In this assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

GENITALIA ASSESSMENT

Subjective:

· CC: “I have bumps on my bottom that I want to have checked out.”

· HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.

· PMH: Asthma

· Medications: Symbicort 160/4.5mcg

· Allergies: NKDA

· FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

· Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

· VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

· Heart: RRR, no murmurs

· Lungs: CTA, chest wall symmetrical

· Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

· Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

· Diagnostics: HSV specimen obtained

Assessment:

· Chancre

· PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

To prepare:

With regard to the SOAP note case study provided:

· Review this week’s Learning Resources, and consider the insights they provide about the case study.

· Consider what history would be necessary to collect from the patient in the case study.

· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

To complete:

Refer to Chapter 5 of the Sullivan text. Analyze the SOAP note case study.  Using evidence based resources, answer the following questions and support your answers using current evidence from the literature.

· Analyze the subjective portion of the note. List additional information that should be included in the documentation.

· Analyze the objective portion of the note. List additional information that should be included in the documentation.

· Is the assessment supported by the subjective and objective information? Why or Why not?

· Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis?

· Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from current evidence based literature.  

In this assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

GENITALIA ASSESSMENT

Subjective:

· CC: “I have bumps on my bottom that I want to have checked out.”

· HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.

· PMH: Asthma

· Medications: Symbicort 160/4.5mcg

· Allergies: NKDA

· FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

· Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

· VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

· Heart: RRR, no murmurs

· Lungs: CTA, chest wall symmetrical

· Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

· Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

· Diagnostics: HSV specimen obtained

Assessment:

· Chancre

· PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

To prepare:

With regard to the SOAP note case study provided:

· Review this week’s Learning Resources, and consider the insights they provide about the case study.

· Consider what history would be necessary to collect from the patient in the case study.

· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

To complete:

Refer to Chapter 5 of the Sullivan text. Analyze the SOAP note case study.  Using evidence based resources, answer the following questions and support your answers using current evidence from the literature.

· Analyze the subjective portion of the note. List additional information that should be included in the documentation.

· Analyze the objective portion of the note. List additional information that should be included in the documentation.

· Is the assessment supported by the subjective and objective information? Why or Why not?

· Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis?

· Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from current evidence based literature.

Develop and Concept Map, using the form provided, on the following patient. Include Diagnostic data and medical orders that you expect to be ordered on the patient.

T.J., a 30-year-old African American client, is in his last year of law school and is clerking for a prestigious law firm. He and his fiancé plan to marry as soon as he graduates. During the last week he has had four dizzy spells and a headache at the base of his skull upon awakening for the last 2 days. His father has a history of hypertension, so T.J. is aware that his symptoms may indicate high blood pressure. On his way home from work, T.J. stops by the clinic and asks the nurse to check his blood pressure. The nursing assessment yields the following data.

Subjective data: States he has had four dizzy spells and has awakened with a headache in the occipital lobe the last two mornings. T.J. has 1 glass of wine at lunch and 2-3 beers in the evening to relax from the tension of school and work. Most of his meals are at fast-food establishments and have a high fat content. T.J. does not smoke. He used to jog 4 mornings a week but quit when he started clerking. He has had nocturia for the last 3 weeks. He is not taking any medication. T.J. states he is concerned about having hypertension because he does not want to take medication.

Objective data: T 98.6°F(37°C), AP 78 beats/min, R 16 breaths/min, BP 142/92 mm Hg, Wt 190 lbs (optimum weight 160). No edema noted in hands, feet, or legs.

Purpose: To recognize that individual culture does impact womans health care, communication,

nutrition, and family influences that shape the families you are caring for.

Concept: Cultural Diversity

Objective: Write a paper regarding a culture and its impact on families, contraception, conception and

birth.

Instructions: Create a cultural diversity paper.

1. This project is to a be written paper 5 pages in length APA format. These 5 pages include a

cover page and a reference page.

2. Refer to Purnells’ Cultural Competency as a guide to assessing the patient in the identified

culture from your Health Assessment course.

3. Is education valued, are boy children preferred over gril children? How do they view families?

Is contraception allowed and who is involved in the decision making regarding birth control

choices?

4. In an unintended pregnancy is adoption allowed? Is assisted reproductive technology accepted?

What about donor sperm or surrogacy?

5. Who attends childbirth? Where do women have babies? What are the special practices

employed to support the new mom and baby? Who in the family system makes decisions

regarding the woman’s health?

6. What implications does culture present to the issues of womens’ health care?

future of nursing discussion 3

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Question Description

Please respond to the discussion questions. Please also respond to the peers discussions.

DQ1

Discuss current research that links patient safety outcomes to ADN and BSN nurses. Based on some real-life experiences, do you agree or disagree with this research?

DQ2

Discuss current research that links patient safety outcomes to ADN and BSN nurses. Based on some real-life experiences, do you agree or disagree with this research?

Peer discussion 1

Due to the push for the minimum educational requirement for nurses to be a baccalaureate degree, research has been performed to determine whether or not nurses prepared with a baccalaureate degree actually perform better in practice and improve patient outcomes. Haskins and Pierson (2016) analyzed the results of nine studies. Overall, the results of this analysis were largely in favor of baccalaureate-prepared nurses.

Results showed that when patients were cared for by a greater number of nurses who had completed baccalaureate programs, they showed a lower risk of 30-day mortality. One of the individual studies actually showed that for every 10% increase in the nurses who held a baccalaureate degree, the 30-day mortality rate reduced by 7% (Haskins & Pierson, 2016).

The authors also examined studies that looked at failure-to-rescue and BSN-prepared nurses. Hospitals with 20-29% and 30-39% baccalaureate degree nurses saw a reduction in failure-to-rescue by 9% and 8%, respectively. When hospitals had >40% baccalaureate nurses, there was a reduction of 18% seen in failure-to rescue (Haskins & Pierson, 2016). These results demonstrate that a baccalaureate degree in nursing has a positive effect on patient outcomes, specifically 30-day mortality and failure-to-rescue (Haskins & Pierson, 2016).

In my personal experience, I do not agree with this research. I don’t agree that a BSN is necessarily better than an ADN degree. I think that it matters more how dedicated the nurse is to learning and preparing him or herself. When I was in my clinical for nursing school and as a new graduate nurse, I was frequently told by nurses at the hospitals I was at that they actually preferred the ADN students over the BSN students because the ADNs were more dedicated to learning and working. I also work with many ADN nurses whom I would trust to care for my family members or myself, and I’ve worked with BSN nurses that I would not give the same trust to. Obviously, that can be reversed also. However, the bottom line is that it cannot always be chalked up to a more expensive degree that makes a person a more competent nurse.

Haskins, S. and Pierson, K. (2016). The impact of the Bachelor of Science in nursing (BSN) degree on patient outcomes: A systematic review. Journal of Nursing Practice Applications & Reviews of Research, 6(1): 40-49. doi: http://dx.doi.org.lopes.idm.oclc.org/10.13178/jnpa…

Peer discussion 2

There are many paths to becoming a nurse whether it is obtaining
an associate’s degree or a bachelor’s degree. Whether you obtain an ADN or BSN
you would start off in the same level of practice within the nursing field and
have the same patient responsibility, although some hospitals are transitioning
to only hiring BSN nurses as studies show having a higher level of education
such as a BSN correlates to improved patient care and health outcomes. In
research done at a hospital in Pennsylvania, there was a link showing BSN
nurses were a 10% increase in proportion of nurses and this resulted in a
reduction of patient deaths by 5% (Robert Wood Johnson Foundation, 2014).

Based on my real life experiences, I do not agree with these

findings. Additionally, going through the BSN program and almost being done, I
know for a fact what I am learning here is not going to improve my patient
care. Being educated does not improve common sense and I feel like many nurses
who potentially injure patients do so because they are careless or have no
common sense and considering book smarts are different then common sense, there
is no correlation between patient safety and having a BSN.

Robert Wood Johnson Foundation. (2014). Building the Case for

More Highly Educated Nurses. Retrieved from: https://www.rwjf.org/en/library/articles-and-news/…

Peer discussion 3

A cross-sectional study dating back to 2013 found that RNs with BSN had better patient outcomes and a lower mortality rates in patients with CHF than nurses without a BSN. Another study in 2017 supports the idea that when comparing nurses with an associate against nurses with a bachelors their ideas on effective patient outcomes are different. Associate nurses focus more on the local bedside level where as bachelor nurses focus more at the systemic level including health care system factors like policy and staffing when it comes to patient safety.

When it comes to my real-life experience I have noticed that nurses with BSN or MSN degrees are on the unit they tend to spend more time in the chart or sitting behind the desk rather than at the bedside. Now this comes down to the individual I do not link a BSN/MSN to desk jobs, but I have noticed as of late new graduate RN’s who came from university do not thrive in the bed side setting like associate level nurses. I also want to point out that every associate level nurse I work with is currently enrolled to get their BSN myself included. So, while only holding an associate we are currently educating ourselves further to that level of BSN. I truly do not see any correlation between the degree being held and the level of care being provided to patients. If anything, personally these types of studies just divide nurses on the unit as some many get attitudes with others due to level of education achieved. I truly believe that when it comes down to patient safety as long as your heart and mind are in the right place patient desired patient outcomes will be achieved regardless of degrees.

Reference:

Anbari, A. B., Vogelsmeier, A., & Dougherty, D. S. (2017). Patient safety communication among differently educated nurses: Converging and diverging meaning systems. Western Journal of Nursing Research. https://doi.org/10.1177%2F0193945917747600

Blegen, M. A., Goode, C. J., Park, S. H., Vaughn, T., & Spetz, J. (2013). Baccalaureate education in nursing and patient outcomes. JONA: Journal of Nursing Administration, 43(2). https://doi.org/10.1097/NNA.0b013e31827f2028

Peer discussion 4

There are multiple paths you can take to become a RN, which is pretty unique in health care. In 2010 the IOM released a report in which called for 80 percent of RNs to have their BSN by 2020. This has been a huge push in hospitals and is part of the gaining magnet recognition. Research does support the claim that RNs with their BSN lead to improved patient outcomes, as opposed to ADNs. One study found that a 10 percent increase in proportion of RNs with BSNs was connected to a 7 percent decrease in patient deaths (RWJF, 2014). Research has supported this association and I do agree with this. BSN programs better prepare nurses to care for the increasingly complex health care demands, with patients that are living longer, are sicker, and a lot have multiple comorbidities. BSN education includes much more critical thinking, complex problem solving, and leadership which ADN programs aren’t necessarily able to provide the students. Another study, which looked at more individual effect of patients rather than the overall hospital numbers, found that “patients who are cared for by a higher proportion of BSN-prepared nurses were less likely to die, stayed in the hospital for shorter periods, and faced lower health care costs” (RWJF, 2014). I know many hospitals are willing to hire nurses with ADNs, but they do expect you to obtain your BSN within a few years, as well as most offering tuition reimbursement after being employed there for so long. These are terms that are aimed to increase the number of employees with their BSN and promote the fulfillment of the IOMs goal and result in improved patient outcomes.

References

Robert Wood Johnson Foundation (RWJF). (2014). Building the Case for More Highly Educated Nurses. Retrieved from https://www.rwjf.org/en/library/articles-and-news/…

Peer discussion 5

Recent research studies have proven that obtaining a bachelor’s degree in nursing is beneficial to the health and mortality of the patients entrusted to our care. Higher education levels significantly decrease patient mortality rates (Aiken,2010), and the American Association of Colleges of Nursing recently suggested a higher level of education, “enhances both clinical competency and care delivery” (AACN,2015). A higher level of education decreases the risk for error, diminishes the possibility of missed care and promotes stronger critical thinking skills (Aiken, 2010). Higher education also promotes confidence in nurses and this confidence is recognized by our patients.

Advancement is a great opportunity for registered nurses. ADN graduates in acute care settings rarely advance to the role of nurse manager, nurse educator, or administration. These superior roles generally require a higher level of education. The skills learned during the associates degree program do not focus on management. For instance, organizing the unit budget and cost effectiveness are not included in the ADN curriculum. Management skills are learned through a BSN approach, and these skills are only briefly mentioned during the ADN program. Effective management is essential to quality patient care and unit survival. A productive work environment should be empowering and capable of increasing morale among peers.

BSN education intensifies the understanding of patient-centered care and communication. A BSN nurse is more likely to be chosen as a resource nurse on any acute care unit. This is because a higher level of education is desired and respected by upper management, patients, and peers. A resource nurse should knowledgeable, and capable of coming up with answers to difficult questions in a short period of time. For example, one BSN nurse on my Palliative care unit, planned a beautiful wedding for a dying patient upon request. This nurse found the resources required to decorate the waiting room like a chapel, prepare a wedding cake, and locate a pastor who was willing to perform the ceremony. The couple wed three hours after the fiancé approached nursing with their desire to marry before the patient passed away. Leadership skills are the result of a higher education. Effective leadership skills must be learned, and a leader uses their skills to transform healthcare. Positive BSN leadership creates a caring foundation that accepts change and thrives on a challenge.

I agree that higher education enhances patient safety and decreases mortality, but I believe we are overlooking one thing. ADN nurses are placed under tremendous pressure to obtain their BSN. Most facilities who hire ADN nurses have them sign a contract which gives the nurse a deadline to complete their BSN. The push is for BSN nurses, so everything is centered around the BSN nurse. As a profession, with the push for BSN nursing, I think we often take the ADN nurse for granted. The associates degree is a stepping stone to the next level. I have sat in meetings where I have heard, “I will no longer hire ADN nurses”, or “ADN’s are not educated to understand research” or “ADN’s do not have the skills to precept Capstone students”. This sends the message that ADN’s are suboptimal and can be traumatizing to the ADN nurse. ADN’s are far from suboptimal but if one hears this daily they will begin to feel inferior and this will hinder patient care. As we grow in our careers and earn higher education we need to remember our roots. The pressure we place on each other is one of the greatest barriers to effective patient care, and that is what we are overlooking. As a BSN nurse we should guide our peers with associates degrees. We should encourage them and build up their confidence, so they too will feel successful and earn their BSN willfully and without delay.

Aiken, L. Nurses for the future. (2010). N Engl J Med, 364 (3): pp 196-98.

American Association of Colleges of Nursing (2015). Creating a more highly qualified nursing

work force. Retrieved from http://www.aacnnursing.org/News-Information/Fact-S…

Peer discussion 6

Time and time again, research has shown that those who possess a bachelor’s of science degree in nursing (BSN) improves patient health and expected goal outcomes. shown that pathways that lead to the bachelor’s degree in nursing (BSN) and higher may improve patient outcomes.According to Robert Wood Johnson Foundation, hospitals that employ larger numbers of BSN-prepared nurses have lower patient mortality rates; reducing the probability of death by 5%. The link between nurse education and patient outcomes was confirmed in 2011(RWJF, 2014). I feel as though the research is biased in that it only supports BSN nurses but it doesn’t state ‘why’ the difference in rates. Do I believe that I am incapable of learning what a nurse with a BSN knows, the answer is no; but, I am aware that society has placed emphasis on the continuance of education; therefore, the need for a BSN is imperative to me being merely considered competent even before my skill is observed. I feel as though if a nurse is dedicated to learning a trade and, or enhancing their skill that is what sets them apart and saves lives. I think that ADN nurses are not given the opportunity, especially at this time, as a nurse who advances their degree; thus, they will not be as knowledgeable as a BSN prepared nurse. However, if taught and permitted to retain their current degree status, I think that they will be just as effective as the nurse who possesses a BSN. I admit I have learned more in this program, however, the material was presented to me for me to learn. I think it is a matter of semantics – if the programs provided for ADN degrees were widely accepted, then level of the degree would not matter. Nurses are more and more being held at a higher standard and expected to perform at the highest level of their skill set. At times the duties fulfilled overlap and the practice of the nurse becomes more advanced. I truly believe the stipulations being placed on delivery of patient care, as it relates to nurses overall, is what has changed the mortality rate; it just so happens that the nurses, because of requirements, were BSN nurses.

Question Description

Assignment consist of reading the attached article and writing an APA formatted paper answering the attached questions:

1. Introduction (one paragraph): The introduction should be interesting and capture the reader’s attention.
   1. Provide a brief description of the research article to be discussed.
   2. Discuss the purpose of your paper. The purpose statement of the paper should relate to the research article reviewed and the implications that it has to evidence based nursing practice.
   3. You will need to summarize and analyze the information from the article in your own words
2. Describe the research question for this study in a paragraph.

1. Describe the research in greater detail.
2. Include your observations about this question.
3. Discuss events or trends that could have affected this question.
4. You will need to summarize and analyze the information from the article in your own words

1. Describe the research design of this study, and in your own words discuss the design.
   1. Discuss the research design of the study.
   2. Discuss the strengths and weaknesses of the type of design and hypothesize why the author utilized the design as opposed to others.
   3. You will need to summarize the information from the article in your own words
2. Describe the sample.

1. Briefly describe the sample size used for this study
2. Make a judgment as to whether the sample size was adequate and defend your answer.
3. Describe the number or participants and determine if the number of participants was adequate compared to the research question and the intent of the study.
4. Are these numbers adequate? Discuss gaps in that you identified.
5. You will need to summarize and analyze the information from the article in your own words
6. Describe the data collection method(s)’

1. Who collected the data?
2. What tools were used?
3. What were the ethical considerations addressed and discuss gaps you identified.
4. You will need to summarize and analyze the information from the article in your own words
5. Describe the limitations of the study.

1. Identify the limitations within the study
2. Describe how the limitations could be overcome in subsequent studies
3. Comment on why limitations are important to list and discuss within a study
4. You will need to summarize and analyze the information from the article in your own words
5. Describe the findings reported in the study.

1. Describe the findings reported in the study
2. Discuss whether the findings of the study answered the research question posed within the study
3. Discuss the credibility of the findings
4. If the findings do not support the research question posed within the study, what do you believe is the reason?
5. You will need to summarize and analyze the information from the article in your own words

Summary

1. Summarize important points from the body of your paper including the key components of the paper.
2. Include a statement about the research question and the findings.
3. Discuss the probability of implementation into practice. Based on these findings, is the evidence that you found on your topic strong enough to suggest a change in practice, or an idea for practice?
4. End with a concluding statement.