Different cultures, customs, beliefs, values and attitudes

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Different cultures, customs, beliefs, values and attitudes

Part I You are planning to expand your fast-food hamburger franchise internationally and have decided to open in the United Arab Emeritus, Israel, Mexico and China. Knowing that all of these countries and its people have different cultures, customs, beliefs, values and attitudes that are unique to their country and different from that of the United States, consider how this would impact your fast-food business. What are some of the considerations to keep in mind concerning how these different social and religious values and cultures have on food preparation and eating, the social behaviors to be sensitive to regarding employees and customers, the type of trainings that will be required, the work attitudes and behaviors, and any ethical standards that you may need to develop? Are the attitudes in these countries individualistic or collective? Different cultures, customs, beliefs, values and attitudes

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Part II If you were to send your top managers to these countries, what type of cultural shock should they expect? How would you help them alleviate this stress? Provide a few examples from each country.

Part III In many countries, “expeditors” can help you cut through layers of bureaucracy so that you can get your business done or done faster. Expeditors are normally paid for what they do, and they may ask you to help finance other expeditors within these countries that will help move your business request through the system faster. The methods that are being used could ultimately be unethical, illegal, or maybe not at all. How would you go about making sure the practice of an expeditor is legal? Would you approve a paid transaction requested by an expeditor if it was acceptable in the country, but unethical back in the United States? (defend your position) What business ethics are involved in your decision making process? What factors should you consider and who should you consult with and why? Different cultures, customs, beliefs, values and attitudes

EBP Influence on Quality Improvement Essay

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EBP Influence on Quality Improvement Essay

Research And Evidence Week 4

How is evidence-based practice (EBP) used in nursing and how does the EBP influence Quality Improvement?

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  • Must address the topic.
  • Rationale must be provided.
  • May list examples from your own nursing practice.
  • 150-word minimum/250-word maximum without the references.
  • Minimum of two references (the course textbook must be one of the references) in APA format, must have been published within last 3-5 years.EBP Influence on Quality Improvement Essay

Psychotherapy for Addictive Disorders Essay Assignment

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Psychotherapy for Addictive Disorders Essay Assignment

Psychotherapy for Addictive Disorders Essay Assignment

“A long-standing debate has roiled over whether addicts have a choice over their behaviors. The disease creates distortions in thinking, feelings, and perceptions, which drive people to behave in ways that are not understandable to others around them. Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.” Psychotherapy for Addictive Disorders Essay Assignment

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–Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine

A common misconception is that addiction is a choice, and addicts are often labeled as individuals who lack morals, willpower, or responsibility. However, addiction is a clinical disorder that must be treated with the support of a health care professional. Although many people who are exposed to potentially addictive substances and behaviors continue life unaltered by their experiences, some people are fueled by these experiences and spiral out of control. In your role as the psychiatric mental health nurse practitioner, you must be prepared to not only work with these individuals who struggle with addiction, but also help them and their families overcome the social stigmas associated with addictive behavior.

This week, as you explore psychotherapy for addiction, you assess clients presenting with addictive disorders. You also examine therapies for treating these clients and consider potential outcomes. Finally, you develop diagnoses for clients receiving psychotherapy and consider legal and ethical implications of counseling these clients.

Learning Resources

Required Readings

Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.

  • Chapter 7, “Motivational Interviewing” (pp. 299–312)
  • Chapter 16, “Psychotherapeutic Approaches for Addictions and Related Disorders” (pp. 565–596)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

 

Note: You will access this text from the Walden Library databases.

Albrecht, U., Kirschner, N. E., & Grusser, S. M. (2007). Diagnostic instruments for behavioral addiction: An overview. German Medical Science Psycho-Social-Medicine, 4, 1–11. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736529/

Fisher, M. A. (2016). The ethical ABCs of conditional confidentiality. In Confidentiality limits in psychotherapy: Ethics checklists for mental health professionals (pp. 13–25). Washington, DC: American Psychological Association. doi:10.1037/14860-002

Walden University. (2016). ASC success strategies: Studying for and taking a test. Retrieved from http://academicguides.waldenu.edu/ASCsuccess/ASCtesting

 

Required Media

Laureate Education (Producer). (2013c). Levy family: Episodes 1 [Video file]. Baltimore, MD: Author.

 

Note: The approximate length of this media piece is 2 minutes.Laureate Education (Producer). (2013c). Levy family: Episodes 2 [Video file]. Baltimore, MD: Author.

 

Note: The approximate length of this media piece is 2 minutes.

Laureate Education (Producer). (2013c). Levy family: Episodes 3 [Video file]. Baltimore, MD: Author. Psychotherapy for Addictive Disorders Essay Assignment

 

Note: The approximate length of this media piece is 6 minutes.

 

Laureate Education (Producer). (2013c). Levy family: Episodes 4 [Video file]. Baltimore, MD: Author.

 

Note: The approximate length of this media piece is 5 minutes.

Laureate Education (Producer). (2013c). Levy family: Episodes 5 [Video file]. Baltimore, MD: Author.

 

Note: The approximate length of this media piece is 2 minutes.

 

Laureate Education (Producer). (2012c). In their own words [Video file]. Baltimore, MD: Author.

 

Note: The approximate length of this media piece is 23 minutes.

 

Dronen, S. O. (2012). New research about Facebook addiction. Retrieved from http://www.uib.no/en/news/36380/new-research-about-facebook-addiction

Substance Abuse and Mental Health Services Administration. (2005). Substance abuse treatment for adults in the criminal justice system. Treatment Improvement Protocol (TIP) Series 44. Rockville, MD: Author. Retrieved from http://store.samhsa.gov/shin/content//SMA13-4056/SMA13-4056.pdf

Substance Abuse and Mental Health Services Administration. (2007). Problem gambling toolkit. Retrieved from http://store.samhsa.gov/product/Problem-Gambling-Toolkit/PGKIT-07

Substance Abuse and Mental Health Services Administration. (2013). Substance abuse treatment for persons with co-occurring disorders: A treatment improvement protocol. Treatment Improvement Protocol (TIP) Series 42. Rockville, MD: Author. Retrieved from http://store.samhsa.gov/shin/content//SMA13-3992/SMA13-3992.pdf

Psychotherapy for Addictive Disorders Essay Assignment

 

Levy family – Assessing Clients With Addictive Disorders

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Levy family – Assessing Clients With Addictive Disorders

To prepare:

  • Review this week’s Learning Resources and consider the insights they provide.
  • Review the Levy Family video Episodes 1 through 5.

The Levy family – Assessing Clients With Addictive Disorders  Assignment

In a 2- to 3-page paper, address the following:

  • After watching Episode 1, describe:
    • What is Mr. Levy’s perception of the problem?
    • What is Mrs. Levy’s perception of the problem?
    • What can be some of the implications of the problem on the family as a whole?
  • After watching Episode 2, describe:
    • What did you think of Mr. Levy’s social worker’s ideas?Levy family – Assessing Clients With Addictive Disorders
    • What were your thoughts of her supervisor’s questions about her suggested therapies and his advice to Mr. Levy’s supervisor?
  • After watching Episode 3, discuss the following:
    • What were your thoughts about the way Mr. Levy’s therapist responded to what Mr. Levy had to say?
    • What were your impressions of how the therapist worked with Mr. Levy? What did you think about the therapy session as a whole?
    • Informed by your knowledge of pathophysiology, explain the physiology of deep breathing (a common technique that we use in helping clients to manage anxiety). Explain how changing breathing mechanics can alter blood chemistry.

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    • Describe the therapeutic approach his therapist selected. Would you use exposure therapy with Mr. Levy? Why or why not? What evidence exists to support the use of exposure therapy (or the therapeutic approach you would consider if you disagree with exposure therapy)?
  • In Episode 4, Mr. Levy tells a very difficult story about Kurt, his platoon officer.
    • Discuss how you would have responded to this revelation.
    • Describe how this information would inform your therapeutic approach. What would you say/do next?
  • In Episode 5, Mr. Levy’s therapist is having issues with his story.
    • Imagine that you were providing supervision to this therapist, how would you respond to her concerns?
  • Support your approach with evidence-based literature.

 

Transcript of video Levy Family:

Episode 1

Program Transcript

[MUSIC PLAYING]

FEMALE SPEAKER: You‘re not dressed? You‘re going to be late for work.

MALE SPEAKER: I‘m not going to work. I‘m sick.

FEMALE SPEAKER: Of courseyou‘re sick. You‘re hungover. Idon’t want the

boys to see you like this. Go back to bed.

MALE SPEAKER: See me like what? I told you, I’m sick.

FEMALE SPEAKER: Well, what do you call it when someone is sick almost

every morning, because they drink every night while they sit in the dark watching

TV?

MALE SPEAKER: You calling me a drunk?

FEMALE SPEAKER: What do you call it?

MALE SPEAKER: I call it, leave me the hell alone.

FEMALE SPEAKER: Baby, you need to stop this. It’s tearing us up. The drinking,

the anger– you’re depressed.

MALE SPEAKER: You said, for better or worse.

FEMALE SPEAKER: My vows don’t cover this. You were never like this before.

You’ve changed. I want us back, the way we used to be.

MALE SPEAKER: That way is dead. It died when I went to Iraq

 

 

Levy Family: Episode 2

Program Transcript

FEMALE SPEAKER: I want to thank you for getting me this Levy case. I think it’s

so interesting. Just can’t wait to meet with the client.

MALE SPEAKER: What do you find interesting about it?

FEMALE SPEAKER: Well, he’s just 31. Usually the vets I work with are older. If

they have PTSD, it’s from traumas a long time ago. But Jake, this is all pretty

new to him. He just left Iraq a year ago.

You know, Iwas thinkinghe’d be perfect for one of those newer treatment

options, art therapy, meditation, yoga, something like that. Levy family – Assessing Clients With Addictive Disorders

MALE SPEAKER: Why?

FEMALE SPEAKER: Well, I’ve been dying to try one of them. I’ve read a lot of

good things. Why? What are you thinking?

MALE SPEAKER: I’m thinkingyou should really think about it some more. Think

about your priorities. It’s a good idea to be open-minded about treatment options,

but the needs of the client have to come first, not just some treatment that you or

I might be interested in.

FEMALE SPEAKER: I mean, Iwasn’t saying it like that. I always think of my

clients first.

MALE SPEAKER: OK. But you mentioned meditation, yoga, art therapy. Have

youseen any research or data that measures how effective they are in

treatment?

FEMALE SPEAKER: No.

MALE SPEAKER: Neither have I. There may be good research out there, and

maybe one or two of the treatments that you mentioned might be really good

ideas. I just want to point out that you should meet your client first, meet Jake

before you make any decisions about how to address his issues. Make sense?

FEMALE SPEAKER: Yeah.

Levy Family: Episode 2

Additional Content Attribution

© 2016 Laureate Education, Inc.

 

Levy Family: Episode 3

Program Transcript

JAKE LEVY: We’d be out on recon in our Humvees, and it would get so hot. We

used to put our water bottles in wet socks and hang them right outside the

window just so the water would cool off of a bit, and maybe then you could drink

it.

Man, it was cramped in there. You’dbe drenched, nowhere to breathe. It’s like

riding around in an oven. And you’d have your helmet on you, 100 pounds of

gear and ammo. I swear, sometimes I feel like it’s still on me, like it’s all still

strapped on me.

FEMALE SPEAKER: How many tours did you do in Iraq?

JAKE LEVY: Three. After that last recon, I just– There were 26 of us. Five

marines in the Humvee I was in. I remember I was wearing my night vision

goggles. We passed through a village and everything was green, like I was in a

dream or under water.

And then there was a flash, bright light just blinded me. There was this explosion.

Ican’t– Ican’t–

FEMALE SPEAKER: It’s OK, Jake. Take it easy. I understand this is difficult.

There’s something I;d like to try with you. It’s called exposure therapy, and it’s a

treatment that’s used a lot with war veterans, especially those struggling with

anxiety and PTSD.

JAKE LEVY: Exposure therapy?

FEMALE SPEAKER: Yes. It’s to help someone like yourself to confront your

feelings and anxieties about a traumatic situation that you’ve experienced. It’s a–

It’s meant to help you get more control of your thoughts, to make sense of what’s

happened, and to not be so afraid of your memories.

JAKE LEVY: Put that in a bottle and I’ll buy 10 cases of it.

FEMALE SPEAKER: Well, one part of it is learning to control your breathing. And

whenyou practice that, you can learn to manage your anxiety, to get more

control of it, not let it control you, to protect yourself. Do you want to try it?

JAKE LEVY: Right now? Levy family – Assessing Clients With Addictive Disorders

FEMALE SPEAKER: Sure.

JAKE LEVY: Why not?

 

Levy Family: Episode 3

FEMALE SPEAKER: OK. Well, I know this sounds crazy, but a lot of people don’t

breathe properly. And it really comes from bad habits. When they inhale and

exhale, all the effort is here in their chest and shoulders. And the problem with

that is you get a really short, shallow breath. And that really increases the stress

and anxiety in your body.

Instead, a more natural breath should always involve your diaphragm, right here

in your abdomen. When you breath in, your belly should expand. And when you

breath out, your belly should fall. OKJAKE LEVY: OK.

FEMALE SPEAKER: So, let’s practice. Close your eyes. Now, I want you put one

hand on your abdomen and the other across your chest. Good. Good. Now, I just

want you to take a few breaths, just like normal. What are you feeling?

JAKE LEVY: I feel my chest moving up and down. But my belly, nothing.

FEMALE SPEAKER: OK. So that’s what I was just talking about. That’s OK. Let’s

try this. I want you take a breath. And this time, I only want you to allow your

abdomen to expend when you breathe in and to fall when you breathe out.

OK, let’s try it. Breathe in. Breathe out. Breathe in. Breathe out.

You feeling better? More relaxed? Levy family – Assessing Clients With Addictive Disorders

Community And Public Week 4 Essay

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Community And Public Week 4 Essay

  • Develop your vision of the ideal health care system.
  • List some of the characteristics that constitute such a system.
  • What would be the goal or goals of your ideal system?
  • Think about how you would go about implementing your ideal system.

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  • Consider some of the problems you are likely to encounter.
  • Must address all of the topics.
  • word minimum 150. no word maximum
  • Minimum of two references (the course textbook can be one of the references, as well as the organizational website.
  • APA format Community And Public Week 4 Essay.

Clinical nurse leader (CNL) Educational preparation and roles

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Clinical nurse leader (CNL) Educational preparation and roles

Respond to the following argument;

In 2007, the American Association of Colleges of Nursing introduced the Clinical Nurse Leader (CNL) role as a response to the increasing concerns regarding the safety and quality of nursing care. The educational preparation of the CNL requires a Master’s Degree that encompasses both clinical and theoretical experiences and results in competencies that develop strong clinical leadership traits (Stavrianopoulos, 2012).

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The CNL influences and enhances patient care both at inpatient and outpatient healthcare environments. CNLs’ duties involve assuming a leadership role among team members, evaluating how the present system is working, and identifying changes that need to take place (University of San Francisco). In general, CNLs affect patient care in the following ways: as an interdisciplinary care team leader, as outcomes manager, as patient educator and advocate, as information manager, and as an advanced clinician (Stavrianopoulos, 2012).

Strategies for Nurse Managers (2017) reports that currently there are an estimated 900 CNLs in the USA. Statistics show that hospitals who employ CNLs have fewer readmission rates, shorter “length of stays”, decreased infection rates, fewer falls, and less RN turnover. The Veterans Health Administration (VA) not only applauds CNLs, but initiated a plan to have at least three CNLs employed at each of its hospitals by 2016. Many organizations have offered scholarships to advance this much-needed nursing career. Clinical nurse leader (CNL) Educational preparation and roles

Disparities in Hypertension in predominately African American Communities versus a more diverse community

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Disparities in Hypertension in predominately African American Communities versus a more diverse community

Disparities  in Hypertension in predominately African American Communities versus a more diverse community

African Americans have the highest population of people diagnosed with hypertension.

Research Question:  Does the development of community programs and providing health education, reduce Disparities  in Hypertension in predominately African American Communities versus a more diverse community?

Begin your discussion by sharing your problem statement and research question. Next, discuss your sampling plan. In addition, discuss your research design. Consider the following as you craft your response.

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Sampling

  • How will the sample be selected?
  • What type of sampling method is used? Is it appropriate to the design?
  • Does the sample reflect the population as identified in the problem or purpose statement?
  • Is the sample size appropriate? Why or why not?
  • To what population may the findings be generalized? What are the limitations in generalizability?

Research design

  • What type of design will be used?
  • Does the design seem to flow from the proposed research problem, theoretical framework, literature review, and hypothesis?

Presents the grading criteria and rubric for this assignment.

Clinical nurse leader (CNL)

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Clinical nurse leader (CNL)

Identify the educational preparation and role(s) of the clinical nurse leader (CNL) designation. Give an example of how the CNL influences direct patient care whether in a hospital or out in the community.

Clinical nurse leader (CNL) was proposed American Association of Colleges of Nursing, an effort to improve patient safety and quality of care (Graduate Nursing Edu.org). CNL is a generalist clinician who have education at master’s degree level or higher (Graduate Nursing Edu.org), upon graduation must sit for Clinical Nurse Leader Certification Examination by the Commission on Nurse Certification (University of Pittsburgh). A CNL has an advanced knowledge, not just in one area or discipline, but on general medicine, which is helpful for coordinating the care provided by the interdisciplinary teams.

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CNL has roles different from other advanced practice clinicians, they are responsible for designing patient care, implementing, and evaluating the care provided to the patients, making sure that the patients receive the right care, while coordinating, delegating, and supervising the care provided by other health care teams clinically.

CNL can influence patient care by the use evidence-based practice and the latest innovated technology to improve patients’ care, they work with physicians, pharmacists, nurse practitioners and other health care teams to provide the most effective medical care (Graduate Nursing Edu.org). It is important to know that CNL serve as mentors to nursing staff, oversee the environment to ensure it is safe for the patients.

CNL can act like a patient’s advocate; they serve as a middle person between the patients and they physicians or healthcare providers. For example, a patient in the community who is not sure what and where to go for help, a CNL would use his/her expertise to inform or teach the patients and family members, the disease condition, and its management, and refer them to the appropriate places for best care.

References

Graduate Nursing Edu.org. (2017) Retrieved on October 2nd. From https://www.graduatenursingedu.org/clinical-nurse-leader/

University of Pittsburgh (2017) Clinical Nurse Leader (CNL). Retrieved October 2nd from http://www.nursing.pitt.edu/degree-programs/master-science-nursing-msn/msn-program-majors/clinical-nurse-leader-cnl-onsite

Cardiovascular Disorders Pharmacotherapy Essay Example

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Cardiovascular Disorders Pharmacotherapy Essay Example

Assignment: Pharmacotherapy for Cardiovascular Disorders

Write a 2-page paper that addresses the following:
The Case Study for this week is the following:

Patient AO has a history of obesity and has recently gained 9 pounds. The patient has been diagnosed with hypertension and hyperlipidemia. Drugs currently prescribed include the following:

1. Atenolol 12.5 mg daily
2. Doxazosin 8 mg daily
3. Hydralazine 10 mg qid
4. Sertraline 25 mg daily
5. Simvastatin 80 mg daily

Explain how the factor you selected might influence the pharmacokinetic and pharmacodynamic processes in the patient from the case study you were assigned.

Describe how changes in the processes might impact the patient’s recommended drug therapy. Be specific and provide examples.

Explain how you might improve the patient’s drug therapy plan and explain why you would make these recommended improvements. Cardiovascular Disorders Pharmacotherapy Essay Example.

Resources:

Drug Enforcement Administration. (n.d.-a). Code of federal regulations. Retrieved February 1, 2019, from https://www.deadiversion.usdoj.gov/21cfr/cfr/1300/1300_01.htm

Fowler, M. D. M., & American Nurses Association. (2015). Guide to the Code of Ethics for Nurses with Interpretive Statements: Development, Interpretation, and Application (2nd ed.). Silver Spring, Maryland: American Nurses Association.

Ladd, E., & Hoyt, A. (2016). Shedding light on nurse practitioner prescribing. The Journal for Nurse Practitioners, 12(3), 166–173. doi:10.1016/j.nurpra.2015.09.17

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

JNC 8 Guidelines for the treatment of hypertension in adults Cardiovascular Disorders Pharmacotherapy Essay Example

ACC/AHA national cholesterol treatment guidelines

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Hypertension and Hyperlipidemia in Obesity: A Case Study on Cardiovascular Pharmacotherapy

Age is one factor that significantly affects the pharmacokinetics (PK) and pharmacodynamics (PD) of medications that are routinely used to treat and manage cardiovascular conditions. For patient AO who has obesity and has been diagnosed with hypertension and hyperlipidemia, the PK and PD of the drugs he has been put on will be affected to a large extent by his age (Katzung, 2018; Rosenthal & Burchum, 2018). It is known that with growing age, the first pass metabolism by the cytochrome P450 isoenzymes in the liver becomes less effective. This is because of the deterioration of the liver with age. Cardiovascular Disorders Pharmacotherapy Essay Example. As a result, the oral drugs that are metabolised in the liver to inactive metabolites through this pathway accumulate in the body after administration because of the delay in metabolising them (Hammer & McPhee, 2018; Huether & McCance, 2017). Hydralazine is one such drug that might suffer this fate and which patient AO is taking. The other way that age affects the PK and PD of cardiovascular medications is through the fact that renal function declines with age. As a result, excretion of drugs through the renal route is compromised in older subjects and the drug and its metabolites can accumulate in the body to dangerous levels. Both atenolol and hydralazine are affected by this scenario (Rosenthal & Burchum, 2018). In older patients, absorption of substances from the gastrointestinal tract also becomes less efficacious Cardiovascular Disorders Pharmacotherapy Essay Example. This includes oral medications. As a result, drugs taken orally, as is the case with patient AO, may not be optimally absorbed. This leads to lower plasma concentrations that may not reach therapeutic levels (Katzung, 2018; Rosenthal & Burchum, 2018).

Older patients have also been known to possess less lean body mass. This mass decreases as one ages. Unfortunately, the distribution of several drugs is dependent on lean body mass. As such, these drugs will not reach all the areas they are supposed to reach because of the age-related deficiency in lean body mass. Their effectiveness is therefore compromised in such older patients (Rosenthal & Burchum, 2018; Katzung, 2018). Lastly but not least, because of these shortcomings, the pharmacodynamics of many of these medications will be affected in that their actions will be prolonged due to accumulation in the blood and body tissues (Katzung, 2018) Cardiovascular Disorders Pharmacotherapy Essay Example.

How these Changes Might Affect the Patient’s Recommended Drug Therapy

Apart from the importance of lifestyle changes that patient AO must effect to mitigate the effects of obesity and hyperlipidemia (Rubenfire, 2018), the changes in PK and PD will necessitate alterations in the dosages of the respective drugs (Armstrong, 2014). For instance, sertraline is known to predispose elderly patients to the risk of falls under normal circumstances (Katzung, 2018). In an older patient with much more prominent of these deteriorative changes, the effect of sertraline may be magnified. Because of this, the dose will need to be reduced in older patients (Armstrong, 2014). Again because of the reduction in renal function, the dosages of both atenolol and hydralazine may also need to be reduced in older patients. This is because they and their metabolites accumulate in the bodies of older patients because of reduced renal excretion (Huether & McCance, 2017; Hammer & McPhee, 2018). Luckily, doxazosin is beneficial in both hypertension and lipid control in older patients. Therefore, its dose may be left as it is. As for simvastatin, it also appears to be stable at the usual dosages (Katzung, 2018; Rosenthal & Burchum, 2018). Cardiovascular Disorders Pharmacotherapy Essay Example

How to Improve the Patient’s Drug Regime

The most important step to achieve this is to reduce the dosages of the drugs whose PK and PD are adversely affected by age as discussed above. This is in line with the bioethical principle of beneficence. That is doing the most good to the patient as opposed to causing them harm by leaving the dosages as they are (Fowler & ANA, 2015).  The reason is to enhance the therapeutic value of the cardiovascular drugs and reduce adverse effects.

References

Armstrong, C. (2014). JNC 8 guidelines for the management of hypertension in adults. American Family Physician, 90(7):503-504. https://www.aafp.org/afp/2014/1001/p503.html

Fowler, M.D.M., & American Nurses Association. (2015). Guide to the Code of Ethics for Nurses with interpretive statements: Development, interpretation, and application, 2nd ed. Silver Spring, MD: American Nurses Association.

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. New York, NY: McGraw-Hill Education. Cardiovascular Disorders Pharmacotherapy Essay Example

Huether, S.E. & McCance, K.L. (2017). Understanding pathophysiology, 6th ed. St. Louis, MO: Elsevier, Inc.

Katzung, B.G. (Ed) (2018). Basic and clinical pharmacology, 14th ed. New York, NY: McGraw-Hill Education.

Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

Rubenfire, M. (2018). 2018 AHA/ACC Multi-society guideline on the management of blood cholesterol. American College of Cardiology. Retrieved 9 March 2020 from https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2018/11/09/14/28/2018-guideline-on-management-of-blood-cholesterol  Cardiovascular Disorders Pharmacotherapy Essay Example

MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment

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MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment

Mixed Up Soap Note (20%, CO 1, 3/ MO 2)
The goal of this assignment is to introduce to the SOAP note format. A SOAP template has been provided below for your use. You will read the Mixed-up Soap Note Scenario. You will identify the Subjective components in the narrative. You will take that data that you\’ve been given, and you will enter the data in the appropriate area on the Soap note, you will want to abbreviate the content and complete a Review of Systems. There is limited objective data. You will then contemplate the information that you\’ve been given, and from this information, you will create a diagnosis and a plan. You will complete the SOAP note, and you can utilize the second document to present your rationales and research. What you will see is that you can do the majority of your Diagnosis with an excellent history. Focus your diagnoses on what you “see.” Often as a provider, you start your diagnoses based on a physical finding or a complaint and then you will fine tune it based on your examination or other tests. For example, a patient presents with a cough based on history; you may then determine the patient is having respiratory distress through observation, you will then continue to fine tune your diagnosis to Wheezing with your examination and then once you have finished you have narrowed it down to Mild intermittent Asthma with exacerbation. This process will start with a vague diagnosis and become more specific as you gather more specific data. MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment

Subtitle or Section:

Read the rest of the case study below and then complete the blank Soap Note attached to the scenario.
Use only the information provided.
Decide what is pertinent and then place the components in the correct sections of subjective and objective components
Use appropriate abbreviations and concise terminology if appropriate
If you are lacking pertinent information supply the questions that you would ask the patient (pretend you are completing the visit, how would you phrase the questions)
Provide a second Word document answering the following questions
What type of history will you obtain for this visit?
What additional history would you obtain from the family that is significant to A.J.\’s situation
Practice using clinical reasoning and list possible diagnoses for A.J. based on the subjective information provided
Provided the following:
· Medical Diagnosis (2)
o ICD 10 code

o Provide pathophysiology

o Pertinent positives

o Pertinent negatives

· Differential diagnosis (3-5)

· ICD 10 code

o Provide pathophysiology (brief for each)

o Pertinent positives

o Pertinent negatives

· Health maintenance/risk profile

· Reference List

APA format

Subtitle or Section:

Mixed Up Soap Note Scenario

Grading Rubric

SOAP Template Actions

 

5220 Advanced Health Assessment

Mixed up Subjective and Objective Data Work Sheet

A.J. is a 15-year-old female who is presenting to your primary clinic setting with her mother.  A.J. is a new patient, and this is her initial visit.  Her complaint is “left leg pain.” MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment

Vitals:    Temp:  37.0 C

HR: 88

RR: 16

BP: 110/72

Height: 5’ 6.”

Weight: 70.5 kg

  1. Read the rest of the case study below and then complete the blank Soap Note attached to the scenario.  Use only the information provided.
    1. Decide what is pertinent and then place the components in the correct sections of subjective and objective components
    2. Use appropriate abbreviations and concise terminology if appropriate
  2. Provide a second Word document answering the following questions
    1. What type of history will you obtain for this visit? MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment
    2. What additional history would you obtain from the family that is significant to A.J.’s situation
    3. Practice using clinical reasoning and list possible diagnoses for A.J. based on the subjective information provided
    4. For each of the following
      1. Medical Diagnosis, 2 primary
        1. Provide pathophysiology/Rationale/Plan
        2. ICD 10 code
      2. Differential diagnosis, 3-5 Differentials
        1. Provide pathophysiology/Rationale/plan
        2. ICD 10 code
  • Health maintenance/risk profile
  1. Pertinent positives
  2. Pertinent negatives
  1. Reference list
  2. APA format

 

A.J. is a 15-year-old female, student.   A.J. participates competitively in Gymnastics.  She recently (3 days ago) had an injury to her left leg when she landed in an awkward position with a dismount from the uneven bars.  She has previously had an injury to her left knee, so the family put a brace on and started crutch use, but has not sought medical care.  The family knew that they had this upcoming appointment, so they chose to wait to seek care.  The left leg pain is isolated to the front lateral aspect of the left knee; It is not improved with their interventions, the mother states that she has given A.J. Motrin 600 mg 3-4 times a day since the injury. The injury is painful at night and worse when she is up at night with pain.  A.J. states that she is having trouble bending her knee when the brace is off.  She is frustrated with the injury and wants it better so that she can go back to practice; she has an important meet in 2 weeks.  A.J is currently a freshman in school (has just started back to school), previously her grades are A’s and B’s and struggles a bit in her algebra class but has utilized a tutor for help and is making progress in that class. MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment

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A.J. states that most of her friends are in the gym, she has a few friends at school, but since the gym takes so much of her time, it is hard to have time for friends in other settings.  A lot of her friends from middle school do not seem to have similar interests, 9th grade was a new school for her and mom is hinting that it has been a hard transition.  Including this injury is making it hard for her to get around the campus between classes.

 

A.J. has no allergies

 

A.J. takes no medications

 

A.J. denies changes in her weight

 

A.J. eats a healthy diet, she has recently talked about becoming a vegetarian, no one in the family has food allergies, and they do not maintain a vegetarian diet.  Mom is concerned that she is not getting enough protein.  A.J. has not mentioned concerns with her weight but often notes that she is taller than other gymnasts and gets frustrated that she is not as limber or agile as her other competitors. MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment

 

A.J. Denies drugs, alcohol or use of illegal substance, no sports enhancing drugs

 

A.J. denies sexual encounters, she likes boys, denies a boyfriend

 

A.J. participated in gymnastics five days a week for 1 to ½ hours a session, she likes to run as well but is recreational, no other clubs or interests

 

Previous left knee injury one year ago, no other broken bones to injuries

 

Birth history, term female, two other sibs (older) who are healthy.  Parents are married, and state that they are happy and financially comfortable.  She lives in a two story house, and her bedroom is upstairs, she is having challenges with navigating the steps with the crutches, one inside dog, no other animals.  Denies mental health concerns, but has been sadder the last couple of days and mom states short tempered with a recent injury.  No surgeries, hospitalizations or significant illness, trauma, or disabilities.  +yearly flu shots, and last got immunizations around age 11 and had one HPV and one Hepatitis A immunization at age 11; mom states that immunizations were up to date.  Denies use of glasses or hearing aid, had her vision and hearing checked at PCP visit at age 11, has not sought primary care since that visit MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment.  A.J. denies eye or vision issues, denies issues with her hearing or ear pain, denies a headache, denies nasal drainage, nose bleeds, or problems with smell or taste.  No sore throat or voice changes, no mouth or teeth issues, and routinely sees a dentist, last visit in the past six months.

 

A.J. Denies issues with her heart, no palpitations or chest pain, no syncope, no abdominal pain or problems with voiding or stooling, denies constipation or diarrhea and no blood in her stool.  No other concerns in her musculature other than her left knee.

 

A.J. is currently having issues sleeping relating to pain, she is sleeping in her bed and has tried to elevate her left leg, denies problems with concentration at school or any memory issues.

 

Family denies any previous blood transfusions or use of chronic medications.

 

A.J. started her periods at age 12 years and had them monthly, used pads and had a period in the past month, no concerns verbalized with length or intensity of bleeding, no birth control and has never seen a GYN.

 

A.J. does not work outside the home

 

Parents: Dad has a high-stress job and hyper tension, on medications, Mom is a stay at home mom, +weight issues but overall no meds and healthy.  Siblings (one in college, girl, +weight issues and overall healthy), brother (senior in high school, is looking at going away to school, healthy).  Mom states no mental health concerns in the family, denies diabetes, exposure to communicable diseases, no recent travel outside of the US, no smokers, no stroke, lung disease, or asthma, no blood disorders, seizures, headache.  Paternal grandfather with hypertension MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment

 

 

The concept with permission granted and appreciation per Dr. J Michaels.

 

  • Name

mixed up soap rubric

  • Description
  • Rubric Detail
Levels of Achievement
Criteria Excellent Competent Novice Needs Improvement
Case Study Completion

Weight 5.00%

100 %

Student is at ease with the information and appropriately understands and displays ability to process the information from the scenario

 75 %

unable to process the information from exam finding, displays lack of synthesis of case study information, student is unable to elaborate or provide additional details

 50 %

Student understands the information but is unable to provide basic details

 0 %

Student does not display ability to provide basic information
Formating/use of soap note template

Weight 5.00%

100 %

Appropriate Use of the Form

 75 %

Competent use of the form

 50 %

Basic use of the form

 0 %

Inadequate use of the form
Subjective

Weight 30.00%

100 %

Appropriately documents the Subjective components from the case study material, Review of systems (ROS)is completed appropriately, 3 HPI, 3 or greater ROS, 2+ Past/Social/Family History item

 75 %

one error in completion of the form, subjective components are missing, or mixing of subjective/objective components, lack of Review of system components or Review of system components are inappropriate or mixing of physical 2 HPI, 2 ROS, 1 Past/Social/Family History

 50 %

greater than one error or Inappropriate completion of the form, subjective components are missing, or mixing of subjective/objective components, lack of Review of system components or Review of system components are inappropriate or mixing of physical

 0 %

Incomplete or missing components
Medical Diagnosis/Rule Outs/Health Profile/Pertinent positives/Pertinent negatives/Diffenentials/Alteration in health prevention

Weight 30.00%

100 %

Appropriately completes the components and displays synthesis of information in the appropriate sections

 75 %

on error or inappropriately labeled/mixed or general lack of synthesis of information provided

 50 %

greater than one error, Components are missing or inappropriately labeled/mixed or overall lack of synthesis of information provided

 0 %

Incomplete or missing components
Plan/Rationale/Patho

Weight 30.00%

100 %

Appropriately completes the components and displays synthesis of information in the appropriate sections

 75 %

One error or Components are missing or inappropriately labeled/mixed or General lack of synthesis of information provided

 50 %

Greater than one error, Components are missing or inappropriately labeled/mixed or overall lack of synthesis of information provided

 0 %

Incomplete or Missing Components

 

 

 

SOAP Note Form
S/ Identifying Information:   (initials, age/DOB, gender, reliability) Family Hx:

 
Personal/Social Hx:
Chief Complaint/RFE:
Hx Present Illness: (7 Variables but do not list as such)
CURRENT HEALTH
Medications:
Allergies:
Last PE & Screenings:
Immunization Status:
LMP & Birth Control (if applicable)
PMH
Illnesses & Trauma:
Hospitalizations/Surgeries:
OB Hx/Sexual Hx:
Emotional/Psy Hx:
REVIEW OF SYSTEMS
General
Nutrition
Skin/Hair/Nails
HEENT
Breasts
Respiratory
CV/peripheral vascular

 
GI
GU
MSK
Psych
Neuro
Lymph/Heme/Endocrine
O/ Physical Exam: T:        P:        R:        BP:          HT:         WT:         BMI:
General
Skin
Head
EENT
Neck 
Breasts/Chest
Lungs
Heart/ perip vascular
Abdomen
Genitalia/Rectum
Lymph
MSK
Neuro
Medical Dx: (2max) Rule Outs (only if applicable):
Health Profile:
age/gender/racial  risks:
Pertinent Positives:(1DX)
personal/family:
screening needs:
Pertinent Negatives: counseling needs:
Immunization/chemo needs:
Differential DX:(3-5)  Alteration in Health Prevention R/T:
Screening deficits:
Counseling deficits:
Nursing Dx:  Immunization/chemo deficits:

 

I. PLAN:  Do separate sections in the plan  to include: Max 1-2 pages

 

Diagnostics:

 

Medications/Treatments:

 

Education:

 

Follow-up:

 

Referrals:

 

Prevention Plan:

 
II. Rationale: ( Max 2 pages)
III. Patho: (Max 2 pages)

 

 

 

 

 

 

 

Mixed Up Soap Note

Name

Institution

 

 

  1. What type of history will you obtain for this visit?
  • Presenting complain
  • History of presenting complaint
  • Past medical history (Sataloff, 2019)
  • Drug history
  • Family history
  • Social history
  1. What additional history would you obtain from the family that is significant to A.J.’s situation
  • Family history e.g. Cardiac and diabetes history
  • Presence of genetic conditions in the family
  1. Practice using clinical reasoning and list possible diagnoses for A.J. based on the subjective information provided
  • Muscle or tendon injury
  • Medial tibial stress syndrome
  • Stress fracture,
  • Exertional compartment syndrome
  • Nerve entrapment
  1. For each of the following:
  2. Medical Diagnosis: Muscle or tendon injury:
  3. Pathophysiology
  • Muscle strain occurs from overstretched muscles and is common among sporting people. Symptoms include leg pain and mobility difficulties among others.
  • Muscle strains cause excessive fiber stretching due to exertion of tensile force at the muscle. The pathophysiological process is characterized by destruction, repair and remodeling. Destruction involves tearing and myofibrils necrosis, creation of hematoma and division of inflammatory cells (Bengtsson, Ekstrand, Waldén & Hägglund, 2017). Repair and remodeling phases involve necrotic tissue phagocytosis, myofibrils regeneration and concomitant development of connective scar tissue, neoformation of vessels and growth of neurons also occur (Hamilton et al., 2020) MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment
  1. ICD 10 code: ICD-10-CM Code S86
  2. Diagnosis 2: Medial tibial stress syndrome
  • Pathophysiology:
  • Clinical exercise induced pain caused by repetitive loading stress during running and jumping and triggered on palpation over a length of ≥5consecutive centimeters. It occurs along the posteromedial tibial border.
  • Foot inversion by dorsiflexes of the tibialis anterior is followed by extension of the great toe. Other toes extend causing pain and dysfuctions.
  • ICD-10-CM Diagnosis Code S83.132A
  • Differential diagnosis, 3-5 Differentials
  • Stress fracture
    • Tiny cracks in bones caused by repetitive force, often from overuse — such as repeatedly jumping up and down or running long distances. Stress fractures can also develop from normal use of a bone that’s weakened by a condition such as osteoporosis.
    • ICD-10-CM Diagnosis Code M84.35

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  • Exertional compartment syndrome
  • It is associated with pain and pressure on the leg due to failure of muscle expansion on the affected tissues. It causes inflammation, pain and disability of arms and legs. It is nerve condition or exercise induced.
  • ICD-10-CM Diagnosis Code M79.A22 (ICD10data, 2018).
  • Nerve entrapment
  • It is characterized by pain, tingling, numbness and muscle weakness. It is a medical condition resulting from direct exertion of pressure on the nerves (Black, Brindle & Honaker, 2016). Localized structural changes and microvascular function interferences cause dysfunction of peripheral-nerves (Kastenschmidt, Mannaa, Muñoz & Villalta, 2019).
  • ICD-10-CM Diagnosis Code S84.02XD

 

  • Pertinent positives
    • muscle injury;
    • pain
  • Pertinent negatives
    • Broken bone

 

 

References

 

Kastenschmidt, J. M., Mannaa, A. H., Muñoz, K. J., & Villalta, S. A. (2019). Immune System Regulation of Muscle Injury and Disease. In Muscle Gene Therapy (pp. 121-139). Springer, Cham.

Hamilton, B., Pollock, N., Reurink, G., de Vos, R. J., Purdam, C., & Thorborg, K. (2020). Muscle Injury Classification and Grading Systems. In Prevention and Rehabilitation of Hamstring Injuries (pp. 189-198). Springer, Cham.

Bengtsson, H., Ekstrand, J., Waldén, M., & Hägglund, M. (2017). No difference in muscle injury rates during professional football matches preceded by three to five days of recovery. British Journal of Sports Medicine, 51(4), 294-294.

Black, J. M., Brindle, C. T., & Honaker, J. S. (2016). Differential diagnosis of suspected deep tissue injury. International wound journal, 13(4), 531-539.

ICD10data. (2018). The Web’s Free 2019/2020 ICD-10-CM/PCS Medical Coding Reference. Retrieved from https://www.icd10data.com/

Sataloff, R. T. (2019). Patient history. Obesity and Voice, 65. MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment

 

 

SOAP Note Form
S/ Identifying Information:   A.J, 15, F

 

MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment

 Family Hx: Parents: Dad has a high-stress job and hyper tension, on medications, Mom is a stay at home mom, +weight issues but overall no meds and healthy.  Siblings (one in college, girl, +weight issues and overall healthy), brother (senior in high school, is looking at going away to school, healthy).  Mom states no mental health concerns in the family, denies diabetes, exposure to communicable diseases, no recent travel outside of the US, no smokers, no stroke, lung disease, or asthma, no blood disorders, seizures, headache.  Paternal grandfather with hypertension
Personal/Social Hx: Has few school friends.

Denies drugs, alcohol or use of illegal substance, no sports enhancing drugs; denies sexual encounters, she likes boys, denies a boyfriend
Chief Complaint/RFE: Left leg pain
Hx Present Illness: (7 Variables but do not list as such)she had  left leg injury 3 days ago; previous left knee injury;
CURRENT HEALTH
Medications:  Motrin 600 mg 3-4 times a day
Allergies: NKA
Last PE & Screenings:  Previous left knee injury one year ago, no other broken bones to injuries
Immunization Status: yearly flu shots, and last got immunizations around age 11 and had one HPV and one Hepatitis A immunization at age 11
LMP & Birth Control (if applicable):  N/a
PMH
Illnesses & Trauma:  none
Hospitalizations/Surgeries: never been hospitalized;
OB Hx/Sexual Hx: regular period; began at 12 years
Emotional/Psy Hx: concerns with height; often notes that she is taller than other gymnasts and gets frustrated that she is not as limber or agile as her other competitors.no major mental health concerns; short tempered and sad due to the injury
REVIEW OF SYSTEMS
General : Negative for fevers, chills, fatigue; weight loss
Nutrition : eats a healthy diet; wants to become vegetarian; not obese
Skin/Hair/Nails : negative for itching, burning, rashes; red and sore at the site of injury
HEENT: denies vision or hearing problems; does not wear glasses or hearing aids; denies nasal drainage, nose bleeds and problems with smell and taste; No sore throat or voice changes, no mouth or teeth issues, and routinely sees a dentist, last visit in the past six months. MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment
Breasts : no lumps or masses
Respiratory : negative for cough; dyspnea on exertion; denies chest pain
CV/peripheral vascular : Denies issues with her heart, no palpitations
GI : Normal bowel sounds, soft, non tender, non distended. No guarding or rebound; no abdominal pain or problems with voiding or stooling, denies constipation or diarrhea and no blood in her stool
GU: Negative for pain; urine normal in frequency and quality
MSK  : positive for painful on the left leg
Psych :  negative for mental issues or trauma
Neuro  : denies syncope
Lymph/Heme/Endocrine  : negative for enlarged nodes in the groin. No history of splenectomy
O/ Physical Exam: T: 37.0C  HR: 88      RR: 16       BP: 110/72        HT: 5.6”     WT: 70.5Kg        BMI: 24.2
General : appears sad and in pain
Skin  : no rashes and lesions
Head  : no head injuries; headache
EENT  no eye or vision issues, hearing or ear pain; nasal drainage, nose bleeds, or problems with smell or taste.  No sore throat or voice changes, no mouth or teeth issues, and routinely sees a dentist, last visit in the past six months.
Neck: no lumps; pain ; no sore throat
Breasts/Chest  : no palpitations or chest pain
Lungs  : clear to auscultation and percussion bilaterally
Heart/ perip vascular : . pulses+2 bilat pedal and +2 radia
Abdomen  : symmetrical without distention; bowel sounds are normal in quality and intensity; No masses or splenomegaly noted; negative for tenderness with deep palpation
Genitalia/Rectum  : no itching or reddening

MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment
Lymph  : no inflamed lymph nodes
MSK  : left leg pain
Neuro : no problems with concentration at school or any memory issues.
Medical Dx: (2max)  :

X-ray

Physical examination

Symptom history

 Rule Outs (only if applicable):
Health Profile:
age/gender/racial  risks:
Pertinent Positives:(1DX)

muscle injury;

pain
personal/family:
screening needs:
Pertinent Negatives:

Broken bone

 counseling needs:
Immunization/chemo needs:
Differential DX:(3-5)

·         Muscle or tendon injury

·         Medial tibial stress syndrome

·         Stress fracture,

·         Exertional compartment syndrome

·         Nerve entrapment,

 Alteration in Health Prevention R/T:
Screening deficits:
Counseling deficits:
Nursing Dx:  •      Muscle or tendon injury Immunization/chemo deficits:

 

I. PLAN:  Do separate sections in the plan  to include: Max 1-2 pages

 

Diagnostics:

·         Grade 2 Muscle or tendon injury

 

Medications/Treatments:

·         Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen; for pain relieving

 

Education:

·         Recovery exercise; massage Therapy; appropriate muscle resting

 

Follow-up:

·         Visit clinic every two weeks

 

Referrals:

·         Physical therapist

 

Prevention Plan: 

·         Patient will walk at a moderate pace for 3 to 5 minutes before doing any sports or other physical activities.

·         Wear shoes that provide stability and ensure that any other protective equipment fits appropriately and is in good condition. MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment.

·         Lift heavy objects or items with care and always use the correct technique.

 
II. Rationale: ( Max 2 pages)

Muscle strain occurs from overstretched muscles and is common among sporting people. Symptoms include leg pain and mobility difficulties among others.
III. Patho: (Max 2 pages)

Muscle strains cause excessive fiber stretching due to exertion of tensile force at the muscle. The pathophysiological process is characterized by destruction, repair and remodeling. Destruction involves tearing and myofibrils necrosis, creation of hematoma and division of inflammatory cells. Repair and remodeling phases involve necrotic tissue phagocytosis, myofibrils regeneration and concomitant development of connective scar tissue, neoformation of vessels and growth of neurons also occur MIXED UP SOAP NOTE – Nurs 5220 Advanced Health Assessment