Week 1 Cardiovascular Clinical CasePatient Setting52 year ol.docx
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Week 1: Cardiovascular Clinical Case Patient Setting: 52 year old Irish American Male that was hospitalized 2 weeks ago for a stent placement. Presenting to your clinic today for follow up as he has not felt well. He sates he has been lightheaded and felt palpitations of his heart. He has also had shortness of breath the last 2 days. HPI Walks 2 miles daily and rides an exercise bicycle 3 times a week; has previously felt the palpitations associated with exercise that usually went away with rest; 2 days ago while washing dishes he began to feel shortness of breath and felt that his heart was “racing”; He hoped the palpitations would go away but they have continued and that is why he is here today. PMH History of hypertension for 10 years, hyperlipidemia for 5 year, status post stent placement 2 weeks ago, and rheumatic heart disease (mitral valve) as a child. He reports adhering to a low cholesterol low fat diet for the last 2 years. Past Surgical History Stent placement 2 weeks ago. Family/Social History Family: Noncontributary Social: Smoked 15 pack/year X 20 years. Quit 5 years ago. Medication History Lisinopril 20 mg PO QD Furosemide 20 mg PO QD Gemfibrozil 600 mg PO BID Allergies NKDA ROS Otherwise negative. Physical exam BP 160/90 (clinic visit 2 months ago 155/85) HR 146, RR 22, T 98.6 F, Wt 254, Ht 5’ 7” Gen: Well developed male in moderate distress. HEENT: PERRLA, (-) JVDm mild AV nicking. Cardio: Rate irregularly irregular, no murmurs or gallops. Chest: Clear to auscultation. Abd: soft, non-tender, active bowel sounds. GU: Deferred. Rectal: Normal. EXT: No edema, normal pulses throughout. NEURO: A&O X3. Laboratory and Diagnostic Testing Na - 136 K - 4.5 Cl - 97 BUN - 20 Cr - 1.2 Total Chol - 240 Trig – 180 INR – 1.1 Chest Xray - Clear ECG – Atrial Fibrillation, no P waves, variable R-R interval normal QRS Week 1: Cardiovascular Clinical Case Patient Setting: 52 year old Irish American Male that was hospitalized 2 weeks ago for a stent placement. Presenting to your clinic today for follow up as he has not felt well. He sates he has been lightheaded and felt palpitations of his heart. He has also had shortness of breath the last 2 days. HPI Walks 2 miles daily and rides an exercise bicycle 3 times a week; has previously felt the palpitations associated with exercise that usually went away with rest; 2 d ays ago while washing dishes he began to feel shortness of breath and felt that his heart was “racing”; He hoped the palpitations would go away but they have continued and that is why he is here today. PMH History of hypertension for 10 years, hy perlipidemia for 5 year, status post stent placement 2 weeks ago, and rheumatic heart disease (mitral valve) as a child. He reports adhering to a low cholesterol low fat diet for the last 2 years. Past Surgical History Stent placement 2 weeks ago. Famil y/Social History Family: Noncontributary Social: Smoked 15 pack /year X 20 years. Quit 5 years ago.
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Week 2 Respiratory Clinical CasePatient Setting65 year old C.docx
Week 2: Respiratory Clinical Case
Patient Setting:
65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle accident presents to the clinic today. States she is having severe wheezing, shortness of breath and coughing at least once daily. She can barely get her words out without taking breaks to catch her breath and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10 weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no seizure activity since initiation of therapy.
PMH
History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago; placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to worsening CHF; symptoms well controlled the last year.
Past Surgical History
None
Family/Social History
Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF
Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.
Medication History
Theophylline SR Capsules 300 mg PO BID
Albuterol inhaler, PRN
Phenytoin SR capsules 300 mg PO QHS
HTCZ 50 mg PO BID
Enalapril 5 mg PO BID
Allergies
NKDA
ROS
Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache, swelling in the extremities and seizures.
Physical exam
BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”
VS after Albuterol breathing treatment - BP 134/79, HR 80, RR 18
Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2. Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU: Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses. NEURO: A&O X3, cranial nerves intact.
Laboratory and Diagnostic Testing
Na - 134
K - 4.9
Cl - 100
BUN - 21
Cr - 1.2
Glu – 110
ALT – 24
AST - 27
Total Chol – 190
CBC - WNL
Theophylline - 6.2
Phenytoin - 17
Chest Xray – Blunting of the right and left costophrenic angles
Peak Flow – 75/min; after albuterol – 102/min
FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%
Week
2
:
Respiratory
Clinical Case
Patient Setting:
65
year old
Caucasian female
that was
discharged from the
hospital
10 weeks ago
after
a
motor vehicle
accident presents to the clinic today.
States she is having severe wheezing, shortness of breath and
coughing at least once daily. She can barely get her words out
without taking breaks to catch her breath
and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months
(more than 4 times per week
average
)
, serious MVA 10
weeks ago; post traumatic seizure 2 w
eeks after the accident; anticonvulsant phenytoin started
–
no
seizure activ.
For this homework assignment, you will continue coding for Reports 2.docx
For this homework assignment, you will continue coding for Reports 2-5, which are located on pages 182-184 of the Step-by-Step Workbook. Using Encoder Pro, create codes for information from Reports 2-5. Additionally, explain how you arrived at that code.
Report 2: Discharge Summary
Diagnoses include:
1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma of unknown primary location.
2. Vena Cava syndrome post placement of Hickman catheter.
3. Anemia due to chronic disease.
4. Hypertension.
HOSPITAL COURSE:
The patient is a 78 year old female whom we have been following in our clinic for hypertension and also chronic pudendal nerve pain. She had been recently diagnosed with pelvic metastatic clear cell carcinoma, which her primary location is unknown at this time. She will be discussing this further after the pathology reports are read. During her hospital stay a Hickman catheter was placed in order to have IV access for pain medication or future cancer therapy. She was also admitted for chronic pain. She did develop swelling of her arms and neck. She was brought to interventional radiology and she did have venography and the Hickman catheter was removed. Her swelling to her arms and neck have decreased greatly. She denies any shortness of breath. No choking sensation as previously noted. Her pain has been managed well with fentanyl patch at 175mcg. She has also been on IV heparin therapy for anticoagulation following the vena cava syndrome. Today, the patient has been having complaints of nausea. She did get some dexamethasone IV for her nausea, which did improve later this morning. Her blood pressure has been under good control. Her labs today include a WBC of 5.18, hemoglobin 7.8, hematocrit 23.7, protime 14.4, INR 1.5, PTT 39.6, BUN 6, sodium 139, potassium 4.2, and CO2 27.2.
DISCHARGE MEDICATIONS:
1. Will continue home medications.
2. Phenergan 12.5 1-2 tabs p.o. p.r.n. every 6 hours for nausea.
3. Lovenox 1 mg/kg subcutaneously every 24 hours.
4. Fentanyl patch 175 mcg to be changed every 3 days.
5. Epogen 40,000 units subcutaneously weekly at the Cancer Center.
REPORT 3. CLINIC CHART NOTE
HISTORY: This 16 year old female is seen today after falling off a curb and twisting her right ankle. She is normally a patient of Dr. Anderson, who is out of town this week. She states that she has pain surrounding the entire foot and ankle. Seems unable or unwilling to bear weight.(Problem focused history)
PHYSICAL EXAM: Ankle and foot examined. Foot is warm to the touch. Some swelling and bruising noted around the lateral aspect of the ankle. X-ray is negative for fracture. (problem focused examination)
IMPRESSION: Sprained right ankle. (MDM complexity straightforward)
PLAN: Elevation; ice to affected area. Weight bearing only as tolerated. Return for follow-up p.r.n.
REPORT 4: ADMIT INPATIENT
This is a 19 year old with a living-related donor kidney transplant as of last month and admitted to hospital fo ...
Henry is a 70yearold African American male with endstage .pdf
Henry is a 70-year-old African American male with end-stage renal disease (ESRD) started
recently on hemodialysis 3 times per week and is having trouble with the diet changes. He dislikes
the taste of his binders (Tums 8/ /calcium carbonate) and reports often forgetting to take them with
meals. His nephrologist referred him for help implementing a renal diet. He went through a class
but is having trouble remembering what he leamed. He is present at the appointment with his adult
daughter. Henry was diagnosed with type 2 diabetes 10 years ago. The doctor said it was likely
that he had DM for several years prior to diagnosis. Henry lives alone but his daughter lives a few
miles away and takes him to his dialysis appointments or else he takes medical transportation.
Henry is mostly homebound, and his daughter brings groceries. She describes him as "set in his
ways." He often eats canned and frozen meals because they are easy to prepare, and he likes
them. He feels fatigued and doesn't have energy to cook but will heat things up and his daughter
will sometimes make food for him and bring it over. His ankles appear swollen. "I sleep a lot at
dialysis so I can't sleep at night very well - plus I get a lot of muscle cramps which keeps me
awake." His urine output is 240mL/ day and he has chronic constipation with a BM every 2 to 3
days. Anthropometrics: Height: 70 inches /178cm Weight: 153lbs/69.5kg BMI: Weight 1 year ago:
170lbs, Weight 3 months ago: 159lbs, Weight before last dialysis session: 165 lbs, Weight after
last dialysis session: 160 tbs Here Is Henry's 24 Hour Recall: B: Often skips as he sleeps late and
doesn't have much of an appetite lately. Drinks 1 cup coffee with 2 tbs half and half when he
wakes up. 5: (11 am) 12 oz orange juice and 1 slice white toast with butter, small handful of
M&M's L (1:00 pm): 2 cups canned tomato soup (tomato is his favorite) 12 saltine crackers and 8
oz 2% milk. 5: 1 large banana D (8 pm): Salisbury steak with mashed potatoes frozen dinner and
12 oz sweetened iced tea. S: (10 pm) 1 cup chocolate ice cream Medications and Supplements:
atenolol, erythropoietin (EPO), ferrlecit, insulin (lantus basil insulin), zemplar, sertraline, miralax,
calcium carbonate tablets Nutrition Physical Exam: Evidence of moderate wasting in the orbital,
buccal, temporal and clavicular regions. Patient moves slowly and dentures appear to fit loosely.
He falls asleep briefly during the nutrition intake. Ankles have evidence of edema.Nutrition
Physical Exam: Evidence of moderate wasting in the orbital, buccal, temporal and clavicular
regions. Patient moves slowly and dentures appear to fit loosely. He falls asleep briefly during the
nutrition intake. Ankles have evidence of edema. Recent Labs and Blood Pressure: Blood
Pressure (BP): 143/92 Question 1 Assess Henry's anthropometrics. Has he lost weight? Gained
weight? Has he gained more than the recommended amount between dialysis sessions?
Calculate his calorie, protein, and fluid ne.
1[Shortened Title up to 50 Characters]2Week 9 Assignment.docx
1
[Shortened Title up to 50 Characters] 2Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.
Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.
Duration: 5 to7 days du ...
Week 2 Respiratory Clinical Case Patient Setting 65 .docx
Week 2: Respiratory Clinical Case
Patient Setting:
65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle
accident presents to the clinic today. States she is having severe wheezing, shortness of breath and
coughing at least once daily. She can barely get her words out without taking breaks to catch her breath
and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10
weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no
seizure activity since initiation of therapy.
PMH
History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago;
placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to
worsening CHF; symptoms well controlled the last year.
Past Surgical History
None
Family/Social History
Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF
Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.
Medication History
Theophylline SR Capsules 300 mg PO BID
Albuterol inhaler, PRN
Phenytoin SR capsules 300 mg PO QHS
HTCZ 50 mg PO BID
Enalapril 5 mg PO BID
Allergies
NKDA
ROS
Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache,
swelling in the extremities and seizures.
Physical exam
BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”
VS after Albuterol breathing treatment - BP 134/79, HR 80, RR 18
Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM
without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2.
Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU:
Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses.
NEURO: A&O X3, cranial nerves intact.
Laboratory and Diagnostic Testing
Na - 134
K - 4.9
Cl - 100
BUN - 21
Cr - 1.2
Glu – 110
ALT – 24
AST - 27
Total Chol – 190
CBC - WNL
Theophylline - 6.2
Phenytoin - 17
Chest Xray – Blunting of the right and left costophrenic angles
Peak Flow – 75/min; after albuterol – 102/min
FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%
Chamberlain College of Nursing NR361
Course Project Milestone 1 Template
Directions: Prior to completing this template, carefully review Course Project Milestone 1 Guidelines. After saving the document to your computer, type your answers directly on this template and save again. This assignment is due by Sunday end of Week 2 by 11:59 p.m. Mountain Time.
Name: __________________________
Assignment Criteria
NOTE: See Milestone 1 Rubric for details required in each area.
Scenario for Milestone Assignment:
Scenario is clear and ...
1[Shortened Title up to 50 Characters]16Week 9 Assignment.docx
1
[Shortened Title up to 50 Characters] 16Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.
Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.
Duration: 5 to7 days d ...
Recommended
Week 2 Respiratory Clinical CasePatient Setting65 year old C.docx
Week 2: Respiratory Clinical Case
Patient Setting:
65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle accident presents to the clinic today. States she is having severe wheezing, shortness of breath and coughing at least once daily. She can barely get her words out without taking breaks to catch her breath and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10 weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no seizure activity since initiation of therapy.
PMH
History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago; placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to worsening CHF; symptoms well controlled the last year.
Past Surgical History
None
Family/Social History
Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF
Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.
Medication History
Theophylline SR Capsules 300 mg PO BID
Albuterol inhaler, PRN
Phenytoin SR capsules 300 mg PO QHS
HTCZ 50 mg PO BID
Enalapril 5 mg PO BID
Allergies
NKDA
ROS
Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache, swelling in the extremities and seizures.
Physical exam
BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”
VS after Albuterol breathing treatment - BP 134/79, HR 80, RR 18
Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2. Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU: Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses. NEURO: A&O X3, cranial nerves intact.
Laboratory and Diagnostic Testing
Na - 134
K - 4.9
Cl - 100
BUN - 21
Cr - 1.2
Glu – 110
ALT – 24
AST - 27
Total Chol – 190
CBC - WNL
Theophylline - 6.2
Phenytoin - 17
Chest Xray – Blunting of the right and left costophrenic angles
Peak Flow – 75/min; after albuterol – 102/min
FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%
Week
2
:
Respiratory
Clinical Case
Patient Setting:
65
year old
Caucasian female
that was
discharged from the
hospital
10 weeks ago
after
a
motor vehicle
accident presents to the clinic today.
States she is having severe wheezing, shortness of breath and
coughing at least once daily. She can barely get her words out
without taking breaks to catch her breath
and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months
(more than 4 times per week
average
)
, serious MVA 10
weeks ago; post traumatic seizure 2 w
eeks after the accident; anticonvulsant phenytoin started
–
no
seizure activ.
For this homework assignment, you will continue coding for Reports 2.docx
For this homework assignment, you will continue coding for Reports 2-5, which are located on pages 182-184 of the Step-by-Step Workbook. Using Encoder Pro, create codes for information from Reports 2-5. Additionally, explain how you arrived at that code.
Report 2: Discharge Summary
Diagnoses include:
1. Chronic pelvic pain secondary to pelvic metastatic clear cell carcinoma of unknown primary location.
2. Vena Cava syndrome post placement of Hickman catheter.
3. Anemia due to chronic disease.
4. Hypertension.
HOSPITAL COURSE:
The patient is a 78 year old female whom we have been following in our clinic for hypertension and also chronic pudendal nerve pain. She had been recently diagnosed with pelvic metastatic clear cell carcinoma, which her primary location is unknown at this time. She will be discussing this further after the pathology reports are read. During her hospital stay a Hickman catheter was placed in order to have IV access for pain medication or future cancer therapy. She was also admitted for chronic pain. She did develop swelling of her arms and neck. She was brought to interventional radiology and she did have venography and the Hickman catheter was removed. Her swelling to her arms and neck have decreased greatly. She denies any shortness of breath. No choking sensation as previously noted. Her pain has been managed well with fentanyl patch at 175mcg. She has also been on IV heparin therapy for anticoagulation following the vena cava syndrome. Today, the patient has been having complaints of nausea. She did get some dexamethasone IV for her nausea, which did improve later this morning. Her blood pressure has been under good control. Her labs today include a WBC of 5.18, hemoglobin 7.8, hematocrit 23.7, protime 14.4, INR 1.5, PTT 39.6, BUN 6, sodium 139, potassium 4.2, and CO2 27.2.
DISCHARGE MEDICATIONS:
1. Will continue home medications.
2. Phenergan 12.5 1-2 tabs p.o. p.r.n. every 6 hours for nausea.
3. Lovenox 1 mg/kg subcutaneously every 24 hours.
4. Fentanyl patch 175 mcg to be changed every 3 days.
5. Epogen 40,000 units subcutaneously weekly at the Cancer Center.
REPORT 3. CLINIC CHART NOTE
HISTORY: This 16 year old female is seen today after falling off a curb and twisting her right ankle. She is normally a patient of Dr. Anderson, who is out of town this week. She states that she has pain surrounding the entire foot and ankle. Seems unable or unwilling to bear weight.(Problem focused history)
PHYSICAL EXAM: Ankle and foot examined. Foot is warm to the touch. Some swelling and bruising noted around the lateral aspect of the ankle. X-ray is negative for fracture. (problem focused examination)
IMPRESSION: Sprained right ankle. (MDM complexity straightforward)
PLAN: Elevation; ice to affected area. Weight bearing only as tolerated. Return for follow-up p.r.n.
REPORT 4: ADMIT INPATIENT
This is a 19 year old with a living-related donor kidney transplant as of last month and admitted to hospital fo ...
Henry is a 70yearold African American male with endstage .pdf
Henry is a 70-year-old African American male with end-stage renal disease (ESRD) started
recently on hemodialysis 3 times per week and is having trouble with the diet changes. He dislikes
the taste of his binders (Tums 8/ /calcium carbonate) and reports often forgetting to take them with
meals. His nephrologist referred him for help implementing a renal diet. He went through a class
but is having trouble remembering what he leamed. He is present at the appointment with his adult
daughter. Henry was diagnosed with type 2 diabetes 10 years ago. The doctor said it was likely
that he had DM for several years prior to diagnosis. Henry lives alone but his daughter lives a few
miles away and takes him to his dialysis appointments or else he takes medical transportation.
Henry is mostly homebound, and his daughter brings groceries. She describes him as "set in his
ways." He often eats canned and frozen meals because they are easy to prepare, and he likes
them. He feels fatigued and doesn't have energy to cook but will heat things up and his daughter
will sometimes make food for him and bring it over. His ankles appear swollen. "I sleep a lot at
dialysis so I can't sleep at night very well - plus I get a lot of muscle cramps which keeps me
awake." His urine output is 240mL/ day and he has chronic constipation with a BM every 2 to 3
days. Anthropometrics: Height: 70 inches /178cm Weight: 153lbs/69.5kg BMI: Weight 1 year ago:
170lbs, Weight 3 months ago: 159lbs, Weight before last dialysis session: 165 lbs, Weight after
last dialysis session: 160 tbs Here Is Henry's 24 Hour Recall: B: Often skips as he sleeps late and
doesn't have much of an appetite lately. Drinks 1 cup coffee with 2 tbs half and half when he
wakes up. 5: (11 am) 12 oz orange juice and 1 slice white toast with butter, small handful of
M&M's L (1:00 pm): 2 cups canned tomato soup (tomato is his favorite) 12 saltine crackers and 8
oz 2% milk. 5: 1 large banana D (8 pm): Salisbury steak with mashed potatoes frozen dinner and
12 oz sweetened iced tea. S: (10 pm) 1 cup chocolate ice cream Medications and Supplements:
atenolol, erythropoietin (EPO), ferrlecit, insulin (lantus basil insulin), zemplar, sertraline, miralax,
calcium carbonate tablets Nutrition Physical Exam: Evidence of moderate wasting in the orbital,
buccal, temporal and clavicular regions. Patient moves slowly and dentures appear to fit loosely.
He falls asleep briefly during the nutrition intake. Ankles have evidence of edema.Nutrition
Physical Exam: Evidence of moderate wasting in the orbital, buccal, temporal and clavicular
regions. Patient moves slowly and dentures appear to fit loosely. He falls asleep briefly during the
nutrition intake. Ankles have evidence of edema. Recent Labs and Blood Pressure: Blood
Pressure (BP): 143/92 Question 1 Assess Henry's anthropometrics. Has he lost weight? Gained
weight? Has he gained more than the recommended amount between dialysis sessions?
Calculate his calorie, protein, and fluid ne.
1[Shortened Title up to 50 Characters]2Week 9 Assignment.docx
1
[Shortened Title up to 50 Characters] 2Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.
Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.
Duration: 5 to7 days du ...
Week 2 Respiratory Clinical Case Patient Setting 65 .docx
Week 2: Respiratory Clinical Case
Patient Setting:
65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle
accident presents to the clinic today. States she is having severe wheezing, shortness of breath and
coughing at least once daily. She can barely get her words out without taking breaks to catch her breath
and states she has taken albuterol once today.
HPI
Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10
weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no
seizure activity since initiation of therapy.
PMH
History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago;
placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to
worsening CHF; symptoms well controlled the last year.
Past Surgical History
None
Family/Social History
Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF
Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.
Medication History
Theophylline SR Capsules 300 mg PO BID
Albuterol inhaler, PRN
Phenytoin SR capsules 300 mg PO QHS
HTCZ 50 mg PO BID
Enalapril 5 mg PO BID
Allergies
NKDA
ROS
Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache,
swelling in the extremities and seizures.
Physical exam
BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”
VS after Albuterol breathing treatment - BP 134/79, HR 80, RR 18
Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM
without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2.
Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU:
Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses.
NEURO: A&O X3, cranial nerves intact.
Laboratory and Diagnostic Testing
Na - 134
K - 4.9
Cl - 100
BUN - 21
Cr - 1.2
Glu – 110
ALT – 24
AST - 27
Total Chol – 190
CBC - WNL
Theophylline - 6.2
Phenytoin - 17
Chest Xray – Blunting of the right and left costophrenic angles
Peak Flow – 75/min; after albuterol – 102/min
FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%
Chamberlain College of Nursing NR361
Course Project Milestone 1 Template
Directions: Prior to completing this template, carefully review Course Project Milestone 1 Guidelines. After saving the document to your computer, type your answers directly on this template and save again. This assignment is due by Sunday end of Week 2 by 11:59 p.m. Mountain Time.
Name: __________________________
Assignment Criteria
NOTE: See Milestone 1 Rubric for details required in each area.
Scenario for Milestone Assignment:
Scenario is clear and ...
1[Shortened Title up to 50 Characters]16Week 9 Assignment.docx
1
[Shortened Title up to 50 Characters] 16Week 9 Assignment
Bethel U. Godwins
Walden University
NURS 6551, Section 8, Primary Care of Women
July 31, 2016
Abnormal Uterine Bleeding
Society for Reproductive Endocrinology and Infertility (SREI, 2012) described abnormal uterine bleeding as bleeding that differs in quality and quantity from normal menstrual bleeding, such as women spotting or bleeding between the women’s menstrual periods; bleeding after sex; bleeding heavier or last more days than normal; and bleeding post menopause. According to SREI (2012), factors that can cause abnormal bleeding include structural abnormalities of the reproductive system, such as uterine polyps, fibroids, and adenomyosis. Furthermore, SREI (2012) explained that vaginal, uterine or cervical lesions, miscarriage, ectopic pregnancy, endometritis, adhesions in the endometrium, and use of an intrauterine device (IUD) can also cause abnormal bleeding. Johns Hopkins Medicine (2016) specified that early recognition of abnormal bleeding, and seeing a health care provider immediately for appropriate diagnosis and treatment increase the chance of successful treatment. Therefore, the author will focus on a single patient comprehensive evaluation, which includes the patient’s personal/health history; physical examination; laboratory/diagnostic tests; diagnosis; treatment/management plan; education strategies; and follow-up care. Comment by DeAllen B Millender: Good introduction.
General Patient Information
Age: 41-year-old
Race/Ethnicity: Hispanic American
Partner Status: Married Comment by DeAllen B Millender: This information is not in APA format.
Current Health Status
Chief Complaint: “I have heavy, prolonged menstrual bleeding with severe cramping for the past one year”.
History of Present Illness (HPI): RG is a 41-year-old Hispanic American female who presented to the clinic with complaint of heavy prolonged menstrual bleeding with severe cramping for the past one year. Patient reported sharp pelvic pain during menstruation, bleeding between periods, pain with intercourse, blood clots during periods. Abdominal pain/pressure and bloating. Patient suggested that these symptoms started after her second caesarean section surgery one year ago. Patient also reported that she takes over-the counter medication, such as ibuprofen to relieve the pain. she also suggested that she uses heating pad on her abdomen/pelvic for pain relief, and she stated that she soaks in a warm sitz bath to ease pelvic pain and cramping. Patient also reported fatigue and weakness. Patient further stated that she decided to see an obstetrician and gynecologist (OB/GYN) because the heavy prolonged bleeding with severe menstrual cramp interfere with her regular activities. Patient denied nausea, vomiting, diarrhea, fever, and chills.
Timing/Onset: Patient said one year ago.
Location: The location of the problem as stated by the patient is pelvic/uterus/vaginal.
Duration: 5 to7 days d ...
Diabetes mellitus - a case presentation for SPM
Case of A Diabetic person with complicated ulcer of foot. It's not perfect in a correct format , but near to it.
Chief complaint I’m here for a medication refill because I r.docx
Chief complaint:
“I’m here for a medication refill because I ran out of my medicines”.
HPI:
Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH:
Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies
:
Penicillin
Vaccination History:
Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs:
Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral .
Give an example from your own experience or research an article or.docx
Give an example from your own experience or research an article or the media in which a business executive did something of significance that is morally right. Use APA format to cite your material from your sources.
Is there a relationship between obesity and socio-economic status? Should obese people be considered a protected class under Title VII of the Civil Rights Act?
1:
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Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and r ...
Pharma Case Study week 8 Chief complaint I’m here for a medi.docx
Pharma Case Study week 8
Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.
HPI: Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH: Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies: Penicillin
Vaccination History: Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden's nodes at the DIP joints, hands. + Crepitus, bil ...
Chief ComplaintMy left foot feels weak and numb. I have a hard ti
Chief Complaint
“My left foot feels weak and numb. I have a hard time pointing my toes up.”
History of Present Illness
D.T. is 42-year-old Caucasian woman who has had an elevated blood sugar and cholesterol 2 years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed her fasting blood sugar was 160 and her cholesterol was 250. However, she felt “perfectly fine at the time” and did not want to take any more medications. Except for a number of “female infections,” she has felt fine recently.Today, she presents to the clinic complaining that her left foot has been weak and numb for nearly 3 weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. She does report that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 50 pounds since her last pregnancy 10 years ago, 20 pounds in the last 6 months alone.
Past Medical History
Seasonal allergic rhinitis (since her early 20s)Breast biopsy positive for fibroadenoma at age 30Gestational diabetes with second child 10 years agoMultiple yeast infections during the past 3 years that she has self-treated with OTC antifungal creams and salt bathHypertension for 10 years
Past Surgical History
C-section 14 years ago
OB-GYN History
Menarche at age 11Last pap smear 3 years ago
Family History
Type 2 DM present in older brother and maternal grandfather. Both were diagnosed in their late 40s. Brother takes both pills and shots.Mother alive and wellFather has COPDTwo other siblings alive and wellAll three children are alive and well
Social History
Married 29 years with 3 children; husband is a school teacherFamily lives in a four bedroom single family homePatient works as a seamstressSmokes 1 pack per day (since age 16) and drinks two alcoholic drinks 4 days per weekDenies illegal drug usesNever exercises and has tried multiple fad diets for weight loss with little success. She now eats a diet rich in fats and refined sugars.
Allergies
NKDA
Medications
Lisinopril 10 mg dailyLoratadine 10 mg daily
Review of SystemsGeneral
Admits to recent onset of fatigue
HEENT
Has awakened on several occasions with blurred vision and dizziness or lightheadedness upon standing: Denies vertigo, head trauma, ear pain, difficulty swallowing or speaking
Cardiac
Denies chest pain, palpitations, and difficulty breathing while lying down
Lungs
Denies cough, shortness of breath, and wheezing
GI
Denies nausea, vomiting, abdominal bloating or pain, diarrhea, or food intolerance, but admits occasional episodes of constipation
GU
Has experienced increased frequency and volumes of urination, but denies pain during urination, blood in the urine, or urinary incontinence
EXT
Denies leg cramps or swelling in the ankles and feet; has never experienced weakness, tin ...
Running Head Clinical Diagnostic Zandria HamiltonMigr.docx
Running Head: Clinical Diagnostic
Zandria Hamilton
Migraine
Tyohon ID:1840-20181018-007
12/2/2018
CC:
" I've been having headache for a while"
HPI:
Patient is a 29-year-old Caucasian female who reports that she has had a headache for a year. She reports a headache is a constant dull ache located at the back of her neck. She reports the pain is a 6/10 at all times. She states that she has been taking ibuprofen 600 mg three times daily, but the medication provides no relief. She reports that the headache is worst during the day when she is out running every day errands.
PMH:
Patient reports no past medical history. Patient reports an MVA that occurred in 2016. Patient reports he sustained no injuries related to MVA. Patient denies having a past surgical history.
Allergies:
Reports no known medication, food or latex allergy.
Medication:
Patient reports the only medication she is currently on Ibuprofen 600 mg po TID as needed for headache.
Social History:
Patient denies recreational drug use. She denies tobacco use. She reports drinking two 8 oz glasses of wine 3 nights weekly. Patient reports she is married with 2 young girls aged 4 and 6. She reports she lives with her husband and 2 daughters. Reports she does not engage in risky sex. Patient reports she is a stay at home mother and is currently unemployed but reports she has a bachelor's degree in Spanish. She states she active member of the Catholic church and attend church every Sunday.
Family history:
Patient reports mother is still alive and has a history of hypertension which was diagnosed when she was 45. She states her father has a history of depression, which he was diagnosed with at age 39. Maternal grandmother died at the age of 83, from complications of CHF but medical history is unknown. Maternal grandfather died of complications of Parkinson's at the age of 75, but medical history is unknown. Paternal grandmother is still alive and medical history is unknown. Paternal grandfather is still a live and patient reports she doesn't know his medical history. Patient reports having 2 siblings who don't have any medical conditions.
Health maintenance and promotion:
Patient reports she was given a flu shot in December of 2017. She reports that she runs a mile 5 times a week in the morning. She reportedly drinks 84 oz. of water daily. She states that she eats a well-balanced diet. She reportedly eats 5 small meals a day. Based on Recommendations by the USPSTF the patient should be screened for high blood pressure in adults over the age of 18. The recommendation is to obtain measurement outside of the clinical setting for diagnostic confirmation before treating.
ROS:
General: Patient denies, fever, chills, or malaise.
Skin: Patient denies any open wounds, bruises, sores, or any areas of breakdown on skin.
HEENT: Patient denies abnormal growths on head. Patient denies having a hard time hearing. He denies ear pain. Patient denies tinnitus. She denies having a sore.
Case StudyChief complaint I’m here for a medication refill .docx
Case Study:
Chief complaint:
“I’m here for a medication refill because I ran out of my medicines”.
HPI:
Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH:
Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies
:
Penicillin
Vaccination History:
Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs:
Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: + Heberden's nodes at the DIP joints, hands. + Crepi.
Financial & Managerial Accounting Assignment 1 – Financial S.docx
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Guidelines for assignment
This is an individual assignment
Ground your answer in relevant theory
Plagiarism and reproduction of someone else’s work as your own will be penalized
Make use of references, where appropriate – Use Harvard or APA referencing method.
Late submission are not accepted
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Structural elements should include an introduction, main body, and a conclusion
Weight – 50%
Word count guidance : part 1 – N/A. Business report wordage should be 2000 +/-10%
Type of assignment: Excel Assessed Work Folder and Business Report
Start / Finish : Week 3 – 4
Learning Outcome Assessed: 1,2,3,4
Submit one single document and not lots of different files.
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November ...
CardiologyEndocrine Case Study Course Student Learning Outcom.docx
Cardiology/Endocrine Case Study
Course Student Learning Outcomes
Upon completion of the case study, students will be able to …
1. Apply the principles of pharmacology relative to pharmacotherapeutics across age levels including the effect of race, gender, ethnic group, and special populations.
2. Describe the uses, actions, effects and nursing implications of general classifications of drugs and selected specific drugs.
3. Investigate media resources and information technologies to enhance knowledge base of pharmacology.
4. Analyze the responsibilities of the nurse when administering drugs.
5. Apply pharmacological research to nursing practice.
Purpose The purpose of this case study is to apply concepts from pharmacology and
pathophysiology, national guidelines, and evidenced based clinical practices in the management of chronic disease. Remember this paper must follow APA guidelines for font, in text citations, reference list etc. No abstract is needed. Provide headings for the different questions in your paper.
Setting This case study takes place in a primary care setting in a small rural hospital clinic that provides health care services to predominately Latino field workers and their families. The rural clinic serves children and adults for all medical needs including well care, acute care, and chronic conditions. Some clients have seasonal insurance, state health insurance, or no insurance. Many live below poverty level according to the federal guidelines. Most do not own a vehicle. Most do not speak English; so, a translator is provided at each visit. The clinic is one hour from the nearest city where higher level of care can be offered to patients in need of specialty care. The clinic is staffed by one family medicine physician, an internist, two nurse practitioners, an RN, two LVNs, a lab tech, eight MAs and support staff. Once a week a cardiologist, podiatrist, pain specialist, orthopedist and ophthalmologist service the clinic. There is an on-site lab and a pharmacy two blocks away. There are two ambulances servicing the entire south end of the county with poor availability for emergencies.
Client
Jose is a 47 year old morbidly obese Latino male who presents to the clinic for follow up evaluation of headaches, dizziness, ringing in his ears and frequent urination. He reports having a headache that “comes and goes” with ringing in his ears and sometimes he sees spots. Jose has taken acetaminophen and states that seems to help. Due to his work schedule of six 12 hour days, Jose has not had preventive care. He reports fatigue and is depressed regarding his current income situation. Jose has just been laid off for the season and will lose his insurance in 30 days until the restart of the harvesting season in March. He is concerned about paying for any health care that may go beyond his benefit period. Jose lives with his pregnant wife, who does not work, and their seven children in a three bedroom one bath house that they share.
Comprehensive SOAP ExemplarPurpose To demonstrate what each s.docx
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue sinc.
Attaining ExpertiseYou are tr.docx
Attaining Expertise
You are training individuals you supervise on how to attain expertise in your field.
Write
a 1,050- to 1,200-word paper on the processes involved with attaining expertise, using your assigned readings in Anderson. Explain how these processes apply to attaining expertise in your current field or in the field you plan to enter. Focus on the cognitive processes that are involved in mastering knowledge and skills.
Include
a title page and references list consistent with APA guidelines.
Click
the Assignment Files tab to submit your assignment.
.
attachment Chloe” is a example of the whole packet. Please follow t.docx
attachment “Chloe” is a example of the whole packet. Please follow the format and write in professional PR tone. So for each paragraph, you should refer to what’s write in the example. The packet includes a pitch letter, a news release (which i already wrote), a feature release, a fact sheet, a executive biography and a media alert. I have already wrote the news release part. I also put in the attachment.
.
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Diabetes mellitus - a case presentation for SPM
Case of A Diabetic person with complicated ulcer of foot. It's not perfect in a correct format , but near to it.
Chief complaint I’m here for a medication refill because I r.docx
Chief complaint:
“I’m here for a medication refill because I ran out of my medicines”.
HPI:
Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH:
Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies
:
Penicillin
Vaccination History:
Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs:
Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral .
Give an example from your own experience or research an article or.docx
Give an example from your own experience or research an article or the media in which a business executive did something of significance that is morally right. Use APA format to cite your material from your sources.
Is there a relationship between obesity and socio-economic status? Should obese people be considered a protected class under Title VII of the Civil Rights Act?
1:
2:
3.
4.
5.
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and r ...
Pharma Case Study week 8 Chief complaint I’m here for a medi.docx
Pharma Case Study week 8
Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.
HPI: Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH: Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies: Penicillin
Vaccination History: Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden's nodes at the DIP joints, hands. + Crepitus, bil ...
Chief ComplaintMy left foot feels weak and numb. I have a hard ti
Chief Complaint
“My left foot feels weak and numb. I have a hard time pointing my toes up.”
History of Present Illness
D.T. is 42-year-old Caucasian woman who has had an elevated blood sugar and cholesterol 2 years ago but did not follow up with a clinical diagnostic work-up. She had participated in the state’s annual health screening program and noticed her fasting blood sugar was 160 and her cholesterol was 250. However, she felt “perfectly fine at the time” and did not want to take any more medications. Except for a number of “female infections,” she has felt fine recently.Today, she presents to the clinic complaining that her left foot has been weak and numb for nearly 3 weeks and that the foot is difficult to flex. She denies any other weakness or numbness at this time. She does report that she has been very thirsty lately and gets up more often at night to urinate. She has attributed these symptoms to the extremely warm weather and drinking more water to keep hydrated. She has gained a total of 50 pounds since her last pregnancy 10 years ago, 20 pounds in the last 6 months alone.
Past Medical History
Seasonal allergic rhinitis (since her early 20s)Breast biopsy positive for fibroadenoma at age 30Gestational diabetes with second child 10 years agoMultiple yeast infections during the past 3 years that she has self-treated with OTC antifungal creams and salt bathHypertension for 10 years
Past Surgical History
C-section 14 years ago
OB-GYN History
Menarche at age 11Last pap smear 3 years ago
Family History
Type 2 DM present in older brother and maternal grandfather. Both were diagnosed in their late 40s. Brother takes both pills and shots.Mother alive and wellFather has COPDTwo other siblings alive and wellAll three children are alive and well
Social History
Married 29 years with 3 children; husband is a school teacherFamily lives in a four bedroom single family homePatient works as a seamstressSmokes 1 pack per day (since age 16) and drinks two alcoholic drinks 4 days per weekDenies illegal drug usesNever exercises and has tried multiple fad diets for weight loss with little success. She now eats a diet rich in fats and refined sugars.
Allergies
NKDA
Medications
Lisinopril 10 mg dailyLoratadine 10 mg daily
Review of SystemsGeneral
Admits to recent onset of fatigue
HEENT
Has awakened on several occasions with blurred vision and dizziness or lightheadedness upon standing: Denies vertigo, head trauma, ear pain, difficulty swallowing or speaking
Cardiac
Denies chest pain, palpitations, and difficulty breathing while lying down
Lungs
Denies cough, shortness of breath, and wheezing
GI
Denies nausea, vomiting, abdominal bloating or pain, diarrhea, or food intolerance, but admits occasional episodes of constipation
GU
Has experienced increased frequency and volumes of urination, but denies pain during urination, blood in the urine, or urinary incontinence
EXT
Denies leg cramps or swelling in the ankles and feet; has never experienced weakness, tin ...
Running Head Clinical Diagnostic Zandria HamiltonMigr.docx
Running Head: Clinical Diagnostic
Zandria Hamilton
Migraine
Tyohon ID:1840-20181018-007
12/2/2018
CC:
" I've been having headache for a while"
HPI:
Patient is a 29-year-old Caucasian female who reports that she has had a headache for a year. She reports a headache is a constant dull ache located at the back of her neck. She reports the pain is a 6/10 at all times. She states that she has been taking ibuprofen 600 mg three times daily, but the medication provides no relief. She reports that the headache is worst during the day when she is out running every day errands.
PMH:
Patient reports no past medical history. Patient reports an MVA that occurred in 2016. Patient reports he sustained no injuries related to MVA. Patient denies having a past surgical history.
Allergies:
Reports no known medication, food or latex allergy.
Medication:
Patient reports the only medication she is currently on Ibuprofen 600 mg po TID as needed for headache.
Social History:
Patient denies recreational drug use. She denies tobacco use. She reports drinking two 8 oz glasses of wine 3 nights weekly. Patient reports she is married with 2 young girls aged 4 and 6. She reports she lives with her husband and 2 daughters. Reports she does not engage in risky sex. Patient reports she is a stay at home mother and is currently unemployed but reports she has a bachelor's degree in Spanish. She states she active member of the Catholic church and attend church every Sunday.
Family history:
Patient reports mother is still alive and has a history of hypertension which was diagnosed when she was 45. She states her father has a history of depression, which he was diagnosed with at age 39. Maternal grandmother died at the age of 83, from complications of CHF but medical history is unknown. Maternal grandfather died of complications of Parkinson's at the age of 75, but medical history is unknown. Paternal grandmother is still alive and medical history is unknown. Paternal grandfather is still a live and patient reports she doesn't know his medical history. Patient reports having 2 siblings who don't have any medical conditions.
Health maintenance and promotion:
Patient reports she was given a flu shot in December of 2017. She reports that she runs a mile 5 times a week in the morning. She reportedly drinks 84 oz. of water daily. She states that she eats a well-balanced diet. She reportedly eats 5 small meals a day. Based on Recommendations by the USPSTF the patient should be screened for high blood pressure in adults over the age of 18. The recommendation is to obtain measurement outside of the clinical setting for diagnostic confirmation before treating.
ROS:
General: Patient denies, fever, chills, or malaise.
Skin: Patient denies any open wounds, bruises, sores, or any areas of breakdown on skin.
HEENT: Patient denies abnormal growths on head. Patient denies having a hard time hearing. He denies ear pain. Patient denies tinnitus. She denies having a sore.
Case StudyChief complaint I’m here for a medication refill .docx
Case Study:
Chief complaint:
“I’m here for a medication refill because I ran out of my medicines”.
HPI:
Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.
She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.
PMH:
Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent placement
Allergies
:
Penicillin
Vaccination History:
Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs:
Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS
: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART
: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: + Heberden's nodes at the DIP joints, hands. + Crepi.
Financial & Managerial Accounting Assignment 1 – Financial S.docx
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Guidelines for assignment
This is an individual assignment
Ground your answer in relevant theory
Plagiarism and reproduction of someone else’s work as your own will be penalized
Make use of references, where appropriate – Use Harvard or APA referencing method.
Late submission are not accepted
Financial & Managerial Accounting
Assignment 1 – Financial Statement Analysis
Structural elements should include an introduction, main body, and a conclusion
Weight – 50%
Word count guidance : part 1 – N/A. Business report wordage should be 2000 +/-10%
Type of assignment: Excel Assessed Work Folder and Business Report
Start / Finish : Week 3 – 4
Learning Outcome Assessed: 1,2,3,4
Submit one single document and not lots of different files.
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______
Age: _______
Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November ...
CardiologyEndocrine Case Study Course Student Learning Outcom.docx
Cardiology/Endocrine Case Study
Course Student Learning Outcomes
Upon completion of the case study, students will be able to …
1. Apply the principles of pharmacology relative to pharmacotherapeutics across age levels including the effect of race, gender, ethnic group, and special populations.
2. Describe the uses, actions, effects and nursing implications of general classifications of drugs and selected specific drugs.
3. Investigate media resources and information technologies to enhance knowledge base of pharmacology.
4. Analyze the responsibilities of the nurse when administering drugs.
5. Apply pharmacological research to nursing practice.
Purpose The purpose of this case study is to apply concepts from pharmacology and
pathophysiology, national guidelines, and evidenced based clinical practices in the management of chronic disease. Remember this paper must follow APA guidelines for font, in text citations, reference list etc. No abstract is needed. Provide headings for the different questions in your paper.
Setting This case study takes place in a primary care setting in a small rural hospital clinic that provides health care services to predominately Latino field workers and their families. The rural clinic serves children and adults for all medical needs including well care, acute care, and chronic conditions. Some clients have seasonal insurance, state health insurance, or no insurance. Many live below poverty level according to the federal guidelines. Most do not own a vehicle. Most do not speak English; so, a translator is provided at each visit. The clinic is one hour from the nearest city where higher level of care can be offered to patients in need of specialty care. The clinic is staffed by one family medicine physician, an internist, two nurse practitioners, an RN, two LVNs, a lab tech, eight MAs and support staff. Once a week a cardiologist, podiatrist, pain specialist, orthopedist and ophthalmologist service the clinic. There is an on-site lab and a pharmacy two blocks away. There are two ambulances servicing the entire south end of the county with poor availability for emergencies.
Client
Jose is a 47 year old morbidly obese Latino male who presents to the clinic for follow up evaluation of headaches, dizziness, ringing in his ears and frequent urination. He reports having a headache that “comes and goes” with ringing in his ears and sometimes he sees spots. Jose has taken acetaminophen and states that seems to help. Due to his work schedule of six 12 hour days, Jose has not had preventive care. He reports fatigue and is depressed regarding his current income situation. Jose has just been laid off for the season and will lose his insurance in 30 days until the restart of the harvesting season in March. He is concerned about paying for any health care that may go beyond his benefit period. Jose lives with his pregnant wife, who does not work, and their seven children in a three bedroom one bath house that they share.
Comprehensive SOAP ExemplarPurpose To demonstrate what each s.docx
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP Note should include. Remember that nurse practitioners treat patients in a holistic manner, and your SOAP Note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65-year-old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last 3 days. She reported that the “cold feels like it is descending into her chest.” The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4 last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but it returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over-the-counter Ibuprofen 200mg -2 PO as needed
6.) Over-the-counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet, on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstruating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65, and the other with prostate CA, dx at age 62. She has one daughter in her 30s, healthy, living in nearby neighborhood.
Lifestyle:
She is retired, has been widowed x 8 years, and lives in the city in a moderate crime area with good public transportation. She is a college graduate, owns her home, and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center that she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue sinc.
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Attaining Expertise
You are training individuals you supervise on how to attain expertise in your field.
Write
a 1,050- to 1,200-word paper on the processes involved with attaining expertise, using your assigned readings in Anderson. Explain how these processes apply to attaining expertise in your current field or in the field you plan to enter. Focus on the cognitive processes that are involved in mastering knowledge and skills.
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attachment “Chloe” is a example of the whole packet. Please follow the format and write in professional PR tone. So for each paragraph, you should refer to what’s write in the example. The packet includes a pitch letter, a news release (which i already wrote), a feature release, a fact sheet, a executive biography and a media alert. I have already wrote the news release part. I also put in the attachment.
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AttachmentFor this discussionUse Ericksons theoretic.docx
Attachment
For this discussion:
Use Erickson's theoretical framework to explore adolescent attachment and its developmental impact.
Choose two issues related to adolescent attachment (for example, attachment relationships with parents and peers, or the nature of attachment system in adolescence) and describe possible implications for adult life.
Support your response with APA-formatted citations from scholarly sources, including both those provided in this unit and any additional evidence you may have researched.
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Attachment Programs and Families Working Together Learn.docx
Attachment: Programs and
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After reading this chapter, you should be able to:
▸▸ Discuss the history of attachment theory and be able to define attachment.
▸▸ Recognize the importance of developing a secure attachment in infants and young
children.
▸▸ Describe the four types of attachment and typical behaviors associated with each.
▸▸ Differentiate among the different kinds of temperaments and explain how a child’s
temperament can affect the development of attachment.
▸▸ Explain how parents can foster a child’s secure attachment during the first three stages
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2
© Jupiterimages/Thinkstock
Attachment Theory Chapter 2
Introduction
It is a marvel to see a family of mallard ducks walk across a street, mother proudly in front and
tiny little ducklings following in a straight line behind. In a flock of sheep with new lambs, it is
amazing to see how each pair is somehow able to find each other. In these cases, there is an
inborn instinct or bond between the mother and new offspring. This is a survival mechanism
that helps the parent care for the tiny, vulnerable new babies.
But what about humans? Do we have a similar bond or connection? Is there some kind of
built-in mechanism that creates a connection between a parent and his or her newborn child?
It is generally believed that humans do have a similar connection or bond, known as attach-
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formed between one individual and another specific individual. Bowlby (1988) believes that
babies are born with behaviors—crying, smiling, and clinging—that elicit caregiving behaviors
from parents. An infant, however, is not born with attachment. Rather, attachment develops
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the development of later relationships and acts as a guide to emotions, perceptions, and
attitudes. The view that attachment is a critical model that sets the stage for healthy develop-
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Describe strategies that caretakers can implement to promote the child's ability to regulate emotions as he or she develops.
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Attached the dataset Kaggle has hosted a data science competitio.docx
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Kaggle has hosted a data science competition to predict category of crime in San Francisco based on 12 years (From 1934 to 1963) of crime reports from across all of San Francisco’s neighborhoods (time, location and other features are given).
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Are there yearly/ Monthly/ Daily/ Hourly trends?
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Attached you will find all of the questions.These are just like th.docx
Attached you will find all of the questions.
These are just like the others I put up before. they need to be awnsered individually. Please use APA format with in text citations and references. My book is at least required as one of the references:
Harr, J. S., Hess, M. H., & Orthmann, C. H. (2012).
Constitutional law and the criminal justice system
(5th ed.). Belmont, CA: Wadsworth.
This assignment needs to be done by Friday by 11:00 P.M Eastern Time.
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Attached the dataset Kaggle has hosted a data science compet.docx
Attached the dataset
Kaggle has hosted a data science competition to predict category of crime in San Francisco based on 12 years (From 1934 to 1963) of crime reports from across all of San Francisco’s neighborhoods (time, location and other features are given).
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Are there yearly/ Monthly/ Daily/ Hourly trends?
Is Crime distribution even across all geographical areas or different?
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* Definitions
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1. Define Word root, mention 5 examples.
2. Define Suffixes, mention 5 examples.
3. Define Prefixes, mention 5 examples.
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250 words each
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B A S I C L O G I C M O D E L D E V E L O P M E N T Pr.docx
B A S I C L O G I C M O D E L D E V E L O P M E N T
Produced by The W. K. Kellogg Foundation
53535353
Developing a Basic Logic
Model For Your Program
Drawing a picture of how your program will achieve results
hether you are a grantseeker developing a proposal for start-up funds or a
grantee with a program already in operation, developing a logic model can
strengthen your program. Logic models help identify the factors that will
impact your program and enable you to anticipate the data and resources
you will need to achieve success. As you engage in the process of creating your
program logic model, your organization will systematically address these important
program planning and evaluation issues:
• Cataloguing of the resources and actions you believe you will need to reach intended
results.
• Documentation of connections among your available resources, planned activities and
the results you expect to achieve.
• Description of the results you are aiming for in terms of specific, measurable, action-
oriented, realistic and timed outcomes.
The exercises in this chapter gather the raw material you need to draw a basic logic
model that illustrates how and why your program will work and what it will accomplish.
You can benefit from creating a logic model at any point in the life of any program.
The logic model development process helps people inside and outside your
organization understand and improve the purpose and process of your work.
Chapter 2 is organized into two sections—Program Implementation, and Program
Results. The best recipe for program success is to complete both exercises. (Full-size
masters of each exercise and the checklists are provided in the Forms Appendix at the
back of the guide for you to photocopy and use with stakeholder groups as you design
your program.)
Exercise 1: Program Results. In a series of three steps, you describe the results you
plan to achieve with your program.
Exercise 2: Program Resources and Activities by taking you through three steps
that connect the program’s resources to the actual activities you plan to do.
Chapter
2
W
B A S I C L O G I C M O D E L D E V E L O P M E N T
Produced by The W. K. Kellogg Foundation
54545454
The Mytown Example
Throughout Exercises 1 and 2 we’ll follow an example program to see how the logic
model steps can be applied. In our example, the folks in Mytown, USA are striving to
meet the needs of growing numbers of uninsured residents who are turning to Memorial
Hospital’s Emergency Room for care. Because that care is expensive and not the best
way to offer care, the community is working to create a free clinic. Throughout the
chapters, Mytown’s program information will be dropped into logic model templates for
Program Planning, Implementation, and Evaluation.
Novice Logic modelers may want to have copies of the Basic Logic Model Template in
front of them and follow along. Those read.
B H1. The first issue that jumped out to me is that the presiden.docx
B H
1. The first issue that jumped out to me is that the president and two vice presidents were the ones to develop the program. Our lecture notes and the text tell us that safety is one topic where management and employees can usually come to an agreement. Everyone wants a safe work environment. We are also taught that consultation is the best way to approach health and safety at work. Again, this means involving more than three people at the company. For starters, I would recommend that the safety program be dismantled and reconstructed by a committee consisting of at least 50% employees, not just senior leadership. I would keep this committee as small as possible and not have it controlled by one person only. The committee should be formed of employees from all sections and representing all possible departments where health and safety are potential issues.
2. The first issue that jumped out to me is that the president and two vice presidents were the ones to develop the program. Our lecture notes and the text tell us that safety is one topic where management and employees can usually come to an agreement. Everyone wants a safe work environment. We are also taught that consultation is the best way to approach health and safety at work. Again, this means involving more than three people at the company. For starters, I would recommend that the safety program be dismantled and reconstructed by a committee consisting of at least 50% employees, not just senior leadership. I would keep this committee as small as possible and not have it controlled by one person only. The committee should be formed of employees from all sections and representing all possible departments where health and safety are potential issues.
N S
1. 1.Top of Form
There could be a number of problems with CMI's safety awareness plan. One major one is that they could not be promoting safety. That is the first step into getting the program to work...employee involvement. First the awareness program was developed by the president and the vice presidents. A safety awareness program can be more successful if employees are involved in the development, and remain involved as it is adjusted and refined. Rules should be in place, and employers must ensure that those rules are followed and enforced consistently. Incentives and competition could be another way to promote safety in the work place. Our text cites that having employees work in teams and have them determine the incentives will keep them involved and promote safety. Also, of course keeping employees up to date on all rules will also promote safety.
2. I think the supervisor's response to employee complaints about John Randall is not appropriate at all. Even thought it is difficult, home problems should not be brought into the work place. Especially if coworkers are complaining about someone's behavior. This does not promote safety at all. To say that Randall will get over it and to disclose that he has personal problems is.
b l u e p r i n t i CONSUMER PERCEPTIONSHQW DQPerception.docx
b l u e p r i n t i CONSUMER PERCEPTIONS
HQW DQ
Perceptions Impact
Your Market?
By Nicole Olynk Widmar and
Melissa McKendree, Purdue University
I aintaining existing mar-
kets for pork products,
I cultivating new markets
for existing products and
creating new products for new markets
are some avenues that the U.S. pork
industry has sought, and continues to
explore, for growth. When it comes to
maintaining markets, there are several
relationships that must be considered.
End consumers, whether in restaurant
or supermarket settings, are increas-
ingly interested in social issues and the
production processes employed in food
production. Livestock products (meat
and dairy products) certainly seem
to get the majority of the spotlight in
regard to consumers' concern for pro-
duction processes.
Shoppers in supermarkets and din-
ers in restaurants have increased access
to information via the Internet, and are
in constant communication with one
another via social media and alterna-
tive news sources about perceptions
of animal agriculture. Even though
most U.S. consumers are not directly
in contact with livestock, concern for
the treatment of animals, including
those employed in food production,
is evident — and increasing. While
in the past consumers were mainly
concerned with factors like the fat or
nutritional content of pork, for exam-
ple, today's savvy shoppers are con-
sidering other factors, like the welfare
of livestock (pigs), safety of workers
employed on farms and potential envi-
ronmental impacts (externalities) of
livestock operations.
Large-scale changes in production
practices are taking place in livestock
24 April 15, 2014
production due to pressures from vari-
ous interested parties. Changes such
as the discontinued use of gestation
stalls, for example, are being sought
via traditional regulatory channels in
some states, but are also being pushed
via non-traditional market channels.
Consider the cumbersome process
of changing regulations, versus the
oftentimes faster (and perhaps easier)
channel of influencing key market
actors. It is no surprise that consum-
ers' concerns are increasingly voiced to
supermarkets and restaurants which,
in turn, take action to satisfy their
customers by placing pressure on sup-
ply-chain players. Changes sought via
"the market," rather than legislation or
regulation, are increasingly common,
and the use of market channels for
communicating throughout the supply
chain is unlikely to stop anytime soon.
www.nationalhogfarmer.com
Figure 1. Reported Recollection of Exposure to Media
Stories Regarding Pig Welfare, by Source
7 0 %
0 %
Television Internet
Media source
Printed Magazines
Newspaper
Books I have not seen
any media stories
regarding pig
welfare.
Melissa McKendree (left) and Nicole Olynk Widmar
A national-scale study completed
at Purdue University by Nicole Olynk
Widmar, Melissa McKendree, and
Candace Croney in 2013 was focused
on assessing consumers' perceptions of
various por.
B R O O K I N G SM E T R O P O L I TA N P O L I CY .docx
B R O O K I N G S
M E T R O P O L I TA N
P O L I CY
P R O G RA M
6
I . I N T R O D U C T I O N
A
s the global economy has become more integrated and urbanized,
fueled in large part by technology, major cities and metropolitan
areas have become key engines of economic growth. The 123 largest
metro areas in the world generate nearly one third of global output
with only 13 percent of the world’s population.
In this urban-centered world, the classic notion of a
global city has been upended. This report introduces
a redefined map of global cities, drawing on a new
typology that demonstrates how metro areas vary in
the ways they attract and amass economic drivers
and contribute to global economic growth in distinct
ways. New concerns about economic stagnation—in
both developing and developed economies—add
urgency to mapping the role of the world’s cities and
the extent to which they are well-positioned to deliver
the next round of global growth.1
Instead of a ranking or indexed score, which many
prior cities indices and reports have capably deliv-
ered,2 this analysis differentiates the assets and
challenges faced by seven types of global cities.
This perspective reveals that all major cities are
indeed global; they participate as critical nodes in
an integrated marketplace and are shaped by global
currents. But cities also operate from much differ-
ent starting points and experience diverse economic
trajectories. Concerns about global growth, productiv-
ity, and wages are not monolithic, and so this typology
can inform the variety of paths cities take to address
these challenges. For metro leaders, this typology
can also ensure better application of peer com-
parisons, enable the identification of more relevant
global innovations to local challenges, and reinforce a
city-region’s relative role and performance to inform
economic strategies that ensure ongoing prosperity.
This report proceeds in four parts. In the following
section, Part II, we explore the three global forces of
urbanization, globalization, and technological change,
and how together they are demanding that city-
regions focus on five core factors—traded clusters,
innovation, talent, infrastructure connectivity, and
governance—to bolster their economic competitive-
ness. Building on these factors, Part III outlines the
data and methods deployed to create the metropoli-
tan typology. Part IV explores the collective economic
clout of the metro areas in our sample and introduces
the new typology of global cities. Finally, Part V
explores the future investments, policies, and strate-
gies required for each grouping of metro areas. Within
the typology framework, we explore the priorities for
action going forward, including the implications for
governance.
REDEFINING
GLOBAL CITIES
THE SEVEN TYPES
OF GLOBAL METRO
ECONOMIES
7
U R B A N I Z AT I O N
The world is becoming more urba.
B L O C K C H A I N & S U P P LY C H A I N SS U N I L.docx
B L O C K C H A I N &
S U P P LY C H A I N S
S U N I L W A T T A L
T E M P L E U N I V E R S I T Y
• To understand the power of blockchain systems, and the things they can do, it is important to
distinguish between three things that are commonly muddled up, namely the bitcoin currency,
the specific blockchain that underpins it and the idea of blockchains in general.
• Economist, 2015
WHAT IS BLOCKCHAIN?
• A technology that permits transactions to be recorded
– Cryptographically chains blocks in order
– Allows resulting ledger accessed by different servers
– Information stored can never be deleted
• A digital distributed ledger that is stored and maintained on multiple systems belonging to multiple
entities sharing identical information (Deloitte)
• Bitcoin was the first demonstrable use
HISTORY OF BLOCKCHAIN
T YPES OF BLOCKCHAINS
• public or permissionless blockchains
– everyone who wants to engage in the network can openly see all transactions. The technology is
transparent, and all who want to engage in making transactions on the blockchain can do so.
• private or permissioned blockchains
– closed and accessible only to a selected few who have permission to engage in the blockchain.
BLOCKCHAIN FEATURES
• A blockchain lets us agree on the state of the system, even if we don’t all trust each other!
• We don’t want a single trusted arbiter of the state of the world.
• A blockchain is a hash chain with some other stuff added
– Validity conditions
– Way to resolve disagreements
• The spread of blockchains is bad for anyone in the “trust business”
WHAT IS BITCOIN
• A protocol that supports a decentralized, pseudo-anonymous, peer-to-peer digital currency
• A publicly disclosed linked ledger of transactions stored in a blockchain
• A reward driven system for achieving consensus (mining) based on “Proofs of Work” for
helping to secure the network
• A “scare token” economy with an eventual cap of about 21M bitcoins
10
OTHER USES OF BLOCKCHAIN
• Supply Chain
• Online advertising
• Smart Contracts
• Voting
BENEFITS OF BLOCKCHAIN
• Consistent
• Democratic
• Secure and accurate
• Segmented and private
• Permanent and tamper resistant
• Quickly updated
• Intelligent – smart contracts
BARRIERS TO BLOCKCHAIN
ADOPTION
• Hype
• Finding the right balance in regulation
• Cybersecurity
• Ease of use over shared databases
• Lack of understanding and knowledge
SUPPLY CHAIN CHALLENGES
• Margin Erosion
• Demand changes
• Ripple Effect
• Supply Chain Risk Management
• Lack of end to end visibility
• Obsolescence of Technology
APPLICATIONS IN SUPPLY CHAINS
• Traceability
• International Trade
• Continuity of Information
• Data Analytics
• Visibility
• Digital contracts and payments
• Check fraud and gaming
EX AMPLES OF BLOCKCHAIN IN
SUPPLY CHAINS
• 300 Cubits
– Blokcchain technology for the shipping industry
• BanQu
– Payment for small businesses
• Bext360
– Social sustainability.
Año 15, núm. 43 enero – abril de 2012. Análisis 97 Orien.docx
Año 15, núm. 43 / enero – abril de 2012. Análisis 97
Orientalizing New Spain:
Perspectives on Asian Influence
in Colonial Mexico1
Edward R. Slack, Jr.2
Resumen
E ste artículo investiga la totalidad de la influencia de Asia sobre la Nueva España que resultó de la conquista de Manila en 1571 y la re-gularización del comercio Transpacífico -comúnmente conocido como
los galeones de Manila o las naos de China- entre las Filipinas y Acapulco.
En sus inicios, una oleada constante de inmigrantes asiáticos, mercancías y
nuevas técnicas de producción influyeron mesuradamente en la sociedad y
la economía colonial mediante un proceso que el autor denomina “Orientali-
zación”. No obstante, en ninguna manera “Orientalización” se debe equiparar
con el concepto de Edward Said de “Orientalismo” por la relación histórica,
única e intima de la Nueva España con Asia a principios de la edad Moderna.
Abstract
This article examines the totality of Asia’s influence on New Spain that resulted
from the conquest of Manila in 1571 and the regularization of transpacific tra-
de – more widely known as the Manila Galleons or naos de China – between the
Philippines and Acapulco. In its wake, a steady stream of Asian immigrants,
commodities, and manufacturing techniques measurably impacted colonial
society and economy through a process the author calls “Orientalization.”
However, “Orientalization” should in no way be equated with Edward Said’s
1. Artículo recibido el 28 de octubre de 2011 y dictaminado el 16 de noviembre de 2011.
2. Eastern Washington University.
98 México y la Cuenca del Pacífico. Año 15, núm. 43 / enero – abril de 2012
Edward R. Slack, Jr.
concept of “Orientalism” because of New Spain’s uniquely intimate historical
relationship with Asia in the early Modern era.
Introduction
Contrary to popular belief, the Philippines Islands were more a colony of New
Spain (Nueva España) than of “Old Spain” prior to the nineteenth century.
The Manila galleons, or naos de China (China ships), transported Asian pro-
ducts and peoples to Acapulco and other Mexican ports for approximately
250 years. Riding this ‘first wave’
of maritime contact between
the Americas and Asia were tra-
velers from China, Japan, the
Philippines, various kingdoms in
Southeast Asia and India known
collectively in New Spain as chinos
(Chinese) or indios chinos (Chine-
se Indians), as the word chino/a
became synonymous with the
Orient. The rather indiscrimi-
nate categorizing of everything
“Asian” under the Spanish noun
for the Ming/Qing empire, its
subjects and export items is easily
discovered in a variety of sources
from that age. To illustrate, the
eig hteenth centur y works of
Italian adventurer Gamelli Carreri and the criollo priest Joachin Antonio
de Basarás (who evangelized in Luzon) nonchalantly refer to the Philippine
Islands as “la China.”3 Additionally, words such as chinería (Chinese-esque,
European/Mexican imitation of Chines.
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- 1. Week 1: Cardiovascular Clinical Case Patient Setting: 52 year old Irish American Male that was hospitalized 2 weeks ago for a stent placement. Presenting to your clinic today for follow up as he has not felt well. He sates he has been lightheaded and felt palpitations of his heart. He has also had shortness of breath the last 2 days. HPI Walks 2 miles daily and rides an exercise bicycle 3 times a week; has previously felt the palpitations associated with exercise that usually went away with rest; 2 days ago while washing dishes he began to feel shortness of breath and felt that his heart was “racing”; He hoped the palpitations would go away but they have continued and that is why he is here today. PMH History of hypertension for 10 years, hyperlipidemia for 5 year, status post stent placement 2 weeks ago, and rheumatic heart disease (mitral valve) as a child. He reports adhering to a low cholesterol low fat diet for the last 2 years. Past Surgical History Stent placement 2 weeks ago. Family/Social History Family: Noncontributary Social: Smoked 15 pack/year X 20 years. Quit 5 years ago. Medication History Lisinopril 20 mg PO QD Furosemide 20 mg PO QD Gemfibrozil 600 mg PO BID
- 2. Allergies NKDA ROS Otherwise negative. Physical exam BP 160/90 (clinic visit 2 months ago 155/85) HR 146, RR 22, T 98.6 F, Wt 254, Ht 5’ 7” Gen: Well developed male in moderate distress. HEENT: PERRLA, (-) JVDm mild AV nicking. Cardio: Rate irregularly irregular, no murmurs or gallops. Chest: Clear to auscultation. Abd: soft, non-tender, active bowel sounds. GU: Deferred. Rectal: Normal. EXT: No edema, normal pulses throughout. NEURO: A&O X3. Laboratory and Diagnostic Testing Na - 136 K - 4.5 Cl - 97 BUN - 20 Cr - 1.2 Total Chol - 240 Trig – 180 INR – 1.1 Chest Xray - Clear ECG – Atrial Fibrillation, no P waves, variable R-R interval normal QRS Week 1: Cardiovascular Clinical Case Patient Setting: 52 year old Irish American Male that was hospitalized 2 weeks ago for a stent placement. Presenting to your clinic today for follow up as he has not felt well. He sates
- 3. he has been lightheaded and felt palpitations of his heart. He has also had shortness of breath the last 2 days. HPI Walks 2 miles daily and rides an exercise bicycle 3 times a week; has previously felt the palpitations associated with exercise that usually went away with rest; 2 d ays ago while washing dishes he began to feel shortness of breath and felt that his heart was “racing”; He hoped the palpitations would go away but they have continued and that is why he is here today. PMH History of hypertension for 10 years, hy perlipidemia for 5 year, status post stent placement 2 weeks ago, and rheumatic heart disease (mitral valve) as a child. He reports adhering to a low cholesterol low fat diet for the last 2 years. Past Surgical History Stent placement 2 weeks ago. Famil y/Social History Family: Noncontributary
- 4. Social: Smoked 15 pack /year X 20 years. Quit 5 years ago. Medication History Lisinopril 20 mg PO QD Furosemide 20 mg PO QD Gemfibrozil 600 mg PO BID Week 1: Cardiovascular Clinical Case Patient Setting: 52 year old Irish American Male that was hospitalized 2 weeks ago for a stent placement. Presenting to your clinic today for follow up as he has not felt well. He sates he has been lightheaded and felt palpitations of his heart. He has also had shortness of breath the last 2 days. HPI Walks 2 miles daily and rides an exercise bicycle 3 times a week; has previously felt the palpitations associated with exercise that usually went away with rest; 2 days ago while washing dishes he began to feel shortness of breath and felt that his heart was “racing”; He hoped the palpitations would go away but they have continued and that is why he is here today. PMH History of hypertension for 10 years, hyperlipidemia for 5 year, status post stent placement 2 weeks ago, and rheumatic heart disease (mitral valve) as a child. He reports adhering to a low cholesterol low fat diet for the last 2 years.
- 5. Past Surgical History Stent placement 2 weeks ago. Family/Social History Family: Noncontributary Social: Smoked 15 pack/year X 20 years. Quit 5 years ago. Medication History Lisinopril 20 mg PO QD Furosemide 20 mg PO QD Gemfibrozil 600 mg PO BID Running head: NAME OF CARE PLAN 1 NAME PLAN OF CARE 2 Title of Plan of Care Name South University Online Faculty Name NSG 6001 Date
- 6. Patient Initials __AM____ Subjective Data: Patient reports sates has been lightheaded, felt palpitations of his heart, and shortness of breath the last 2 days. States has previously felt the palpitations associated with exercise that usually went away with rest; 2 days ago while washing dishes he began to feel shortness of breath and felt that his heart was “racing”; He hoped the palpitations would go away but they have continued and that is why he is here today. Chief Compliant: 52 years old male status post stent placement 2 weeks ago presenting for follow up with chief complaint of lightheadedness, palpitations, and shortness of breath for 2 days, not relieved by rest. History of Present Illness: (Analysis of current problems in chronologic order using symptom analysis [onset, location, frequency, quality, quantity, aggravating/alleviating factors, associated symptoms and treatments tried]). PMH/Medical/Surgical History: (Includes medications and why taking, allergies, other major medical problems, immunizations, injuries, hospitalizations, surgeries, psychiatric history, obstetric and history sexual history). Significant Family History: (Includes family members and specific inheritable diseases). Social History: (Includes home living situation, marital history, cultural background, health habits, lifestyle/recreation, religious practices, educational background, occupational history, financial security and family history of violence). Review of Symptoms: (Review each body system -This section
- 7. you should place POSITIVE for… information in the beginning then state Denies…). - General:; Integumentary:; Head:; Eyes: ; ENT:; Cardiovascular:; Respiratory: ; Gastrointestinal:; Genitourinary:; Musculoskeletal:; Neurological:; Endocrine:; Hematologic:; Psychologic: . Objective Data: Vital Signs: BP - ; P ; R ; T ; Wt. ; Ht. ; BMI . Physical Assessment Findings: (Includes full head to toe review) HEENT: Lymph Nodes: Carotids: Lungs: Heart: Abdomen: Genital/Pelvic: Rectum: Extremities/Pulses: Neurologic: Laboratory and Diagnostic Test Results: (Include result and interpretation.) Assessment: (Include at least 3 priority diagnosis with ICD-10 codes. Please place in order of priority.) Plan of Care: (Addressing each dx with diagnostic and therapeutic management as well as education and counseling provided). References Definition: 'Android Obesity' (nod). Retrieved from http://www.medilexicon.com/medicaldictionary.php?t=62022 Drugs.com. (2016). Aspirin - FDA prescribing information, side effects and uses. Retrieved from https://www.drugs.com/pro/aspirin.html Drugs.com. (2016). Atorvastatin - FDA prescribing information, side effects and uses. Retrieved from
- 8. https://www.drugs.com/pro/atorvastatin.html Drugs.com. (2016). Bupropion: MedlinePlus Drug Information. Retrieved from https://www.nlm.nih.gov/medlineplus/druginfo/meds/a695033.ht ml Drugs.com. (2016). Tenormin - FDA prescribing information, side effects and uses. Retrieved from https://www.drugs.com/pro/tenormin.html Mayo Clinic. (2015). Heart disease. from http://www.mayoclinic.org/diseases-conditions/heart-disease/in- depth/heart-healthy-diet/art-20047702