Confidentiality healthcare worksheet

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Confidentiality healthcare worksheet

In health care, confidentiality is vital. In this assignment, you will learn about the importance of confidentiality and

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various laws that were enacted to protect confidentiality in health care. You will also look at the legal and ethical implications of using technology while considering confidentiality requirements in the health care industry.

Law Requirements

Complete the following chart.

Define the law (45 to 90 words).

Identify stakeholders involved in law (45 words).

Differentiate the confidentiality requirements of the law (45 to 90 words).

Identify the name of a law that was enacted to protect confidentiality in the health care industry.

Describe the impact the law has on the health care industry (45 to 90 words).

Statutory law

Regulatory law

Common law

Select one law you identified above that was enacted to protect confidentiality in the health care industry and use it answer the following prompt in 350 to 525 words.

• Analyze the legal and ethical implications of using technology in the health care industry.

o Consider the increased use of technology in health care settings and the law you selected that was enacted to protect confidentiality.

Cite 2 peer-reviewed, scholarly, or similar references to support your paper.

Format your references according to APA guidelines.

References

Infections Assignment Paper

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Infections Assignment Paper

  1. What are the potential consequences of being a healthcare worker who is unresponsive to the hepatitis B vaccine?
  2. For an HIV vaccine to be effective, it almost certainly will have to be a live attenuated virus. What is a major concern related to the use of this type of vaccine for HIV?
  3. If an individual is immunocompromised, what might be the risk of giving a live attenuated virus vaccine (e.g., rubella)?

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  1. New and more effective antimicrobials are developed every year. Many of these are effective in treating common ailments such as bronchitis and sinusitis, as well as more serious systemic infections. What are some potential consequences of the development of new antimicrobials?
  2. Why do you think that the United States and other nations have not yet distributed a vaccine to prevent the spread of avian flu? Are there any other factors you can think of that have contributed to this rise? Infections

Mucor Assignment Paper

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Mucor Assignment Paper

Explain what Mucor is and how a patient is likely to become infected with Mucor. Describe the pathophysiologic progression of the infection into pneumonia and at least two medical/nursing interventions that would be helpful in treating the patient

 

Mucor is “a fungi of the order Mucorales and class Zygomycetes” (Maheen et al, 2014). It causes a disease called mucormycosis, a mold infection which could be life threatening and has to be treated emergently. “Mucormycosis is not common but can be frequent in immunocompromised patients (neutropenic, diabetic ketoacidosis) (NIH, 2016). Mucor is a fungus living in the soil. Humans can get infected through soil or inhaling it in the air. When a person inhales Mucor spores she or he can become infected with it. If a patient has weak immune system this fungus starts to grow in the lungs causing pneumonia. Symptoms might include cough, shortness of breath and fever. Early detection is crucial as this fungus can disseminate quickly (Maheen, 2014). Mucor Assignment Paper

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Two interventions:

  1. Amphotericin B is he most often drug of choice to treat this fungus infection
  2. Monitor patient’s respiratory status (respiratory treatments as needed, oxygen as needed, monitor vital signs for hypoxia and deterioration).
  3.  .      Examine the laboratory blood test results and arterial blood gases provided in “Discussion Question Resource: Laboratory Blood Test Results.” What laboratory values are considered abnormal? Explain each abnormality and discuss the probable causes from a pathophysiologic perspective.
  4.  

Laboratory Blood Test Results and Arterial Blood Gases

Na          141 meq/L WNL Mg                     1.7 mg/dL   WNL pH          7.50            H
K            4.5 meq/L  WNL PO4                   2.9 mg/dL    L PaO2      59 mm Hg on room air  L
Cl           105 meq/L WNL Glu, fasting       138 mg/dL     H PaCO2   25 mm Hg                         L
HCO3    29 meq/L    H Hb                     13.7 g/dL    WNL
BUN      16 mg/dL   WNL Hct                    39.4%          WNL
Cr           0.9 mg/dL WNL WBC                 15,200/mm³    H
Ca          8.7 mg/dL   L Lymphocytes    10%                 L

 

 

This patient’s laboratory values point to the infection. WBC’s are elevated meaning the body is trying to fight the infection. Lymphocytes are low which might be sign of compromised immune system. Fasting glucose is high which means patient’s body is not in the homeostatic state, most probably is high due to infection.

ABG’s are not WNL. They indicate patient’s respiratory system is compromised and are confirming pneumonia which is seen on the X-ray as well.

Breathing is compromised which reflects PaO2 (low oxygen saturation) and PaCO2 being low .

Patient’s respiratory rate is most probably elevated and breathing is not deep enough well. Oxygen exchange is not sufficient because of the infection therefore level of O2 and CO2 is not WNL. PH is high (alkaline) which leads to elevated bicarbonate levels as well. Mucor Assignment Paper

 

3.      What medications and medical treatments are likely to be prescribed by the attending physician on this case? List at least three medications and three treatments. Provide rationale for each of the medications and treatments you suggest.

 

  1. Recommended medications:

–      Amphotericin B, posaconazole, isavuconazole. These medications are antifungals. (Centers for  Disease Control [CDC], 2015).

–      Steroids to decrease inflammation and improve breathing

–      Cough medication, antipyretics and analgesics.

 

2.Treatments:

–      possibly bronchoscopy or surgery . Mucor can cause tissue necrosis (CDC, 2015)

–      breathing treatment and oxygen to increase gas exchange

–      monitor ABG’s and vital signs closely to prevent deconditioning

 

References:

 

Centers for Disease Control and Prevention (CDC). (2015). Mucormycosis. Retrieved from https://www.cdc.gov/fungal/diseases/mucormycosis/treatment.htm

 

Maheen Z. Abidi, Nayantara Coelho-Prabhu, James Hargreaves, Tim Weiland, Irminne Van Dyken, Aaron Tande, Pritish K. Tosh, Randall C. Walker, and Nathan W. Cummins, “Mucormycosis in Patients with Inflammatory Bowel Disease: Case Series and Review of the Literature,” Case Reports in Medicine, vol. 2014, pp. 1–7, 2014. Mucor.

 

National Institute of Health. (2011). Mucormycosis Caused by unusual Mucormycotes, Non-Rhizopus, -Mucor, and Lichtheimia Species. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21482731/

 

Ziaee, A., Zia, M., Bayat, M., & Hashemi, J. (2016). Molecular Identification of Mucor and Lichtheimia Species in Pure Cultures of Zygomycetes. Jundishapur Journal of Microbiology, 9(4), e35237. http://doi.org/10.5812/jjm.35237. Mucor Assignment Paper

Family Health – Week 6 Discussion 1st REPLY

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Family Health – Week 6 Discussion 1st REPLY

Please reply to the following discussion with one or more references. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates. 

Responses must consist of at least 350 words (not including the greeting and the references), do NOT repeat the same thing your classmate is saying, try to add something of value like a resource, educational information to give to patients, possible bad outcomes associated with the medicines discussed in the case, try to include a sample case you’ve seen at work and discuss how you feel about how that case was handled. Try to use supportive information such as current Tx guidelines, current research related to the treatment, and anything that will enhance learning in the online classroom. Family Health – Week 6 Discussion 1st REPLY

References must come from peer-reviewed/professional sources (No WebMD/Mayo Clinic or Wikipedia please!).

Jessica Alper

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Cause of acute delirium in elderly patients with dementia

Many older people, with and without dementia can be all of a sudden be affected by delirium, which is defined as acute sudden confusion. When an elderly patient becomes confused very suddenly, it is important to look at all possible underlying causes. Mayne et al. (2019) state that “non-specific symptoms, such as confusion, are often suspected to be caused by urinary tract infection (UTI) and continues to be the most common reason for suspecting a UTI”. Delirium in the elderly is usually associated with lengthened hospital stays, complexed care, institutionalization, along with high mortality rates, difficulties for the caregivers and increased healthcare costs. Signs and symptoms associated with UTIs in the elderly include confusion or delirium, increased lethargy, blunted fever response, new-onset incontinence, as well as anorexia (Rodriguez-Manas, 2020). There are various risk factors associated with UTIs in a male patient. Some of these include prostatic hypertrophy, diabetes, or both, which can lead to high post-void residuals.

Testing

A confused patient who has recently become delirious should be investigated for the source of the delirium. Krinitski et al. (2021) state that “the diagnosis of UTI requires not only confirmed bacteriuria but also the presence of genitourinary symptoms, which often cannot be reliably confirmed in the many delirious individuals who are unable to adequately express themselves”. However in this case study, it is know that the patient is experiencing urinary incontinence, which further justifies the diagnosis of UTI.

A urinary analysis and culture are both highly suggested for this patient. When bacteria from the UTI has been detected in the elderly, providers usually “consider behavioral or mental changes, including delirium, as non-urinary manifestations of UTI, especially in patients with cognitive impairment, from whom local urinary tract symptoms are often difficult to obtain” (Krinitsky et al., 2021). Depending on the bacteria that is growing, different types of antibiotics may be used.  Family Health – Week 6 Discussion 1st REPLY

Treatment option

Males experience disturbed normal voiding mainly due to their benign prostatic hyperplasia (BPH). Due to their enlarged prostate, “generation of a retrograde turbulent urine flow, enabling the ascension of uropathogens to the bladder and eventually into the prostate, which explains the high frequency of prostatic involvement in males with UTI” (Smithson et al., 2019). As such, fluoroquinolones such as cipro can be used in order to treat the UTI with adequate prostatic diffusion.

It is also important to note that normal voiding in the elderly patients is the first line of defense against UTIs. In a patient with dementia however, it may be difficult to trust that they will void regularly and that they take their medications properly and at the right time. Nothing that the patient’s MMSE score dropped from 18 to 12, this patient has progressed from moderate to severe dementia. Because of this change of cognition, it would be more beneficial and appropriate for this patient to be admitted to the hospital for IV antibiotics. A referral to the emergency department is therefore warranted.

References

Krinitski, D., Kasina, R., Klöppel, S., & Lenouvel, E. (2021). Associations of delirium with urinary tract infections and asymptomatic bacteriuria in adults aged 65 and older: A systematic review and meta-analysis. Journal of the American Geriatrics Society, 69(11), 3312–3323. https://doi.org/10.1111/jgs.17418

Mayne, S., Bowden, A., Sundvall, P., & Gunnarsson, R. (2019). The scientific evidence for a potential link between confusion and urinary tract infection in the elderly is still confusing – a systematic literature review. BMC Geriatry, 19(32). https://doi.org/10.1186/s12877-019-1049-7

Rodriguez-Mañas L. (2020). Urinary tract infections in the elderly: a review of disease characteristics and current treatment options. Drugs in context, 9, 2020-4-13. https://doi.org/10.7573/dic.2020-4-13

Smithson, A., Ramos, J., Nino, E., Culla, A., Pertierra, U., Friscia, M., & Batisda, M. T. (2019). Characteristics of febrile urinary tract infections in older male adults. BMC Geriatrics, 19(334). https://doi.org/10.7573/dic.2020-4-13. Family Health – Week 6 Discussion 1st REPLY

 

Family Health – Week 6 Discussion 2nd REPLY

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Family Health – Week 6 Discussion 2nd REPLY

Please reply to the following discussion with one or more references. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.  Family Health – Week 6 Discussion 2nd REPLY

Responses must consist of at least 350 words (not including the greeting and the references), do NOT repeat the same thing your classmate is saying, try to add something of value like a resource, educational information to give to patients, possible bad outcomes associated with the medicines discussed in the case, try to include a sample case you’ve seen at work and discuss how you feel about how that case was handled. Try to use supportive information such as current Tx guidelines, current research related to the treatment, and anything that will enhance learning in the online classroom.

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References must come from peer-reviewed/professional sources (No WebMD/Mayo Clinic or Wikipedia please!).

Ana Claudia

Diagnosis

One of the earliest symptoms of dementia (ICD-10 code F03. 90) is delirium (ICD-10 code F05), which could be the primary warning that an individual is getting sick. Cases of both dementia and acute delirium in the elderly are presented. Especially when it comes to alleged dementia as well as severe delirium, the healthcare practitioner’s focus will be on determining the highly likely diagnosis (Lai et al., 2021). In accordance with the case study’s findings, a number of factors, including substance withdrawal, stress, inflammation, and direct intoxication may all have a role in the development of acute delirium. If an individual is going through detox from addiction, their neurotransmitter system will go through a time of disruption inside the excitatory and inhibitory pathways. Family Health – Week 6 Discussion 2nd REPLY

Anticholinergic medications, dopaminergic drugs, and electrolyte imbalances are some more examples of conditions that can affect neurotransmitter production or release. It might affect the process in a roundabout way. These include, but are not limited to, hypercalcemia, hypoxia, hypoglycemia, and ischemia. All of those are obviously only a small sample of the many examples of inequality. Furthermore, cytokines are a group of molecules that are produced as a result of inflammation (Tieges et al., 2020). As a result, these cytokines commonly interfere with the proper action of neurotransmitters. Comparatively, the stress response is linked to the secretion of neurotoxic glucocorticoids as well as noradrenaline. The information covered so far suggests that while attempting to diagnose acute delirium, it is important to take into account any coexisting clinical disorders. In particular, renal failure or injury; cerebrovascular illness; insomnia; malignancy; heart arrhythmias; seizures; delirium from medicines; and pulmonary pathology are all conditions that can cause hypovolemia.

Additional Testing to Be Considered

Particularly for elderly individuals, there are a variety of options available when treating acute delirium plus dementia situations addressed by healthcare professionals. According to Mattison (2020), depending on the circumstances, it is necessary to first explain how to diagnose delirium signs by analyzing the patient’s medical history and doing a comprehensive physical examination. We can then proceed to determine what caused the delirium after that is complete. Supplemental diagnostic tests may be required to determine the highly likely origin of the medical issue. Particular tests that could be performed on the patient include electrolyte levels, complete blood count, creatine, C-reactive protein, liver function tests, thyroid-stimulating hormone, calcium, kidney tests, blood glucose levels, and urinalysis. The potential of acute delirium can be ruled out by performing the aforementioned medical tests and diagnostics. Additional diagnostic techniques, including a computer tomography scan of the head, an electroencephalogram, and a chest x-ray, may be performed in conjunction with testing cerebrospinal fluid. Acute delirium can be caused by a number of medical issues, including but not limited to electrolyte imbalances, seizures, cardiac irregularities, renal failure, respiratory disorders, and strokes. Thus, further evaluations might be useful in excluding them.

Treatment

Whereas doctors are expected to treat a wide variety of illnesses, it is ultimately the patient’s obligation to shape the course of treatment. However, there are a variety of considerations that go into deciding how to manage medical disorders. According to Pavone et al. (2018), any and all treatment decisions made for the patient in the pilot case will be consistent with the most recent etiology for the patient and any adjustments to that etiology. Antibiotics may be utilized to cure infections, replacement treatment could reverse hypovolemic shock, anticonvulsant drugs could reduce the severity of seizures, and hypoxia could be remedied, among many other things. It is also worth noting that antipsychotics are routinely used for recurrent hyperactive delirium, despite there being little evidence to back up this practice. Case study data suggest that clomethiazole is the best treatment for alcohol withdrawal. In other words, clomethiazole is usually the medication of choice for treating alcohol withdrawal symptoms. Family Health – Week 6 Discussion 2nd REPLY

Paradoxical reactions and oversedation are possible side effects of benzodiazepines. However, they remain an integral component of the treatment regimen for people suffering from severe psychomotor agitation, and who also require antipsychotics. Additionally, haloperidol is the antipsychotic of choice because it is supported by the largest body of evidence compared to other drugs in its class (Mulkey et al., 2019). One mg of haloperidol every 3 hours is recommended, with a maximum daily dose of 25 milligrams. Surprisingly, it is possible to treat acute delirium without the use of pharmaceuticals by providing the client with a stable and familiar environment. Encompassing the patient’s loved ones in his or her care is also recommended, as are strategies such as increasing stimulation throughout the day and decreasing it at night, encouraging the patient to get up and walk around, soothing the patient with aromatherapy and music, and enabling the client to start receiving physical contact from loved ones. The ones who make the sufferer feel the most at ease are on this list.

References

Lai, P. H. L., Halvorsen, C., & Matz, C. (2021). The relationship between occupation types, education, and volunteer behaviors among older Americans. Innovation in Aging, 5(Supplement_1), 690–690. https://doi.org/10.1093/geroni/igab046.2592

Mattison, M. L. P. (2020). Delirium. Annals of Internal Medicine, 173(7), ITC49–ITC64. https://doi.org/10.7326/aitc202010060

Mulkey, M. A., Everhart, D. E., Kim, S., Olson, D. M., & Hardin, S. R. (2019). Detecting delirium using a physiologic monitor. Dimensions of Critical Care Nursing, 38(5), 241–247. https://doi.org/10.1097/dcc.0000000000000372

Pavone, K. J., Cacchione, P. Z., Polomano, R. C., Winner, L., & Compton, P. (2018). Evaluating the use of dexmedetomidine for the reduction of delirium: An integrative review. Heart & Lung, 47(6), 591–601. https://doi.org/10.1016/j.hrtlng.2018.08.007

Tieges, Z., Stott, D. J., Shaw, R., Tang, E., Rutter, L.-M., Nouzova, E., Duncan, N., Clarke, C., Weir, C. J., Assi, V., Ensor, H., Barnett, J. H., Evans, J., Green, S., Hendry, K., Thomson, M., McKeever, J., Middleton, D. G., Parks, S., & Walsh, T. (2020). A smartphone-based test for the assessment of attention deficits in delirium: A case-control diagnostic test accuracy study in older hospitalised patients. PLOS ONE, 15(1), Family Health – Week 6 Discussion 2nd REPLY e0227471. https://doi.org/10.1371/journal.pone.0227471

 

 

Family Health – Week 6 Discussion

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Family Health – Week 6 Discussion

For this assignment, you will review the latest evidence-based guidelines, cite your sources in your work and provide references for the citations in APA format.

References must come from peer-reviewed/professional sources (No WebMD/Mayo Clinic or wikipedia please!).

See doc attached with the instructions

This week’s content discussed common psychiatric disorders in the Adult and Older Adult client.  Often a secondary diagnosis is masked due to their psychiatric disorder.  Review the following case study and answer the following questions.

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Mr. White is a 72-year-old man, with a history of hypertension, COPD and moderate dementia, who presents with 4 days of increased confusion, nighttime restlessness, visual hallucinations, and urinary incontinence. His physical exam is unremarkable except for tachypnea, a mildly enlarged prostate, inattentiveness, and a worsening of his MMSE score from a baseline of 18 to 12 today.

Mr. White’s presentation is most consistent with an acute delirium (acute change in cognition, perceptual derangement, waxing and waning consciousness, and inattention).

  1. What is the most likely diagnosis to frequently cause acute delirium in patients with dementia?
  2. What additional testing should you consider if any?
  3. What are treatment options to consider with this patient? Family Health – Week 6 Discussion

 

Family Health – Week 6 SOAP NOTE

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Family Health – Week 6 SOAP NOTE

Submit a full SOAP note using provided bellow template. Primary or presumptive Dx should be on GI or endocrinology- thyroid, diabetes, adrenal condition. Use attached SOAP Note template which is in the WORD format. Review the video on how to write a SOAP Note and use the perfect soap note document to guide you.

Remember to always document the education about when to seek ER care.

In the evaluation of the encounter also include your level of interaction with the patient.

Remember to also include the reason why the patient is taking each one of the listed medicines.

Try including the ages of the listed family members. Family Health – Week 6 SOAP NOTE

Remember to include rationales with each one of the differentials.

You must include 3 differential diagnosis plus the actual diagnosis.

SOAP NOTE

Name: Date: Time:
  Age: Sex:
SUBJECTIVE
CC: 

Reason given by the patient for seeking medical care “in quotes”

 
HPI:  Use OLDCART acronym

Describe the course of the patient’s illness, including when it began, character of symptoms, location where the symptoms began, aggravating or alleviating factors; pertinent positives and negatives, other related diseases, past illnesses, surgeries or past diagnostic testing related to present illness.

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Medications: (list with reason for med ) write medicine the same way you write a Rx

 
PMH (list approximate year of Dx of the disease or when surgical procedure performed)

Allergies:

 

Medication Intolerances:

 

Chronic Illnesses/Major traumas

 

Hospitalizations/Surgeries

 

 
Family History (list immediate family, age, disease, and whether is dead or alive)

Does your mother, father or siblings have any medical or psychiatric illnesses?  Anyone diagnosed with: lung disease, heart disease, htn, cancer, TB, DM, or kidney disease.

 
Social History

Education level, occupational history, current living situation/partner/marital status, substance use/abuse, ETOH, tobacco, marijuana.  Safety status

 
ROS (Start each sentence with words such as “Denies, admits, complains, reports”, do not use the words “No, positive for, negative for”. Do NOT list physical exam findings here. If the body system not assess write “Non-Contributory” Family Health – Week 6 SOAP NOTE
General

 

 Cardiovascular

 
Skin

 

 Respiratory

 
Eyes

 

 Gastrointestinal

 
Ears

 

 Genitourinary/Gynecological

 
Nose/Mouth/Throat

 

 Musculoskeletal
Breast Neurological
Heme/Lymph/Endo Psychiatric
OBJECTIVE- this is where you document physical exam findings, do NOT use the word NORMAL to document a finding, and instead explain what normal is. For example, the gait is not normal, the gait is steady. If the body part not assessed then type “Deferred”.
Weight        BMI Temp BP
Height Pulse Resp
General Appearance
Skin
HEENT
Cardiovascular
Respiratory
Gastrointestinal
Breast
Genitourinary

 
Musculoskeletal
Neurological
Psychiatric
Lab Tests (lists any tests ordered and status of the test, if a rapid test was done at the office, list the results)

 
Special Tests (List any imaging study or special test ordered and status of the test, if the result is available, write the result)

 
 Diagnosis
 Differential Diagnoses with ICD 10 codes (these are Dx you considered, but then ruled out)

    • 1-
    • 2-
    • 3-

Diagnosis with ICD 10 Code

o

CPT Code/Office visit code:

 
Plan/Therapeutics
    • Plan:
      • Further testing
      • Medication
      • Education
      • Non-medication treatments
      • Follow Up
      • Referral
      • When to seek emergency care

 
 Evaluation of  patient encounter

Document your level of interaction with the patient.

Weaknesses:

Strengths:

Reflection:

References:

SOAP NOTE

Name:  DB Date: 1/13/2017 Time: 10:33AM
  Age: 33 Sex: Female
SUBJECTIVE
CC: 

“My back hurts”.
HPI:  (Use OLDCART)

She reports feeling pain in her lower back that started yesterday while at work. Last night she went to sleep as usual, when she woke up this morning she was in a lot of pain and was very stiff. The pain is described as a 7/10 on the pain scale, feels like burning. Pt states pain is worse in the R lumbo-sacral area. Pain radiated to her R buttock. It hurts her to stand up or to find a comfortable position. Pain worsens after bending or lifting. Her back hurts even at rest, but gets worse with movement. Taking Tylenol 500mg 2 caplets with no relief of the pain. Denies hx of UTI symptoms; Denies vaginal discharge or dyspareunia; denies change in bladder or bowel habits; denies weight loss or fever. Denies hx of previous back pain, injury or trauma. States she works as a cashier at the grocery store where she stands most of the day. Yesterday was her second day of working over time at work and she thinks since she works standing up, this might have cause for her to feel pain in her lower back. Denies muscle weakness, paresthesia, loss of sensations, and no severe or progressive neurological deficit in lower extremity. Family Health – Week 6 SOAP NOTE
Medications: (list with reason for med )

Tylenol Extra Strength 500 mg Caplets, 2 tabs q4-6 hr for back pain with no relief

Metformin 500mg 1 PO QD for Type 2DM

Lisinopril 10mg 1 po QD for HTN
PMH

Allergies:   NKDA, denies food allergies

Medication Intolerances: Denies

Chronic Illnesses/Major traumas: HTN (2016), Type 2 NIDDM (2017)

Hospitalizations/Surgeries: Appendectomy (2001)
Family History

States her parents (mother 59, father 63), siblings (sister 34, brother 27) and daughter- 4y/o are healthy and both sets of grandparents are alive and live in Colombia (doesn’t know age or if they have any medical problems).
Social History

General: Born and raised in Cali, Colombia, moved to the US with her parents when she was 17 years old.

Marital status: Single Mom of a 4-yr/old girl. Ex-husband not involved financially or physically in care of child.

Living situation: Parents live 100 miles away. One brother in town; sees brother seldom. Mrs. B has a few close friends. Pt sates she is in debt “way over head”. No health insurance benefits. Considers herself a strong and independent woman.

Children: One 4-yr/old daughter who is healthy

Occupation: Works at a local grocery store as a cashier. She stands most of the day in her job. Sees job only as a means of providing income for her and her daughter.

Leisure Patterns: Pt states she doesn’t have time to “relax”.

Social habits: Denies smoking or alcohol consumption. Does not exercise.

Spirituality: No church involvement but states that she believes in God.

Nutrition: Pt states her appetite has increased owing to “stress”, craves chocolate, eats what she wants, no special diet. Has not experienced any changes on her weight.

Sleep Patterns: States that she usually gets about 7 hrs of sleep every night.
ROS
General

States there have not been any changes in the past 5 years. He has been wearing the same size of clothes for the past 5 years. Denies weakness, fatigue, or fever.

Head: Denies headache, head injury, dizziness, or lightheadedness.

 Cardiovascular

States she was just recently diagnosed with HTN, takes Lisinopril every night, states she checks her BP at least once a week when she goes to the grocery store and it is always below 130/80. Denies any troubles with her heart, rheumatic fever, or heart murmurs. Denies having chest pain or discomfort, palpitations, dyspnea, orthopnea, paroxysmal nocturnal dyspnea, or edema. Has never had EKG done.
Skin

Reports dryness of the skin, especially on his hands, legs and feet. Denies rashes, lumps, sores, itching, and changes in color. Denies changes in his nails or hair. Denies changes in size or color of moles.

 Respiratory

Denies cough, sputum, hemoptysis, dyspnea, wheezing, or pleurisy. Has not had a Chest X Ray done. Denies having asthma, bronchitis, emphysema, pneumonia, or tuberculosis.
Eyes

Denies any changes in her vision. Does not use glasses. Last eye exam 2 years ago (Oct/15). Denies any pain, redness, excessive tearing, double or blurred vision, spots, specks, flashing lights, glaucoma or cataracts.

 Gastrointestinal

Denies trouble swallowing, heartburn, changes in appetite, or nausea. States she has bowel movements every other day normally, the stools are small, brown and formed. Denies pain or bleeding with defecation. No changes in bowel habits. Denies black or tarry stools, hemorrhoids, constipation, or diarrhea. Denies abdominal pain, food intolerance or excessive belching or passing gas. Denies jaundice, live, or gallbladder trouble. Denies Hepatitis. Does not remember if she has received Hep B vaccine.
Ears

States she doesn’t have any hearing problems. Denies tinnitus, vertigo, earaches, infection, or discharge. Denies use of hearing aides.

 Genitourinary/Gynecological

Goes to the bathroom 4 or 5 times a day. Denies polyuria, nocturia, urgency, burning or pain during urination. Denies hematuria, urinary infections, kidney or flank pain, kidney stones, urethral colic, suprapubic pain, or incontinence. No changes in bladder habits.

Menarche at age 13. States she gets her period approx. q 28 days and it lasts about 5 days. Flow heavier on the first 2 days. Denies bleeding between periods. LMP: September 4th. Denies PMS. Denies any vaginal discharge, dyspareunia, itching, sores, lumps, or STDs. G1 P1, spontaneous vaginal delivery at 39 weeks. Denies any complications with her pregnancy. Denies use of birth control methods. Not sexually active at the moment. Has had one partner in the past 5 years. Denies exposure to HIV infection or STDs. Family Health – Week 6 SOAP NOTE
Nose/Mouth/Throat

Pt states she gets occasional allergies and colds that cause her to have stuffiness and discharge. Denies hay fever, nose bleeding, or sinus trouble. Throat: States her teeth are yellow and sometimes her gums would bleed. Denies use of dentures. Last dental examination 2 yrs ago (Oct/15). Denies sore tongue, frequent sore throats or hoarseness. Denies having dry mouth or excessive thirst.

Neck: Denies swollen glands, goiter, lumps, pain, or stiffness in the neck.

 Musculoskeletal

Denies muscle weakness, paresthesia, loss of sensations, no severe or progressive neurological deficit in lower extremity. No Hx of cancer, or risk factors for spinal infection (no IV drug abuse, UTI, Immune suppression). Pt reports feeling lower back pain that started yesterday while at work that is worse in the R lumbo-sacral area. Pain radiates to her R buttock. Pt states it hurts to stand up or find a comfortable position. States her back hurts even at rest, but pain gets worse when she moves. Pain worsens after bending or lifting. Denies other muscle or joint pain, stiffness, arthritis or hx of gout. Denies fever, chills, rash, anorexia, weight loss or weakness.
Breast

Denies lumps, pain, discomfort or nipple discharge.

 Neurological

Denies changes in mood, attention or speech. Denies changes in orientation, memory, insight, or judgment. Denies headaches, dizziness, vertigo, fainting, blackouts, seizures, weakness, paralysis, numbness or loss of sensation, tingling or pins and needles, tremors or other involuntary movements.
Heme/Lymph/Endo

Denies anemia, easy bruising or bleeding, and past transfusions. Denies excessive thirst and hunger. Denies thyroid trouble, heat or cold intolerance, excessive sweating, polyuria or changes in shoe size. Denies weight changes or fever.

Periferal Vascular: Pt states she has a few spider veins that look like bruises, she got them during the pregnancy. Denies leg cramps, varicose veins, past clots in veins, swelling in calves, legs or feet. Pt states there have not been any changes in the color of her fingertips or toes during cold temperatures/weather. Denies any swelling or tenderness.

 Psychiatric

Denies nervousness, tension, mood changes, depression, or memory changes.
OBJECTIVE
Weight  120lbs      BMI 20 Temp 98 F BP  114/74
Height 67” Pulse 89 Resp 20
General Appearance

Skin warm and dry w/o discoloration or pallor, A/O x 3, appropriate responses, cooperative, appears concerned w/o signs of acute distress.
Skin

Skin is warm, pink and supple, no lesions noted.
HEENT

Normocephalic, PERRLA, EOMs intact, fundoscopic: red reflex present, no nicking or hemorrhage. TM intact bilaterally, pearly with + light reflex. Nares patent, neck supple. Pharynx: swallows w/o difficulty, no erythema; Neck: thyroid non palpable, no carotid bruits.
Cardiovascular

Carotid upstrokes are brisk, w/o bruits. The PMI is tapping, 7cm lateral to the midsternal line in the 5th intercostal space. S1 louder than S2 on auscultation. No murmurs or extra sounds. Extremities are warm and w/o edema. No varicosities or stasis changes. Calves are supple and nontender. No femoral or abdominal bruits. Brachial, radial, femoral, popliteal, dorsalis pedis, and posterior tibial pulses are 2+ , brisk, and symmetric.
Respiratory

Thorax is symmetric with good expansion. Lungs resonant. Breath sounds vesicular; no rales, wheezes, or ronchi.
Gastrointestinal

Abdomen is flat with active bowel sounds in all four quadrants. It is soft and non-tender; no masses or hepatosplenomegaly. No CVA tenderness.
Breast

Deferred
Genitourinary

Deferred
Musculoskeletal

No joint deformities. Positive ROM in hands, wrists, elbows, shoulders, knees and ankles. Gait/Posture: Flexed forward at 15º, walked slowly with a wide based stance, and grimaced with movement. Heel and toe walking intact. Spinal column: No kyphosis, scoliosis or lordosis; unable to extend or rotate. Lateral movement: bilaterally to 20º. All attempts at ROM produced pain. Right paravertebral muscle spasm noted in lumbar area. Straight leg raise (SLR) negative, Patrick test negative, crossed SLR negative. No noted major motor weakness on knee extension, ankle plantar flexors, evertors, dorsiflexors. No CVA Tenderness.
Neurological

Cranial nerves II to XII intact. Good muscle bulk and tone. Strength 5/5 throughout. Rapid alternating movements and point to point movements are intact. Gait stable. Pinprick, light touch, position sense, vibration, and stereognosis intact, Romberg negative. Reflexes 2 + and symmetric with plantar reflexes down going.
Psychiatric

Alert, relaxed and cooperative. Thought process is coherent. Oriented to person, place and time.
Lab Tests

None ordered today. Family Health – Week 6 SOAP NOTE

 
Special Tests

None ordered today.
 Diagnosis
 Diagnosis:

1. Acute lumbosacral strain (M54.5)

    

Differentials:

  1. Acute lumbosacral pain (M54.5): Minimal discomfort initially followed by increased pain and stiffness 12-36 hrs later, SLR, crossed SLR, heel and toe walking were intact. No muscular weakness or loss of sensation. DTRs were equal and not depressed. Babinski negative. Spasm noted in paravertebral muscles.
  2. Herniated lumbar disc (M51.2): Pain in buttocks.
  3. Sciatica (M54.3): Pain in back/buttocks.
  4. Possible vertebral Fx (S32.009A): Low back pain.

 
Plan/Therapeutics
Plan:

Diagnostic: No tests needed at this time

    Therapeutic: Pharmacological:

D/C OTC Tylenol. Start Ibuprofen 600mg 1 po q8h x 7 days then PRN for pain. Robaxin 500mg 1 po QAM, 2 po QHS x 2 weeks then 1 po Q8H PRN for back pain.

    Non-pharmacological:

Local application of ice may help initially to decrease pain, apply cold pack for 20 minutes q2-3 hours while awake. After 2-3 days, either heat or ice may be applied. No bed rest indicated. Take 3-7 days off work (her job would increase stress on her back), or perform other duties until the symptoms abate.

    Patient Education:

  1. Avoid jerky, hurried movements when lifting
  2. Lift with legs by straddling the load; bend knees to pick up load; keep back straight (do not bend back)
  3. Keep objects close to the body at navel level when lifting
  4. Avoid twisting, bending, reaching while lifting
  5. Avoid prolonged sitting
  6. Change positions often while sitting
  7. A soft support belt for the back, armrests to support some body weight, a slight reclining chair may make sitting more comfortable
  8. Firm mattress/bed board, lying supine with hips and knees flexed on pillows is beneficial when sleeping
  9. May return to work in 4-8 days
  10. As soon as she returns to regular activities (in 2 weeks), aerobic conditioning exercises such as walking, swimming, stationary biking, or even light jogging may be recommended to avoid debilitation.

    Referral: None

    Follow-Up: Come back if the pain does not improve by 50% in 24-48 hrs. Return to the office in 7-10 days. Return sooner if neurological symptoms worsen or bowel/bladder dysfunction occurs.
 Evaluation of  patient encounter:

I was able to assess the patient independently and then later present the case to my preceptor by providing her with the pertinent positive on the ROS and on the physical exam findings. I participated in the Dx selection and in the treatment plan.

Weaknesses: I must by managing my time. It took me almost 45 minutes to work on this case.

Strengths: I have improved my physical exam skills, I feel confident and comfortable interacting with patients on my own.

Reflection: I feel like I am improving with collecting enough information and with performing focused physical exams. I feel like everything is starting to fall in the right place. Family Health – Week 6 SOAP NOTE

 

References:

Bickley, L. (2007). Bates’ Guide to Physical Examination & History Taking (9th Edition), Lippincott, Williams and Wilkins Publishers

National Guideline Clearinghouse. (2008). Management of Acute Low Back Pain. Retrieved November 10, 2008 from http://www.guideline.gov/summary/summary.aspx?doc_id=12491&nbr=006422&string=back+AND+pain

Uphold C, Graham M. Clinical Guidelines in Family Practice. 4th ed. Gainesville, Fl: Barmarrae Books Inc; 2003:370-376.

 

 

Project #2 Guidelines Simplified Primary Care Office/Clinic Budget Assignment

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Project #2 Guidelines Simplified Primary Care Office/Clinic Budget Assignment

Project 2, GUIDELINES ATTACHMENT BELOW

Primary care office/clinic budget, group of up to 5 people. Budget Scenario:You are managing an office that has at least 150 pts visits a day,  one physician is to see on average 4-5 pts per hour, and one NP is too see about 3-4 pts per hour.  Compose a budget proposal that will include personnel and supply cost. Personnel budget includes NPs, CMAs, office manager, secretaries needed in this office, use FTE as the work load distribution. It is recommended that you interview an office manager to get more information.   Please refer to syllabus for more details. If doing a group project, only one group member can submit the assignment with all group member listed in cover page.  Project #2 Guidelines Simplified Primary Care Office/Clinic Budget Assignment

Project #2 Guidelines

Simplified Primary Care Office/Clinic Budget Assignment

This assignment is to be completed using Microsoft table or Excel format. All group members must be present during the class presentation in order to receive credits for the project.

  1. You are building a new primary care office. You will need to identify practice location, rent cost, furnishing, practice equipment, office supplies, medical/surgical/medicine/vaccine supplies, office supplies etc… Please state your practice vision, mission, values, and goals. Please select the location of your practice, your target population and service offered.
  2. How many FTE MDs, NPs, medical assistants (CMA), secretary and other personnel are needed in your office? One FTE employee is to work 2080 hours per year, which include at least 120 hours of paid vacation time, 80 hours of sick/personal time, and 8 holidays (64) hours. Project #2 Guidelines Simplified Primary Care Office/Clinic Budget Assignment

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The following questions will help you figure out how many FTE are needed in an office

  1. How many exam rooms are there in the office? At least 1 per provider, 2 will be optimal.
  2. What is the average daily censes? Expected to be 150-200 for this assignment.
  3. How many pts is an MD and a NP expected to see? Average 4 pts/hour for MD, 3 pts/hour for NP.
  4. How many providers does the office need each day?
  5. Each CMA is to assist 2 providers; how many CMA FTE are needed for the office? Each day?
  6. Each secretary is to assist 3 providers; how many secretaries are needed for the office?
  7. Other personnel? Biller? Housekeeping? You decide.
  8. Please set salaries for MD, NP, medical assistant, and office secretary based on your research. All personnel working more than 21 hours a week need to have 25% fringe benefit. What is the unit’s budget for the personnel?
  9. Supply and expense budget for the office for a year

The following item must be included: Office supplies with detail item list, medical-surgical supplies, stock drugs include vaccines, fluid etc., equipment include computer with item list, equipment repairs, telephone and phone line cost, staff training and education, recruitment.

All items, amount of items and cost chosen need to base on research and actual cost such as salary from salary survey data; vaccine from CDC or manufacture sites etc.    Project #2 Guidelines Simplified Primary Care Office/Clinic Budget Assignment

 

Discuss Barriers to Practice as an APN in Michigan

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Discuss Barriers to Practice as an APN in Michigan

Discuss barriers to practice as an APN in Michigan

from both a state and national perspective.  Research methods to influence policy change from various forms of competition, state legislative and executive branches of government and interest groups.

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Requirements:

Using the readings from this week as well as outside reliable resources to:

  1. Identify and describe practice barriers for all four APNs roles in Michigan and discuss these barriers on a state and national level. The four roles include the nurse midwife, nurse anesthetist, nurse practitioner and clinical nurse specialist. Discuss Barriers to Practice as an APN in Michigan
  2. Identify forms of competition on the state and national level that interfere with APN’s ability to practice independently.
  3. Identify the specific lawmakers by name at the state level (i.e., key members of the Michigan legislative branch and executive branch of government)
  4. Discuss interest groups that exist at the state and national levels that influence APN policy.
  5. Discuss methods used to influence change in policy in forms of competition, state legislative and executive branches of government and interest groups.
  6. A scholarly resource must be used for EACH discussion question each week.
DISCUSSION CONTENT
Category Points % Description
Practice Barriers 15 15% Provides relevant evidence of scholarly inquiry clearly stating how the evidence describes APN barriers to practice. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
Competition 15 15% Provides relevant evidence of scholarly inquiry clearly stating the forms of competition to APN practice. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
Key Law Makers 15 15% Provides relevant evidence of scholarly inquiry in identifying law makers at the state level. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
Interest Groups 15 15% Provides relevant evidence of scholarly inquiry at identifying interest groups at the state and national level. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.  Discuss Barriers to Practice as an APN in Michigan
Methods to Influence Change 15 15% Provides relevant evidence of scholarly inquiry of methods used to influence a change to eliminate barriers.

Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion.
  75 75% Total CONTENT Points= 75 pts

 

Pharmacology, Theoretical And Research, Biology Lab Assignment

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Pharmacology, Theoretical And Research, Biology Lab Assignment

Parts 3 and 4 have the same questions. However, you must answer with references and different writing, always addressing them objectively, as if you were different students. Similar responses in wording or references will not be accepted.

Parts 5 and 6 have the same questions. However, you must answer with references and different writing, always addressing them objectively, as if you were different students. Similar responses in wording or references will not be accepted.

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APA format

1) Minimum 8 pages  (No word count per page)- Follow the 3 x 3 rule: minimum of three paragraphs per page

You must strictly comply with the number of paragraphs requested per page.

The number of words in each paragraph should be similar

         Part 1: minimum  2 pages

         Part 2: minimum  2 pages

         Part 3: minimum 1 page

         Part 4: minimum  1 page

         Part 5: minimum  1 page

         Part 6 minimum  1 page

Submit 1 document per part

2)¨******APA norms

        The number of words in each paragraph should be similar

        Must be written in the 3 person

All paragraphs must be narrative and cited in the text- each paragraph

The writing must be coherent, using connectors or conjunctive to extend, add information, or contrast information.  Pharmacology, Theoretical And Research, Biology Lab Assignment

         Bulleted responses are not accepted

         Don’t write in the first person 

         Do not use subtitles or titles      

Don’t copy and paste the questions.

Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks)

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 3 references (APA format) per part not older than 5 years  (Journals, books) (No websites)

All references must be consistent with the topic-purpose-focus of the parts. Different references are not allowed

5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

Q3. Research is…………………………………………………. (a) The relationship between……… (b) EBI has to

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.doc

__________________________________________________________________________________

The number of words in each paragraph should be similar

Parts 3 and 4 have the same questions. However, you must answer with references and different writing, always addressing them objectively, as if you were different students. Similar responses in wording or references will not be accepted.

Parts 5 and 6 have the same questions. However, you must answer with references and different writing, always addressing them objectively, as if you were different students. Similar responses in wording or references will not be accepted.

Part 1: Advance pharmacology

 

Ms. Jones brings 6-week-old Sam to the clinic because of a bright red rash in the diaper area that has gotten worse since she started putting over-the-counter antibiotic cream on it 3 days ago. Sam is diagnosed with diaper Candida or a yeast infection. Clotrimazole (Lotrimin) topical TID for 14 days to the diaper area has been prescribed. Pharmacology, Theoretical And Research, Biology Lab Assignment

1. Describe the therapeutic actions of Clotrimazole (Lotrimin) (Two paragraphs)

2. Describe antifungal drugs uses and (Two paragraphs)

a. Side effects.

3. Develop a teaching plan for Ms. Jones including age-appropriate considerations for Sam.(Two paragraphs)

The number of words in each paragraph should be similar

Part 2: Theoretical and research

1. Critically appraise a qualitative research design (One paragraph)

2. Describe two advantages of  qualitative research design (One paragraph)

3. Describe two disadvantages of  qualitative research design (One paragraph)

4. Critically appraise a quantitative research design. (One paragraph)

5. Describe two advantages of  quantitative research design (One paragraph)

6. Describe two disadvantages of  quantitative research design (One paragraph)

The number of words in each paragraph should be similar

Parts 3 and 4 have the same questions. However, you must answer with references and different writing, always addressing them objectively, as if you were different students. Similar responses in wording or references will not be accepted.

Part 3: Biology Lab

All living organisms respond (are adapted) to environmental factors where they live. However, besides human beings, other animal species can transform their environments.

1. Describe two examples of animal species that can transform their environments (One paragraph)

a. Otters

b. Beavers

2. Discuss how beneficial these types of behaviors are for the ecosystem. (One paragraph)

3. Discuss how detrimental these types of behaviors are for the ecosystem. (One paragraph)

Part 4: Biology Lab

All living organisms respond (are adapted) to environmental factors where they live. However, besides human beings, other animal species can transform their environments.

1. Describe two examples of animal species that can transform their environments (One paragraph)

a. Birds

b. Ants

2. Discuss how beneficial these types of behaviors are for the ecosystem. (One paragraph)

3. Discuss how detrimental these types of behaviors are for the ecosystem. (One paragraph)

The number of words in each paragraph should be similar

Parts 5 and 6 have the same questions. However, you must answer with references and different writing, always addressing them objectively, as if you were different students. Similar responses in wording or references will not be accepted. Pharmacology, Theoretical And Research, Biology Lab Assignment

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Part 5: Facilitative Communication and Helping Skills

Four paragraphs per page

Topic: Exploring and Discovering the Client’s Issues and Concerns

You learned about the importance of thoroughly exploring challenges, problems, situations, and environments. You also learned about discovering client strengths, resources, areas of resiliency, and empowerment. You had opportunities to think about how to apply what you have learned about human behavior and the social environment in the previous chapters and other courses.

1. Describe ways to invite clients to collaborate with you in the exploration of problems and challenges.

2. What information is necessary as they gain a thorough understanding of the problems and challenges their clients face?

3. What is involved in gaining a thorough understanding of the broader situation or environment (physical and social) of your clients?

a. Why is this process important?

4. Describe the process of acknowledging and learning more about client strengths.

Part 6 : Facilitative Communication and Helping Skills

Four paragraphs per page

Topic: Exploring and Discovering the Client’s Issues and Concerns

You learned about the importance of thoroughly exploring challenges, problems, situations, and environments. You also learned about discovering client strengths, resources, areas of resiliency, and empowerment. You had opportunities to think about how to apply what you have learned about human behavior and the social environment in the previous chapters and other courses.

1. Describe ways to invite clients to collaborate with you in the exploration of problems and challenges.

2. What information is necessary as they gain a thorough understanding of the problems and challenges their clients face?

3. What is involved in gaining a thorough understanding of the broader situation or environment (physical and social) of your clients?

a. Why is this process important?

4. Describe the process of acknowledging and learning more about client strengths.  Pharmacology, Theoretical And Research, Biology Lab Assignment