A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis; however, as a precaution, the doctor ordered a CT scan. The CT scan revealed a growth on the pancreas, which turned out to be pancreatic cancer—the real cause of the cramping.Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.In this Lab Assignment, you will analyze an Episodic 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.To PrepareReview the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.· With regard to the Episodic note case study provided:o Review this week’s Learning Resources, and consider the insights they provide about the case study.o Consider what history would be necessary to collect from the patient in the case study.o 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?o Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.The Assignment1. Analyze the subjective portion of the note. List additional information that should be included in the documentation.2. Analyze the objective portion of the note. List additional information that should be included in the documentation.3. Is the assessment supported by the subjective and objective information? Why or why not?4. What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?5. 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 three different references from current evidence-based literature.Remember you MUST complete a FULL abdominal exam.Please write this up as a narrative so that you are able to correctly explain your analysis.REQUIRED READINGSBall, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.Chapter 6, “Vital Signs and Pain Assessment”This chapter describes the experience of pain and its causes. The authors also describe the process of pain assessment.Chapter 18, “Abdomen”In this chapter, the authors summarize the anatomy and physiology of the abdomen. The authors also explain how to conduct an assessment of the abdomen.Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.Chapter 3, “Abdominal Pain”This chapter outlines how to collect a focused history on abdominal pain. This is followed by what to look for in a physical examination in order to make an accurate diagnosis.Chapter 10, “Constipation”The focus of this chapter is on identifying the causes of constipation through taking a focused history, conducting physical examinations, and performing laboratory tests.Chapter 12, “Diarrhea”In this chapter, the authors focus on diagnosing the cause of diarrhea. The chapter includes questions to ask patients about the condition, things to look for in a physical exam, and suggested laboratory or diagnostic studies to perform.Chapter 29, “Rectal Pain, Itching, and Bleeding”This chapter focuses on how to diagnose rectal bleeding and pain. It includes a table containing possible diagnoses, the accompanying physical signs, and suggested diagnostic studies.Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.These sections below explain the procedural knowledge needed to perform gastrointestinal procedures.Chapter 107, “X-Ray Interpretation: Chest (pp. 480–487)Chapter 115, “X-Ray Interpretation of Abdomen” (pp. 514–520)Note: Download this Student Checklist and Abdomen Key Points to use during your practice abdominal examination.Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Abdomen: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W.

Religion and Ethics

My exploration of this topic will examine sub-questions such as, What factors of the online learning environment have contributed to the degradation of young students’ mental health during the COVID-19 pandemic? What age group of students were affected the most by the online learning environment? And what steps can be taken to remedy the negative mental health consequences and unfinished learning students experienced during the COVID-19 pandemic?

For this Discussion, review the case Learning Resources and the case study excerpt presented. Reflect on the case study excerpt and consider the therapy approaches you might take to assess, diagnose, and treat the patient’s health needs.Case: An elderly widow who just lost her spouse.Subjective: A patient presents to your primary care office today with chief complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD. Her husband of 41 years passed away 10 months ago. Since then, she states her depression has gotten worse as well as her sleep habits. The patient has no previous history of depression prior to her husband’s death. She is awake, alert, and oriented x3. Patient normally sees PCP once or twice a year. Patient denies any suicidal ideations. Patient arrived at the office today by private vehicle. Patient currently takes the following medications:• Metformin 500mg BID• Januvia 100mg daily• Losartan 100mg daily• HCTZ 25mg daily• Sertraline 100mg dailyCurrent weight: 88 kgCurrent height: 64 inchesTemp: 98.6 degrees FBP: 132/86By Day 3 of Week 7Post a response to each of the following:• List three questions you might ask the patient if she were in your office. Provide a rationale for why you might ask these questions.• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.• Explain what, if any, physical exams, and diagnostic tests would be appropriate for the patient and how the results would be used.• List a differential diagnosis for the patient. Identify the one that you think is most likely and explain why.• List two pharmacologic agents and their dosing that would be appropriate for the patient’s antidepressant therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.• For the drug therapy you select, identify any contraindications to use or alterations in dosing that may need to be considered based on the client’s ethnicity. Discuss why the contraindication/alteration you identify exists. That is, what would be problematic with the use of this drug in individuals of other ethnicities?• Include any “check points” (i.e., follow-up data at Week 4, 8, 12, etc.), and indicate any therapeutic changes that you might make based on possible outcomes that may happen given your treatment options chosen.Respond to the this discussion. All questions need to be addressed.Discussion 1 EnThree questions to ask the patient and a rationale for asking these questions.How may I be of assistance today? This question creates a rapport between you and the patients, and it makes her know that the doctor is ready to listen and help her.What are you doing to cope with grief after losing your husband? This question will help the care provider assess the approaches the patient is using to cope with grief and be able to identify the ones working and not working for the patient.Are you living with someone at home, and are you following your regimen correctly? By asking this question, the care provider will understand the type of support system available at home and know which support to prescribe for the patient and if the support at home is helping the patient follow her regimen correctly.People in the patient’s life to speak to or get feedback from to further assess the patientPeople in the patient’s life to speak to include her children, her aide, and close friend per her authorization. The feedback I will get from these people will help me know the severity of the patient’s problem. Some of the questions I will ask them are;1. Has the patient been experiencing worse symptoms of depression since her husband’s dead? This question will help me understand people close to her can know when she is depressed.2. Does the patient complain about her treatment regimen? This question will allow me to know the side effects of the treatment if any.3. Has the sleeping patterns changes recently? This question will help me understand the severity of insomnia.Physical and diagnostic testsThe physical exams appropriate for this patient include heart rhythm, eye assessment, and oxyhemoglobin saturation. The diagnostic tests for this patient include polysomnography and actigraphy tests. These tests will be used to measure the patient’s sleep patterns. The actigraphy measures sleep efficiency, sleep latency, and total sleep time, and polysomnography will diagnose sleep disorders (Niel et al., 2020)Differential diagnoses for the patientThe patient’s differential diagnoses include generalized anxiety disorder, major depressive disorder, and restless leg syndrome. Major depressive disorder (MDD) is likely to explain why the patient is experiencing insomnia. MDD’s clinical presentation include insomnia, difficulty concentrating, appetite loss, and hopelessness. The patient’s husband’s loss contributed to depression, which affected her sleeping pattern. According to Bennabi et al. (2019), patients with MDD are at risk of experiencing sleeping disorders.  Since the patient is responding to grief, her chances of developing MDD are high.Pharmacologic agents and their dosingSelegiline Transdermal patch. Apply 6mg daily dose, which is applied every day. If symptoms do not improve, the dose can be increased by 3mg daily for two weeks until it reaches a maximum of 12gm daily. The drug inhibits Monoamine Oxidase-B isoenzyme (Bied et al., 2015).Eszopiclone. The required dose is 3mg, which is administered orally before the patient goes to bed. It is the first-line drug for insomnia, and it interacts with gamma-aminobutyric acid (GABA) receptors at the allosterically binding sites at the benzodiazepine receptors. The drug works by slowing brain activities to allow sleep. The drug induces sedation and hypnosis hence causing sleep (Dixon et al., 2015). Since the patient is complaining of insomnia, eszopiclone will be appropriate in improving this symptom.Drug therapy contraindicationsContraindications of using selegiline transdermal include increased risks of serotonin syndrome. The drug contraindicates in the patients taking selective serotonin reuptake inhibitors, mirtazapine, and other vasoconstrictors and analgesics.Check pointsAfter administering these drugs, the patient will be assessed after a four-week interval to determine if the symptoms have improved. If the symptoms have not improved after four weeks, selegiline transdermal will be increased by 3mg for four weeks until 12gm, which is the maximum dose per day. If the symptoms improve within the first four weeks, the regimen will be maintained until the patient completes the dose. After completing the dose, the patient will sleep well and the symptoms of depression will be well managed.ReferencesBennabi, D., Charpeaud, T., Yrondi, A., Genty, J. B., Destouches, S., Lancrenon, S., … & Haffen, E. (2019). Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental. BMC psychiatry, 19(1), 1-12.   https://doi.org/10.1186/s12888-019-2237-xBied, A. M., Kim, J., & Schwartz, T. L. (2015). A critical appraisal of the selegiline transdermal system for major depressive disorder. Expert review of clinical pharmacology, 8(6), 673-681. https://doi.org/10.1586/17512433.2016.1093416Dixon, C. L., Harrison, N. L., Lynch, J. W., & Keramidas, A. (2015). Zolpidem and eszopiclone prime α1β2γ2 GABAA receptors for longer duration of activity. British journal of pharmacology, 172(14), 3522-3536. https://doi.org/10.1111/bph.13142Niel, K., LaRosa, K. N., Klages, K. L., Merchant, T. E., Wise, M. S., Witcraft, S. M., Hancock, D., Caples, M., Mandrell, B. N., & Crabtree, V. M. (2020). Actigraphy versus polysomnography to measure sleep in youth treated for craniopharyngioma. Behavioral sleep medicine, 18(5), 589-597. https://doi.org/10.1080/15402002.2019.1635133

Topic 3 DQ 1When a teen starts menstruating she it is possible for her to get pregnant. But with teen pregnancy comes risks. There are so many things that can go wrong with a woman in her twenties who are pregnant but those numbers go even higher in a teen. Some of the concerns are preterm birth, low birth weight, high blood pressure that leads to preeclampsia, and infant mortality. Teens are not mature to understand how important the health of the baby is. They tend to take the pregnancy for granted and not change one thing about their nutrition or physical activity. In Okeechobee County, the teen pregnancy rate is 11.97% and the rate in Florida is 10.3%. These rates are high however they have decreased over the last ten years. The decrease is most likely due to all the programs that Florida has to offer. Unfortunately, teen pregnancy cost the residents of Florida money and adds a burden on our healthcare. This could be the reason that there has been changing and we see a decrease.Healthy Start is a grant- based program through the state that helps women and infants with a variety of services. They have classes such as childbirth, car seat, parenting, and breastfeeding. Education is the main role that this program takes on. Every participates is case managed to make sure they have all the information or resources to help with their needs. All services are free to any Florida resident who is pregnant or an infant up to three years oldThe Pregnancy Center of Okeechobee is a local organization in my community of Okeechobee. They have services very similar to Health Start but also have a full- time RN on site with an ultrasound tech and equipment. They are grant- based but also rely on donations from the residents. The center has a thrift shop for the residents to shop from. All the items in the shop are donated so there can be anything from clothes to furniture and everything in between. The center really has great support from our little community. With all these services available and the education that is provided it is no wonder, the numbers have gone down.Using 250-300 APA format with references to support the discussion.Adolescent pregnancy is viewed as a high-risk situation because it poses serious health risks for the mother and the baby. Describe various risk factors or precursors to adolescent pregnancy. Research community and state resources devoted in adolescent pregnancy and describe at least two of these resources. Research the teen pregnancy rates for the last 10 years for your state and community. Has this rate increased or decreased? Discuss possible reasons for an increase or decrease.