Phil 2230: Philosophy of Religion
Final Essay Assignment
The Assignment: An argumentative essay (defending a thesis) evaluating an argument or view we have discussed in the second portion of the course – from the midterm essay through the end of the course. In using the word “evaluate” I mean to give you a lot of freedom with respect to constructing your thesis. You could argue that C. Stephen Evans’ criteria for identifying revelation suggest that the Qu’ran is in fact more likely to be revelation from God than the Bible is (or the opposite). Or you could argue that Evans’s criteria are not actually good ways to identify revelation. Or you could argue that Freud’s objection to religious belief succeeds – or fails. Or that Manis’s view of Hell is better than the alternatives. Or that no view of hell avoids objections, and so we shouldn’t believe in hell. And so forth – you have a lot of freedom. Just make sure that you are making, and defending, a claim about one of the views or arguments we have discussed.
Grading: I will grade for these factors:
· There must be a clear thesis and well-structured, clear arguments supporting the thesis. (This is by far the most important element of the grade.)
· Your statement of the argument or view which you are evaluating should be clear and fair; you should indicate understanding of the issues involved.
· Grammar and writing should be free of errors.
If you do everything right – you have a good thesis, solid arguments, good composition – you will get an A-. A full A requires that you do something outstanding – most likely an interesting original argument or view, or perhaps a really outstanding and insightful way of stating a problem, or something of that sort. So a full A is a significant achievement. An A+ means that the paper could, with work, be a publishable piece – this is graduate-quality work, and undergraduates almost never receive this grade.
Here is a complete statement of my grading scale:
A+: The idea is an original contribution to the debate and is the sort of paper that may be published in a professional journal or presented at a professional conference. This is graduate-level work, and undergraduates rarely receive this grade.
A: You did everything right, and had something extra special, most likely interesting and original arguments or ideas, or perhaps a particularly insightful way of putting a problem or some especially brilliant writing.
A-: You did everything right – good, clear thesis and organization, good arguments, and good writing – but you are missing the extra originality or creativity to make this an A.
B+: You did what was asked of you (pretty clear thesis, pretty good writing, and decent arguments), but something on that list (thesis, writing, arguments) is quite good, above the B level.
B: You did what was asked of you – you have a pretty clear thesis, pretty good writing, and decent arguments.
B-: You pretty much did what was asked of you, but something import.
Running Head Comparison and contrast2Comparison and contras.docxhealdkathaleen
Running Head: Comparison and contrast 2
Comparison and contrast 2
Post Concussive Syndrome and Traumatic Brain Injury
Student’s Name
Instructor Affiliation
Date
Requirements:
Week 2: Case Discussion: Pulmonary Part One
Setting: A free medical clinic that provides health care for the under-insured.
Your next patient, Michelle G., age 40, is a regular of the clinic and the last patient of the day. The chart states she is here for recent episodes of shortness of breath.
You enter the room and Michelle G is dressed in work clothes, standing up looking at a health poster on the wall. You introduce yourself and ask her what brings her to the clinic today. "I think I may have a cold. I've been having a hard time breathing on and off lately."
HPI: "I notice I'm short of breath mostly at work but by the time I get home feel fine. No episodes of shortness of breath on the weekends that I can recall. But a few hours back at work and I start to feel like I cannot catch my breath again. A few months ago this happened and it was so bad I left work and went to urgent care where they gave me a breathing treatment of some kind and sent me home on an antibiotic. I would like you to give me another antibiotic. She denies sputum. No new allergy triggers noted. She denies heartburn.
PMHx: Michelle G. reports her overall health as good.
Childhood/previous illnesses: eczema as a child
Chronic illnesses: Has seasonal allergies, spring is her worst season. Was seen by an allergy specialist ten years ago, Took allergy shots for five years with great results, now only takes Zyrtec when needed.
Surgeries: Cholecystectomy
Hospitalizations: childbirth x 3.
Immunizations: up-to-date on all vaccinations.
Allergies: Strawberries-Rash; erythromycin- severe GI upset.
Blood transfusions: none
Drinks alcohol socially, smoked 1 pack per week for 3 years in her 20's. Denies illicit drug use.
Sleeps 6 to 7 hours a night. Exercises four to five days per week.
Current medications: Multivitamin, Zyrtec
Social History: Married, lives with husband and 3 children. Worked in advertising up until 18 months ago when she got laid off. In order to help with the household finances she took a job as a Baker's assistant at an Artisan Bread Bakery. She arrives at 4 a.m. every morning to begin baking breads/pastries for the day.
Family History: Children are healthy- daughter currently has a sinus infection. Parents are deceased. Mother at age 80 from congestive heart failure. Father died at age 82 from lung cancer, diagnosed when metastasized to brain. PGM: died from unknown causes, PGF: Stroke at age 82. MGM: died at 83, had HTN, atherosclerosis and many heart attacks. PGF: died at 71 from complications of COPD.
PE: Height 5'10", Weight 140 pounds
Vital signs : BP 130/70, T 98.0, P 75, R 18 Sao2 98% on RA
General: 40-year-old Caucasian female appears stated age in no apparent distress. Alert, oriented, and cooperative. Able to speak in full sentences and does ...
1
Week 9 Patient Comprehensive Exam
Walden University
NURS 6512 Advanced Health Assessment
Dr. Vijayarani Suresh
August 2, 2021
This study source was downloaded by 100000830998373 from CourseHero.com on 04-29-2022 17:04:44 GMT -05:00
https://www.coursehero.com/file/104102356/Week-9-Patient-Comprehensive-Examdocx/
https://www.coursehero.com/file/104102356/Week-9-Patient-Comprehensive-Examdocx/
2
Week 9 Patient Comprehensive Exam
Week 9
Shadow Health Comprehensive SOAP Note Template
Patient Initials: T.J. Age:28 Gender: female
SUBJECTIVE DATA:
Chief Complaint (CC): “I’m here because I need a physical for my new job.”
History of Present Illness (HPI): T.J. is a 28-year-old African American female who is
here today for a general physical for a new job as an accounting clerk soon. She is
oriented to person, place, and time. She is calm, pleasant, and attentive. T.J. has dressed
appropriately for the season and is a good historian.
Medications: Metformin 850mg BID, last dose this morning
Flovent Inhaler two puffs twice daily, last used this morning
Albuterol Inhaler for rescue hasn’t been used recently. She states approximately three
months ago and has only used it twice last year.
Drospirenone/Ethinyl estradiol birth control, one pill daily. She started taking these four
months ago and was prescribed by her GYN MD. Last dose this morning.
Ibuprofen and Tylenol as needed
Allergies: Cats: makes asthma worse. PCN: “Not sure; I have been told this since I was a
child.” Denies any food allergies. She denies latex allergy. She states she does have some
environmental allergies.
Past Medical History (PMH): The patient has asthma, PCOS, and Type II Diabetes. She
states she checks her glucose every morning, and they have been stable. She has had
GERD in the past; however, she isn’t currently taking medication. She has only been
hospitalized for asthma as a child that she remembers and never for surgery. The patient
denies any severe injuries that would impair her. T.J. was seen for heart palpitations that
since then have subsided. She has been monitoring her blood pressure as it has fluctuated
at times but has now been normal. Last menstrual cycle was approximately two weeks
ago. The patient has never been pregnant and is up to date on her immunizations except
for the influenza vaccine. She recently had a routine pap smear; however, she needs to be
educated on how to do self-breast exams, as she states she has only had a doctor perform
this and doesn’t know what to look for. She denies any depressive or anxiety symptoms.
She has never had thoughts of harming herself or others, and She denies having a
transfusion. The patient states she was seen here a few months ago for a foot injury that
since then has subsided. She has back issues at times but is currently feeling well. The
This study source was downloaded by 100000830998373 from CourseHero.com on 04-29-2022 17:04:44 GMT -05:00
https://www.coursehero.com/file/1 ...
This week we are covering HEENT. At this time you are assigned an TakishaPeck109
This week we are covering HEENT. At this time you are assigned an episodic/focused note. You will need this assigned case study to complete the Case Study Assignment for this week. Focused assessment means you still fill out all review of systems and as needed type “Patient denies” in the sections that you are not covering or are needed. Again, you are allowed to make up the information that is needed to fill out the episodic note.
If your LAST NAME starts with letters A – J: please proceed with Option 1.
If your LAST NAME starts with letters K – Z: please proceed with Option 2.
Option 1:
CASE STUDY: Focused Throat Exam
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus during the past 2 weeks, Lily figured she shouldn't take her 3-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
To Prepare
· By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
· Review this week's Learning Resources and consider the insights they provide.
· Consider what history would be necessary to collect from the patient.
· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?
· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
This
week
we
are
covering
HEENT.
At
this
time
you
are
assigned
an
episodic
/
focuse
d
note.
You
will
need
this
assigned
case
study
to
complete
the
Case
Study
Assignment
for
this
week.
Focused
assessment
means
you
still
fill
out
all
review
of
systems
and
...
Heres another one. It is only a discussion but I need to reference t.docxhoward4little59962
Heres another one. It is only a discussion but I need to reference the text and one outside source at least. You may choose any factor you like.
Discussion: Respiratory Alterations
In clinical settings, patients often present with various respiratory symptoms such as congestion, coughing, and wheezing. While identifying a symptom’s underlying illness can be challenging, it is essential because even basic symptoms such as persistent coughing can be a sign of a more severe disorder. Advanced practice nurses must be able to differentiate between moderate and severe respiratory disorders, as well as properly diagnose and prescribe treatment for their patients. For this reason, you must have an understanding of the pathophysiology of respiratory disorders.
Consider the following three scenarios:
Scenario 1:
Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection.
Scenario 2:
Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.
Scenario 3:
Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state .
Running Head Comparison and contrast2Comparison and contras.docxhealdkathaleen
Running Head: Comparison and contrast 2
Comparison and contrast 2
Post Concussive Syndrome and Traumatic Brain Injury
Student’s Name
Instructor Affiliation
Date
Requirements:
Week 2: Case Discussion: Pulmonary Part One
Setting: A free medical clinic that provides health care for the under-insured.
Your next patient, Michelle G., age 40, is a regular of the clinic and the last patient of the day. The chart states she is here for recent episodes of shortness of breath.
You enter the room and Michelle G is dressed in work clothes, standing up looking at a health poster on the wall. You introduce yourself and ask her what brings her to the clinic today. "I think I may have a cold. I've been having a hard time breathing on and off lately."
HPI: "I notice I'm short of breath mostly at work but by the time I get home feel fine. No episodes of shortness of breath on the weekends that I can recall. But a few hours back at work and I start to feel like I cannot catch my breath again. A few months ago this happened and it was so bad I left work and went to urgent care where they gave me a breathing treatment of some kind and sent me home on an antibiotic. I would like you to give me another antibiotic. She denies sputum. No new allergy triggers noted. She denies heartburn.
PMHx: Michelle G. reports her overall health as good.
Childhood/previous illnesses: eczema as a child
Chronic illnesses: Has seasonal allergies, spring is her worst season. Was seen by an allergy specialist ten years ago, Took allergy shots for five years with great results, now only takes Zyrtec when needed.
Surgeries: Cholecystectomy
Hospitalizations: childbirth x 3.
Immunizations: up-to-date on all vaccinations.
Allergies: Strawberries-Rash; erythromycin- severe GI upset.
Blood transfusions: none
Drinks alcohol socially, smoked 1 pack per week for 3 years in her 20's. Denies illicit drug use.
Sleeps 6 to 7 hours a night. Exercises four to five days per week.
Current medications: Multivitamin, Zyrtec
Social History: Married, lives with husband and 3 children. Worked in advertising up until 18 months ago when she got laid off. In order to help with the household finances she took a job as a Baker's assistant at an Artisan Bread Bakery. She arrives at 4 a.m. every morning to begin baking breads/pastries for the day.
Family History: Children are healthy- daughter currently has a sinus infection. Parents are deceased. Mother at age 80 from congestive heart failure. Father died at age 82 from lung cancer, diagnosed when metastasized to brain. PGM: died from unknown causes, PGF: Stroke at age 82. MGM: died at 83, had HTN, atherosclerosis and many heart attacks. PGF: died at 71 from complications of COPD.
PE: Height 5'10", Weight 140 pounds
Vital signs : BP 130/70, T 98.0, P 75, R 18 Sao2 98% on RA
General: 40-year-old Caucasian female appears stated age in no apparent distress. Alert, oriented, and cooperative. Able to speak in full sentences and does ...
1
Week 9 Patient Comprehensive Exam
Walden University
NURS 6512 Advanced Health Assessment
Dr. Vijayarani Suresh
August 2, 2021
This study source was downloaded by 100000830998373 from CourseHero.com on 04-29-2022 17:04:44 GMT -05:00
https://www.coursehero.com/file/104102356/Week-9-Patient-Comprehensive-Examdocx/
https://www.coursehero.com/file/104102356/Week-9-Patient-Comprehensive-Examdocx/
2
Week 9 Patient Comprehensive Exam
Week 9
Shadow Health Comprehensive SOAP Note Template
Patient Initials: T.J. Age:28 Gender: female
SUBJECTIVE DATA:
Chief Complaint (CC): “I’m here because I need a physical for my new job.”
History of Present Illness (HPI): T.J. is a 28-year-old African American female who is
here today for a general physical for a new job as an accounting clerk soon. She is
oriented to person, place, and time. She is calm, pleasant, and attentive. T.J. has dressed
appropriately for the season and is a good historian.
Medications: Metformin 850mg BID, last dose this morning
Flovent Inhaler two puffs twice daily, last used this morning
Albuterol Inhaler for rescue hasn’t been used recently. She states approximately three
months ago and has only used it twice last year.
Drospirenone/Ethinyl estradiol birth control, one pill daily. She started taking these four
months ago and was prescribed by her GYN MD. Last dose this morning.
Ibuprofen and Tylenol as needed
Allergies: Cats: makes asthma worse. PCN: “Not sure; I have been told this since I was a
child.” Denies any food allergies. She denies latex allergy. She states she does have some
environmental allergies.
Past Medical History (PMH): The patient has asthma, PCOS, and Type II Diabetes. She
states she checks her glucose every morning, and they have been stable. She has had
GERD in the past; however, she isn’t currently taking medication. She has only been
hospitalized for asthma as a child that she remembers and never for surgery. The patient
denies any severe injuries that would impair her. T.J. was seen for heart palpitations that
since then have subsided. She has been monitoring her blood pressure as it has fluctuated
at times but has now been normal. Last menstrual cycle was approximately two weeks
ago. The patient has never been pregnant and is up to date on her immunizations except
for the influenza vaccine. She recently had a routine pap smear; however, she needs to be
educated on how to do self-breast exams, as she states she has only had a doctor perform
this and doesn’t know what to look for. She denies any depressive or anxiety symptoms.
She has never had thoughts of harming herself or others, and She denies having a
transfusion. The patient states she was seen here a few months ago for a foot injury that
since then has subsided. She has back issues at times but is currently feeling well. The
This study source was downloaded by 100000830998373 from CourseHero.com on 04-29-2022 17:04:44 GMT -05:00
https://www.coursehero.com/file/1 ...
This week we are covering HEENT. At this time you are assigned an TakishaPeck109
This week we are covering HEENT. At this time you are assigned an episodic/focused note. You will need this assigned case study to complete the Case Study Assignment for this week. Focused assessment means you still fill out all review of systems and as needed type “Patient denies” in the sections that you are not covering or are needed. Again, you are allowed to make up the information that is needed to fill out the episodic note.
If your LAST NAME starts with letters A – J: please proceed with Option 1.
If your LAST NAME starts with letters K – Z: please proceed with Option 2.
Option 1:
CASE STUDY: Focused Throat Exam
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus during the past 2 weeks, Lily figured she shouldn't take her 3-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
To Prepare
· By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
· Review this week's Learning Resources and consider the insights they provide.
· Consider what history would be necessary to collect from the patient.
· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?
· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
This
week
we
are
covering
HEENT.
At
this
time
you
are
assigned
an
episodic
/
focuse
d
note.
You
will
need
this
assigned
case
study
to
complete
the
Case
Study
Assignment
for
this
week.
Focused
assessment
means
you
still
fill
out
all
review
of
systems
and
...
Heres another one. It is only a discussion but I need to reference t.docxhoward4little59962
Heres another one. It is only a discussion but I need to reference the text and one outside source at least. You may choose any factor you like.
Discussion: Respiratory Alterations
In clinical settings, patients often present with various respiratory symptoms such as congestion, coughing, and wheezing. While identifying a symptom’s underlying illness can be challenging, it is essential because even basic symptoms such as persistent coughing can be a sign of a more severe disorder. Advanced practice nurses must be able to differentiate between moderate and severe respiratory disorders, as well as properly diagnose and prescribe treatment for their patients. For this reason, you must have an understanding of the pathophysiology of respiratory disorders.
Consider the following three scenarios:
Scenario 1:
Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection.
Scenario 2:
Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.
Scenario 3:
Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state .
CASE STUDY 2 Focused Throat Exam Lily is a 20-year-old student .docxmoggdede
CASE STUDY 2: Focused Throat Exam Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus during the past 2 weeks, Lily figured she shouldn't take her 3-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
To Prepare
· By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
· Review this week's Learning Resources and consider the insights they provide.
· Consider what history would be necessary to collect from the patient.
· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?
· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
Episodic/Focused SOAP Note Template
– (delete information on this template and input one related to the patient in the case study above).
Patient Information:
Initials, Age, Sex, Race
S.
CC
(chief complaint) a BRIEF statement identifying why the patient is here - in the patient’s own words - for instance "headache", NOT "bad headache for 3 days”.
HPI
: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:
Location: h.
Rogerian ArgumentTaken from the principles of psychologi.docxdaniely50
Rogerian Argument
Taken from the principles of psychologist Carl Rogers
Origins of this
principle
Based on Carl Rogers’ theory that people involved in disputes should not respond to each other until they fully and fairly state the other person’s position.
4 Parts of the Rogerian Argument
1. Introduction
2. Contexts
3. Writer’s position
4. Benefits to opponent
1. Introduction
The writer describes an issue well enough to show that he/she fully understands and respects the alternative position.
“Let’s meet in the middle.”
2. Contexts
The writer describes cases/contexts in which the alternative position may be legitimate.
“You may be right sometimes…”
3. Writer’s
Position
The writer states her/his position and presents circumstances in which it is valid. This is where the writer supports her/his views with evidence.
“This is why my position is right.”
4. Benefits to
Opponent
The writer explains to the opponent how he/she would benefit from adopting the writer’s position.
“See what you might gain by agreeing
with me?”
Summation
Rogerian arguments steer clear of incendiary and stereotypical language.
They emphasize how both sides of the argument might benefit by working together.
They advocate a win-win outcome.
1
Comprehensive Client Family Assessment
Demographic Information
Date of assessment: 09/14/2018.
DOB: 011/01/1970.
Age: 48.
Race: Black.
SSN: 000000001. Ethnicity: African American.
Address: On file. Tel: 972-000-0000.
Residential Status: Homeless.
County: 9K. Military Status: None.
Language: English.
Interpreter Needed: No.
Primary Insurance: Uninsured.
Annual Gross Income: $0.
Employment Status: Unemployed.
Number of people in the household: 1.
Highest Grade: 11.
School Attendance for the past 3 Months: None.
Arrival Time: 1000 Time Disposition Completed: 1100
Location of client: Lake Worth Nursing Home
Presenting Problem
“My meds are not working.”
History of Present Illness
The patient is presenting with suicidal ideation with a plan and intent to jump off the bridge or self-stabs with a knife. The patient complained about his medication, Latuda is no longer working. Currently homeless with no job or income. Though calm, polite, and cooperative with organized thoughts, patient reports depression and anxiety (American Psychiatric Association, 2013).
Past psychiatric history
1- Major Depressive disorder, Recurrent Episode with psychotic features
2- Alcohol use disorder; severe
3- Bipolar I Disorder most recent episode depressed Severe
Medical history
None Reported
Substance use history
Alcohol Abuse: began drinking at age 15 and drinks 8 to 10 bottles of beer daily, yesterday was his last time he drank.
Developmental history
None Reported
Family psychiatric history
Positive for family history of mental illness on the paternal side.
Psychosocial history
The patient is unemployed and enjoys han.
Unit 4 Discussion 1Critical Thinking and Diagnostic ReasoningP.docxmarilucorr
Unit 4 Discussion 1
Critical Thinking and Diagnostic Reasoning
Please select one of the following case studies and complete the chart. Please review audio-videos, PowerPoint presentations, and assigned chapters to assist with this Assignment. You are expected to role play the selected scenario with a family member to gather necessary data to complete the chart. For each person described in the following situations, discuss the developmental/age, socioeconomic, ethical considerations, and cross-cultural considerations that should be considered during the gathering of subjective and objective data, and the provision of health care. Discuss any additional information that might be needed before a judgment or diagnosis can be made. Submit the completed chart to the Discussion Board by Friday at 11:59 p.m.
1. A. E. is a 35-year-old African American female, and is 5 months pregnant presenting to the office today for a routine prenatal visit. She complains that her neck feels swollen and that she has been feeling nervous and tired. She also complains about the heat, excessive sweating, and how she “can’t seem to get cool during these summer months.” She attributes all these complaints to her pregnancy.
2. J. L. is a 55-year-old Caucasian female who had a CVA within the past week. J. L. is easily frustrated, anxious, fearful, and her speech is slurred. She needs verbal cuing for any task she is asked to carry out. She eats only food on the left side of the tray and responds only when approached from the left side.
Components of
assessment
Subjective
Diagnostic Reasoning
(list key questions — use PQRSTU pneumonic)
Objective
Normal vs.
abnormal findings
(must note pertinent body systems to be examined)
Differential
diagnoses
(list 3)
Nurses diagnosis (list 1)
List relevant labs and
diagnostic studies (if any)
Normal
Differential
Abnormal Findings
Nurses Diagnosis
Developmental/age considerations:
Socioeconomic considerations:
Cross-cultural considerations:
Ethical considerations:
Additional info needed to formulate actual diagnosis:
MN552 Advanced Health Assessment
Unit 3 SOAP Note Section II and III Written Guide
1. Document appropriate data in the relevant body system.
a. Do not state “Negative, NA or Unremarkable” for any systems because the reader will not know which questions were actually asked by the provider.
2. This is a comprehensive health history and should not contain physical exam findings. The focused history data is relevant to the chief complaint and identified by pertinent positive data documented during the health history.
3. Address each component of the SOAP note as noted in the written guide with relevant data.
4. You may continue with the same volunteer to complete each section of the SOAP note.
II. Life style patterns
0. Immigrant status: Born in San Diego, California. U.S. Citizen
0. Spiritual resources/religion: ...
Comprehensive SOAP TemplateThis template is for a full history.docxdonnajames55
Comprehensive SOAP Template
This template is for a full history and physical. For this course include only areas that are related to the case.
Patient Initials: _______
Age: _______
Gender: _______
Note: The mnemonic below is included for your reference and should be removed before the submission of your final note.
O = onset of symptom (acute/gradual)
L= location
D= duration (recent/chronic)
C= character
A= associated symptoms/aggravating factors
R= relieving factors
T= treatments previously tried – response? Why discontinued?
S= severity
SUBJECTIVE DATA: Include what the patient tells you, but organize the information.
Chief Complaint (CC): In just a few words, explain why the patient came to the clinic.
History of Present Illness (HPI): This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes ofeach principal symptom in paragraph form not a list:
1. Location
2. Quality
3. Quantity or severity
4. Timing, including onset, duration, and frequency
5. Setting in which it occurs
6. Factors that have aggravated or relieved the symptom
7. Associated manifestations
Medications: Include over-the-counter, vitamin, and herbal supplements. List each one by name with dosage and frequency.
Allergies: Include specific reactions to medications, foods, insects, and environmental factors. Identify if it is an allergy or intolerance.
Past Medical History (PMH): Include illnesses (also childhood illnesses), hospitalizations.
Past Surgical History (PSH): Include dates, indications, and types of operations.
Sexual/Reproductive History: If applicable, include obstetric history, menstrual history, methods of contraception, sexual function, and risky sexual behaviors.
Personal/Social History: Include tobacco use, alcohol use, drug use, patient’s interests, ADL’s and IADL’s if applicable, and exercise and eating habits.
Immunization History: Includelast Tdap, Flu, pneumonia, etc.
Significant Family History: Include history of parents, grandparents, siblings, and children.
Lifestyle: Include cultural factors, economic factors, safety, and support systems and sexual preference.
Review of Systems: From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History (this includes the systems that address any previous diagnoses).Remember that the information you include in this section is based on what the patient tells you so ensure that you include all essentials in your case (refer to Chapter 2 of the Sullivan text).
General: Include any recent weight changes, weakness, fatigue, or fever, but do not restate HPI data here.
HEENT:
Neck:
Breasts:
Respiratory:
Cardiovascular/Peripheral Vascular:
Gastrointestinal:
Genitourinary:
Mu.
It is a case study report of mucopolysaccharidosis, I did when I was posted in Kanti Children's hospital
Prepared by:
Rashmi Regmi
B. Sc Nursing
Manmohan Memorial Institute of Health Sciences
Chief compliant(CC) Joshuas hyperactive and attentional difficultJinElias52
Chief compliant(CC) Joshua's hyperactive and attentional difficulties have been exhibited both at school and at home.
HISTORY: Joshua is a Hispanic or Latino 10-year-old boy. This evaluation was requested because
mother is worried about patient's aggressive behavior toward his younger brother and ADHD
symptoms. Mother report that patient was diagnosed at age 6 by pediatrician with ADHD,
medication was started at that time (mother unable to remember name) until age 9. Mother stopped
administering medication because it caused decrease appetite, insomnia and weight loss. Patient
is not currently taking any medication at this time.
Behavior Described In:
Symptoms/ behavior Joshua exhibits symptoms of inattention. He reports difficulty sustaining attention. His mind
wanders or he forgets. He does not seem to listen when spoken to directly. He often needs
directions repeated. Joshua is easily distracted by noises. by the radio. by other people. Joshua
needs supervision or frequent redirection. He has a short attention span.
Joshua exhibits signs of hyperactivity. He exhibits restlessness or fidgety behavior. This
behavior is evident during school hours. He tends to frequently leave his seat. He is
easily bored and changes activities frequently. Joshua 's excessive movement has been noted. He
is fidgety or squirms when required to sit still for a period of time. He frequently jumps or climbs.
Joshua exhibits signs of impulsive behavior. He frequently interrupts others. He often acts
in a reckless manner. He has difficulty accepting limits.
Joshua has other exhibited symptoms.
He exhibits stubborn or willful behavior.
EXAM: Joshua appears flat, inattentive, distracted, normal weight, He exhibits speech that is
normal in rate, volume, and articulation and is coherent and spontaneous. Language skills are
intact. Affect is appropriate, full range, and congruent with mood. Associations are intact and
logical. There are no apparent signs of hallucinations, delusions, bizarre behaviors, or other
indicators of psychotic process. Associations are intact, thinking is logical, and thought content
appears appropriate. Suicidal ideas or intentions are denied. Homicidal ideas or intentions are
denied. There are signs of anxiety. A short attention span is evident. Judgment appears to be
poor. Insight into problems appears to be poor. He is easily distracted. Joshua is restless. Joshua is
fidgety. There is physical hyperactivity. Joshua displayed defiant behavior during the examination.
Joshua made poor eye contact during the examination. Vocabulary and fund of knowledge indicate
cognitive functioning in the normal range. Cognitive functioning and fund of knowledge are intact
and age appropriate. Short- and long-term memory are intact, as is ability to abstract and do
Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation
Comprehensive psychiatric evaluations are a way to reflect on your practicum experiences and connect the experiences ...
Discussion: Respiratory Alterations
In clinical settings, patients often present with various respiratory symptoms such as congestion, coughing, and wheezing. While identifying a symptom’s underlying illness can be challenging, it is essential because even basic symptoms such as persistent coughing can be a sign of a more severe disorder. Advanced practice nurses must be able to differentiate between moderate and severe respiratory disorders, as well as properly diagnose and prescribe treatment for their patients. For this reason, you must have an understanding of the pathophysiology of respiratory disorders.
Consider the following three scenarios:
Scenario 1:
Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection.
Scenario 2:
Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.
Scenario 3:
Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-produci.
Make a SOAP Note Assessing Ear, Nose, and ThroatMost ear, nose, a.docxeubanksnefen
Make a SOAP Note: Assessing Ear, Nose, and Throat
Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test.
In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
Note:
By Day 1 of this week, your instructor will have assigned you to one of the following case studies to review for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance.
Remember that not all comprehensive SOAP data are included in every patient case.
Case 1:
Nose Focused Exam
Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he's taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.
Case 2:
Focused Throat Exam
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn't take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
Case.
you will evaluate the history of cryptography from its origins. Ana.docxmattjtoni51554
you will evaluate the history of cryptography from its origins. Analyze how cryptography was used and describe how it grew within history. Look at reasons why cryptography was used and how it developed over the years. Was it used or implemented differently in varying cultures?
need it in two pages.
No plagarism
.
You will do this project in a group of 5 or less. Each group or in.docxmattjtoni51554
You will do this project in a group of 5 or less. Each group or individual will sign up to present on a public health issue and intervention of their choice. They will provide background information on the public health issue and explain why it is relevant and/or prevalent. They will also determine if some of the factors discussed throughout the course (i.e. urbanization, vulnerable populations, health disparities, social determinants of health, public health ethics, health literacy, etc.) were major factors in the development and implementation of the intervention that they choose to highlight. The groups or individuals will prepare a presentation of their information as well as a paper to depict their findings. The presentation can be in any form including, but not limited to, a PowerPoint presentation, a Prezi, a website, a video recording, etc.
My assigned part.
vulnerable populations Morolake
health disparities Morolake
social determinants of health, public health ethics Morolake
PPT
THE IMPLEMENTATION PLAN THAT WAS USED TO FORMULATE THE COMMUNICATION CAMPAIGN
3 slides excluding the references
.
More Related Content
Similar to Phil 2230 Philosophy of ReligionFinal Essay AssignmentThe A.docx
CASE STUDY 2 Focused Throat Exam Lily is a 20-year-old student .docxmoggdede
CASE STUDY 2: Focused Throat Exam Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus during the past 2 weeks, Lily figured she shouldn't take her 3-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
To Prepare
· By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
· Review this week's Learning Resources and consider the insights they provide.
· Consider what history would be necessary to collect from the patient.
· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?
· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
Episodic/Focused SOAP Note Template
– (delete information on this template and input one related to the patient in the case study above).
Patient Information:
Initials, Age, Sex, Race
S.
CC
(chief complaint) a BRIEF statement identifying why the patient is here - in the patient’s own words - for instance "headache", NOT "bad headache for 3 days”.
HPI
: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:
Location: h.
Rogerian ArgumentTaken from the principles of psychologi.docxdaniely50
Rogerian Argument
Taken from the principles of psychologist Carl Rogers
Origins of this
principle
Based on Carl Rogers’ theory that people involved in disputes should not respond to each other until they fully and fairly state the other person’s position.
4 Parts of the Rogerian Argument
1. Introduction
2. Contexts
3. Writer’s position
4. Benefits to opponent
1. Introduction
The writer describes an issue well enough to show that he/she fully understands and respects the alternative position.
“Let’s meet in the middle.”
2. Contexts
The writer describes cases/contexts in which the alternative position may be legitimate.
“You may be right sometimes…”
3. Writer’s
Position
The writer states her/his position and presents circumstances in which it is valid. This is where the writer supports her/his views with evidence.
“This is why my position is right.”
4. Benefits to
Opponent
The writer explains to the opponent how he/she would benefit from adopting the writer’s position.
“See what you might gain by agreeing
with me?”
Summation
Rogerian arguments steer clear of incendiary and stereotypical language.
They emphasize how both sides of the argument might benefit by working together.
They advocate a win-win outcome.
1
Comprehensive Client Family Assessment
Demographic Information
Date of assessment: 09/14/2018.
DOB: 011/01/1970.
Age: 48.
Race: Black.
SSN: 000000001. Ethnicity: African American.
Address: On file. Tel: 972-000-0000.
Residential Status: Homeless.
County: 9K. Military Status: None.
Language: English.
Interpreter Needed: No.
Primary Insurance: Uninsured.
Annual Gross Income: $0.
Employment Status: Unemployed.
Number of people in the household: 1.
Highest Grade: 11.
School Attendance for the past 3 Months: None.
Arrival Time: 1000 Time Disposition Completed: 1100
Location of client: Lake Worth Nursing Home
Presenting Problem
“My meds are not working.”
History of Present Illness
The patient is presenting with suicidal ideation with a plan and intent to jump off the bridge or self-stabs with a knife. The patient complained about his medication, Latuda is no longer working. Currently homeless with no job or income. Though calm, polite, and cooperative with organized thoughts, patient reports depression and anxiety (American Psychiatric Association, 2013).
Past psychiatric history
1- Major Depressive disorder, Recurrent Episode with psychotic features
2- Alcohol use disorder; severe
3- Bipolar I Disorder most recent episode depressed Severe
Medical history
None Reported
Substance use history
Alcohol Abuse: began drinking at age 15 and drinks 8 to 10 bottles of beer daily, yesterday was his last time he drank.
Developmental history
None Reported
Family psychiatric history
Positive for family history of mental illness on the paternal side.
Psychosocial history
The patient is unemployed and enjoys han.
Unit 4 Discussion 1Critical Thinking and Diagnostic ReasoningP.docxmarilucorr
Unit 4 Discussion 1
Critical Thinking and Diagnostic Reasoning
Please select one of the following case studies and complete the chart. Please review audio-videos, PowerPoint presentations, and assigned chapters to assist with this Assignment. You are expected to role play the selected scenario with a family member to gather necessary data to complete the chart. For each person described in the following situations, discuss the developmental/age, socioeconomic, ethical considerations, and cross-cultural considerations that should be considered during the gathering of subjective and objective data, and the provision of health care. Discuss any additional information that might be needed before a judgment or diagnosis can be made. Submit the completed chart to the Discussion Board by Friday at 11:59 p.m.
1. A. E. is a 35-year-old African American female, and is 5 months pregnant presenting to the office today for a routine prenatal visit. She complains that her neck feels swollen and that she has been feeling nervous and tired. She also complains about the heat, excessive sweating, and how she “can’t seem to get cool during these summer months.” She attributes all these complaints to her pregnancy.
2. J. L. is a 55-year-old Caucasian female who had a CVA within the past week. J. L. is easily frustrated, anxious, fearful, and her speech is slurred. She needs verbal cuing for any task she is asked to carry out. She eats only food on the left side of the tray and responds only when approached from the left side.
Components of
assessment
Subjective
Diagnostic Reasoning
(list key questions — use PQRSTU pneumonic)
Objective
Normal vs.
abnormal findings
(must note pertinent body systems to be examined)
Differential
diagnoses
(list 3)
Nurses diagnosis (list 1)
List relevant labs and
diagnostic studies (if any)
Normal
Differential
Abnormal Findings
Nurses Diagnosis
Developmental/age considerations:
Socioeconomic considerations:
Cross-cultural considerations:
Ethical considerations:
Additional info needed to formulate actual diagnosis:
MN552 Advanced Health Assessment
Unit 3 SOAP Note Section II and III Written Guide
1. Document appropriate data in the relevant body system.
a. Do not state “Negative, NA or Unremarkable” for any systems because the reader will not know which questions were actually asked by the provider.
2. This is a comprehensive health history and should not contain physical exam findings. The focused history data is relevant to the chief complaint and identified by pertinent positive data documented during the health history.
3. Address each component of the SOAP note as noted in the written guide with relevant data.
4. You may continue with the same volunteer to complete each section of the SOAP note.
II. Life style patterns
0. Immigrant status: Born in San Diego, California. U.S. Citizen
0. Spiritual resources/religion: ...
Comprehensive SOAP TemplateThis template is for a full history.docxdonnajames55
Comprehensive SOAP Template
This template is for a full history and physical. For this course include only areas that are related to the case.
Patient Initials: _______
Age: _______
Gender: _______
Note: The mnemonic below is included for your reference and should be removed before the submission of your final note.
O = onset of symptom (acute/gradual)
L= location
D= duration (recent/chronic)
C= character
A= associated symptoms/aggravating factors
R= relieving factors
T= treatments previously tried – response? Why discontinued?
S= severity
SUBJECTIVE DATA: Include what the patient tells you, but organize the information.
Chief Complaint (CC): In just a few words, explain why the patient came to the clinic.
History of Present Illness (HPI): This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes ofeach principal symptom in paragraph form not a list:
1. Location
2. Quality
3. Quantity or severity
4. Timing, including onset, duration, and frequency
5. Setting in which it occurs
6. Factors that have aggravated or relieved the symptom
7. Associated manifestations
Medications: Include over-the-counter, vitamin, and herbal supplements. List each one by name with dosage and frequency.
Allergies: Include specific reactions to medications, foods, insects, and environmental factors. Identify if it is an allergy or intolerance.
Past Medical History (PMH): Include illnesses (also childhood illnesses), hospitalizations.
Past Surgical History (PSH): Include dates, indications, and types of operations.
Sexual/Reproductive History: If applicable, include obstetric history, menstrual history, methods of contraception, sexual function, and risky sexual behaviors.
Personal/Social History: Include tobacco use, alcohol use, drug use, patient’s interests, ADL’s and IADL’s if applicable, and exercise and eating habits.
Immunization History: Includelast Tdap, Flu, pneumonia, etc.
Significant Family History: Include history of parents, grandparents, siblings, and children.
Lifestyle: Include cultural factors, economic factors, safety, and support systems and sexual preference.
Review of Systems: From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History (this includes the systems that address any previous diagnoses).Remember that the information you include in this section is based on what the patient tells you so ensure that you include all essentials in your case (refer to Chapter 2 of the Sullivan text).
General: Include any recent weight changes, weakness, fatigue, or fever, but do not restate HPI data here.
HEENT:
Neck:
Breasts:
Respiratory:
Cardiovascular/Peripheral Vascular:
Gastrointestinal:
Genitourinary:
Mu.
It is a case study report of mucopolysaccharidosis, I did when I was posted in Kanti Children's hospital
Prepared by:
Rashmi Regmi
B. Sc Nursing
Manmohan Memorial Institute of Health Sciences
Chief compliant(CC) Joshuas hyperactive and attentional difficultJinElias52
Chief compliant(CC) Joshua's hyperactive and attentional difficulties have been exhibited both at school and at home.
HISTORY: Joshua is a Hispanic or Latino 10-year-old boy. This evaluation was requested because
mother is worried about patient's aggressive behavior toward his younger brother and ADHD
symptoms. Mother report that patient was diagnosed at age 6 by pediatrician with ADHD,
medication was started at that time (mother unable to remember name) until age 9. Mother stopped
administering medication because it caused decrease appetite, insomnia and weight loss. Patient
is not currently taking any medication at this time.
Behavior Described In:
Symptoms/ behavior Joshua exhibits symptoms of inattention. He reports difficulty sustaining attention. His mind
wanders or he forgets. He does not seem to listen when spoken to directly. He often needs
directions repeated. Joshua is easily distracted by noises. by the radio. by other people. Joshua
needs supervision or frequent redirection. He has a short attention span.
Joshua exhibits signs of hyperactivity. He exhibits restlessness or fidgety behavior. This
behavior is evident during school hours. He tends to frequently leave his seat. He is
easily bored and changes activities frequently. Joshua 's excessive movement has been noted. He
is fidgety or squirms when required to sit still for a period of time. He frequently jumps or climbs.
Joshua exhibits signs of impulsive behavior. He frequently interrupts others. He often acts
in a reckless manner. He has difficulty accepting limits.
Joshua has other exhibited symptoms.
He exhibits stubborn or willful behavior.
EXAM: Joshua appears flat, inattentive, distracted, normal weight, He exhibits speech that is
normal in rate, volume, and articulation and is coherent and spontaneous. Language skills are
intact. Affect is appropriate, full range, and congruent with mood. Associations are intact and
logical. There are no apparent signs of hallucinations, delusions, bizarre behaviors, or other
indicators of psychotic process. Associations are intact, thinking is logical, and thought content
appears appropriate. Suicidal ideas or intentions are denied. Homicidal ideas or intentions are
denied. There are signs of anxiety. A short attention span is evident. Judgment appears to be
poor. Insight into problems appears to be poor. He is easily distracted. Joshua is restless. Joshua is
fidgety. There is physical hyperactivity. Joshua displayed defiant behavior during the examination.
Joshua made poor eye contact during the examination. Vocabulary and fund of knowledge indicate
cognitive functioning in the normal range. Cognitive functioning and fund of knowledge are intact
and age appropriate. Short- and long-term memory are intact, as is ability to abstract and do
Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation
Comprehensive psychiatric evaluations are a way to reflect on your practicum experiences and connect the experiences ...
Discussion: Respiratory Alterations
In clinical settings, patients often present with various respiratory symptoms such as congestion, coughing, and wheezing. While identifying a symptom’s underlying illness can be challenging, it is essential because even basic symptoms such as persistent coughing can be a sign of a more severe disorder. Advanced practice nurses must be able to differentiate between moderate and severe respiratory disorders, as well as properly diagnose and prescribe treatment for their patients. For this reason, you must have an understanding of the pathophysiology of respiratory disorders.
Consider the following three scenarios:
Scenario 1:
Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection.
Scenario 2:
Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.
Scenario 3:
Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-produci.
Make a SOAP Note Assessing Ear, Nose, and ThroatMost ear, nose, a.docxeubanksnefen
Make a SOAP Note: Assessing Ear, Nose, and Throat
Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test.
In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
Note:
By Day 1 of this week, your instructor will have assigned you to one of the following case studies to review for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance.
Remember that not all comprehensive SOAP data are included in every patient case.
Case 1:
Nose Focused Exam
Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he's taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.
Case 2:
Focused Throat Exam
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn't take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
Case.
you will evaluate the history of cryptography from its origins. Ana.docxmattjtoni51554
you will evaluate the history of cryptography from its origins. Analyze how cryptography was used and describe how it grew within history. Look at reasons why cryptography was used and how it developed over the years. Was it used or implemented differently in varying cultures?
need it in two pages.
No plagarism
.
You will do this project in a group of 5 or less. Each group or in.docxmattjtoni51554
You will do this project in a group of 5 or less. Each group or individual will sign up to present on a public health issue and intervention of their choice. They will provide background information on the public health issue and explain why it is relevant and/or prevalent. They will also determine if some of the factors discussed throughout the course (i.e. urbanization, vulnerable populations, health disparities, social determinants of health, public health ethics, health literacy, etc.) were major factors in the development and implementation of the intervention that they choose to highlight. The groups or individuals will prepare a presentation of their information as well as a paper to depict their findings. The presentation can be in any form including, but not limited to, a PowerPoint presentation, a Prezi, a website, a video recording, etc.
My assigned part.
vulnerable populations Morolake
health disparities Morolake
social determinants of health, public health ethics Morolake
PPT
THE IMPLEMENTATION PLAN THAT WAS USED TO FORMULATE THE COMMUNICATION CAMPAIGN
3 slides excluding the references
.
you will discuss the use of a tool for manual examination of a .docxmattjtoni51554
you will discuss the use of a tool for manual examination of a phone:
Example tools used
Hardware tools
1.Project-A-Phone
2. Fernico ZRT
3. Eclipse Screen Capture Tool
4.Cellebrite USB camera
Software solution tools
1. ScreenHunter
2. Snagit
Select one of the tools mentioned in the text and describe the tools functionality and process used in an examination of a device.
Using the Internet, research the web for an article related to the tool and answer the following questions:
What are some of the advantages or disadvantages of the tool?
Discuss the tools setup
Appraise the value of the tool in gathering evidence for the prosecution
.
you will discuss sexuality, popular culture and the media. What is .docxmattjtoni51554
you will discuss sexuality, popular culture and the media. What is social and sexual norms? What would you consider the ideal sexual behavior and pattern with regards to sexuality and society? Be sure to use your textbook as a reference and submit your initial posting with citations and references at a minimum of 200 words by Thursday.
.
You will discuss assigned questions for the ModuleWeek. · Answe.docxmattjtoni51554
You will discuss assigned questions for the Module/Week.
· Answers to questions must be supported with research and citations. It is not unusual, for instance, to have 3–4 citations per paragraph in doctoral-level research.
· Remember also that writing a research paper, especially at the doctoral-level, requires you to weave in ideas from numerous sources and then in turn synthesizing those ideas to create fresh insights and knowledge.
Specifics:
· 10-12 pages of content, double-spaced
· Must include citations from all readings and presentations for the assigned module (including the Fischer presentations and readings) and at least 15 scholarly sources
· Must include Biblical integration (the Fischer sources will help to that end)
· Current APA format
Module/Week 5 Essay
Discuss the following:
· Define governance.
· What are some of the connotations of the term governance as well?
· What is meant by “good” governance?
· Provide a Biblical perspective on governance in the public administration context.
Essay Paper Grading Rubric
Criteria
Levels of Achievement
Content
(70%)
Advanced
94-100%
Proficient
88-93%
Developing
1-87%
Not present
Total
Content
42.5 to 45 points
:
· Thoroughly answers each assigned question.
· Provides a well-reasoned synthesis of key ideas.
39.5 to 42 points
:
· Answers each assigned question.
· Provides some synthesis of key ideas.
1 to 39 points
:
· Fails to answer one or more questions.
· Largely fails to provide a meaningful synthesis of key ideas.
0 points
Not present
Research & Support
42.5 to 45 points
:
· Goes beyond required reading to provide an in-depth, researched discussion of the assigned questions.
· Supports assertions with research and numerous citations from all required reading, presentations, and scholarly source material.
39.5 to 42 points
:
· For the most part, goes beyond required reading to provide a discussion of the assigned questions.
· For the most part, supports assertions with research and citations.
1 to 39 points
:
· Largely fails to go beyond the required reading to answer questions.
· Limited use of research and citations to support assertions.
0 points
Not present
Biblical Integration
30.5 to 32.5 points
:
Provides a nuanced discussion of Biblical concepts as related to the content and assigned questions.
28.5 to 30 points
:
For the most part, provides a discussion of Biblical concepts as related to the content and assigned questions.
1 to 28 points
:
Provides only a limited discussion of Biblical concepts as related to the content and assigned questions.
0 points
Not present
Structure (30%)
Advanced
94-100%
Proficient
88-93%
Developing
1-87%
Not present
Total
Sources & Citations
19 to 20 points:
· All required readings and presentations from the current and prior modules must be cited.
· At least 15 scholarly sources are used.
17.5 to 18.5 points:
· Most of the required readings and present.
You will develop a proposed public health nursing intervention to me.docxmattjtoni51554
You will develop a proposed public health nursing intervention to meet an identified need and/ or gap in your own community. This must be within the scope of the staff level public health/ community health nurse. (Note: you cannot propose building facilities or purchasing a mobile health van). The intervention should demonstrate your application of previous learning in the program related to process improvement and evidence based nursing practice. Quality peer reviewed references are required to support the need as well as the structure, elements, and evaluation of the intervention.Focus on your own local community. You will use resources found in CANVAS, FSW library, and the web to develop this project. Note that census and other epidemiological data is not available down to zip codes or census tracts in Florida- only by county and/ or city & state.
Community Data Collection Survey – THIS IS THE FIRST STEP IN TO COMPLETE YOUR FINAL PAPER. Community Data Collection Survey
Collect relevant data about your community covering the required areas in the survey tool. References are required to support the data. The final part of the Survey is your summary of the identified gap/ need that will be the focus of a targeted public health nursing intervention in your Community Assessment Project. The Data Assessment Form is in Course Resources in Modules. The form is a tool to assist you collect your data and information.
This is a scholarly paper with appropriate use of tables (see APA Manual for how to format and label tables).
Utilize the resources and web sites located in Course Resources in Canvas. In addition, Community Health Assessments are usually published by your county and/ city with relevant information. The data is usually based on county and/ city information. You can also look at Robert Wood Johnson Foundation information on public health issues that may be applicable to your area. Many resources are provided in Course Resources as a starting point for your data collection. DO NOT Submit the tool... this is a paper.
NUR 4636C Community Health Nursing Assessment Tool v2-1.docx
PAPER CONTENT:
Community Being Assessed
Vital Statistics
Births
Deaths
Causes of mortality and morbidity
Leading infectious diseases
Number of healthy days
3. Social Determinants of Health
Access to health care
Housing
Employment
Environment -Water and Air quality, pollution
Safety- police, fire
Education systems
Recreation
Government role in health access/ provision
Issue/ need identified.
includes at least 5 references from current peer-reviewed nursing journals and /or textbook or reliable education, government or organizational website.
This is for the Lee county area.
.
You will develop a comprehensive literature search strategy. After r.docxmattjtoni51554
You will develop a comprehensive literature search strategy. After reviewing Chapter 5 in
How To Do A Systematic Literature Review In Nursing: A Step-By-Step Guide
(Bettany-Saltikov, 2012), address the following:
Identify each step involved in the comprehensive literature search strategy
Outline each step as it applies to your capstone
Next, you will locate two existing scholarly articles that are Attached and show evidence of (1) properly paraphrasing and citing the abstract, and (2) directly quoting two sentences from the abstract
(with proper attribution). Be sure to include a reference list that corresponds with your general citation and direct quote citation. You do
not
need a title page.
Please keep in mind that I am looking for evidence of understanding the difference between properly
paraphrasing conten
t and a
direct quote
. Both require its respective in-text citation.
In two diferent paragraph give your personal opinion to Jordan Paltani and Felita Daniel-sacagiu
Jordan Paltani
Write What is Right
Each step involved in the comprehensive literature search strategy include evaluating references to help find ideas of sources to use, searching by hand to avoid bias, reading “grey” conference proceedings and/or PhD theses, and contacting authors to get access to unpublished literature.
Each step as it applies to my capstone would be first looking at references from the online article
Study: the kidney shortage kills more than 40,000 people a year
, searching in library books starting with organ donation and leading to the shortage of organs, finding doctors who specialize in kidney transplant and see what their PhD thesis was based up, and contacting Dr. Pasavento who wrote the article
Facing Organ Donor Shortage, Patients Forced to Get Creative
.
The article
The Organ Shortage Crisis in America : Incentives, Civic Duty, and Closing the Gap
discusses how the cadaveric kidney donors are becoming insufficient to meet the needs of those in need of a transplant. The author states
“Nearly 120,000 people are in need of healthy organs in the United States (Flescher, 2018).”
It explains how they are trying to increase living donors to donate to those in need either related or unrelated (Flescher, 2018). The author states,
“Every ten minutes a new name is added to the list, while on average twenty people die each day waiting for an organ to become available.”
With that being said, some ideas include paying those for their kidneys or having them just spend a day at dialysis with a patient.
The article
Relieving the kidney donor shortage
, discusses how kidney transplantation is the only treatment for kidney failure. Having a kidney transplant is cheaper than dialysis, which is only a Band-Aid for kidney failure. Financial incentives are currently an idea to have the amount of living donors increase. This can be beneficial for both the donor and the recipient. The autho.
You will develop a formal information paper that addresses the l.docxmattjtoni51554
You will develop a formal information paper that addresses the legal basis of current Department of Homeland Security jurisdiction, mission, and responsibilities. You will need to specifically analyze hazards, to include manmade or technological and naturally occurring hazards, and terrorism, domestic and foreign, in the information paper.
You are an action officer in your local jurisdiction's Office of Homeland Security. This is a recently created office. As a medium-size jurisdiction, the city manager's office has dual responsibilities in many of the leadership and management positions. This is often referred to as being dual-hatted. The chief of police has been assigned as the director of the Office of Homeland Security for the city. She has no prior experience or knowledge of the requirements involved in homeland security and has asked you to provide a formal report on the topic. The chief intends to share this report with other office managers, city department heads, the city manager, and the elected officials of the city (mayor and city council).
Your report is an information paper and should be formatted as such. The report should address the following items:
The legal basis of current Department of Homeland Security jurisdiction, mission, and responsibilities
Legal definitions of hazards, to include manmade or technological and naturally occurring hazards
Legal definitions of terrorism, domestic and foreign
Review of state law and statutes (using your home or residency state) as it applies to hazards
Review of state law and statutes (using your home or residency state) as it applies to terrorism
Summarize your top 5 key points
Provide any recommendations that you may have to your city's leadership concerning homeland security issues
Reference all source material and citations using APA 6th edition
.
You will design a patient education tool that can be used by nurses .docxmattjtoni51554
You will design a patient education tool that can be used by nurses for teaching patients
using computer applications
. You will then present your tool to the class and explain the purpose, how you created it, reasoning for your choice of applications, and provide current evidence of the effectiveness of this patient education. This presentation is 5-10 minutes.
Assignment File(s)
Patient Education Project and Presentation
[Word Document]
Rubric
NM 208 Patient Education Project Tool
NM 208 Patient Education Project ToolCriteriaRatingsPtsThis criterion is linked to a Learning OutcomeUse of Computer Applications
20.0
to >17.0
ptsHigh ProficiencyCreative, innovative, effective use of computer applications17.0
to >14.0
ptsModerately High ProficiencyEffective use of computer applications14.0
to >10.0
ptsProficient PointsIneffective use of computer use of applications10.0
to >0
ptsLow-Level Proficiency/Non-ProficientLacking use of computer applications
20.0 pts
This criterion is linked to a Learning OutcomeOrganization
20.0
to >17.0
ptsHigh ProficiencyExtremely well organized; logical format that was easy to follow; flowed smoothly from one idea to another and cleverly conveyed; the organization enhanced the effectiveness of the project17.0
to >14.0
ptsModerately High ProficiencyWell organized; logical format that was easy to follow; flowed smoothly from one idea to another and conveyed; the organization enhanced the effectiveness of the project14.0
to >10.0
ptsProficient PointsSomewhat organized; ideas were not presented coherently and transitions were not always smooth, which at times distracted the audience10.0
to >0
ptsLow-Level Proficiency/Non-ProficientChoppy and confusing; format was difficult to follow transitions of ideas were abrupt and seriously distracted the audience
20.0 pts
This criterion is linked to a Learning OutcomeContent Accuracy
20.0
to >17.0
ptsHigh Proficiency100 % of the facts are accurate17.0
to >14.0
ptsModerately High Proficiency99-90% of the facts are accurate14.0
to >10.0
ptsProficient Points89-80% of the facts are accurate10.0
to >0
ptsLow-Level Proficiency/Non-ProficientFewer than 80% of facts are accurate
20.0 pts
This criterion is linked to a Learning OutcomeResearch
20.0
to >17.0
ptsHigh ProficiencyWent above and beyond to research information; solicited material in addition to what was provided; brought in personal ideas and information to enhance project; and utilized variety of resources to make project effective17.0
to >14.0
ptsModerately High ProficiencyDid a very good job of researching; utilized materials provided to their full potential; solicited adequate resources to enhance project; at time took the initiative to find information outside of school.14.0
to >10.0
ptsProficient PointsUsed the material provided in an acceptable manner, but did not consult any additional resources10.0
to >0
ptsLow-Level Proficiency/Non-ProficientDid not utilize resources effectively.
You will design a patient education tool that can be used by nur.docxmattjtoni51554
You will design a patient education tool that can be used by nurses for teaching patients
using computer applications.
You will then present your tool to the class and explain the purpose, how you created it, reasoning for your choice of applications, and provide current evidence of the effectiveness of this patient education. This presentation is 5-10 minutes.
DUE DATE:
Total Points: 200
Patient Education Project Tool Rubric - 100 points
Points
18-20
14-17
10-16
0
Comments
Use of Computer Applications
Creative, innovative, effective use of computer applications
Effective use of computer applications
Ineffective use of computer use of applications
Lacking use of computer applications
Organization
Extremely well organized; logical format that was easy to follow; flowed smoothly from one idea to another and cleverly conveyed; the organization enhanced the effectiveness of the project
Well organized; logical format that was easy to follow; flowed smoothly from one idea to another and conveyed; the organization enhanced the effectiveness of the project
Somewhat organized; ideas were not presented coherently and transitions were not always smooth, which at times distracted the audience
Choppy and confusing; format was difficult to follow transitions of ideas were abrupt and seriously distracted the audience
Content Accuracy
100 % of the facts are accurate
99-90% of the facts are accurate
89-80% of the facts are accurate
Fewer than 80% of facts are accurate
Research
Went above and beyond to research information; solicited material in addition to what was provided; brought in personal ideas and information to enhance project; and utilized variety of resources to make project effective
Did a very good job of researching; utilized materials provided to their full potential; solicited adequate resources to enhance project; at time took the initiative to find information outside of school.
Used the material provided in an acceptable manner, but did not consult any additional resources
Did not utilize resources effectively; did little or no fact gathering on the topic
Creativity
Was extremely clever and presented with originality; a unique approach that truly enhanced the project
Was clever at times; thoughtfully and uniquely presented
Added a few original touches to enhance the project but did not incorporate them throughout
Little creative energy used during this project; was bland, predictable, and lacked “zip”
Patient Education Project Class Presentation Rubric: 100 points
Points
18-20
14-17
10-13
5-9
0-4
Comments
Voice
Speaker uses appropriate pitch, volume, and rate of speaking. Articulation excellent.
Hasty conversational style; does not interfere with volume or articulation. Communication is unhampered.
Low volume; hasty conversational style compromises artic.
You will create an entire Transformational Change Management Plan fo.docxmattjtoni51554
You will create an entire Transformational Change Management Plan for a medium-sized public company that has lost business to a competitor that has chosen to outsource much of its production operations. The company has been based in a small Midwestern town, it is one of the largest employers, and it has an excellent reputation for employee welfare. It is now planning to do the very same offshoring, which will involve large layoffs of long-term employees.
week 4: Communication Plan (100–150 words)
Include the following context in the communication plan:
What stakeholders require communication?
What will be communicated to them?
Who will send the communication?
What communication medium will be used?
.
You will create an Access School Management System Database that can.docxmattjtoni51554
You will create an Access School Management System Database that can be used to store, retrieve update and delete the staff/student.
Design an Access database to maintain information about school staff and students satisfying the following properties:
1. The staff should have the following: ID#, name, and classes they are teaching
2. The student should have the following: ID#, name, section, class
3. Create a module containing the section, subject and teacher information
4. Create a module containing student fee information
5. Create a module containing the instructors salary
6. Create a module with the classroom assignments (be mindful that each class/lab should not have the same information as another class)
.
You will create a 13 slide powerpoint presentation (including your r.docxmattjtoni51554
You will create a 13 slide powerpoint presentation (including your reference page) about advocating for adoption.
Be creative in developing a presentation that will highlight an issue, choice/decision, or life altering event that may impact someone's life.
You need to have at least 7 credible references
These will need to be noted within the presentation and at the end of the presentation.
.
You will create a 10 minute virtual tour of a cultural museum” that.docxmattjtoni51554
You will create a 10 minute virtual tour of a “cultural museum” that teaches your audience about a particular culture. The museum that you select must be within the United States. For example, The United States Holocaust Memorial Museum, Art Institute of Chicago, Ellis Island, Charles H. Wright African American Museum, etc. You will create a “virtual tour” of the museum by creating a PowerPoint presentation with at least one slide dedicated to each “room” of the museum. You must provide the history of the museum through the use of visual imagery. You might choose to display some of the objects/artifacts that would be included in the museum, audio or video clips related to the spaces, or text that might appear on the displays or signs at the museum. Be sure you have a title slide with the name of the museum you chose on it. Your final product should be very creative AND very realistic. You will have to do extensive research on the museum that you choose. Your audience should walk away from your presentation with the feeling that they have just left the museum. The audience should also gain new information about the culture that they did not know before your presentation. You will also need to submit a reference page using APA format. This should be primarily a visual tour. Please limit any text on slides to short headings and/or bullet points. I do not require any citations for images/photos.
.
You will continue the previous discussion by considering the sacred.docxmattjtoni51554
You will continue the previous discussion by considering the sacred/secular divide that is often seen within society today. After watching the presentation titled The Sacred/Secular Divide, interact with your classmates by discussing the following questions:
How does the tendency to push religion away from the public arena effect the Christian’s ability to engage culture?
What are the areas within your own life that depict the sacred/secular divide?
How can the sacred/secular divide be eliminated within your sphere of influence?
In your discussion, indicate to which of the points of the Sacred/Secular Divide you are responding throughout your post.
.
You will craft individual essays in response to the provided prompts.docxmattjtoni51554
You will craft individual essays in response to the provided prompts. You must use the current Turabian style with default margins and 12-pt Times New Roman font. For each essay, include a title page and reference page, also in current Turabian format. You must include citations to a sufficient number of appropriate scholarly sources to fully support your assertions and conclusions (which will likely require more than the minimum number of citations). Each paper must contain at least 5
7 scholarly sources
original to this paper
,
The UN— “A More Perfect Union?”
Considering the readings, video presentations, and your own research, draft a quality 6–7-page research paper on the role, legitimacy, and authority of the UN according to the following prompts, answering in a separate or integrated manner as you wish.
Identify at least 3reasons that states might defend the intrinsic legitimacy of the UN as a governing authority. In reverse, identify at least 3reasons that states might criticize its legitimacy and authority.
In short, make an argument for the limits and possibilities of the UN as a legitimate governing authority in a world of sovereign states.
What is the relationship of the UN to the current international system of states?
Considering the reasons for the creation of the UN after WWII, does it seem driven by political necessity or the political utility? In plainer English, do states need the UN more than the UN needs the states? Or do states both large and small find the UN a useful tool for improving their relative power and legitimacy vis-à-vis other states and global institutions? Is there some position in-between?
Using other sources and extra-Scholar sources (The commentaries, teachings, other writings, etc.) to inform your own reasoning, comment on the compatibility with the idea of
World Government
. [
Attention
: The Instructor does not view the question as rhetorical, nor the answer self-evident. So, reason carefully.] For example, if the logic of collective action under the
Articles of Confederation
—the logic of state sovereignty—failed to secure American liberties as well as the ‘more perfect union’, the new Constitution established by the Framers in 1787 to replace it, effectively requiring states to cede sovereignty to a larger collective authority, why would the same logic of collective action not justify the UN as a ‘more perfect union’ to replace an anarchic system of sovereign states putting the world at risk in a nuclear age?
.
You will complete the Aquifer case,Internal Medicine 14 18-year.docxmattjtoni51554
You will complete the Aquifer case,
Internal Medicine 14: 18-year-old female for pre-college physical
,
focusing on the
“Revisit three months later”
for this assignment.
After completing the Aquifer case, you will present the case and supporting evidence in a PowerPoint presentation with the following components:
Slide 1: Title, Student Name, Course, Date
Slide 2: Summary or synopsis of Judy Pham's case
Slide 3: HPI
Slide 4: Medical History
Slide 5: Family History
Slide 6: Social History
Slide 7: ROS
Slide 8: Examination
Slide 9: Labs (In-house)
Slide 10: Primary Diagnosis and 3 Differential Diagnoses – ranked in priority
Primary Diagnosis should be supported by data in the patient’s history, exam, and lab results.
Slide 11: Management Plan: medication (dose, route, frequency), non-medication treatment, tests ordered, education, follow-up/referral.
Slide 12-16: An evaluation of 5 evidence-based articles applicable to Ms. Pham’s case: evaluate 1 article per slide.
Include title, author, and year of article
Brief summary/purpose of the study
How did the study support Ms. Pham’s case?
Course texts will not count as a scholarly source. If using data from websites you must go back to the literature source for the information; no secondary sources are allowed, e.g. Medscape, UptoDate, etc.
Slide 17: Reference List
You will submit the PowerPoint presentation in the
Submissions Area by the due date assigned. Name your Case Study Presentation SU_NSG6430_W7_A2_lastname_firstinitial.doc
.
You will complete the Aquifer case,Internal Medicine 14 18-.docxmattjtoni51554
You will complete the Aquifer case,
Internal Medicine 14: 18-year-old female for pre-college physical
,
focusing on the
“Revisit three months later”
for this assignment.
After completing the Aquifer case, you will present the case and supporting evidence in a PowerPoint presentation with the following components:
Slide 1: Title, Student Name, Course, Date
Slide 2: Summary or synopsis of Judy Pham's case
Slide 3: HPI
Slide 4: Medical History
Slide 5: Family History
Slide 6: Social History
Slide 7: ROS
Slide 8: Examination
Slide 9: Labs (In-house)
Slide 10: Primary Diagnosis and 3 Differential Diagnoses – ranked in priority
Primary Diagnosis should be supported by data in the patient’s history, exam, and lab results.
Slide 11: Management Plan: medication (dose, route, frequency), non-medication treatment, tests ordered, education, follow-up/referral.
Slide 12-16: An evaluation of 5 evidence-based articles applicable to Ms. Pham’s case: evaluate 1 article per slide.
Include title, author, and year of article
Brief summary/purpose of the study
How did the study support Ms. Pham’s case?
Course texts will not count as a scholarly source. If using data from websites you must go back to the literature source for the information; no secondary sources are allowed, e.g. Medscape, UptoDate, etc.
Slide 17: Reference List
You will submit the PowerPoint presentation in the
Submissions Area by the due date assigned. Name your Case Study Presentation SU_NSG6430_W7_A2_lastname_firstinitial.doc
.
You will complete several steps for this assignment.Step 1 Yo.docxmattjtoni51554
You will complete several steps for this assignment.
Step 1:
You will become familiar with an assessment tool (AChecker) to examine Web accessibility for a couple Web sites. This is a freely available tool that you can learn about by reviewing the tutorial found
here
.
Step 2:
Select two Web sites that are somewhat similar in functionality. Find one that you think is good and one that you think is bad. Whether or not the Web site is good or bad is based upon your own personal perspective.
Step 3:
Examine the Web sites regarding your suggestions as to how they might be improved.
Step 4:
Create a PowerPoint presentation that includes 10–12 slides with voice recording that presents your recommended improvements. Discuss the good and bad factors of each Web site. Discuss how a sample task is supported on each of the Web sites. Describe how the Web site can be redesigned or revised to achieve better results.
The requirements for the presentation are as follows:
Title slide
Introduction to the 2 Web sites
Comparison of the 2 Web sites
A summary of AChecker's findings for each site
Explanation of how to improve the sample task
Listing of recommended improvements
Information regarding anticipated localization and globalization factors
Summary and conclusions
At least 3–5 references
Be sure to consider the following:
Patterns
Wizards
Interactivity
Animation
Transitions
.
You will compile a series of critical analyses of how does divorce .docxmattjtoni51554
You will compile a series of critical analyses of "how does divorce effect the wellness of children?" through the four general education lenses: history, humanities, natural and applied sciences, and social sciences. Using the four lenses, explain "how does divorce effect the wellness of children?" within wellness has or has not influenced modern society.
.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Phil 2230 Philosophy of ReligionFinal Essay AssignmentThe A.docx
1. Phil 2230: Philosophy of Religion
Final Essay Assignment
The Assignment: An argumentative essay (defending a thesis)
evaluating an argument or view we have discussed in the second
portion of the course – from the midterm essay through the end
of the course. In using the word “evaluate” I mean to give you a
lot of freedom with respect to constructing your thesis. You
could argue that C. Stephen Evans’ criteria for identifying
revelation suggest that the Qu’ran is in fact more likely to be
revelation from God than the Bible is (or the opposite). Or you
could argue that Evans’s criteria are not actually good ways to
identify revelation. Or you could argue that Freud’s objection to
religious belief succeeds – or fails. Or that Manis’s view of Hell
is better than the alternatives. Or that no view of hell avoids
objections, and so we shouldn’t believe in hell. And so forth –
you have a lot of freedom. Just make sure that you are making,
and defending, a claim about one of the views or arguments we
have discussed.
Grading: I will grade for these factors:
· There must be a clear thesis and well-structured, clear
arguments supporting the thesis. (This is by far the most
important element of the grade.)
· Your statement of the argument or view which you are
evaluating should be clear and fair; you should indicate
understanding of the issues involved.
· Grammar and writing should be free of errors.
If you do everything right – you have a good thesis, solid
arguments, good composition – you will get an A-. A full A
requires that you do something outstanding – most likely an
interesting original argument or view, or perhaps a really
2. outstanding and insightful way of stating a problem, or
something of that sort. So a full A is a significant achievement.
An A+ means that the paper could, with work, be a publishable
piece – this is graduate-quality work, and undergraduates almost
never receive this grade.
Here is a complete statement of my grading scale:
A+: The idea is an original contribution to the debate and is the
sort of paper that may be published in a professional journal or
presented at a professional conference. This is graduate-level
work, and undergraduates rarely receive this grade.
A: You did everything right, and had something extra special,
most likely interesting and original arguments or ideas, or
perhaps a particularly insightful way of putting a problem or
some especially brilliant writing.
A-: You did everything right – good, clear thesis and
organization, good arguments, and good writing – but you are
missing the extra originality or creativity to make this an A.
B+: You did what was asked of you (pretty clear thesis, pretty
good writing, and decent arguments), but something on that list
(thesis, writing, arguments) is quite good, above the B level.
B: You did what was asked of you – you have a pretty clear
thesis, pretty good writing, and decent arguments.
B-: You pretty much did what was asked of you, but something
important (thesis, writing, arguments) is sub-par.
C+, C, C-: Some important elements of the paper are sub-par,
but the paper is passable.
3. D+, D, D-: The paper barely deserves college credit, but isn’t
quite an outright failure.
Running head: NURSING
NURSING
8
Comprehensive Patient Assessment
Name:
Institution:
Course:
Tutor:
Date:
Comprehensive Patient Assessment
The most import aspect of an accurate process of care delivery
is a comprehensive assessment of the patient. Assessment makes
it possible for the care provider to gather relevant information
concerning the health condition of the patient thus creating the
ground for appropriate intervention. Nurses have a general role
to ensure the correct data concerning the health of a patient is
recorded appropriately. This data is then analyzed to facilitate
clinical decision-making (Linsley, Kane & Owen, 2011). Proper
analysis of the health information is crucial in the determination
of the conditions the patient is suffering from as well as the
condition he/she is at risk of developing. A SOAP note is one of
the documents containing the health information of a patient
that guides clinicians in decision making. A soap note
comprises of the current and past health information of the
patient, the social and medical history as well as the history of
4. hospitalization and medications used by the patient. This paper
highlights a comprehensive assessment of a woman presenting
with symptoms typical of Human papilloma virus.
SUBJECTIVE
Patient: _PT_ Age: _39 _ Gender: __F_ Marital
status__Married_ Race __African American
Chief complaint: “I am here today due to rough though painless
bumps on the pubic region together with general woman health
examination.”
History of present illness
PT is a thirty-nine-year-old African America female patient who
has visited the clinic complaining of painless pink bumps on the
pubic area. The patient states that the bumps are shaped like
cauliflower. The patient noted these warts three weeks ago but
dismissed them as simple rashes caused by excessive heat. She
is not sure for how long these bumps had existed before she
noticed them. However, the patient makes it clear that she has
not experienced abnormal vaginal discharge. The patient points
out that the bumps have led to mild irritation, itching and
burning sensation around the pubic area. She has tried to clean
the affected area with warm water and soap, but the problem has
persisted. The patient has also been experiencing pain in the
vulva thus increasing the discomfort associated with these
warts. The patient has not experienced any changes in urinary
urge and frequency. Over the last, few days the discomfort
associated with these warts have increased thus increasing the
need for specialized care. Nonetheless, the patient has not taken
any medication for the problem.
Past medical history
The patient was diagnosed with Chlamydia three years ago,
which was effectively treated through administration of
antibiotics- azithromycin. The problem cleared up in two weeks,
and she has not been diagnosed with Chlamydia ever since. She
was also diagnosed with bacterial vaginosis in 2012, but the
condition was managed with metronidazole gel. The patient
does not have a chronic condition such as diabetes,
5. hypertension, or cerebral vascular accident. The patient makes
it clear that she has not suffered from any health disorders
related to inappropriate lifestyles such as substance abuse,
alcoholism, consumption of junk foods, and cigarette smoking.
However, the is vague when an inquiry is made concerning her
sexual health. She notes that she has been in a monogamous
family all through even though a month ago she was involved in
a sexual relationship with a long time friend.
Immunization
The patient has an up to date immunization schedule. She
received a tetanus shot together with a flu shot in June 2016.
Allergies: The patient has not been diagnosed with any form of
allergic reaction.
Medications: none
Medication Intolerance: None
Chronic health problems: bacterial vaginosis and herpes simplex
virus
Hospitalization and procedures: The patient has not been
diagnosed with a condition requiring a surgical operation. Also,
she has not been hospitalized previously. Comment by
Grammarly: Deleted:In additi Comment by Grammarly:
Deleted:n
Family medical history:
The patient’s family has a history of chronic disorders. His
father was diagnosed with hypertension and diabetes mellitus,
which are believed to be the leading causes of death. Her
mother is still alive, but suffers from hypertension and chronic
kidney stones; she also has a brother, who is asthmatic.
However, the records of the health information of her
grandparents cannot be traced.
Social history
Occupation: The patient works as a clerk at a local store.
Marital status: the patient has been married for the last 19 years
and lives with her husband in their home.
Children: she is a mother of two boys aged 13 and 15 years.
Birth control: she uses condom as her main birth control method
6. Exercise: The patient engages in simple physical exercises once
or twice every week. She also jogs and runs around for at least
thirty minutes when she is off duty.
Alcohol and tobacco: the patient notes that she drinks alcohol
occasionally, mostly during social events. She has never smoked
cigarettes in her life.
Substance abuse: the patient denies involvement in any form of
drugs and substance abuse.
Safety: the patient asserts that her home offers the security,
social support, and environmental safety necessary for a family.
Review of systems
General: the patient states she has not experienced intense
changes in weight; she also denies body weakness and fatigue,
fever as well as chills.
Head: Her head is normal with no physical injuries or bruises
Eyes: The patient has not experienced any form of vision loss;
he does not have blurred vision or double vision. She does not
suffer from pain in the eyes, redness, or itching. The patient
does not wear contacts and denies difficulty focusing,
peripheral vascular changes, scotoma, diplopia, and dryness in
the eyes.
Ears: she does not have hearingproblems. The ears are also free
of abnormal discharge. She states that she does not experience
ear pain, ringing, or itching in the ears.
Nose/throat/mouth: the patient does not have a runny nose, and
she does not experience nasal congestion and sneezing. She
denies painful sensation in the throat, dryness in the mouth and
hoarseness. Her oral mucosa is pink in color and moist.
Cardiovascular: the patient denies any form of a cardiovascular-
related problem; she does not experience chest pain, discomfort,
or unnecessary pressure. Also, she does not experience
palpitations and edema. She does not have a history of varicose
veins, dyspnea, heart murmurs, and activity intolerance.
Respiratory: she denies respiratory problems such as shortness
of breath, dyspnea, wheezing, and coughing. Also, she does not
experience increased production of sputum. She also denies a
7. history of respiratory infections, exposure to smoke, pain on
inspiration and exposure to TB. Comment by Grammarly:
Deleted:In additi Comment by Grammarly: Deleted:n
Skin: The skin of the patient is dry and warm to the touch
besides being free of rashes, bruises, injuries, and lesions.
However, she has noted small bumps on the vulva and the skin
around the external genitalia. She states she has been
experiencing mild itching in the genital region.
Gastrointestinal: the patient reports good gastrointestinal
health: she does not suffer from pain in the abdomen, nausea
and vomiting, diarrhea and constipation, anorexia, and
heartburn. The patient also denies changes in appetite, food
intolerance and changes in bowel patterns as well as
hemorrhoids and flatulence.
Genitourinary: the patient denies urinary incontinence, dysuria,
and heavy bleeding. She has not experienced any changes in
urinary urge and frequency. She denies burning sensation during
urination. However, she has been experiencing mild pelvic pain
and abnormal vaginal discharge. The patient is sexually active.
She has not missed her menses.
Endocrine: the patient does not report any thyroid problems,
heat and cold intolerance, excessive weight gain or loss,
sweating, polydipsia, and polyuria. The patient does not use any
form of hormonal therapy. No changes in facial and body hair,
skin, and nails texture are reported.
Breast: The patient notes that she does not have lumps in the
breasts. She does not experience breast pain, abnormal
discharge, or soreness.
Musculoskeletal: She denies musculoskeletal pain, arthritis, and
edema. She does not experience stiffness of the joints, mo
report made on a history of gout, deformities, decreased
strength, and swelling, as well as chronic low back pain and a
decreased range of motion.
Neurological: the patient denies focal weakness, blackout, and
seizures. She does not suffer from a depressive disorder,
confusion, headaches, and dizziness. She does not experience
8. numbness in the extremities or changes in bladder control. She
has not experienced incidences of memory loss, vertigo, and
instability.
Psychiatric: she does not have a history of anxiety and
depression, mood and thought disorders, as well as confusion.
She denies mood swings, suicidal ideation, and substance abuse.
OBJECTIVE
Constitutional
Weight: 155 lbs
Height: 5’ 5’’
BMI: 25.6
Temperature: 99.7 F
Blood pressure: 112/64
Pulse rate: 81
Respiration rate: 19
General
Besides looking well nourished, the patient is healthy and does
not appear distressed.
Skin- No lesions or bruises detected on the skin of the patient.
She does not have any open cuts, ulcers, rashes, inflammation,
redness, or injuries. However, examination of the genital area
reveals the presence of small bumps.
HEENT: the head of the patient is free of abnormalities; she
does not have scalp tenderness and bald spots; her eyes do not
have an abnormal discharge, and the conjunctiva appears pink.
The sclera is white and extraocular movements are intact.
Corneal light reflex is normal. Her ears have a normal external
appearance, and the ear canals are open with no abnormal
discharge. The tympanic membrane is clear, and the hearing
capacity is intact. The appearance of the patient’s nose is
normal; the nostrils are open, with no mucous and septum is
midline. The oral mucosa is pink and moist with no missing
teeth. No sign of inflammation or lesions in the throat is
detected. The tonsils are not inflamed.
Cardiovascular: no murmurs, rub or gallops noted; S1 and S2
rate and rhythm normal; no bruits detected; normal pulses
9. detected bilaterally; normal sounds detected through
auscultation.
Respiratory: The patient’s respiration is even and unlabored;
auscultation reveals clear lung sound. No wheezes and rhonchi
detected.
Gastrointestinal: physical examination of the abdomen reveals it
is soft and non-tender as well as nondistended; no masses
detected, auscultation reveals normal bowel sounds in all
quadrants
Breast: the breasts are free of masses, lumps, and abnormal
discharge.
Genitourinary/ Gynecological: palpitation does not reveal
bladder tenderness or bladder distention. Vaginal mucosa is
pink; white vaginal discharge noted; multiple lesions noted on
the external genitalia; the warts are broad, soft, and non-
keratinized. The cervix is normal; the lymph nodes around the
inguinal region are not inflamed.
Musculoskeletal: the patient has normal range of motion, and
the stability of the joints is normal; the joints are not tender or
inflamed.
Neurological: the patient is alert and oriented; her
communication ability has not been disrupted; she reveals
normal attention and concentration and her sensation to touch is
intact.
Psychiatric: the patient's thoughts are normal and logical, and
her judgment is intact. She appears calm and cooperative.
Comment by Grammarly: Deleted:l
Immunologic: no bleeding detected; the lymph nodes are not
palpable.
Laboratory tests and other diagnostic tests
Urinalysis
The Urine appears yellowish in color
Urine is free from deposits
PH-7.0, SG -1.010, UBG-0.2
Colonoscopy:
Tiny bumps are detected on the skin around the genital area
10. Pap smear– results of PAP smear are pending
Gonorrhea– results of gonorrhea test are pending
Blood tests:
Complete Blood Count,
Thyroid Stimulating Hormone test,
Antibodies test,
Vitamin D level test
No special tests conducted
ASSESSMENTS
Primary diagnosis: Human papilloma virus
The primary diagnosis for PT is Human papilloma virus. The
patient has symptoms that are similar to those of this condition.
Some of these symptoms include the presence of small
cauliflower bumps on the genital area. The genital warts are
detected on the vulva, the cervix as well as in the vagina. In
some cases, warts resolve, but in others, they persist for a
longer period. In HPV, warts usually appear weeks or even
months after a sexual encounter making it hard for the patient to
realize she is responsible for transmission of HPV (Rosenblatt
& Campos, 2009). The patient is sexually active and has stated
that she had a sexual encounter with her longtime friend some
weeks ago thus increasing the risk of HPV.
Differential Diagnosis:
Genital herpes – Genital herpes is a common sexually
transmitted disease. Most of those who have herpes do not know
it since it is usually asymptomatic or mild. The common
symptoms of this condition are small blisters that eventually
break open (Warren, 2009). This condition was ruled out since
the patient does not present with flu-like symptoms and swollen
lymph nodes.
Chlamydia – There is a possibility of the patient being
diagnosed with Chlamydia since she presents with painless soles
and mild itching on the genitals. However, this condition was
ruled out since the patient does not have a fever, and painful
sensation while urinating (Golanty & Edlin, 2012). Also, the
patient has not experienced incidences of bleeding between
11. period.
Genital sores – The patient can be diagnosed with genital sores
since she has red bumps on the genital area. This condition was
ruled out for this patient since she does not have swollen
glands, severe itching around the genital area, and pain in the
legs and buttocks. Also, the patient does not experience painful
urination (Germain, 2013).
Chancroid – Chancroid is a possible diagnosis for the patient
since she has small red bumps on the labia. This condition was
ruled out since the patient does not experience pain during
urination. The patient does not have swollen lymph nodes and
bleeding ulcers, which are common among patients (Carroll,
2012).
PLAN
Further tests:
Colonoscopy and Acetic acid test: colonoscopy involves the
examination of the vagina and the cervix. Acetic acid can be
applied on the genital area to enhance the degree of visibility of
genital warts.
Viral culture: This test involves the use of scrapings of the
bumps as well as a swab of cells from the cervix.
Treatment
In most cases, genital warts clear on their own; however, when
they persist appropriate treatment modalities should be applied.
There is a high likelihood of recurrence since viruses have no
cure. The treatment of HPV includes a combination of topically
and orally administered medications (Woods, 2002).
Salicylic acid: this medication is an over the counter topically
administered medication that removes warts over time. This
medication should be used cautiously since it may lead to skin
irritation (Carroll, 2012).
Imiquimod: Imiquimod is a prescription cream that enhances the
body’s immunity over HPV. This medication can generate some
side effects including redness of the affected areas and should
be applied cautiously (Marr, 2010).
Trichloroacetic acid: this medication helps in burning of warts.
12. Sinecathechins: This cream is usually applied to the genital and
anal areas to clear of genital warts. Comment by Grammarly:
Deleted:n
Patient education
It is advisable for the patient to limit the number of sexual
partners. The patient should also maintain high levels of
hygiene, and avoid wearing tight undergarments.
The patient should reduce the application of lotions and creams
since excessive use if these medications might lead to severe
irritation of the skin.
Follow-up care
A follow-up plan of two months is appropriate for this patient.
The physician should call the patient to collect her gonorrhea
and PAP smear results.
References Comment by Grammarly: Deleted:Top of Form
Bottom of Form
Top of Form
Bottom of Form
Top of Form
Bottom of Form
Carroll, J. L. (2012). Discovery Series: Human Sexuality.
Boston, MA: Cengage Learning,
Germain, A. (2013). Reproductive tract infections: Global
impact and priorities for women's reproductive health. Boston,
MA: Springer.
Golanty, E., & Edlin, G. (2012). Human sexuality: The basics.
Sudbury, MA: Jones & Bartlett Learning.
Linsley, P., Kane, R., & Owen, S. (2011). Public health and the
nursing role: Contemporary principles and practice. Oxford:
Oxford University Press.
Marr, L, M., (2010). Sexually Transmitted Diseases: A
Physician Tells You What You Need to Know. New York, NY:
JHU Press.
Rosenblatt, A., & Campos, G. H. G. (2009). Human
13. papillomavirus: A practical guide for urologists. Berlin:
Springer-Verlag.
Warren, T. (2009). The Good News about the Bad News:
Herpes, Everything You Need to Know. New York, NY: New
Harbinger Publications
Woods S., (2002). Everything You Need to Know About Std-
Sexually Transmitted Disease. New York, NY: The Rosen
Publishing Group
SOAP Note 3
Walden University
Nurs 6551: Primary Care of Women
Dr Anita Manns
3/17/2018
SOAP Note Week 3
Date: 03/08/2018
Name: TS Age: 33 Gender: Female Race:
Caucasian
SUBJECTIVE
Chief Complaint: TS came to the clinic with complains of
unusual bleeding and discharge, difficulty urinating, pain
around vaginal area, pain during intercourse and abnormal pap
14. results.
HPI: The patient presented with painful urination, vaginal
discharge and coitus pain. She also noted an increase in vaginal
bleeding, Pap tests taken have been abnormal and pelvic area
has also been experiencing pain. This has been going on for two
weeks, for which she has been using OTC Ibuprofen.
PMH:
Allergies: None
Current Medication: Ibuprofen 600mg BD.
Immunization: Up to date
Previous Routine Tests: A normal pap smear 6 months ago
Past Illnesses: Recurrent UTI.
Hospitalizations: None.
Pregnancy History: G0 P0 A0
Family History: Mother has Type 2 Diabetes, Father has
Hypertension, No siblings; She lives with husband who has
Arthritis.
Social History: She is an occasional smoker and is a social
drinker. She denies use of illicit drugs. She tries to stay active
by doing Zumba dance during free times. She works as a
Lyricist for a music company.
ROS:
Constitutional: The patient appears unwell and is worried that
the symptoms are gradually increasing and it has even started to
affect his day to day life because of the pain. She denies
incidences of fever, diarrhea, nausea and weight gain or loss.
HEENT: No headache, head bruises or rashes. Hearing
capability seems normal. Uses reading glasses.
Cardiovascular: Normal heart rate and denies any murmurs,
gallops and clicks.
Respiratory: The chest rises and falls rhythmically with the
patient not complaining of wheezing, and coughing.
Gastrointestinal: Denies diarrhea, abnormal bowel movements
and pain in the abdomen.
Genitourinary: Complains of pain while urinating, painful
coitus, pain in the pelvic area, vaginal discharge and abnormal
15. bleeding. Patient denies hematuria, urgency and frequency in
urination.
Musculoskeletal: The patient denies any pain in the muscles,
back pain or pain in the joints.
Neurologic: The patient has no deformities with the balance and
is sensitive to the stimuli.
Psychiatric: Denies insomnia, nightmares, suicidal thoughts and
abnormal headache.
OBJECTIVE:
Constitutional: T 97.5F, BP 114/71, HR 77, RR 23, Ht 4” 5’, Wt
146lbs
General: The patient is well groomed and responds questions.
She looks distressed.
Head: No deformities or poor hair growth observed.
Eyes: Sclera white, normal light sensitivity and no abnormal
discharge, no redness
Ears: Bilaterally intact, TM intact, no discharge
Nose: Pink and Moist mucosa, no sneezing or excessive
discharge or congestion, no polyps
Throat: No Inflammation, swelling or dislocation.
Mouth: Oral mucosa is pink and moist
Cardiovascular: RRR, no murmurs, clicks or gallops. S1 and S2
present, capillary refill <3 seconds.
Respiratory: Chest clear, no wheezing or rales
Gastrointestinal: No diarrhea or constipation; generalized
tenderness; bowel sounds present in all 4 quadrants.
Genitourinary: Painful urination, painful coitus, pain in the
pelvic area, vaginal discharge and abnormal bleeding, no
hematuria, urgency and frequency in urination.
Musculoskeletal: Normal gait, no muscular tenderness or
swelling
Neurologic: The patient has normal gait, responds effectively to
all temperature extremes.
Psychiatric: No insomnia, nightmares, suicidal thoughts
Labs: Pap smear, endometrial biopsy, Curettage and dilation,
transvaginal ultrasound and Computed tomography.
16. ASSESSMENT
Diagnosis: Endometrial cancer
Endometrial cancer: This refers to a type of cancer that majorly
affects the uterine lining makes the cells to grow abnormally to
the point where they can affect other body parts (Shafer & Van
Le, 2013). During early onset of the condition, there will be
excessive vaginal bleeding that does not have a relationship
with menstrual periods. The other symptoms include painful
sex, pain while urinating, vaginal discharge and painful pelvic
area (Kulkarni & Harshavardhan, 2017). The Pap smear showed
abnormal results of glandular cells that are abnormal. All the
other tests were positive for endometrial cancer.
Endometrial Hyperplasia: Common presentation is abnormal
uterine bleeding. In premenopausal women, the symptoms
include irregular heavy menstruation or amenorrhea in some
cases. Endometrial biopsy differentiates endometrial
hyperplasia from cancer. However there in 42.6% cases of
endometrial cancer, the initial diagnosis was hyperlasia with
atapia (Endometrial Cancer, 2018).
Endometriosis: Symptoms include pain, dyspareunia and painful
defecation. It is common in young premenopausal women.
Physical examination reveals tenderness and nodularity. Pelvic
ultrasound can be done to confirm endometrioma (Endometrial
Cancer, 2018).
PLAN:
The ideal treatment for this cancer is through surgery where the
tumor will be removed (Shafer & Van Le, 2013). Additionally,
some of the healthy tissues that surround the tumor will be
removed since they could be containing some cancer cells.
Simple Hysterectomy will be ideal for the patient due to the
extent of the spread of the cells (Eifel, 2015). In this case, the
cervix and uterus will be removed since the cancer cells have
not spread so much to the other parts of the reproductive
system.
The patient will have to keep visiting the health facility after
the procedure for routine maintenance and test to ascertain that
17. the tumor does not regenerate.
Reflection notes:
In this case, the diagnosis itself is a big shock to the patient.
Also, the pain suffered by TS is limiting her from his daily
activities. Ignoring these could attribute to mood disorders or
depression. She should be introduced to support groups with
people going through the same diagnosis. This will also help her
overcome the mental and physical pain caused by the disease.
References
Eifel, P. J. (2015). Treatment of Endometrial Cancer. Pelvic
Cancer Surgery, 315-325. doi:10.1007/978-1-4471-4258-4_30
Endometrial cancer. (n.d.). Retrieved March 18, 2018, from
https://online.epocrates.com/diseases/26635/Endometrial-
cancer/Differential-Diagnosis
Kulkarni, Y., & Harshavardhan. (2017). Recurrent Endometrial
Cancer. Current Concepts in Endometrial Cancer, 107-116.
doi:10.1007/978-981-10-3108-3_9
Shafer, A., & Van Le, L. (2013). Endometrial Hyperplasia and
Endometrial Cancer. Gynecological Cancer Management, 53-66.
doi:10.1002/9781444307542.ch5
North American Philosophical Publications
Petitionary Prayer
Author(s): Eleonore Stump
Source: American Philosophical Quarterly, Vol. 16, No. 2 (Apr.,
1979), pp. 81-91
Published by: University of Illinois Press on behalf of the North
American Philosophical
Publications
Stable URL: http://www.jstor.org/stable/20009745 .
Accessed: 16/01/2015 20:24
Your use of the JSTOR archive indicates your acceptance of the
18. Terms & Conditions of Use, available at .
http://www.jstor.org/page/info/about/policies/terms.jsp
.
JSTOR is a not-for-profit service that helps scholars,
researchers, and students discover, use, and build upon a wide
range of
content in a trusted digital archive. We use information
technology and tools to increase productivity and facilitate new
forms
of scholarship. For more information about JSTOR, please
contact [email protected]
.
University of Illinois Press and North American Philosophical
Publications are collaborating with JSTOR to
digitize, preserve and extend access to American Philosophical
Quarterly.
http://www.jstor.org
This content downloaded from 164.107.207.173 on Fri, 16 Jan
2015 20:24:11 PM
All use subject to JSTOR Terms and Conditions
http://www.jstor.org/action/showPublisher?publisherCode=illin
ois
http://www.jstor.org/action/showPublisher?publisherCode=napp
http://www.jstor.org/action/showPublisher?publisherCode=napp
http://www.jstor.org/stable/20009745?origin=JSTOR-pdf
http://www.jstor.org/page/info/about/policies/terms.jsp
http://www.jstor.org/page/info/about/policies/terms.jsp
American Philosophical Quarterly
Volume 16, Number 2, April 1979
19. I. PETITIONARY PRAYER
ELEONORE STUMP
ORDINARY
Christian believers of every period
have in general taken prayer
to be fundamen?
tally a request made of God for something specific
believed to be good by the one praying. The technical
name for such prayer is "impetraci?n" ; I am going to
refer to it by the more familiar designation "peti?
tionary prayer." There are, of course, many impor?
tant kinds of prayer which are not requests; for
example,
most of what is sometimes called "the higher
sort of prayer"?praise, adoration, thanksgiving?
does not consist in requests and is not included under
petitionary prayer.
But basic, common petitionary
prayer poses problems
that do not arise in connection
with the more contemplative varieties of prayer,
and
it is petitionary prayer with its special problems that I
want to examine in this paper.
20. Of those problems, the one that has perhaps been
most discussed in the recent literature is the con?
nection between petitionary prayer and miracles.
For
instance, if one believes in divine response to peti?
tionary prayer, is one thereby committed to a belief in
miracles? But as much as possible I want to avoid this
issue (and several others involving petitionary
prayer1) in order
to concentrate on
just
one
problem.
It is, I think, the problem stemming from petitionary
prayer which has most often occurred to ordinary
Christian believers from the Patristic period to the
present. Discussion of it
can be found, for example, in
Origen's third-century treatise
on
prayer,2 in various
writings of Aquinas,3 and, very recently,
in a book by
21. Keith Ward.4
Put roughly and succinctly, the problem
comes to
this: is a belief in the efficacy and usefulness of
petitionary prayer consistent with
a belief in an
omniscient, omnipotent, perfectly good God? It is,
therefore, a problem only
on certain assumptions
drawn from an ordinary, orthodox, traditional view
of God and of petitionary prayer. If one thinks, for
example,
as D. Z. Philipps does,5 that all "real"
petitionary prayer is reducible to the petition "Thy
will be done," then the problem I want to discuss
evaporates. And if
one thinks of God as the unknow?
able, non-denumerable, ultimate reality, which is
not
an entity at all, as Keith Ward does,6 the problem I
am interested in does not even arise. The cases which
concern me in this paper are those in which someone
praying
22. a
petitionary prayer makes
a
specific request
freely (at least in his own view) of an omniscient,
omnipotent, perfectly good God, conceived of in the
traditional orthodox way. I am specifying that the
prayers are made freely because I
want to discuss this
problem
on the assumption that
man has free will and
that not everything is predetermined. I am making
this assumption, first because I
want to examine the
problem of petitionary prayer as it arises for ordinary
Christian believers, and I think their understanding
of the problem typically includes the assumption that
man has free will, and secondly because adopting the
opposite view enormously complicates the attempt
to
understand and justify petitionary prayer. If all things
are
23. predetermined?and worse, if they
are all prede?
termined by the omnipotent and omniscient God to
whom one is
praying?it
is much harder to conceive
of a satisfactory justification for petitionary prayer.
One consequence of my making this assumption is
that I will not be drawing on important traditional
Protestant accounts of prayer such as those given by
Calvin and Luther, for instance, since while they may
be thoughtful, interesting accounts, they
assume
God's complete determination of everything.
I think that I can most effectively and plausibly
show the problem which interests
me
by presenting
a
sketchy analysis of the Lord's Prayer. It is
a prayer
attributed to Christ himself, who is supposed to have
8i
24. 1 For a good recent account of the problem of petitionary prayer
and miracles, see Robert Young, "Petitioning God," American
Philosophical Quarterly, vol. 11 (1974), pp. 193?201. Other
issues I intend to avoid include Peter Geach's worries about
prayer for events in
the past in God and the Soul (London, 1969), pp. 89 ff., and
about "certain tensed propositions about the divine will... in
connexion with
prayer" (op. cit., p. 97).
2 Eric George Jay, Origen's Treatise on Prayer (London, 1954),
vols. V-VI, pp. 92-103.
3 Most notably, Summa theologiae, 2a-2ae, 83, 1?17; Summa
contra gentiles, I.III. 95-96; In IV. Sent., dist. XV, q. 4, a. 1.
4 The Concept of God (New York, 1974), pp. 221-222. Ward
introduces the problem only as an embarrassment for what he
calls
"Thomistic" theology. Cf my review in The Philosophical
Review, vol. 86 (1977), pp. 398-404.
5 The Concept of Prayer (New York, 1966), pp. 112 ff.
6
Cf The Concept of God (op. cit.), pp. 62, 101, in, and 185.
This content downloaded from 164.107.207.173 on Fri, 16 Jan
2015 20:24:11 PM
All use subject to JSTOR Terms and Conditions
http://www.jstor.org/page/info/about/policies/terms.jsp
82 AMERICAN PHILOSOPHICAL QUARTERLY
produced it just for the purpose of teaching his
25. disciples how they ought
to pray. So it is an example of
prayer which orthodox Christians accept as a para?
digm, and it is, furthermore,
a clear instance of
petitionary prayer. Consequently, it is
a
particularly
good example for my purposes. In what follows, I
want to make clear, I am not concerned either to take
account of contemporary Biblical exegesis
or to
contribute to it. I want simply to have a look at the
prayer?in fact,
at only half the prayer?as it is heard
and prayed by ordinary twentieth-century
Christians.
As the prayer is given in Luke 11, it contains
seven
requests. The last four have to do with the personal
needs of those praying, but the first three
are
requests
26. of a broader sort.
The first, "Hallowed be thy name," is commonly
taken as a request that God's name be regarded
as
holy.7 I
am not sure what it means to regard God's
name as
holy, and I
want to avoid worries about the
notion of having attitudes towards God's
name. All
the same, I think something of the following sort is a
sensible interpretation of the request. The
common
Biblical notion of holiness has at its root a sense of
strong separateness.8 And it may be that
to
regard
God's name as holy is only to
react to it very
differently from the way in which
one reacts to any
27. other name?and that could happen because
it seems
specially precious or also (for example) because it
seems
specially feared.
On this understanding of the
request, it would be fulfilled if everyone (or almost
everyone) took
a
strongly emotional and respectful
attitude towards God's name. But it may be that this is
too complicated
as an
interpretation of the request,
and that to regard God's
name as holy is simply
to love
and revere it. In that case, the request is fulfilled if
everyone or almost everyone regards God's
name very
reverentially. And there
are New Testament passages
28. which foretell states of affairs fulfilling both these
interpretations of the request?prophesying
a time at
or near the end of the world when all men fear or love
God's name, and a time when the inhabitants of earth
are all dedicated followers of God.9
The second request in the Lord's Prayer is that
God's kingdom
come. Now according
to orthodox
Judaeo-Christian beliefs, God is and always has been
ruler of the world. What then does it mean to ask for
the advent of his kingdom? Plainly, there is at least
some sense in which the kingdom of heaven has
not yet
been established on earth and can be waited and
hoped for. And this request seems to be for those
millenial times when everything
on earth goes as it
ought
to go, when men beat their swords into
plowshares (Is. 2:4) and the wolf dwells at peace with
29. the lamb (Is. 11:6, 65:25). This too, then, is
a
request
for a certain state of affairs involving all
or most men,
the state of affairs at the end of the world prophesied
under one or another description in Old and New
Testament passages (cf., e.g., Rev. 21:1-4).
And it seems closely related to the object of the
third request, "Thy will be done on earth as it is in
heaven." There is, of course, a sense in which,
according to Christian doctrine, God's will is always
done on earth. But that is the sense in which God
allows things to happen as they do (God's so-called
"permissive will"). God permits certain people
to
have evil intentions, he permits certain people
to
commit crimes, and so on, so that he wills to let
happen what does happen ; and in this sense his will is
always done. But in heaven, according
to Christian
doctrine, it is not that God permits what
30. occurs to
occur, and so wills in accordance with what happens,
but rather that what happens happens in accordance
with his will. So only the perfect good willed uncon?
ditionally by God is ever done in heaven. For God's
will to be done on earth in such a way, everyone on
earth would always have to do only good. This
request, then,
seems to be another way of asking for
the establishment of God's kingdom
on earth; and it
also seems linked with certain New Testament
prophecies?there
will be a "new earth," and the
righteous meek will inherit it (cf., e.g., Mt. 5:5 and
Rev. 5:10 and 21:1-4).
What I think is most worth noticing in this context
about all three of these first requests of the Lord's
Prayer is that it seems absolutely pointless, futile, and
absurd to make them. All three seem to be requests for
the millenium or for God's full reign on earth. But it
appears from New Testament prophecies that God
31. has already determined
to
bring about such
a state of
7
Cf, for example, the similar understanding of this petition
in two very different theologians : Augustine, Homilies
on the Gospels, Serm. 6 ;
and Calvin, Institutes of the Christian Religion, III.
xx. 41.
8 The most common Old Testament word for "holy" and its
correlates is some form o?"kadash," the basic, literal meaning
of which is
separation, withdrawal,
or state of being set apart ; cf. Gesenius, A Hebrew and English
Lexicon of
the Old Testament. In the New Testament, the
most frequently used word is "hagiazo"
and its correlates, the basic meaning of which also includes the
notion of being separate
and being
set apart ; cf. Thayer, A Greek-English Lexicon of the
New Testament, and Arndt and Gringich, A Greek-English
Lexicon of the New Testament
32. and
Other Early Christian Literature.
9
Cf, e.g., Is. 2: 2-21, 45: 23, and 65: 23; Matt. 24;
Mk. 13; Lk. 21; and Rev. 6: 15?17.
This content downloaded from 164.107.207.173 on Fri, 16 Jan
2015 20:24:11 PM
All use subject to JSTOR Terms and Conditions
http://www.jstor.org/page/info/about/policies/terms.jsp
PETITIONARY PRAYER
83
affairs in the future. And if God has predetermined
that there will be such a time, then what is asked for in
those three requests is already
sure to come. But, then,
what is the point of making the prayer? Why ask for
something that is certain
to come whether you beg for
it or flee from it? It is no answer to these questions
to
say, as some theologians have done,10 that
one prays in
this way just because Jesus prescribed such a prayer.
33. That attempt at
an answer
simply transfers
re?
sponsibility for the futile action from the one praying
to the one being prayed to ; it says nothing about what
sense there is in the prayer itself. On the other hand, if,
contrary to theological appearances, the things
prayed for
are not
predetermined and their
occur?
rence or nonoccurrence is still in doubt, could the issue
possibly be resolved by someone's asking for
one or
another outcome? If Jimmy Carter, say, (or
some
other Christian) does not ask for God's kingdom to
come, will God therefore fail to establish it? Or will he
establish it just because Jimmy Carter asked for it,
though he would
not have done so otherwise? Even
Carter's staunchest supporters might well find it
34. frightening to think so ; and yet if we do not answer
these questions in the affirmative, the prayer
seems
futile and pointless. So either
an omniscient, omni?
potent, perfectly good God has predetermined this
state of affairs or he hasn't; and either way, asking for
it seems to make no sense. This conclusion is applic?
able to other cases of petitionary prayer
as well. To
take just
one
example, suppose that Jimmy Carter
prays the altruistic and Christian prayer that a
particular atheistic friend of his be converted and so
saved from everlasting damnation. If it is in God's
power to save that man, won't he do so without
Jimmy Carter's prayers? Won't a perfectly good God
do all the good he
can no matter what anyone prays
for or does not pray for? Consequently, either God of
his goodness will
35. save the man in any case, so that the
prayer is pointless,
or there is some point in the prayer
but God's goodness appears impugned.
We can, I think, generalize these arguments to all
petitionary prayer by means of a variation on the
argument from evil against God's existence.11 (The
argument that follows does not seem to me to be an
acceptable one, but it is the sort of argument that
underlies the objections to petitionary prayer which I
have been presenting. I will say something about
what I think are the flaws in this argument later in the
paper.)
( i ) A perfectly good being never makes the world worse
than it would otherwise be if he can avoid doing so.
The phrase "than it would otherwise be" here should
be construed as "than the world would have been had
he not brought about
or omitted to bring about
some
state of affairs." In other words, a perfectly good being
never makes the world, in virtue of what he himself
36. does or omits to do, worse than it would have been had
he not done or omitted to do something
or other.
Mutatis mutandis, the same remarks apply
to "than it
would otherwise be" in (4) and (7) below.
(2) An omniscient and omnipotent being can avoid
doing anything which it is not logically necessary for
him to do.
.'.(3) An omniscient, omnipotent, perfectly good being
never makes the world worse than it would otherwise
be unless it is logically necessary for him to do so.
(1.2)
(4) A perfectly good being always makes the world
better than it would otherwise be if he can do so.
(5) An omniscient and omnipotent being can do any?
thing which it is not logically impossible for him to
do.
.'.(6) An omniscient, omnipotent, perfectly good being
always makes the world better than it would other?
37. wise be unless it is logically impossible for him to do
so. (4, 5)
(7) It is never logically necessary for an omniscient,
omnipotent, perfectly good being to make the world
worse than it would otherwise be ; it is never logically
impossible for
an omniscient, omnipotent, perfectly
good being to make the world better than it would
otherwise be.
.'.(8) An omniscient, omnipotent, perfectly good being
never makes the world worse than it would otherwise
be and always makes the world better than it would
otherwise be. (3, 6, 7)
This subconclusion implies that unless the world is
infinitely improvable, either the world is or will be
absolutely perfect
or there is no omniscient, omni?
potent, perfectly good being. In other words, (8) with
the addition of a pair of premisses?
(i) The world is not infinitely improvable
10
38. See, for example, Martin Luther, Large Catechism pt. III. 169.
Luther's argument for prayer has more force in the context of
the
catechism than it does in the context of a philosophical
discussion, because Luther's purpose there is the practical one
of blocking what he
understands as believers' excuses for not praying. 11
My approach to the argument from evil, which underlies the
following argument, owes a good deal to Carl Ginet and
Norman
Kretzmann.
This content downloaded from 164.107.207.173 on Fri, 16 Jan
2015 20:24:11 PM
All use subject to JSTOR Terms and Conditions
http://www.jstor.org/page/info/about/policies/terms.jsp
84
AMERICAN PHILOSOPHICAL QUARTERLY
and
(ii) It is not the case that the world is or will be
absolutely perfect (i.e., there is and always will
be evil in the world)?
implies the conclusion of the argument from evil.
That is not a surprising result since this argument is
dependent
39. on the argument from evil.12
(9) What is requested in every petitionary prayer is
or
results in a state of affairs the realization of which
would make the world either worse or better than it
would otherwise be (that is, than it would have been
had that state of affairs not been realized).
It is not always clear whether
a
petitionary prayer is
requesting just
an
earthly
state of affairs, or God's
bringing about that earthly
state of affairs. So, for
example, when
a mother prays for the health of her
sick son, it is not always clear whether she is requesting
simply the health of her son or God's restoration of the
health of her son. If we can determine the nature of
the request
40. on the basis of what the one praying
desires and hopes
to get by
means of prayer, then at
least in most cases the request will be just for
some
earthly state of affairs. What is important
to the
mother is simply her son's getting well. For
a case in
which the request is for God's bringing about some
earthly
state of affairs, we might consider Gideon's
prayer concerning the fleece, discussed below. In any
event, I intend "state of affairs" in this argument to
range broadly enough
to cover both sorts of cases.
.'.(10) If what is requested in
a
petitionary prayer is or
results in a state of affairs the realization of which
would make the world worse than it would other?
41. wise be, an omniscient, omnipotent, perfectly good
being will not fulfill that request. (8)
.'.(11) If what is requested in
a petitionary prayer is or
results in a state of affairs the realization of which
would make the world better than it would other?
wise be, an omniscient, omnipotent, perfectly good
being will bring about that state of affairs
even if no
prayer for its realization has been made. (8)
It might
occur to someone here that what is requested
in at least some petitionary prayers is that God bring
about a certain state of affairs in response to the particular
petitionary prayer being made.
In such cases, of course, it is
logically impossible that God bring about what is
requested in the petitionary prayer
in the absence of
that petitionary prayer. It is
not clear to me that there
42. are such cases. The familiar entreaties such as "Hear
the voice of my supplications" (Ps. 28:2) in the
Psalms seem to me not to be cases of the relevant sort,
because they
seem to be an elaborate "Please" rather
than anything influencing the nature of what is
requested in the prayer. Perhaps one of the best
candidates for such a case is Gideon's prayer about the
fleece: "If you will save Israel by my hand, as you
have said, I will put a fleece of wool on the floor and if
the dew is on the fleece only and it is dry on all the
earth, then I will know that you will save Israel by my
hand, as you have said" (Judges 6:36-37; cf. also
6:39). Gideon here is requesting that God give him a
sign by means of the fleece of wool. Does his prayer
amount to a request that God produce dew only
on
the fleece and not on the surrounding ground,
or does
it come to a request that God do so in response to
Gideon's prayer? If there are cases in which the
request implicitly or explicitly includes reference to
the prayer itself, then in those cases the inference from
43. (8) to ( 11 ) is not valid ; and such cases ought simply to
be excluded from consideration in this argument.
.'.(12) Petitionary prayer effects no change. (9, 10, 11)
There is, of course, a sense in which the offering of
a
prayer is itself a new state of affairs and accompanies
or results in natural, psychological changes in the
one
praying, but step (12) ought to be understood as
saying that no prayer is itself efficacious in causing a
change of the
sort it was
designed
to cause. An
argument which might be thought to apply here,
invalidating the inference to the conclusion (13), is
that prayer need not effect any change in order
to be
considered efficacious, provided the offering of the
prayer itself is a sufficient reason in God's view for
God's fulfilment of the prayer.13 In other words, if, for
44. certain reasons apart from consideration of a prayer
for a state of affairs S, God has determined to bring
about S, a prayer for S may still be considered to be
efficacious if and only if God would have brought
about S just in response to the prayer for S. But I think
that even if this view is correct, it does not in fact
invalidate the inference to (13). There is a difference
between being efficacious and having a point. This
argument about the efficacy of prayer
seems to
assume that not all answers to prayer will be of the
overdetermined type. And
as
long
as a believer is not
in a
position
to know which states of affairs are
divinely determined to
occur
regardless of prayers,
12 There is a noteworthy difference between (ii) and the
premiss ordinarily supplied in its stead in arguments
from evil, namely, (ii')
"There is evil in the world". The difference suggests a way to
45. develop an alternative
or at least an addition to the standard free will defense
against the argument from evil.
13 See Terence Penelhum, Religion and Rationality (New York,
197r), pp. 287-292.
This content downloaded from 164.107.207.173 on Fri, 16 Jan
2015 20:24:11 PM
All use subject to JSTOR Terms and Conditions
http://www.jstor.org/page/info/about/policies/terms.jsp
PETITIONARY PRAYER
85
there is some point in petitionary prayer?any given
case may be one in which God would not have
brought about the desired state of affairs without
prayer for it. But if it is the case for every fulfilled
prayer that God would have brought about the
desired state of affairs without the prayer, it does seem
that there is no point in petitionary prayer, except for
those cases (which I think must at best form a very
small minority) in which the real object of the one
praying
a
petitionary prayer is
not so much to see the
46. realization of the state of affairs he is requesting
as to
have some influence on or contact with the Deity by
means of petitionary prayer ; and such
cases may then
simply be excepted from the conclusion of the
argument.
.".(13) Petitionary prayer is pointless. (12)
The basic strategy of this argument is
an
attempt to
show that there is an inconsistency between God's
goodness and the efficacy of petitionary prayer; but it
is possible to begin with other divine attributes and
make a case for a similar inconsistency,
so that we can
have other, very different arguments to the same
conclusion, namely, that petitionary prayer is point?
less. Perhaps the
most formidable of such alternative
arguments is the one based on God's immutability,
47. an
argument the strategy of which
can be roughly
summarized in this way. Before a certain petitionary
prayer is made, it is the case either that God will bring
about the state of affairs requested in the prayer
or
that he will not bring it about. He cannot have left
the matter open since doing
so would imply
a sub?
sequent change in him and he is immutable. Either
way, since he is immutable, the prayer itself can
effect no change in the state of affairs and hence is
pointless. Even leaving aside problems of fore?
knowledge and free will to which this argument (or
attempted objections to it) may give rise, I think that
orthodox theology will find no real threat in the
argument because of the doctrine of God's eternality.
However problematic that doctrine may be in itself, it
undercuts arguments such as this one because it
maintains God's atemporality.14 My thirteen-step
48. argument against petitionary prayer is, then,
not the
only argument rejecting petitionary prayer
on theis
tic principles, but it (or some argument along the
same
lines) does, I think, make the strongest
case
against petitionary prayer, given Christian doctrine.
The premiss that is most likely to appear false in the
argument, at first reading,
is (9) because
one is
inclined to think that there are many petitionary
prayers which, if they
are
granted, would
not make
the world either better or worse than it would
otherwise be. Such a view might be accommodated
without damaging the argument simply by weaken?
ing (9) and the conclusion : many petitionary prayers,
49. and surely the most important ones, are such that if
fulfilled they make the world either a better or a worse
place. But I think it is possible to argue plausibly for
(9) in the strong form I have given it. Take, for
instance, the case of a little boy who prays for
a
jack
knife. Here, we might think,
we have an example of
a
petitionary prayer the fulfilment of which makes the
world neither better nor worse. But, on the one hand,
if the little boy has prayed for a jack-knife, surely he
will be happier if he gets it, either because he very
much wants a jack-knife
or because God has honored
his request. Consequently,
one could argue that
fulfilling the request makes the world better in virtue
of making the
one
praying happier. Or,
on the other
50. hand, if we think of the little boy's prayer for a jack
knife from God's point
of view, then we see that
fulfilment of the prayer involves not just the little
boy's acquiring a jack-knife but also God's bringing it
about in answer to prayer that the little boy acquire
a
jack-knife. Fulfilling the prayer, then, will have
an
influence on at least the little boy's religious beliefs
and perhaps
also on those of his parents and
even on
those of the people in his parents' community. One
might argue that the influence in this
case would be
deleterious (since it is conducive to wrong views of the
purpose of prayer and of relationship with God), and
consequently that fulfilling this prayer would make
the world a worse place than it would otherwise be. So
I think it is possible to argue plausibly that the
fulfilment of even such a prayer would make the world
51. either a worse or a better place.
Christian literature contains a number of dis?
cussions of the problem with petitionary prayer and
various attempts to solve it. For the sake of brevity, I
want to look just at the proposed solution Aquinas
gives. It is the most philosophically sophisticated of
the solutions I know; and in the wake of the twentieth
century revival of Thomism, it is the solution adopted
by many theologians and theistic philosophers to?
day.15 Thomas discusses problems of petitionary
prayer in his Sentence commentary and in the Summa
contra gentiles.,16 but the clearest exposition of his views
14
Norman Kretzmann and I examine the concept of eternity in
ancient and medieval metaphysics and theology in our
forthcoming
book on that subject, attending particularly to the usefulness of
the concept in resolving certain problems in rational theology.
15
See, for example, the articles on prayer in the Dictionnaire de
Th?ologie Catholique and The New Catholic Encyclopedia. 16
See In IV. Sent., dist. XV, q.4, a.l, and Summa contra gentiles,
I. III. 95-96.
This content downloaded from 164.107.207.173 on Fri, 16 Jan
2015 20:24:11 PM
52. All use subject to JSTOR Terms and Conditions
http://www.jstor.org/page/info/about/policies/terms.jsp
86 AMERICAN PHILOSOPHICAL QUARTERLY
is in the question on prayer in the Summa theologiae,
where he devotes an entire article to showing that
there is sense and usefulness in petitionary prayer.17
The basic argument he relies on to rebut various
objections against the usefulness of prayer is this.
Divine Providence determines not only what effects
there will be in the world, but also what causes will
give rise to those effects and in what order they will do
so. Now human actions, too, are causes. "For,"
Thomas says, "we pray not in order to change the
divine disposition but for the sake of acquiring by
petitionary prayer what God has disposed to be
achieved by prayer."18
Perhaps the first worry which this argument
oc?
casions stems from the appearance of theological
determinism in it: God determines not only what
effects there will be but also what the causes of those
effects will be and in what order the effects will be
produced. It is hard to see how such a belief is
53. compatible with freedom of the will. In the preamble
to this argument, however, Thomas says he is con?
cerned not to deny free will but,
on the contrary, to
give
an account of prayer which preserves free will. So
I want
simply
to assume that he has in mind some
distinction or some theory which shows that, despite
appearances, his argument is not committed to a
thorough-going determinism, and I
am
going
to
ignore any troubles in the argument having
to do with
the compatibility of predestination or foreknowledge
and free will.
For present purposes, what is
more troublesome
about this argument is that it does not provide any
real help with the problem it
54. means to solve.
According
to Thomas, there is nothing absurd
or
futile about praying
to God, given God's nature,
because God has by his providence arranged things
so
that free human actions and human prayers will form
part of the chain of cause and effect leading to the
state of the world ordained in God's plan. And so,
on
Thomas's view, prayer should not be thought of
as an
attempt to get God to do something which he would
not otherwise do but rather as an effort to produce
an
appropriate and preordained cause which will result
in certain effects since God in his providence has
determined things
to be so. Now surely there
can be
55. no doubt that, according to Christian doctrine, God
wants men to pray and answers prayers; and con?
sequently it is plain that God's plan for the world
includes human prayers as causes of certain effects.
The difficulty lies in explaining how such a doctrine
makes sense. Why should prayers be included in
God's plan
as causes of certain effects? And what
sense is there in the notion that a perfect and
unchangeable God, who disposes and plans every?
thing, fulfills men's prayers asking him to do one thing
or another? Thomas's argument, I think, gives
no
help with these questions and so gives no help with
this problem of petitionary prayer.
This argument of Thomas's is roughly similar in
basic strategy to other traditional arguments for
prayer19 and is furthermore among the most fully
developed and sophisticated arguments for prayer,
but it seems to me inadequate
to make sense of
petitionary prayer. I think, then, that it is worthwhile
56. exploring
a sort of argument different from those that
stress the connection between God's omniscience or
providence and men's prayers. In what follows I
want
to offer a tentative and preliminary sketch of the way
in which such an argument might go.
Judaeo-Christian concepts of God commonly rep?
resent God as loving mankind and wanting to be
loved by men in return. Such anthropomorphic talk is
in sharp
contrast to the more
sophisticated-sounding
language of the Hellenized and scholastic arguments
considered so far. But a certain sort of
anthropomor?
phism is as much a part of Christianity as is Thomas's
"perfect being theology,"20 and it, too, builds on
intricate philosophical analysis, beginning perhaps
with Boethius's attempt in Contra Eutychen et Nestorium
to explain what it
means to say of something that it is
a
57. person. So to say that God loves men and wants to be
loved in return is to say something that has
a
place in
philosophical theology and is indispensable to
Christian doctrine. Throughout the Old and New
Testaments, the type of loving relationship wanted
between man and God is represented by various
images, for example, sometimes
as the relationship
between husband and wife, sometimes as that be?
tween father and child. And sometimes (in the Gospel
of John, for instance) it is also represented as the
relationship between
true friends.21 But if the re?
lationship between God and human beings is to be
17
See 2a-2ae, q. 83, a.2.
18 See reply, a.2. "Non enim propter hoc oramus ut divinam
dispositionem immutemus: sed ut id impetremus quod Deus
disposuitper orationes sanctorum
implendum ..."
58. 19
Cf., e.g., Origen, op. cit., and Augustine, City of God, Bk.V, ix.
20
Plainly, a good deal of skilful work is needed to weave such
anthropomorphism and scholastic theology
into one harmonious whole.
The problem is, of course, given lengthy, detailed treatment in
various scholastic writings, including
Thomas's Summa theologiae.
21 See especially Jn. 15: 12-15.
This content downloaded from 164.107.207.173 on Fri, 16 Jan
2015 20:24:11 PM
All use subject to JSTOR Terms and Conditions
http://www.jstor.org/page/info/about/policies/terms.jsp
PETITIONARY PRAYER
87
one which at least sometimes can be accurately
represented as the love of true friendship, then there is
a problem for both parties to the relationship, because
plainly it will not be easy for there to be friendship
between an omniscient, omnipotent, perfectly good
person and a fallible, finite, imperfect person. The
troubles of generating and maintaining friendship in
such a case are surely the perfect paradigms of which
59. the troubles of friendship between a Rockefeller child
and a slum child are just pale copies. Whatever other
troubles there are for friendship in these cases, there
are at least two dangers for the disadvantaged
or
inferior member of the pair. First, he
can be so
overcome
by the advantages
or
superiority of his
"friend" that he becomes simply a shadowy reflection
of the other's personality,
a slavish follower who
slowly loses all
sense of his own tastes and desires and
will. Some people, of course, believe
that just this
sort
of attitude towards God is what Christianity wants
and gets from the best of its adherents ; but I think
that such a belief goes counter to the spirit of the
Gospels, for example, and I don't think that it can be
60. found even in such intense mystics
as St. Teresa and
St. John of the Cross. Secondly, in addition to the
danger of becoming completely dominated, there is
the danger of becoming spoiled in the way that
members of a royal family in a ruling house are
subject to. Because of the power at their disposal in
virtue of their connections, they often become tyran?
nical, willful, indolent, self-indulgent,
and the like.
The greater the discrepancy in status and condition
between the two friends, the greater the danger of
even
inadvertently overwhelming and oppressing
or
overwhelming and spoiling the lesser member of the
pair ; and if he is overwhelmed in either of these ways,
the result will be replacement of whatever kind of
friendship there might have been with
one or another
sort of using. Either the superior member of the pair
will use the lesser as his lackey, or the lesser will use the
61. superior
as his personal power
source. To put it
succinctly, then, if God wants some kind of true
friendship with men, he will have to find a way of
guarding against both kinds of overwhelming.
It might occur to someone to think that even if we
assume the view that God wants friendship between
himself and human beings, it does not follow that he
will have any of the problems just sketched, because
he is omnipotent.22 If he wants friendship of this sort
with men, one might suppose, let him just will it and it
will be his. I do not want to stop here to argue against
this view in detail, but I do want just to suggest that
there is reason for thinking it to be incoherent, at least
on the assumption of free will adopted at the
beginning of this paper, because it is hard to see how
God could bring about such a friendship magically,
by
means of his omnipotence,
and yet permit
the
62. people involved to have free will. If he could do so, he
could make a person freely love him in the right sort of
way, and it does not seem reasonable to think he could
do so.23 On the face of it, then, omnipotence alone
does not do away with the two dangers for friendship
that I sketched above. But the institution of peti?
tionary prayer,
I think, can be understood
as a
safeguard against
these dangers.
It is easiest to argue that petitionary prayer
serves
such a function in the case of a man who prays for
himself. In praying for himself, he makes an explicit
request for help, and he thereby acknowledges a need
or a desire and his dependence on God for satisfying
that need or desire. If he gets what he prayed for, he
will be in a position to attribute his good fortune to
God's doing and to be grateful to God for what God
has given him. If we add the undeniable uncertainty
of his getting what he prays for, then we will have
safeguards against what I will call (for lack of a better
63. phrase) overwhelming spoiling. These conditions
make the act of asking
a
safeguard against tyrannical
and self-indulgent pride, even if the one praying
thinks of himself grandly as having God on his side.
We can see how the asking guards against the
second danger, of oppressive overwhelming, if
we
look for a moment at the function of roughly similar
asking for help when both the one asking and the one
asked are human beings. Suppose
a teacher sees that
one of his students is avoiding writing a paper and is
thereby storing up trouble for himself at the end of the i
term. And suppose that the student asks the teacher
for extra
help in organizing working time and
scheduling the various parts of the work. In that case I
think the teacher can without any problem give the
student what he needs, provided, of course, that the
teacher is willing
to do as much for any other student,
64. and so on. But suppose, on the other hand, that the
student does not ask the teacher for help and that the
221 want to avoid detailed discussion of the various
controversies over omnipotence. For present purposes, I will
take this as a rough
definition of omnipotence
: a
being is omnipotent if and only if he can do anything which it is
not logically impossible for him to do and if he
can avoid doing anything which it is not logically necessary for
him to do.
23
Controversy over this point is related to the more general
controversy over whether or not it is possible for an omnipotent,
omniscient,
perfectly good God to create men who would on every occasion
freely do what is right. For a discussion ofthat general
controversy and
arguments that it is not possible for God to do so, see Alvin
Plan tinga.''s God and Other Minds (Ithaca, 1967), pp. 132-148;
I am in agreement
with the general tenor of Plantinga's remarks in that section of
his book.
This content downloaded from 164.107.207.173 on Fri, 16 Jan
2015 20:24:11 PM
All use subject to JSTOR Terms and Conditions
http://www.jstor.org/page/info/about/policies/terms.jsp
65. 88 AMERICAN PHILOSOPHICAL QUARTERLY
teacher instead calls the student at home and simply
presents him with the help he needs in scheduling and
discipline. The teacher's proposals in that
case are
more than likely to strike the student as meddling
interference, and he is likely to respond with more or
less polite variations
on "Who asked you?" and
"Mind your own business." Those responses, I think,
are healthy and just. If the student were having
ordinary difficulties getting his work done and yet
docilely and submissively accepted the teacher's
unrequested scheduling of his time, he would have
taken the first step in the direction of unhealthy
passivity towards his teacher. And if he and his
teacher developed that sort of relationship, he could
end by becoming a lackey-like reflection of his
teacher. Bestowing
at least some benefits only in
response to requests for them is
a
safeguard against
such an outcome when the members of the re?
66. lationship
are not
equally balanced.
It becomes much harder to argue for this defense of
prayer
as soon as the complexity of the
case is
increased even just
a little. Take, for example,
Monica's praying
for her son Augustine.
There is
nothing in Monica's praying for Augustine which
shows that Augustine recognizes that he has
a need for
God's help or that he will be grateful if God gives him
what Monica prays for. Nor is it plain that Monica's
asking shields Augustine
from oppressive overwhelm?
ing by God. So it seems as if the previous arguments
fail in this case. But consider again the
case in which a
67. teacher sees that a student of his could use help but
does not feel that he can legitimately volunteer
his
help unasked. Suppose that John,
a friend of that
student, comes to see the teacher and says, "I don't
know if you've noticed, but Jim is having trouble
getting to his term paper. And unless he gets help, I
think he won't do it at all and will be in danger of
flunking the course."
If the teacher now goes to help
Jim and is rudely or politely asked "What right have
you got to interfere?," he'll say, "Well, in fact, your
friend came to me and asked me to help." And if John
is asked the same question, he will probably reply,
"But I'm your friend; I had to do something." I think,
then, that because John asks the teacher,
the teacher
is in a position to help with less risk of oppressive
meddling than before. Obviously,
he cannot go very
far without incurring that risk as fully as before ; and
68. perhaps
the most he can do if he wants to avoid
oppressive meddling is to try to elicit from Jim
in
genuinely
uncoercive ways a request for help. And,
of
course, I chose Monica and Augustine
to introduce
this case because, as Augustine tells it in the
Confessions, God responded
to Monica's fervent and
continued prayers for Augustine's salvation by
ar?
ranging the circumstances
of Augustine's life in such
a
way that finally Augustine himself freely asked God
for salvation.
One might perhaps think that there is something
superfluous and absurd in God's working through the
intermediary of prayer in this way. If Jim's friend can
69. justify his interference on the grounds that he is Jim's
friend and has to do something, God can dispense with
this sort of petitionary prayer,
too. He can give aid
unasked on the grounds that he
is the creator and has to
do something. But suppose that Jim and John are only
acquaintances who have discussed nothing
more than
their schoolwork; and suppose that John, by
overhearing Jim's phone conversations,
has come to
believe that all Jim's academic troubles
are
just
symptoms of problems he is having with his parents. If
John asks the teacher to help Jim with his personal
problems, and if the teacher begins even a delicate
attempt to do so by saying that John asked him to do
so, he and John could both properly be told to mind
their own business. It is not the status of his re?
lationship
70. or even the depth of his
care and com?
passion for Jim which puts John in a position to
defend himself by saying "But I'm your friend."
What protects John against the charge of oppressive
meddling is rather the degree to which Jim has freely,
willingly, shared his life and thoughts and feelings
with John. So John's line of defense against the charge
of oppressive meddling can be attributed to God only
if the person God is to aid has willingly shared his
thoughts and feelings and
the like with God. But it is
hard to imagine anyone putting himself in such a
relation to a person he believes to be omnipotent and
good without his also asking for whatever help he
needs.
Even if the argument can be made out
so far, one
might be inclined to think that it will not be sufficient
to show the compatibility of God's goodness with the
practice of petitionary prayer. If one supposes that
God brought Augustine to Christianity in response to
Monica's prayers, what is one to say about
Augustine's fate if Monica had not prayed for him?
71. And what does this view commit one to maintain
about people
who neither pray for themselves nor are
prayed for? It looks as if an orthodox Christian who
accepts the argument about petitionary prayer
so far
will be committed to a picture of this sort. God is
analogous
to a human father with two very different
children. Both Old and New Testaments depict God
as doing many good things for men without being
asked to do so, and this human father, too, does
unrequested good things for both his children. But
This content downloaded from 164.107.207.173 on Fri, 16 Jan
2015 20:24:11 PM
All use subject to JSTOR Terms and Conditions
http://www.jstor.org/page/info/about/policies/terms.jsp
PETITIONARY PRAYER
89
one child, who is healthy and normal, with healthy,
normal relations to his father, makes frequent
re?
72. quests of the father which the father responds to and
in virtue of which he bestows benefits on the child.
The other child is selectively blind, deaf, dumb, and
suffering from whatever other maladies
are necessary
to make it plausible that he does not even know he has
a father. Now either there are some benefits that the
father will never bestow unless and until he is asked ;
and in that case he will do less for his defective child,
who surely has more need of his help than does the
healthy child. Or, on the other hand, he will bestow
all his benefits unasked on the defective child, and
then he seems to make a mockery of his practice with
the normal child of bestowing some benefits only in
response to requests?he is, after all, willing
to bestow
the same benefits without being asked. So it seems
that we are still left with the problem we started with :
either God is not perfectly good or the practice of
petitionary prayer is pointless. But suppose the father
always
meets the defective child's needs and desires
even though the child never comes to know of the
existence of his father. The child knows only that he is
73. always taken
care of, and when he needs something,
he gets what he needs. It seems to
me
intuitively clear
that such a practice
runs a
great risk, at least, of
making the defective child willful and tyrannical. But
even if the defective child is not in danger of being
made worse in some respects in this situation, still it
seems plain that he would be better off if the father
could manage to put the child in a position to know
his father and to frame a request for what he wants.
So I think a good father will fulfill the child's needs
unasked; but I think that he can do so without
making
a
mockery of his practice of bestowing
benefits in response to requests only if putting the
child in a position
to make requests is among his first
concerns.
74. And as for the question whether God would have
saved Augustine without Monica's prayers, I think
that there is intermediate ground between the
asser?
tion that Monica's prayers are necessary to
Augustine's salvation, which
seems to
impugn God's
goodness, and the claim that they
are
altogether
without effect, which undercuts petitionary prayer. It
is possible, for example, to argue that God would have
saved Augustine without Monica's prayers but not in
the same amount of time or not by the
same process or
not with the same effect. Augustine, for instance,
might have been converted to Christianity but not in
such a way as to become one of its most powerful
authorities for centuries.24
With all this, I have still looked only at cases that
are easy for my position ; when
75. we turn to
something
like a prayer for Guatemala after the earthquake?
which begins to come closer to the sort of petitions in
the first half of the Lord's Prayer?it is much harder
to know what to say. And perhaps it is simply too hard
to come up with
a reasonable solution here because
we need more work on the problem of evil. Why
would a good God permit the
occurrence of earth?
quakes in the first place? Do the reasons for his
permitting the earthquake affect his afterwards help?
ing the country involved? Our inclination is surely to
say that a good God must in any case help the
earthquake victims,
so that in this instance at any rate
it is pointless
to pray. But plainly
we also have strong
inclinations to say that a good God
must in any case
prevent earthquakes
76. in populated
areas. And since
orthodox Christianity is committed to distrusting
these latter inclinations, it is at least at sea about the
former ones. Without more work on the problem of
evil, it is hard to know what to say about the
difference prayer might make in this sort of case.
I think it is worth noticing, though, that the first
three requests of the Lord's prayer do not run into the
same difficulties. Those requests seem generally
equivalent to a request for the kingdom of God on
earth, that state of affairs in which, of their own free
will, all men on earth are dedicated, righteous lovers
of God. Now suppose it is true that God would bring
about his kingdom on earth even if an individual
Christian such as Jimmy Carter did not pray for it. It
does not follow in this case, however, that the prayer
in question is pointless and makes no difference.
Suppose
no one
prayed for the advent of God's
kingdom
on earth or felt a need or desire for those
77. millenial times strongly enough to pray for them. It
24 I have presented the case of Monica and Augustine in a
simplified form in order to have an uncomplicated hard case for
the view I am
arguing. As far as the historical figures themselves
are concerned, it is plain that Monica's overt, explicit,
passionate concern for her son's
conversion greatly influenced the course of his life and shaped
his character from boyhood on. It is not clear whether
Augustine would have
been anything like the man he was if his mother had not been as
zealous on behalf of his soul as she was, if she had not prayed
continually
and fervently for his salvation and let him know she was doing
so. Augustine's character and personality were what they were
in large part
as a result of her fierce desire for his espousal of Christianity;
and just his knowledge that his beloved mother prayed so
earnestly for his
conversion must have been a powerful natural force helping to
effect that conversion. In this context the question whether God
could have
saved Augustine without Monica's prayers takes on different
meaning, and an affirmative answer is much harder to give with
reasoned
confidence.
This content downloaded from 164.107.207.173 on Fri, 16 Jan
78. 2015 20:24:11 PM
All use subject to JSTOR Terms and Conditions
http://www.jstor.org/page/info/about/policies/terms.jsp
90 AMERICAN PHILOSOPHICAL QUARTERLY
seems unreasonable to think that God could bring
about his earthly kingdom under those conditions,
or
if he could, that it would be the state of affairs just
described, in which earth is populated by people who
freely love God.23 And if so, then making the requests
in the first half of the Lord's Prayer resembles other,
more
ordinary activities in which only the effort of
a
whole group is sufficient to achieve the desired result.
One man can't put out
a forest fire, but if everyone in
the vicinity of a forest fire realized that fact and on
that basis decided not to try, the fire would rage out of
control. So in the case of the opening petitions of the
Lord's Prayer, too, it seems possible to justify peti?
tionary prayer without impugning God's goodness.
79. Obviously, the account I have given is just a
preliminary sketch for the full development of this
solution, and a good deal
more work needs to be done
on the problem. Nonetheless, I think that this
account
is on the right track and that there is
a workable
solution to the problem of petitionary prayer which
can be summarized in this way. God must work
through the intermediary of prayer, rather than
doing everything
on his own initiative, for man's sake.
Prayer
acts as a kind of buffer between man and God.
By safeguarding the weaker
member of the relation
from the dangers of overwhelming domination and
overwhelming spoiling, it helps to promote and
preserve
a close relationship between
an omniscient,
80. omnipotent, perfectly good person and a fallible,
finite, imperfect person. There is, of course,
some?
thing counter-intuitive in this notion that prayer
acts
as a buffer; prayer of all sorts is commonly and I think
correctly said to have
as one of its main functions the
production of closeness between
man and God. But
not just any sort of closeness will result in friendship,
and promoting the appropriate
sort of closeness will
require inhibiting or preventing inappropriate sorts
of closeness, so that a relationship of friendship
depends
on the maintenance of both closeness and
distance between the two friends. And while I do not
mean to denigrate the importance of prayer in
producing and preserving the appropriate sort of
closeness, I think the problem of petitionary prayer at
issue here is best solved by focusing on the distance
81. necessary for friendship and the function of peti?
tionary prayer in maintaining that distance.
As for the argument against prayer which I laid out
at the start of the paper, it seems to me that the flaw
lies in step (7), that it is never logically necessary for
God to make the world worse than it would otherwise
be and never logically impossible for him to make the
world better than it would otherwise be. To take a
specific example
from among those discussed so far,
orthodox Christianity is committed to claiming that
the advent of God's kingdom
on earth, in which all
people freely love God, would make the world better
than it would otherwise be. But I think that it is not
possible for God to make the world better in this way,
because I think it is not possible for him to make men
freely do anything.23 And in general, if it is arguable
that God's doing good things just in virtue of men's
requests protects
men from the dangers described and
preserves them in the right relationship to God, then
it is not the case that it is always logically possible for
God to make the world better and never logically
necessary for him to make the world worse than it
82. would otherwise be. If men do not always pray for all
the good things they might and ought to pray for,
then in some cases either God will not bring about
some good thing or he will do so but at the expense of
the good wrought and preserved by petitionary
prayer.
It should be plain that there is nothing in this
analysis of prayer which requires that God fulfil every
prayer ; asking God for something is not in itself a
sufficient condition for God's doing what he is asked.
Christian writings are full of examples of prayers
which are not answered, and there are painful
cases of
unanswered prayer in which the one praying
must be
tempted more to the belief that God is his implacable
enemy than to the sentimental-seeming
belief that
God is his friend. This paper proposes no answer for
these difficulties. They require a long, hard, careful
look at the problem of evil, and that falls just outside
the scope of this paper.
And, finally, it may occur to someone to wonder
whether the picture of God presented in this analysis
is at all faithful to the God of the Old or New
83. Testaments. Is this understanding of God and prayer
anything that Christianity ought to accept or even
find congenial? It
seems to me that one could point
to
many stories in either the Old or New Testament in
support of
an affirmative answer?for example,
Elijah's performance on Mt. Carmel (I Kings 18), or
the apostles' prayer for
a successor to
Judas
(Acts i : 24-26). But for a small and particularly nice
piece of evidence,
we can turn to the story in the
Gospel of Luke which describes Jesus making the
Lord's Prayer and giving
a lecture on how one is to
pray. According to the Gospel, Jesus is praying and in
such a way that his disciples see him and know that he
is praying. One of them makes
a
84. request of him which
has just a touch of rebuke in it: teach us to pray, as
John taught his disciples to pray (Lk. 11:1 ). If there is
a note of rebuke there, it seems just. A religious
master
should teach his disciples to pray, and a good teacher
This content downloaded from 164.107.207.173 on Fri, 16 Jan
2015 20:24:11 PM
All use subject to JSTOR Terms and Conditions
http://www.jstor.org/page/info/about/policies/terms.jsp
PETITIONARY PRAYER
91
does not wait until he is asked to teach his students
important lessons. But Jesus is portrayed
as a
good
teacher of just this sort in the Gospel of Luke.25 Does
the Gospel, then,
mean its readers to understand that
Jesus would not have taught his disciples how to pray
if they had not requested it? And if it does not, why is
Jesus portrayed as waiting until he is asked? Perhaps
85. the Gospel
means us to understand26 that Jesus does so
just in order to teach by experience as well as by
sermon what is implicit throughout the Lord's
Prayer: that asking makes
a difference.27
Cornell University Received March jo, igy8
25
See, for example, the lessons taught in the two incidents
described in Lk. 21: 1-6.
26 I have used awkward circumlocutions in this paragraph in
order to make plain that it is not my intention here to make any
claims
about the historical Jesus or the intentions of the Gospel writer.
I am not concerned in this paper to do or to take account of
contemporary
theories of Biblical exegesis. My point is only that the story in
the Gospel, as it has been part of ordinary Christian tradition,
lends itself to
the interpretation I suggest.
27 In writing this paper, I have benefited from the comments
and criticisms of John Boler, Norman Care, and Bill Rowe. I am
particularly indebted to my friend Norman Kretzmann for his
thorough reading and very helpful criticism of the paper. And I
am grateful
to John Crossett, from whom I have learned a great deal and
whose understanding of philosophical problems in Christian
theology is much
86. better than my own.
This content downloaded from 164.107.207.173 on Fri, 16 Jan
2015 20:24:11 PM
All use subject to JSTOR Terms and Conditions
http://www.jstor.org/page/info/about/policies/terms.jspArticle
Contentsp. 81p. 82p. 83p. 84p. 85p. 86p. 87p. 88p. 89p. 90p.
91Issue Table of ContentsAmerican Philosophical Quarterly,
Vol. 16, No. 2 (Apr., 1979), pp. 81-166Petitionary Prayer [pp.
81-91]Self-Predication and Plato's Theory of Forms [pp. 93-
103]What Should We Do about Future People? [pp. 105-113]A
New Defence of Common Sense [pp. 115-122]Phenomenal
Qualities [pp. 123-129]Is Freudian Psychoanalytic Theory
Pseudo-Scientific by Karl Popper's Criterion of Demarcation?
[pp. 131-141]Superadded Properties: The Limits of Mechanism
in Locke [pp. 143-150]Life and Death as the Arrival and
Departure of the Psyche [pp. 151-157]Feeling Guilty [pp. 159-
164]Books Received [p. 165-165]