elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Serum bilirubin (indirect) 2.5 mg/dl. Abdominal ultrasound demonstrated enlarged gall bladder, dilated common bile duct and multiple stones in the bile duct. The APRN diagnoses the patient with acute cholecystitis and refers her to the ED for further treatment.
Question 1 of 2:
Describe how gallstones are formed and why they caused the symptoms that the patient presented with.
Question 2 of 2:
Explain how the patient became jaundiced
3. Ruth is a 49-year-old office worker who presents to the clinic with a chief complaint of abdominal pain x 2 days. The pain has significantly increased over the past 6 hours and is now accompanied by nausea and vomiting. The pain is described as “sharp and boring” in mid epigastrum and radiates to the back. Ruth admits to a long history of alcohol use, and often drinks up to a fifth of vodka every day.
Physical Exam: Temp 102.2F, BP 90/60, respirations 22. Pulse Oximetry 92% on room air.
General: thin, pale white female in obvious pain and leaning forward. Moving around on exam table and unable to sit quietly.
CV-tachycardic. RRR without gallops, rubs, clicks or murmurs
Resp-decreased breath sounds in both bases with poor inspiratory effort
Abd- epigastric guarding with tenderness. No rebound tenderness. Negative Cullen’s and + Turner’s signs observed. Hypoactive bowel sounds x 2 upper quadrants, and no bowel sounds heard in both lower quadrants.
The APRN makes a tentative diagnosis of acute pancreatitis based on history and ph.
Running Head Clinical Diagnostic Zandria HamiltonMigr.docx
Running Head: Clinical Diagnostic
Zandria Hamilton
Migraine
Tyohon ID:1840-20181018-007
12/2/2018
CC:
" I've been having headache for a while"
HPI:
Patient is a 29-year-old Caucasian female who reports that she has had a headache for a year. She reports a headache is a constant dull ache located at the back of her neck. She reports the pain is a 6/10 at all times. She states that she has been taking ibuprofen 600 mg three times daily, but the medication provides no relief. She reports that the headache is worst during the day when she is out running every day errands.
PMH:
Patient reports no past medical history. Patient reports an MVA that occurred in 2016. Patient reports he sustained no injuries related to MVA. Patient denies having a past surgical history.
Allergies:
Reports no known medication, food or latex allergy.
Medication:
Patient reports the only medication she is currently on Ibuprofen 600 mg po TID as needed for headache.
Social History:
Patient denies recreational drug use. She denies tobacco use. She reports drinking two 8 oz glasses of wine 3 nights weekly. Patient reports she is married with 2 young girls aged 4 and 6. She reports she lives with her husband and 2 daughters. Reports she does not engage in risky sex. Patient reports she is a stay at home mother and is currently unemployed but reports she has a bachelor's degree in Spanish. She states she active member of the Catholic church and attend church every Sunday.
Family history:
Patient reports mother is still alive and has a history of hypertension which was diagnosed when she was 45. She states her father has a history of depression, which he was diagnosed with at age 39. Maternal grandmother died at the age of 83, from complications of CHF but medical history is unknown. Maternal grandfather died of complications of Parkinson's at the age of 75, but medical history is unknown. Paternal grandmother is still alive and medical history is unknown. Paternal grandfather is still a live and patient reports she doesn't know his medical history. Patient reports having 2 siblings who don't have any medical conditions.
Health maintenance and promotion:
Patient reports she was given a flu shot in December of 2017. She reports that she runs a mile 5 times a week in the morning. She reportedly drinks 84 oz. of water daily. She states that she eats a well-balanced diet. She reportedly eats 5 small meals a day. Based on Recommendations by the USPSTF the patient should be screened for high blood pressure in adults over the age of 18. The recommendation is to obtain measurement outside of the clinical setting for diagnostic confirmation before treating.
ROS:
General: Patient denies, fever, chills, or malaise.
Skin: Patient denies any open wounds, bruises, sores, or any areas of breakdown on skin.
HEENT: Patient denies abnormal growths on head. Patient denies having a hard time hearing. He denies ear pain. Patient denies tinnitus. She denies having a sore.
1 A 45-year-old male comes to the clinic with a chief complaint.docx
1 A 45-year-old male comes to the clinic with a chief complaint
QUESTION 1 A 45-year-old male comes to the clinic with a chief complaint of epigastric abdominal pain that has persisted for 2 weeks. He describes the pain as burning, non-radiating and is worse after meals. Also, he denies nausea, vomiting, weight loss or obvious bleeding. Finally, he admits to bloating and frequent belching.
PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.
Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain
Family Hx-non contributary
Social history-recently divorced and expressed concern at how expensive it is to support 2 homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He denies illicit drug use, vaping or unprotected sexual encounters.
Breath test in the office revealed + urease.
The healthcare provider suspects the client has peptic ulcer disease.
1 of 2 Questions:
What factors may have contributed to the development of PUD?
2 of 2 Questions:How do these factors contribute to the formation of peptic ulcers?
QUESTION 3 A 36-year-old morbidly obese female comes to the office with a chief complaint of “burning in my chest and a funny taste in my mouth”. The symptoms have been present for years but patient states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5 weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night when she is lying down and has had to sleep with 2 pillows. Says she has started coughing at night which has been interfering with her sleep. Also, denies palpitations, shortness of breath, or nausea.
PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2)
Family history-non contributary
Medications-amlodipine 10 mg po qd, dicyclomine 20 mg po, ibuprofen 600 mg po q 6 hr prn
Social hx- 15 pack/year history of smoking, occasional alcohol use, denies vaping
The health care provider diagnoses the patient with gastroesophageal reflux disease (GERD).
Question:
The client asks the APRN what causes GERD. What is the APRN’s best response?
QUESTION 4 A 34-year-old construction worker presents to his Primary Care Provider (PCP) with a chief complaint of passing foul smelling dark, tarry stools. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are performed.
Question:
What factors can contribute to an upper GI bleed?
Question 5 A 64-year-old steel worker presents to h.
Recommended
Yan 2Yichao YanKara WilliamsESL 10696 April 2019 Rough.docx
Yan 2
Yichao Yan
Kara Williams
ESL 1069
6 April 2019
Rough Draft Analysis of Argument Essay
In the article “What Else Can I Do to Get the School Supplies My Student Need?” the author discusses that, textbook still plays an important role in today’s class. There are so many debates about weather using online text book or physical textbook in school nowadays. The author as a college teacher claims that physical textbook helps her students have better understanding of knowledges. Also, she thinks physical textbook reduced the financial burden on students. However, online source or online textbook should have more benefit then the physical textbook.
First of all, the author claims that physical textbook could helps student read and understand better of new knowledges. The resources that teachers need for their teaching are so differently. It depended on student’s grade and their teaching style. Even people nowadays assume textbooks are outdated, inefficient and biased, author still think using textbook is very important for students to know about some academic basic information, which could help students master the course better.
APPENDIX I r Reports
DIAGNOSES include:
1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma
of unknown PrimarY location.
2. Yeta cava sy.rdromi post placement of Hickman catheter'
3. Anemia due to chronic disease.
4. Hypertension.
HOSPITAL COURSE: The patient is a 78-year-old female whom we have
been following in our clinic ior hypertension and also chronic pudendal
nerve pain. Shie had been recently biagnosed with pelvic me,tastatic clear
cell caicinoma, which her primaiy location is unknown at this time' She
will be discussing this further after the pathology reports are, read. During
her hospital stalia Hickman catheter was placed in order to have IV access
for pain medication or future cancer therapy. She was also admitted for
chronic pain. she did develop swelling of her arms and neck. She was
broughtio interventional radiology and she did have venography and the
Hickman catheter was removed. Her swelling to her arms and neck have
decreased greatly. She denies any shortness of breath. No choking sensation
as previouily noted. Her pain has been managed well with fentanyl patch at
175 mcg. She has also been on IV heparin therapy for anticoagulation
followitig the vena cava syndrome. Today, the patient hasbeen having
complaiits of nausea. She did get some dexamethasone IV for her nausea,
which did improve later this morning. Her blood plessure has been under
good control. Her labs today include a wBC of 5.18, hemoglobin 7.8,
f,ematocrit 23.7, protime 74.4,INR 1'5, PTT 39'6, BUN 6, sodium 139'
potassium 4.2, CO2 27.2.
DISCHARGE, PLANS:
1. IV heparin is discontinued. She will be switched ovel to Lovenox
r mg/kg subcutaneously daily. The patient will have Home Health to
help her set uP these iniections.
2. She will continue with the fentanyl patch 175 mcg for the pain..
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.
1.The APRN is giving a pathophysiology lecture to APRN students on .docx
1. The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, glomerular filtration rate, autoregulation, and related hormone factors regulating renal blood flow
Question:
What would be the most important concept of hormonal regulation that the APRN should address?
2. The APRN is giving a pathophysiology lecture to APRN students on renal blood flow, related hormones, and glomerular filtration rate.
Question:
What would be the most important concept of glomerular filtration rate that the APRN should address?
A 46-year-old Caucasian female presents to the PCP’s office with a chief complaint of severe, intermittent right upper quadrant pain for the last 3 days. The pain is described as sharp and has occurred after eating french fries and cheeseburgers and radiates to her right shoulder. She has had a few episodes of vomiting “green stuff”. States had fever and chills last night which precipitated her trip to the office. She also had some dark orange urine, but she thought she was dehydrated.
Physical exam: slightly obese female with icteric sclera as well as generalized jaundice. Temp 101˚F, pulse 108, respirations 18. Abdominal exam revealed rounded abdomen with slightly hypoactive bowel sounds. + rebound tenderness on palpation of right upper quadrant. No tenderness or rebound in epigastrium or other quadrants. Labs demonstrate elevated WBC, elevated serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels. Serum bilirubin (indirect) 2.5 mg/dl. Abdominal ultrasound demonstrated enlarged gall bladder, dilated common bile duct and multiple stones in the bile duct. The APRN diagnoses the patient with acute cholecystitis and refers her to the ED for further treatment.
Question 1 of 2:
Describe how gallstones are formed and why they caused the symptoms that the patient presented with.
Question 2 of 2:
Explain how the patient became jaundiced
3. Ruth is a 49-year-old office worker who presents to the clinic with a chief complaint of abdominal pain x 2 days. The pain has significantly increased over the past 6 hours and is now accompanied by nausea and vomiting. The pain is described as “sharp and boring” in mid epigastrum and radiates to the back. Ruth admits to a long history of alcohol use, and often drinks up to a fifth of vodka every day.
Physical Exam: Temp 102.2F, BP 90/60, respirations 22. Pulse Oximetry 92% on room air.
General: thin, pale white female in obvious pain and leaning forward. Moving around on exam table and unable to sit quietly.
CV-tachycardic. RRR without gallops, rubs, clicks or murmurs
Resp-decreased breath sounds in both bases with poor inspiratory effort
Abd- epigastric guarding with tenderness. No rebound tenderness. Negative Cullen’s and + Turner’s signs observed. Hypoactive bowel sounds x 2 upper quadrants, and no bowel sounds heard in both lower quadrants.
The APRN makes a tentative diagnosis of acute pancreatitis based on history and ph.
Running Head Clinical Diagnostic Zandria HamiltonMigr.docx
Running Head: Clinical Diagnostic
Zandria Hamilton
Migraine
Tyohon ID:1840-20181018-007
12/2/2018
CC:
" I've been having headache for a while"
HPI:
Patient is a 29-year-old Caucasian female who reports that she has had a headache for a year. She reports a headache is a constant dull ache located at the back of her neck. She reports the pain is a 6/10 at all times. She states that she has been taking ibuprofen 600 mg three times daily, but the medication provides no relief. She reports that the headache is worst during the day when she is out running every day errands.
PMH:
Patient reports no past medical history. Patient reports an MVA that occurred in 2016. Patient reports he sustained no injuries related to MVA. Patient denies having a past surgical history.
Allergies:
Reports no known medication, food or latex allergy.
Medication:
Patient reports the only medication she is currently on Ibuprofen 600 mg po TID as needed for headache.
Social History:
Patient denies recreational drug use. She denies tobacco use. She reports drinking two 8 oz glasses of wine 3 nights weekly. Patient reports she is married with 2 young girls aged 4 and 6. She reports she lives with her husband and 2 daughters. Reports she does not engage in risky sex. Patient reports she is a stay at home mother and is currently unemployed but reports she has a bachelor's degree in Spanish. She states she active member of the Catholic church and attend church every Sunday.
Family history:
Patient reports mother is still alive and has a history of hypertension which was diagnosed when she was 45. She states her father has a history of depression, which he was diagnosed with at age 39. Maternal grandmother died at the age of 83, from complications of CHF but medical history is unknown. Maternal grandfather died of complications of Parkinson's at the age of 75, but medical history is unknown. Paternal grandmother is still alive and medical history is unknown. Paternal grandfather is still a live and patient reports she doesn't know his medical history. Patient reports having 2 siblings who don't have any medical conditions.
Health maintenance and promotion:
Patient reports she was given a flu shot in December of 2017. She reports that she runs a mile 5 times a week in the morning. She reportedly drinks 84 oz. of water daily. She states that she eats a well-balanced diet. She reportedly eats 5 small meals a day. Based on Recommendations by the USPSTF the patient should be screened for high blood pressure in adults over the age of 18. The recommendation is to obtain measurement outside of the clinical setting for diagnostic confirmation before treating.
ROS:
General: Patient denies, fever, chills, or malaise.
Skin: Patient denies any open wounds, bruises, sores, or any areas of breakdown on skin.
HEENT: Patient denies abnormal growths on head. Patient denies having a hard time hearing. He denies ear pain. Patient denies tinnitus. She denies having a sore.
1 A 45-year-old male comes to the clinic with a chief complaint.docx
1 A 45-year-old male comes to the clinic with a chief complaint
QUESTION 1 A 45-year-old male comes to the clinic with a chief complaint of epigastric abdominal pain that has persisted for 2 weeks. He describes the pain as burning, non-radiating and is worse after meals. Also, he denies nausea, vomiting, weight loss or obvious bleeding. Finally, he admits to bloating and frequent belching.
PMH-+ for osteoarthritis, seasonal allergies with frequent sinusitis infections.
Meds-Zyrtec 10 mg po daily and takes it year-round, ibuprofen 400-600 mg po prn pain
Family Hx-non contributary
Social history-recently divorced and expressed concern at how expensive it is to support 2 homes. Works as a manager at a local tire and auto company. He has 25 pack/year history of smoking, drinks 2-3 beers/day, and drinks 5-6 cups of coffee per day. He denies illicit drug use, vaping or unprotected sexual encounters.
Breath test in the office revealed + urease.
The healthcare provider suspects the client has peptic ulcer disease.
1 of 2 Questions:
What factors may have contributed to the development of PUD?
2 of 2 Questions:How do these factors contribute to the formation of peptic ulcers?
QUESTION 3 A 36-year-old morbidly obese female comes to the office with a chief complaint of “burning in my chest and a funny taste in my mouth”. The symptoms have been present for years but patient states she had been treating the symptoms with antacid tablets which helped until the last 4 or 5 weeks. She never saw a healthcare provider for that. She says the symptoms get worse at night when she is lying down and has had to sleep with 2 pillows. Says she has started coughing at night which has been interfering with her sleep. Also, denies palpitations, shortness of breath, or nausea.
PMH-HTN, venous stasis ulcers, irritable bowel syndrome, osteoarthritis of knees, morbid obesity (BMI 48 kg/m2)
Family history-non contributary
Medications-amlodipine 10 mg po qd, dicyclomine 20 mg po, ibuprofen 600 mg po q 6 hr prn
Social hx- 15 pack/year history of smoking, occasional alcohol use, denies vaping
The health care provider diagnoses the patient with gastroesophageal reflux disease (GERD).
Question:
The client asks the APRN what causes GERD. What is the APRN’s best response?
QUESTION 4 A 34-year-old construction worker presents to his Primary Care Provider (PCP) with a chief complaint of passing foul smelling dark, tarry stools. He stated the first episode occurred last week, but it was only a small amount after he had eaten a dinner of beets and beef. The episode today was accompanied by nausea, sweating, and weakness. He states he has had some mid epigastric pain for several weeks and has been taking OTC antacids. The most likely diagnosis is upper GI bleed which won’t be confirmed until further endoscopic procedures are performed.
Question:
What factors can contribute to an upper GI bleed?
Question 5 A 64-year-old steel worker presents to h.
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 ...
Financial & Managerial Accounting Assignment 1 – Financial S.docx
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Guidelines for assignment
This is an individual assignment
Ground your answer in relevant theory
Plagiarism and reproduction of someone else’s work as your own will be penalized
Make use of references, where appropriate – Use Harvard or APA referencing method.
Late submission are not accepted
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Structural elements should include an introduction, main body, and a conclusion
Weight – 50%
Word count guidance : part 1 – N/A. Business report wordage should be 2000 +/-10%
Type of assignment: Excel Assessed Work Folder and Business Report
Start / Finish : Week 3 – 4
Learning Outcome Assessed: 1,2,3,4
Submit one single document and not lots of different files.
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November ...
1[Shortened Title up to 50 Characters]2Week 9 Assignment.docx
1
[Shortened Title up to 50 Characters] 2Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.
Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.
Duration: 5 to7 days du ...
1[Shortened Title up to 50 Characters]16Week 9 Assignment.docx
1
[Shortened Title up to 50 Characters] 16Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.
Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.
Duration: 5 to7 days d ...
Clinical ScenarioREASON FOR CONSULTATION Desaturation to 64.docx
Clinical Scenario:
REASON FOR CONSULTATION:
Desaturation to 64% on room air 1 hours ago with associated shortness of breath.
HISTORY OF PRESENT ILLNESS:
Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago and is now working properly. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 22, blood pressure 138/38. O2 sat was 64% on room air. The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91% on 4L NC. The patient was seen and examined at 10:10 a.m. She reports that she has been having mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of visit was 22 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiation treatment for laryngeal cancer and her last treatment was 1 to 2 weeks ago. She reports that she has 2 to 3 treatments left. She denies any chest pain at this time and denies any previous history of CHF. Review of her vital signs show that she has been having intermittent fevers since yesterday morning. Of note, she was admitted to the hospital 3 weeks ago for an atrial fibrillation with RVR for which she was cardioverted and has not had any further problems. The cardiologist at that time said that she did not need any anticoagulation unless she reverted back into A-fib.
REVIEW OF SYSTEMS:
Constitutional:
Negative for diaphoresis and chills.
Positive for fever and fatigue.
HEENT:
Negative for hearing loss, ear pain, nose bleeds, tinnitus.
Positive for throat pain secondary to her laryngeal cancer.
Eyes:
Negative for blurred vision, double vision, photophobia, discharge or redness.
Respiratory:
Positive for cough and shortness of breath
. Negative for hemoptysis and wheezing.
Cardiovascular:
Negative for chest pain, palpitations, orthopnea, leg swelling or PND.
Gastrointestinal:
Negative for heartburn, nausea, vomiting, abdominal pain, diarrhea, constipation, blood in stool or melena.
Genitourinary:
Negative for dysuria, urgency, frequency, hematuria and flank pain.
Musculoskeletal:
Negative for myalgias, back pain and falls.
Skin:
Negative for itching and rash.
Neurological:
Negative for dizziness, tingling, tremors, sensory changes, speech changes.
Endocrine/hematologic/allergies:
Negative for environmental allergies or polydipsia. Does not bruise or bleed easily.
Psychiatric:
Negative for depression, hallucinations and memory loss.
PAST MEDICAL HISTORY:
Diabetes mellitus that was diagnosed 12 years ago with neuropathy. This resolved after gastric.
1. CC I have been having terrible chest and arm pain for the p.docx
1. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dlHis diagnosis is an acute inferior wall myocardial infarction.1 of 2 Questions:Why is HDL considered the “good” cholesterol?
QUESTION 2
. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dlHis diagnosis is an acute inferior wall myocardial infarction.2 of 2 Questions:Explain the role inflammation has in the development of atherosclerosis.
QUESTION 3
. A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.
Question:
What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?
QUESTION 4.
A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought he had the flu and took him to an Urgent Care Center. He was given Tamiflu® and sent home. He says the Tamiflu.
Nursing information helps you to collect history of patient which is helpful
Helps you to collect information
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 ...
Think kidneys in primary and secondary care
Presentation given at the Diabetes UK conference 2016 by Dan Lasserson
These are 19 questions for my international politics class. I need t.docx
These are 19 questions for my international politics class. I need the answers in less than 24h. I'm not paying more than $25. It has to be fully answered! Please, if you don't know politics don't even bother. Please, don't waste my time.
Thanks.
Here you go:
Fully answer each question with the question number on the attached, rule sheets. Please keep all pages together.
ALL QUESTIONS, INCLUDING “OPINION QUESTIONS” REQUIRE CONCLUSIONS BASED UPON FULLY ARTICULATED AND REASONED PREMISES, NOT JUST A SUMMARY OPINION ANSWER,
1. lf a terrorist group sets off a nuclear bomb in one American city which city do you think they will choose and why? Discuss fully.
2. Nuclear Terrorism
a. Is it in the interests of a foreign government to harbor/sanction a terrorist group in its territory that it KNOWS to be planning to detonate a nuclear bomb in one or more American cities? Yes or no and why?
b. Discuss any immediate and long term consequences of such a government’s decision to harbor such a terrorist group?
3. Discuss problems of international scope that can be or have been created by the current three non—signatories to the Nuclear Non Proliferation Treaty Of 1969, namely, India, Pakistan and Israel. Note: also address North Korea, which though it has signed the NPT is not in current compliance. Iran has signed the NPT though there are issues with the West.
4. Thanks to hydraulic fracturing, or
fracking
, the United States is now the world’s number one producer of natural gas though not of oil. Yet, the worldwide price of oil is always valued in US. dollars. Why is this so? What international consequences or for individual countries might exist if oil were NOT so pegged in US. dollars?
5. Twenty-one leaders of the Nazi regime were tried at Nuremburg immediately after World War II. They were tried under four counts agreed by the victorious allies: war crimes not justified by military necessity, crimes against humanity, crimes against peace and waging aggressive war. Eleven defendants were hanged; three were acquitted and seven were given prison sentences. All imprisoned defendants were released early, except Albert Speer and Rudolf Hess who had been imprisoned in England after 1940. Except for War Crimes trials held at The Hague after the Bosnian War of 1993, no war crimes trials have been held, no perpetrators of Nuremburg offenses have been tried, punished or even sought out by the NATO allies or otherwise by the international community. With all of the destructive and genocidal wars that have occurred since WWII and the villains who have perpetrated Nuremburg crimes, why have not more war crimes trials occurred? Are the Nuremburg offenses of any enduring value? Is there such a thing as meaningful international law in the Nuremburg trials?
6. The Ukraine situation
a. Who or which side in the conflict do you think started the conflict and why?
b. Leaving aside who or which side is responsible for starting the conflict, do you think the Weste.
These are discussion questions (4). Need short response to each o.docx
These are discussion questions (4). Need short response to each of questions.
Total page: 1
"Security Support Responsibilities" Please respond to the following:
1) Imagine you are the CIO of an organization. Construct an outline of four ongoing responsibilities that the digital forensics personnel must complete each week. Provide a possible scenario for how each responsibility may be performed to fulfill the forensics’ needs of an organization.
2) Compare the responsibilities you listed above with those of an IT security professional.
Give your opinion on how responsibilities of digital forensics personnel and IT security professional are similar and in which ways are they different.
"Functional Security Support Roles" Please respond to the following:
3) Identify three steps required for implementing a physical and environmental security program. Select one step that would be the most challenging to perform and one step that you believe is the most important for providing protection against information assets of an organization. Explain why you chose each step.
4) Suggest three security support competencies of a privacy professional that support the security strategy of an organization. Justify your suggestions.
.
More Related Content
Similar to For this homework assignment, you will continue coding for Reports 2.docx
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 ...
Financial & Managerial Accounting Assignment 1 – Financial S.docx
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Guidelines for assignment
This is an individual assignment
Ground your answer in relevant theory
Plagiarism and reproduction of someone else’s work as your own will be penalized
Make use of references, where appropriate – Use Harvard or APA referencing method.
Late submission are not accepted
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Structural elements should include an introduction, main body, and a conclusion
Weight – 50%
Word count guidance : part 1 – N/A. Business report wordage should be 2000 +/-10%
Type of assignment: Excel Assessed Work Folder and Business Report
Start / Finish : Week 3 – 4
Learning Outcome Assessed: 1,2,3,4
Submit one single document and not lots of different files.
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November ...
1[Shortened Title up to 50 Characters]2Week 9 Assignment.docx
1
[Shortened Title up to 50 Characters] 2Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.
Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.
Duration: 5 to7 days du ...
1[Shortened Title up to 50 Characters]16Week 9 Assignment.docx
1
[Shortened Title up to 50 Characters] 16Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.
Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.
Duration: 5 to7 days d ...
Clinical ScenarioREASON FOR CONSULTATION Desaturation to 64.docx
Clinical Scenario:
REASON FOR CONSULTATION:
Desaturation to 64% on room air 1 hours ago with associated shortness of breath.
HISTORY OF PRESENT ILLNESS:
Mrs. X is 73-year-old Caucasian female who was admitted to the general surgery service 3 days ago for a leaking j-tube which was surgically replaced 2 days ago and is now working properly. This morning at 07:30, the RN reported that the patient was sleeping and doing fine, then the CNA made rounds at 0900 and Mrs. X was found be mildly dyspneic. Vital signs were checked at that time and were; temperature 38.6, pulse 120, respirations 22, blood pressure 138/38. O2 sat was 64% on room air. The general surgeon was notified by the nursing staff of the hypoxia, an order for a chest x-ray and oxygen therapy were given to the RN. The O2 sat is maintaining at 91% on 4L NC. The patient was seen and examined at 10:10 a.m. She reports that she has been having mild dyspnea for 2 days that has progressively gotten worse. She does not use oxygen at home. Her respiratory rate at the time of visit was 22 and she feels short of breath. She has felt this way in the past when she had pneumonia. She is currently undergoing radiation treatment for laryngeal cancer and her last treatment was 1 to 2 weeks ago. She reports that she has 2 to 3 treatments left. She denies any chest pain at this time and denies any previous history of CHF. Review of her vital signs show that she has been having intermittent fevers since yesterday morning. Of note, she was admitted to the hospital 3 weeks ago for an atrial fibrillation with RVR for which she was cardioverted and has not had any further problems. The cardiologist at that time said that she did not need any anticoagulation unless she reverted back into A-fib.
REVIEW OF SYSTEMS:
Constitutional:
Negative for diaphoresis and chills.
Positive for fever and fatigue.
HEENT:
Negative for hearing loss, ear pain, nose bleeds, tinnitus.
Positive for throat pain secondary to her laryngeal cancer.
Eyes:
Negative for blurred vision, double vision, photophobia, discharge or redness.
Respiratory:
Positive for cough and shortness of breath
. Negative for hemoptysis and wheezing.
Cardiovascular:
Negative for chest pain, palpitations, orthopnea, leg swelling or PND.
Gastrointestinal:
Negative for heartburn, nausea, vomiting, abdominal pain, diarrhea, constipation, blood in stool or melena.
Genitourinary:
Negative for dysuria, urgency, frequency, hematuria and flank pain.
Musculoskeletal:
Negative for myalgias, back pain and falls.
Skin:
Negative for itching and rash.
Neurological:
Negative for dizziness, tingling, tremors, sensory changes, speech changes.
Endocrine/hematologic/allergies:
Negative for environmental allergies or polydipsia. Does not bruise or bleed easily.
Psychiatric:
Negative for depression, hallucinations and memory loss.
PAST MEDICAL HISTORY:
Diabetes mellitus that was diagnosed 12 years ago with neuropathy. This resolved after gastric.
1. CC I have been having terrible chest and arm pain for the p.docx
1. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dlHis diagnosis is an acute inferior wall myocardial infarction.1 of 2 Questions:Why is HDL considered the “good” cholesterol?
QUESTION 2
. CC: “I have been having terrible chest and arm pain for the past 2 hours and I think I am having a heart attack.”HPI: Mr. Hammond is a 57-year-old African American male who presents to the Emergency Department with a chief complaint of chest pain that radiates down his left arm. He states that he started having pain several hours ago and says the pain “it feels like an elephant is sitting on my chest”. He rates the pain as 8/10. Nothing has made the pain better or worse. He denies any previous episode of chest pain. Denies nausea, dyspnea, or lightheadedness. He was given 0.4 mg nitroglycerine tablet sublingual x 1 which decreased, but not stopped the pain.Lipid panel reveals Total Cholesterol 324 mg/dl, high density lipoprotein (HDL) 31 mg/dl, Low Density Lipoprotein (LDL) 122 mg/dl, Triglycerides 402 mg/dl, Very Low-Density Lipoprotein (VLDL) 54 mg/dlHis diagnosis is an acute inferior wall myocardial infarction.2 of 2 Questions:Explain the role inflammation has in the development of atherosclerosis.
QUESTION 3
. A 45-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the Emergency Room (ER) with complaints of sharp retrosternal chest pain that worsens with deep breathing or lying down. She reports a 3-day history of low-grade fever, listlessness and says she feels like she had the flu. Physical exam reveals tachycardia and a pleural friction rub. She was diagnosed with acute pericarditis.
Question:
What does the Advanced Practice Registered Nurse (APRN) recognize as the result of the pleural friction rub?
QUESTION 4.
A 15-year-old adolescent male comes to the clinic with his parents with a chief complaint of fever, nausea, vomiting, poorly localized abdominal pain, arthralgias, and “swollen lymph nodes”. States he has felt “lousy” for a couple weeks. The fevers have been as high as 102 F. His parents thought he had the flu and took him to an Urgent Care Center. He was given Tamiflu® and sent home. He says the Tamiflu.
Nursing information helps you to collect history of patient which is helpful
Helps you to collect information
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 ...
Think kidneys in primary and secondary care
Presentation given at the Diabetes UK conference 2016 by Dan Lasserson
Similar to For this homework assignment, you will continue coding for Reports 2.docx (20)
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
Financial & Managerial Accounting Assignment 1 – Financial S.docx
Financial & Managerial Accounting Assignment 1 – Financial S.docx
1[Shortened Title up to 50 Characters]2Week 9 Assignment.docx
1[Shortened Title up to 50 Characters]2Week 9 Assignment.docx
1[Shortened Title up to 50 Characters]16Week 9 Assignment.docx
1[Shortened Title up to 50 Characters]16Week 9 Assignment.docx
Clinical ScenarioREASON FOR CONSULTATION Desaturation to 64.docx
Clinical ScenarioREASON FOR CONSULTATION Desaturation to 64.docx
1. CC I have been having terrible chest and arm pain for the p.docx
1. CC I have been having terrible chest and arm pain for the p.docx
Nursing information helps you to collect history of patient which is helpful
Nursing information helps you to collect history of patient which is helpful
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.docx
More from alisoncarleen
These are 19 questions for my international politics class. I need t.docx
These are 19 questions for my international politics class. I need the answers in less than 24h. I'm not paying more than $25. It has to be fully answered! Please, if you don't know politics don't even bother. Please, don't waste my time.
Thanks.
Here you go:
Fully answer each question with the question number on the attached, rule sheets. Please keep all pages together.
ALL QUESTIONS, INCLUDING “OPINION QUESTIONS” REQUIRE CONCLUSIONS BASED UPON FULLY ARTICULATED AND REASONED PREMISES, NOT JUST A SUMMARY OPINION ANSWER,
1. lf a terrorist group sets off a nuclear bomb in one American city which city do you think they will choose and why? Discuss fully.
2. Nuclear Terrorism
a. Is it in the interests of a foreign government to harbor/sanction a terrorist group in its territory that it KNOWS to be planning to detonate a nuclear bomb in one or more American cities? Yes or no and why?
b. Discuss any immediate and long term consequences of such a government’s decision to harbor such a terrorist group?
3. Discuss problems of international scope that can be or have been created by the current three non—signatories to the Nuclear Non Proliferation Treaty Of 1969, namely, India, Pakistan and Israel. Note: also address North Korea, which though it has signed the NPT is not in current compliance. Iran has signed the NPT though there are issues with the West.
4. Thanks to hydraulic fracturing, or
fracking
, the United States is now the world’s number one producer of natural gas though not of oil. Yet, the worldwide price of oil is always valued in US. dollars. Why is this so? What international consequences or for individual countries might exist if oil were NOT so pegged in US. dollars?
5. Twenty-one leaders of the Nazi regime were tried at Nuremburg immediately after World War II. They were tried under four counts agreed by the victorious allies: war crimes not justified by military necessity, crimes against humanity, crimes against peace and waging aggressive war. Eleven defendants were hanged; three were acquitted and seven were given prison sentences. All imprisoned defendants were released early, except Albert Speer and Rudolf Hess who had been imprisoned in England after 1940. Except for War Crimes trials held at The Hague after the Bosnian War of 1993, no war crimes trials have been held, no perpetrators of Nuremburg offenses have been tried, punished or even sought out by the NATO allies or otherwise by the international community. With all of the destructive and genocidal wars that have occurred since WWII and the villains who have perpetrated Nuremburg crimes, why have not more war crimes trials occurred? Are the Nuremburg offenses of any enduring value? Is there such a thing as meaningful international law in the Nuremburg trials?
6. The Ukraine situation
a. Who or which side in the conflict do you think started the conflict and why?
b. Leaving aside who or which side is responsible for starting the conflict, do you think the Weste.
These are discussion questions (4). Need short response to each o.docx
These are discussion questions (4). Need short response to each of questions.
Total page: 1
"Security Support Responsibilities" Please respond to the following:
1) Imagine you are the CIO of an organization. Construct an outline of four ongoing responsibilities that the digital forensics personnel must complete each week. Provide a possible scenario for how each responsibility may be performed to fulfill the forensics’ needs of an organization.
2) Compare the responsibilities you listed above with those of an IT security professional.
Give your opinion on how responsibilities of digital forensics personnel and IT security professional are similar and in which ways are they different.
"Functional Security Support Roles" Please respond to the following:
3) Identify three steps required for implementing a physical and environmental security program. Select one step that would be the most challenging to perform and one step that you believe is the most important for providing protection against information assets of an organization. Explain why you chose each step.
4) Suggest three security support competencies of a privacy professional that support the security strategy of an organization. Justify your suggestions.
.
There is two assignments in Society and Technology and one assignmen.docx
There is two assignments in Society and Technology and one assignment in business communications. I am willing to pay $50.00 total. I have attached the assignments to this message. I also attached a piece that is included in part II of the business communication homework assignment that you will need to complete it.
.
There has been a lot of concern over the Digital Divide. For your di.docx
There has been a lot of concern over the Digital Divide. For your discussion this week, address the following:
What are some of the problems caused by the Digital Divide?
What ideas or solutions do you propose for addressing this issue?
The explosive growth of smartphones may be a path that allows developing countries to move quickly into the digital age. What advantages would there be to supporting the growth of smartphone usage over computer usage in a developing country?
.
There is a notably challenging requirement for all emergency manager.docx
There is a notably challenging requirement for all emergency managers and homeland security professionals at all levels and across all sectors—coordinating plans with all potential stakeholders. Prospective partners can range from one incident to the next, but plans and planners must accommodate the needs, interests, and capabilities of all potential contributors so as to create the most comprehensive and integrated plan, policy, or strategy. One might consider such coordination a matter of common sense, but this is often overlooked, at least in part, for various reasons.
Causes might stem from the actions—or lack thereof—of EM/HS team members, external partners, or both. Lethargy; lack of resources such as time, funding, or expertise; lack of interest on any stakeholder’s or planner’s part; lack of understanding the criticality of advance collaboration; or a simple failure to follow up with organizations and individuals upon whom an EM/HS may depend, may each play a part in explaining why collaboration is not fully accomplished. It can also be difficult for individuals at the planner level, or those inexperienced in incident response, to have the vision that is necessary to foresee an assortment of circumstances requiring relationships with agencies and people and their attendant special capabilities.
Stakeholders may include fire, police, emergency services, and community leadership. Providers of public services, including public utilities, school leadership and networks, city engineers, and others, are also probably key players to consult. However, threats, conditions, hazards, limitations, geography, climate, and many other factors also combine to create the need for tailored planning, which will probably require special relationships. In other words, there is no one-size-fits-all template to employ for identifying, developing and nurturing requisite partnerships.
Advance coordination—that is, developing relationships, sharing information, and understanding the various contributors’ capabilities before you need them for managing emergencies—is essential. Knowing what specific skills, resources, and capacities entities can bring to bear in preventing or responding to crises allows planners to incorporate these capabilities into strategies, plans, and exercises. This knowledge also aids leaders and resource managers in identifying gaps in capacity, which will need filling somehow. At the same time, once an incident occurs or seems immediately likely, the ability to contact vital participants to literally assemble and join the active response effort makes for an optimally efficient and effective endeavor.
What type of information is coordinated? Everything from listing points-of-contact and their current, tested contact information to knowing what special skills an organization or individual might have. For example, if the community believes that certain hazardous materials are a threat, say by accidental spill or if used in a weapon, the EM.
There are two things1. Let us use this thread to center a discus.docx
There are two things
1. Let us use this thread to center a discussion on the reading from David
Tyack
entitled "Constructing Difference." You can take the discussion in any direction, like the article's relevance to the present, elements of the work that resonate or clash with your opinion, current events that illustrate
Tyack
's thesis in modern contexts, etc, etc.
two paragraphs answer/
in APA style
2. The article by
Tyack
has made me reflect on the why behind some of the actions I took as a student growing up in the public education system. As a child, I was aware of what made a student "successful" which meant saying the pledge of allegiance every day, following the directions of the teacher, correctly regurgitating information on the tests and attaining an A. As I can recall, lessons in most of my classes were mostly rote and of only one perspective. Now that I am older and have 5 years of classroom teaching experience, I have had the opportunity to look at the reasons for why I was educated in the way I did. Understanding the context in which our educational system was purposed which was mainly to create patriotic students who would assimilate to an American culture. In the mid 20's during the WW1 era that there was a lot of pressure to maintain conformity due to the high stakes nature of war. In 1923, 35 states enacted laws that made E
nglish
the only language you can instruct in, in the U.S (
Tyack
, 1993).
Even the Ku Klux Klan in Oregon was trying to ensure all students attended public school (
Tyack
, 1993). This idea of conformity and rote learning was one of the leading reasons I was disenfranchised with school during my childhood even though I succeeded academically on paper. It wasn't until college that I really had professors that pushed me to analyze and look at events through different perspectives. It now makes sense that teaching students a rote conformist style of education is a tool mainly used for control. For example, in the article in mentioned how Mexicans would not want to engage in menial jobs if they were properly educated, because they realized they could accomplish much more. This idea led to schools tracking students based on their perception of their capabilities which meant students of color would thereby be placed in a lower track or lower achieving classes. We know the theories that used race and head size as a rationale to confirm intelligence were absolutely false and that intelligence is not based on race at all. Education has a negative connotation in my opinion largely due to some people in history using it as a tool to control or coerce people into thinking they are not capable because of the way they look. This sways far from the intended purpose of creating citizens that will be able to analyze and think critically in a variety of academic disciplines, so they can be contributing members to our democracy. Part of thinking critically is being able to empathize and see the world through the .
There are two things in boldWhat is your philosophy of educatio.docx
There are two things: in bold
What is your philosophy of education? What are the theoretical underpinnings of that philosophy? What does your philosophy look like at the school site and in the classroom?
What are the theoretical underpinnings of that philosophy? What does your philosophy look like at the school site and in the classroom?
What does your philosophy look like at the school site and in the classroom?
At least one paragraph for each
questions
.
This is for Education class.
Feedback for below two peers
.
1.
I always remember my education in my public grade school as a very positive and safe environment. There is no doubt that the teachers played a big role in creating such an environment and they were always excited to be at work. Experiencing this type of education in my primary years inspired me to become this kind of teacher for my first graders. On the other hand, I remember that there came a point in about fourth grade where I began losing interest in school. Looking back I know that it was because I did not feel challenged. Because of this, I felt as though there were talents and strengths that I had that I was not able to fully develop and utilize. Because I lacked in motivation and yearning to challenge myself, I promised myself that I would be a teacher who challenged all of her students regardless of their backgrounds and abilities.
My philosophy of education is to hold all students to high standards and instill in them the confidence and motivation to reach those high standards. This takes a lot of trust on their end so it is also my philosophy to create an environment where students feel comfortable to explore new ways of learning, thinking, and expressing themselves.
Motivation theories have always stuck with me since motivation was something that I struggled with in school. Intrinsic motivation, self determination, and autonomy support (2010) are all theoretical underpinnings to my philosophy.
My school site prides itself on community. This year we implemented the “TRIBES” agreements school wide. It gives our community guidelines to follow and we are able to hold each other accountable. Following the Tribes agreements means that students must show mutual respect, not put each other down, listen attentively, try their personal best, and they are given the right to pass in community circles. These agreements not only apply to the students, but to our entire staff and parents as well. As a first grade teacher, it is something I am reminding my students of daily. I try to implement a community circle once a week. The most recent circle we did was an appreciation circle where we gave a compliment/ appreciation to the person to the right of us. It only takes about 15 minutes, but it is this kind of activity that creates an environment where students feel included and appreciated. Furthermore, it is in this type of classroom where students can find motivation to succeed in learning.
Reference.
There are two persons,First one he developed health and opened a .docx
There are two persons,
First one: he developed health and opened a lot of health centers in different places
second one: Interested in art and has a lot of achievements in the field of art
-------------------------------------------------- ------------------------------
Required: an argument essay about who is the hero between these two characters? Why
((Put first person is the hero))
The first body + second: make them about the importance of health and the importance of what he had done in the field of health.
Third body: make it about art as something beautiful and useful, but it does not help a lot of people.
-------------------------------------------------- ------------------------------
I do not want Outsourcing
I hope that you choose simple words easy to understand, because I am a novice person
I want today at 21:00.
.
there are two Advertising pictures uploaded in the attachment. I wan.docx
there are two Advertising pictures uploaded in the attachment. I want you to pick on of them and write a thesis statement. After you write the thesis that you are going to use in the eassy but write it by itself so i can know what is the thesis. Then write 4 pages essay.
YOU CAN FIND ALL INSTRUCTION IN THE FILE THAT I UPLOADED.
thank you!
.
There are three main questions.Each question MUST use progra.docx
There are three main questions.
Each question
MUST
use program' R ' (stastics program) or ' EXCEL ' to solve some questions
( eg. plotting scatters)
12 hours left until deadline (Until July 13th 2015, 17:00 EST (Newyork timezone))
The three questions will be provided as image file.
** You should solve question # 3.9, 3.10, and 3.14 through image files.
.
There are three (3) articles for reading and comparison matrixoutli.docx
There are three (3) articles for reading and comparison matrix/outline for completion
Article 1 - Socialization of doctoral students to academic norms by Weidman & Stein (2003)
Article 2 - Developmental networks and learning: Toward an interdisciplinary perspective on identity development during doctoral study by Baker and Lattuca (2010)
Article 3 - Critical thinking distance education and traditional education bt Visser, Visser & Schlosser (2003)
Please follow the instruction. Due: 08/31/2015
Thanks in advance
.
There are stories of sacrifice, bondage and exodus, and survival in .docx
There are stories of sacrifice, bondage and exodus, and survival in the wilderness that are an integral part of the Jewish tradition. Compare and contrast the plots of these stories with secular stories that you are aware of with similar themes.
In addition, discuss the significance of the secular stories for the intended audiences. What sorts of assumptions or biases might audiences who are not the target audiences draw from these stories (perhaps if they don’t identify with the main characters of the stories)
.
There are multifaceted ethical issues relating to international inve.docx
There are multifaceted ethical issues relating to international investments. One aspect relates to human rights. Most Latin American governments have constitutions that mandate health care as a human right, yet some of these countries provide poor health care for the majority of their population.
During the 1980s, the general populace of these countries deteriorated, even though several Latin American countries developed strategies to reposition medical personnel and services to rural areas. Throughout this time, many international donors provided assistance; however they did so with imposed conditions. An example of this constrained assistance was the World Bank, which imposed restrictions that included privatization of health care, as well as required limitations on universal access.
Did the World Bank and other international donors act responsibly and ethically in constraining their humanitarian assistance? Who has the responsibility for the health care of the Latin American people? Is it a reasonable and socially responsible practice to offer international assistance in exchange for an opportunity to shape a country's political and/or social system? Why or why not?
.
There are problems in the file.10 hours left until deadline .docx
There are problems in the file.
10 hours left until deadline (Until July 20th 2015, 19:00 EST (Newyork timezone))
The two questions will be provided as image file.
** You should solve questions with explanations of answers.YOU WILL SOLVE Homework3!
For question one, i upload another file so that you can refer it to solve question #1. (file name: problem5 and you may have to refer problem 5 in that file to solve question #1 of Homework3. )
.
There are many points of overlap between Frankenstein, The Isl.docx
There are many points of overlap between
Frankenstein
,
The Island of Dr. Moreau
, and
Jurassic Park
in terms of theme (scientific experimentation, transgression, ethics, & hubris); plot; and moral caution. But in this last category, “moral caution” the narratives seem to create some grey area amid whether something can be done, should be, done, how it should be done, and what cautions should be employed. Please reflect on how
Jurassic Park
extends, confirms, and/or departs from the ethical concerns and “cautions” of the previous texts.
250 words
.
There are many different types of infrastructure attacks. These inc.docx
There are many different types of infrastructure attacks. These include, but are not limited to, malware, insertion, buffer overflow, etc. Examine the many different types of attacks and select the two that you believe are the easiest for success and why you consider these the easiest for success. Provide a rationale for your response. Include an explanation as to how the hacker tools are used.
.
There are many great research projects already using willing partici.docx
There are many great research projects already using willing participants, and modern technology to harness the help of citizen scientists like you. It is a great way for people to learn more about a subject that they are interested in while helping researchers gather important information.
Explore the following resources to learn more about Citizen Science:
Read the following article from the Kaplan Library. A copy of this article is in Doc Sharing as well:
Hand E. (2010). Citizen science: People power.
Nature, 466
(7307). 685.
Source:
NASA. (n.d.).
For citizen scientists
. Retrieved from
http://science.nasa.gov/citizen-scientists/
Source:
National Oceanic and Atmospheric Administration. (n.d.).
Be a citizen scientist
. Retrieved from
http://www.nws.noaa.gov/om/brochures/Citizen_Scientist.pdf
Source:
United States Geologic Survey. (2012).
Join citizens and scientists tracking the pulse of our planet.
Retrieved from
http://www.usgs.gov/blogs/features/usgs_top_story/join-citizens-and-scientists-tracking-the-pulse-of-our-planet/
Source:
U.S. Environmental Protection Agency. (n.d.).
Composting for facilities basics.
Retrieved from
http://www.epa.gov/adopt/
.
You can also do some research on your own to find other citizen science projects that are out there.
In your posts this unit answer the following questions:
What is “citizen science”?
What is the benefit of using citizens to help out with scientific research in this way?
What citizen science program(s) interests you the most? Please provide a specific link and information about your chosen citizen science program.
Would you be interested in giving any of the citizen science programs a try? Why, or why not?
200 words
.
There are many different theories as to why people commit crimes, su.docx
There are many different theories as to why people commit crimes, such as, self interest, social environment, opportunities, and wanting more power to name a few. What is your reasoning as to why people commit criminal acts? Ensure that you have
150 words for your initial post. MAKE SURE YOU SITE YOUR WORK
.
There are five essential principles of management. These include pla.docx
There are five essential principles of management. These include planning, organizing, directing, controlling, and leading. For this assignment you will conduct outside research of the topics of planning, organizing, directing, controlling, and leading.
You have been asked to give a presentation to a group of new managers in a health care setting. This presentation must cover each of the five principles discussed above. For each principle you will need to provide a real world example in which you or another leader has successfully performed the function and the impact that function had. You need to demonstrate in your presentation the value each principle has in the real word.
Requirements:
·
Your presentation should be in Microsoft PowerPoint
·
Be 10–12 slides in length (not including the cover slide or reference slide)
·
Include comprehensive speaker’s notes
·
Include appropriate graphics, images, and slide transitions
.
There are four general principles of effective intervention that hav.docx
There are four general principles of effective intervention that have become organizing concepts of community corrections. They have stimulated what has become known as the “what works” movement. Write a paper outlining the four general principles of the “what works” movement.
Thesis:
Your thesis (which is part of your first paragraph) should list the four principles of the effective intervention.
Body:
The body of your paper (your entire paper excluding the thesis and conclusion) should give a thoughtful analysis of the four general principles of effective intervention in a sequential order. Explain what the principles mean. Look for examples. Determine if the principles are effective. Explain why the principles either are, or are not, effective.
Conclusion:
The conclusion (which is part of the last paragraph) should, at the very least, restate the thesis.
The paper must be four pages in length (excluding title and reference pages) and formatted according to APA style. You must use at least three scholarly resources
.
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- 1. For this homework assignment, you will continue coding for Reports 2-5, which are located on pages 182-184 of the Step-by- Step Workbook. Using Encoder Pro, create codes for information from Reports 2-5. Additionally, explain how you arrived at that code. Report 2: Discharge Summary Diagnoses include: 1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma of unknown primary location. 2. Vena Cava syndrome post placement of Hickman catheter. 3. Anemia due to chronic disease. 4. Hypertension. HOSPITAL COURSE: The patient is a 78 year old female whom we have been following in our clinic for hypertension and also chronic pudendal nerve pain. She had been recently diagnosed with pelvic metastatic clear cell carcinoma, which her primary location is unknown at this time. She will be discussing this further after the pathology reports are read. During her hospital stay a Hickman catheter was placed in order to have IV access for pain medication or future cancer therapy. She was also admitted for chronic pain. She did develop swelling of her arms and neck. She was brought to interventional radiology and she did have venography and the Hickman catheter was removed. Her swelling to her arms and neck have decreased greatly. She denies any shortness of breath. No choking sensation as
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