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Answer the following Questions: Question 1. To win Congressional election candidates need to compete in two campaigns—one for votes and one for the financial and support resources to reach out to voters. Discuss this concept. Question 2. Discuss the influence of incumbency, redistricting, national political conditions, and the personal and career situations of potential Congressional candidates on their decision to run for Congress. .

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Choose 5 questions and answer them with my materials only Dispossession 1- What is meant by “dispossession”? 2- What does and does not change in this process? Forced Movements 1- Name three ways Native Americans were moved from their homeplace? Reservations 1- What was meant by, “kill the Indian, save the man”? 2- How was religion involved in reservations? 3- After being removed from their “spiritual homeplace”, how might this affect American Indian religion? Christianity 1- Name one way Native Americans were “converted” to Christianity, and why they chose to do so? 2- To some American Indians, what was missing in the Christian perspective or practices? Two Faces of History 1- Name opposing views of the world between Native Americans and Europeans? Is this evident today? Leading Figures 1- Describe a “leading figure” according to a Native American perspective. Give three examples. 2- Who are the notable leaders we learn about in school? Why them? What do they often have in common? .

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Choose a communication situation you recently experienced at your workplace or other organization you are affiliated with. Use the human communication process described in your text, starting on page 11, "Human Communication: Message and Constitutive Processes," to analyze why—or why not—a shared reality was experienced as an end result. Summarize your experience and include your analysis as an attachment in this assignment thread. Consider the following items in your analysis: Identify the source and the receiver. What was the message and what type of message function was it serving? How was it encoded? How was it decoded? What channel was used to transmit the message? What type of noise was experienced? Comment on the competencies, fields of experience, and culture of the participants involved. Identify the communication context of this situation. What was the intended effect versus the actual effect of the message? Was a shared reality constructed? If not, what needed to change? .

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Choose 5 interconnected leadership task (listed below). Tell why each task is important to understand as a leader that is involved with the strategic planning process. Explain what each process means and what is involved with the five that you picked. Interconnected Leadership task: 1)Understanding the context 2)Understanding the people involved, including oneself 3)Sponsoring Process 4)Championing the process 5)Facilitating the process 6)Fostering collective leadership 7)Using dialogue and discussion 8)Making and implementing policy decisions 9)Enforcing norms, settling disputes, and managing residual conflict 10) Pulling it all together Outline: Cover Page Abstract Introduction: (Overview what you will discuss) Body (2 FULL Pages of Content) Reference Page (2-3 references) .

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Choose 5 out of the first 10 questions, 5 pages essay 1. Where do American Indians believe they come from? 2. As a student, how would you approach going to a ceremony? 3. How would “I” (meaning Mr. Madril), define/describe an American Indian “church”? 4. Why is the idea of the ‘circle’ valued by some American Indian people? 5. Define ‘ontology’ 6. How do some American Indian people view eagles/eagle feathers? 7. How has Christianity and American Indian people interacted? 8. Name or describe some ‘sacred places’/sacred spaces 9. Name some ‘ceremonies’ 10. What is a ‘holy person’? .

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Choose 3 or 4 poems from Elizabeth Bishop. You may choose any poems that you want, whether in our eText or from another source, but be sure to use proper citations for each of them. Discuss how the poet’s life has influenced her or his poetry. You may find context from the poet’s childhood, personal experiences, etc. and link them to poems of your choice. Be careful not to give me five pages of biography! When referencing poems, you may quote specific lines but do not type the entire poem into your essay. MLA Format 5-6 pages, double spaced, not including Works Cited page Works Cited page Proper in-text citations .

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

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Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice. Practice 1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families. 2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others. 3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death. 4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified. Education 1. Those who practice in secondary or tertiary palliative care will have specialist education and certification. 2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula. 3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available. 4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families. Research 1. Increase the integration of evidence-based care across the dimensions of end-of-life care. 2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal. 3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life. 4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments. 5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices. Administration 1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families. 2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care. 3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury. 4. Suppo.

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Choose 1 focal point from each subcategory of practice, education, research and administration and describe how the APRN can provide effective care in end of life management. Using the American nurses association position statement, recommendations for improvement in end of life management focuses on practice, education, research and administration. Listed below are steps that nurses can take to overcome barriers in healthcare practice. Practice 1. Strive to attain a standard of primary palliative care so that all health care providers have basic knowledge of palliative nursing to improve the care of patients and families. 2. All nurses will have basic skills in recognizing and managing symptoms, including pain, dyspnea, nausea, constipation, and others. 3. Nurses will be comfortable having discussions about death, and will collaborate with the care teams to ensure that patients and families have current and accurate information about the possibility or probability of a patient’s impending death. 4. Encourage patient and family participation in health care decision-making, including the use of advance directives in which both patient preferences and surrogates are identified. Education 1. Those who practice in secondary or tertiary palliative care will have specialist education and certification. 2. Institutions and schools of nursing will integrate precepts of primary palliative care into curricula. 3. Basic and specialist End-of-Life Nursing Education Consortium (ELNEC) resources will be available. 4. Advocate for additional education in academic programs and work settings related to palliative care, including symptom management, supported decision-making, and end-of-life care, focusing on patients and families. Research 1. Increase the integration of evidence-based care across the dimensions of end-of-life care. 2. Develop best practices for quality care across the dimensions of end-of-life care, including the physical, psychological, spiritual, and interpersonal. 3. Support the use of evidence-based and ethical care, and support decision-making for care at the end of life. 4. Develop best practices to measure the quality and effectiveness of the counseling and interdisciplinary care patients and families receive regarding end-of-life decision-making and treatments. 5. Support research that examines the relationship of patient and family satisfaction and their utilization of health care resources in end-of-life care choices. Administration 1. Promote work environments in which the standards for excellent care extend through the patient’s death and into post-death care for families. 2. Encourage facilities and institutions to support the clinical competence and professional development that will help nurses provide excellent, dignified, and compassionate end-of-life care. 3. Work toward a standard of palliative care available to patients and families from the time of diagnosis of a serious illness or an injury. 4. Sup.

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

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

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

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

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Chief complaint: “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”. HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies. Denies associated symptoms of fever and chills. PMH: Diabetes Mellitus, type 2. Surgeries: None Allergies: Augmentin Medication: Metformin 500mg PO BID. Vaccination History: Immunization is up to date and she received her flu shot this year. Social history: College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago. Family history: Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN. ROS: Constitutional: Negative for fever. Negative for chills. Respiratory: No Shortness of breath. No Orthopnea Cardiovascular: Regular rhythm. Skin: Right great toe swollen, itchy, painful and discolored. Psychiatric : No anxiety. No depression. Physical examination: Vital Signs Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored HEENT : Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: Slow gait but steady. No Kyphosis. SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit. PSYCH: Normal affect. Cooperative. Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98. Assessment: Primary Diagnosis: Proximal subungual onychomycosis Differential Diagnosis: Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis Special Lab : Fungal culture confirms.

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China, which had been such a powerful and dynamic model for Korea and Japan between the 6th & 8th centuries degenerated, broke apart, and collapsed by the end of the 9th century. China was no longer a valid model, and Korea and Japan set out on separate trajectories that were quite evident by the 12th century. In what ways did Korea and Japan begin to differ from the Chinese model? Differ from each other? .

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Children and adolescents with schizophrenia have more difficulty functioning in academic or work settings, and significant impairment usually persists into adulthood. They may have speech or language disorders and in some cases borderline intellectual functioning. These individuals are more likely to complete suicide attempts or die from other accidental causes. Schizophrenia is characterized by positive and negative symptoms. Positive symptoms include hallucinations, delusions, and behavior disturbance. Negative symptoms include blunted affect and attention, apathy, and lack of motivation and social interest. In this Assignment, you compare treatment plans for adults diagnosed with schizophrenia with treatment plans for children and adolescents diagnosed with schizophrenia. You also consider the legal and ethical issues involved in medicating children diagnosed with schizophrenia. The Assignment (2 pages): Compare at least two evidence-based treatment plans for adults diagnosed with schizophrenia with evidence-based treatment plans for children and adolescents diagnosed with schizophrenia. Explain the legal and ethical issues involved with forcing children diagnosed with schizophrenia to take medication for the disorder and how a PMHNP may address those issues. All papers submitted include a title page, introduction, summary, and references. .

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CHILD PROTECTION AGENCIES INFOGRAPHIC 2 Child Protection Agency ( Summary of how the agency’s philosophies support or align with t he philosophical tenets promoted by Adoption and Safe Families Act. One of the principles and philosophy is dedication. This is an important philosophy for the agency especially for the reason that it promotes the hope and opportunity for the people in need. Performance excellence is also supportive philosophy since it exemplifies the innovativeness and solutions that are based on available evidence, transcend borders and built knowhow. On the other hand, professionalism supports the philosophical tenets promoted by ASAF especially for the reason that it affects the quality of service provided by the child protection agency, the attitude they bring, the associations they create and the commitment towards achieving the goals of the agency. Integrity enhances the ethical mannerisms of each of the employees within the firm as they extend their services. Stewardship of the resources is an important philosophy especially for the reason that it increases the transparency and accountability of the employees within the Administration for Children and Families especially while they handle the organizational resources. Respect is also an important in that it enhances team work amongst their colleagues and the partners ("ACF Vision, Mission, & Values", 2020) . ) References ACF Vision, Mission, & Values. (2020). Retrieved 8 April 2020, from https://www.acf.hhs.gov/about/acf-vision-mission-values ADMINISTRATION FOR CHILDREN AND FAMILIES Vision "Children, youth, families, individuals and communities who are resilient, safe, healthy, and economically secure" Mission "To foster health and well-being by providing federal leadership, partnership and resources for the compassionate and effective delivery of human services." Principles Dedication Excellence Professionalism Integrity Stewardship Respect PRIORITIZING CHILD PROTECTION3 Dr. Davis, Every child should be treasured, protected, and nurtured. When this does not happen, the division of Family and Children Services (DFCS), in partnership with the police and the court system, must step in to ensure the safety of children in compromised situations. Georgia child abuse and neglect reporting when someone suspect that a child is being abused or neglected, the Office of the Child Advocate (OCA) encourages you to make a report to the Division of Family and Children Services (DFCS). In order to make a report to DFCS, you may: Report by phone, by email and FAX. Reference Retrieved from https://dfcs.georgia.gov/services/child-abuse-neglect Prioritizing Child Protection Karla, I am enriched. Although, as child protection becomes a primary global agenda, various agencies have taken the lead role of sensitizing the public on the essence of looking after children's welfare and influencing the relevant government authorities to do the same. The Children's B.

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Chicago Red Line Assignment Noticings are defined as “observations without judgment”. They elicit in us a sense of curiosity, slowing down our internalized stereotypes and allowing us to become more aware of the world around us. For this assignment, ride the Red Line CTA train from Howard to 95th/Dan Ryan. Take notes while you’re sitting on the train. What is coming up for you? What do you notice happening around you – the people who get on and off the train and the neighborhoods it passes through? How do you notice yourself responding? What emotions and feelings come up for you? What surprises you? Submit a two-page (500 words) . .

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Child, Family, and Community Family-Centered Early Care and Education Seventh Edition Janet Gonzalez-Mena Boston Columbus Indianapolis New York San Francisco Upper Saddle River Amsterdam Cape Town Dubai London Madrid Milan Munich Paris Montreal Toronto Delhi Mexico City Sao Paulo Sydney Hong Kong Seoul Singapore Taipei Tokyo A01_GONZ2275_07_SE_FM.indd 1 10/14/15 8:19 PM Vice President and Editorial Director: Jeffery W. Johnston Executive Editor: Julie Peters Editorial Assistant: Pamela DiBerardino Developmnet Editor: Jon Theiss Executive Product Marketing Manager: Chris Barry Executive Field Marketing Manager: Krista Clark Program Manager: Megan Moffo Production Project Manager: Janet Domingo Full-Service Project Management: Lumina Datamatics Composition: Lumina Datamatics Credits and acknowledgments for material borrowed from other sources and reproduced, with permission, in this textbook appear on the appropriate page within the text. Every effort has been made to provide accurate and current Internet information in this book. However, the Internet and information posted on it are constantly changing, so it is inevitable that some of the Internet addresses listed in this textbook will change. Copyright © 2017, 2013, 2009, 2006, 2002 by Pearson Education, Inc. All rights reserved. Manufactured in the United States of America. This publication is protected by Copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or likewise. To obtain permission(s) to use material from this work, please submit a written request to Pearson Education, Inc., Permissions Department, One Lake Street, Upper Saddle River, New Jersey 07458, or you may fax your request to 201-236-3290. Library of Congress Cataloging-in-Publication Data Gonzalez-Mena, Janet, author. Child, family, and community : family-centered early care and education / Janet Gonzalez-Mena. — Seventh edition. pages cm Includes bibliographical references and index. ISBN 978-0-13-404227-5 (alk. paper) 1. Socialization. 2. Child rearing. 3. Families. I. Title. HQ783.G59 2017 649’.1—dc23 2015030163 10 9 8 7 6 5 4 3 2 1 ISBN 10: 0-13-404227-1 ISBN 13: 978-0-13-404227-5 A01_GONZ2275_07_SE_FM.indd 2 10/14/15 8:19 PM To Shaquam Kimberly Edwards, contributor to this edition. Shaquam took on what I consider the hardest part of this revision— making it into an e-book. She stepped in willingly and capably to meet the creative challenges of bringing the book to life digitally. I’m forever grateful for her contributions! I wrote the first edition of this book on a typewriter. Putting later editions on the computer was a big step forward for me. Shaquam took me into the e-book era, gracefully and enthusiastically, for which I’m thankful. A01_GONZ2275_07_SE_FM.indd 3 10/14/15 8:19 PM A0.

Child, Family, and CommunityFamily-Centered Early C.docx

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Child abuse investigations are some of the most heart wrenching and difficult for a criminal investigator to pursue. Nevertheless, they are a requirement of the role. Investigators must stay focused on the investigative and legal requirements for thorough, unbiased, and legally sufficient investigations in order to present the evidence in a court of law. Select any high-profile child victim case (e.g., Susan Smith, JonBenet Ramsey, Polly Klaas, Jessica Lunsford, etc.) and discuss what you would do to prevent your personal opinions, feelings, and biases to negatively affect the criminal investigation. .

Child abuse investigations are some of the most heart wrenching and .docx

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Chief complaint: “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”. HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief. She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin AF cream and it did not help relief her symptoms. She has not tried other remedies. Denies associated symptoms of fever and chills. PMH: Diabetes Mellitus, type 2. Surgeries: None Allergies : Augmentin Medication: Metformin 500mg PO BID. Vaccination History: Immunization is up to date and she received her flu shot this year. Social history: College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago. Family history: Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN. ROS: Constitutional: Negative for fever. Negative for chills. Respiratory: No Shortness of breath. No Orthopnea Cardiovascular: Regular rhythm. Skin: Right great toe swollen, itchy, painful and discolored. Psychiatric: No anxiety. No depression. Physical examination: Vital Signs Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored HEENT : Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness. NECK : Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS : No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART : Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally. ABDOMEN : No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY : No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL : Slow gait but steady. No Kyphosis. SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit. PSYCH : Normal affect. Cooperative. Labs : Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98. A: Primary Diagnosis: Proximal subungual onychomycosis Differential Diagnosis: Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis Special Lab: Fungal culture confirms fungal infec.

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