Pediatric Assessment: PDA with RSV Assignment

TOPIC: Module 07 Assignment – Pediatric Assessment: PDA with RSV

 Purpose of Assignment

The goal of creating a nursing concept map and create a plan of care for a child with bronchiolitis. The nursing interventions would reflect the underlying respiratory syncytial virus with patent ductus arteriosus (PDA) history.

 

Competency

Apply the foundations of pediatric nursing when caring for clients with health alterations.

 

Scenario

You are working in a large urban pediatric clinic after-hours.

A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions.

• The child is in less than 10^th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA).
• Born at 36 weeks gestation.
• Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare.
• T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96%
• A swab for respiratory syncytial virus (RSV) is positive.

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Doctor orders – Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated.

After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home and can return to pediatric afterhours or ER if needed.

Client is discharged with these orders:

• methylprednisolone 0.4 mg/kg oral BID for 3
• Albuterol Q4 hours for 24 hours, then Q 6 hours for 24 hours, and Q6 as needed.
• Call if needed prior to the Q4 dose.
• Manage fever with Tylenol and continue hydration and nasal bulb suction Q6 while awake.
• Return for re-evaluation in 3 days

Pediatric Assessment: PDA with RSV Assignment

Instructions

In a two to three-page APA formatted paper, provide reponses for these questions and requests for information:

Criteria:

1. Describe the pathophysiology of bronchiolitis and identify the most common organism causing this infection. What laboratory testing can confirm your suspicion?
2. Describe the pathophysiology of PDA and why the history of PDA is significant in this scenario.
3. What risk factors place Vivi Mitchell at a greater risk for the development of bronchiolitis?
4. What are the characteristic signs/symptoms of bronchiolitis?
5. Vivi Mitchell been prescribed the following medications; acetaminophen, albuterol nebulizer, corticosteroids. Provide the rationale for why each medication has been included as part of her medical management and explain any potential contraindications related to these medications.
6. You are designing Vivi Mitchell’s plan of care. Identify two priority nursing diagnoses to include in your plan. For each nursing diagnosis, identify two SMART goals, and two interventions for each goal.
7. What short and long-term possible complications should the nurse anticipate?
8. What client education is appropriate for Vivi Mitchell as she is discharged from the after-care clinic?

* Include a minimum of four scholarly sources

 

Format

• Standard American English (correct grammar, punctuation, etc.)
• Logical, original and insightful
• Professional organization, style, and mechanics in APA format

 

NO CONSIDERATION FOR PLAGIARISM

APA FORMAT AND INDEX CITATION

PLEASE WRITE FROM NURSING PROSPECTIVE

 

DUE 2/10/22

Pediatric Assessment: PDA with RSV Assignment

• FOLLOW ALL Rubric Details CORRECTLY TO AGAIN FULL POINTS

·

·         Criteria 1, 2, 3

23% of total grade

Mastery: Advanced or exceeds achievement

Addresses criteria correctly with thorough development of the topic. Gives clinical examples. Includes research in the answer.

14.72

Proficiency: Clear/effective achievement

Addresses criteria correctly. Demonstrates solid understanding of the topic. Gives examples without research.

13.69

Competence: Adequate/basic achievement

Addresses criteria correctly. Demonstrates basic understanding of the topic.

12.36

Emerging: Limited or growing achievement

Addresses criteria incorrectly.

9.57

·         Criteria 4, 5, 6

15% of total grade

Mastery: Advanced or exceeds achievement

Addresses criteria correctly with thorough development of the topic. Gives clinical examples. Includes research in the answer.

9.6

Proficiency: Clear/effective achievement

Addresses criteria correctly. Demonstrates solid understanding of the topic. Gives examples without research.

8.93

Competence: Adequate/basic achievement

Addresses criteria correctly. Demonstrates basic understanding of the topic.

8.06

Emerging: Limited or growing achievement

Addresses criteria incorrectly.

6.24

·         Criteria 7, 8, 9

31% of total grade

Mastery: Advanced or exceeds achievement

Addresses criteria correctly with thorough development of the topic. Gives clinical examples. Includes research in the answer. Pediatric Assessment: PDA with RSV Assignment

19.84

Proficiency: Clear/effective achievement

Addresses criteria correctly. Demonstrates solid understanding of the topic. Gives examples without research.

18.45

Competence: Adequate/basic achievement

Addresses criteria correctly. Demonstrates basic understanding of the topic.

16.67

Emerging: Limited or growing achievement

Addresses criteria incorrectly.

12.9

·         Tone

15% of total grade

Mastery: Advanced or exceeds achievement

Uses consistent professional tone with excellent use of medical terminology.

9.6

Proficiency: Clear/effective achievement

Tone is professional. Good use of medical terminology.

8.93

Competence: Adequate/basic achievement

Tone is professional. Inconsistent use of medical terminology.

8.06

Emerging: Limited or growing achievement

Tone is consistently unprofessional with poor use of medical terminology.

6.24

·         Spelling and Grammar

9% of total grade

Mastery: Advanced or exceeds achievement

Demonstrates an exemplary application of spelling and grammar.

5.76

Proficiency: Clear/effective achievement

Displays proper grammar application and writing contains minimal to no spelling errors. May contain rare improper uses of words (ex., their vs. there), a misplaced modifier, or a run-on sentence, but does not detract from the overall understanding of the sentence and/or paragraph.

5.36

Competence: Adequate/basic achievement

Spelling and grammar errors occur but are inconsistent. Paragraphs and sentences are coherent but may exhibit spelling errors, run-on’s or fragments, and/or improper verb tense usage.

4.84

Emerging: Limited or growing achievement

Spelling and grammar contain substantial errors that makes sentences and/or paragraphs incoherent. Pediatric Assessment: PDA with RSV Assignment

3.74

·         APA Style

7% of total grade

Mastery: Advanced or exceeds achievement

APA citations are free of style and formatting errors.

4.48

Proficiency: Clear/effective achievement

Errors in APA citations are less noticeable and do not detract from the ability to locate the original source (for example, a missing or misused comma or period, missing parentheses, author name not properly abbreviated, indentation is misaligned).

4.17

Competence: Adequate/basic achievement

Errors in APA citations are noticeable and may detract from the ability to locate the original source (for example, no title provided, year of publication is missing, no punctuation).

3.76

Emerging: Limited or growing achievement

Citations do not follow APA Style. Quotations, paraphrases, and summaries are not cited, or there is no attempt to cite them using APA style.

2.91

Pediatric Assessment: PDA with RSV Assignment

This should be done in next 11 hours

Mood disorders can impact every facet of a child’s life, making the most basic activities difficult for clients and their families. This was the case for 13-year-old Kara, who was struggling at home and at school. For more than 8 years, Kara suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues. As a psychiatric mental health nurse practitioner working with pediatric clients, you must be able to assess whether these symptoms are caused by psychological, social, or underlying growth and development issues. You must then be able recommend appropriate therapies.

This week, as you examine antidepressant therapies, you explore the assessment and treatment of pediatric clients with mood disorders. You also consider ethical and legal implications of these therapies.

 

Assignment: Assessing and Treating Pediatric Clients With Mood DisorderWhen pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.

Note: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients. Psychiatric Nursing Assignment

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Learning Objectives

Students will:

• Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clients
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapy
• Evaluate efficacy of treatment plans
• Analyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clients

 

Assignment: Assessing and Treating Pediatric Clients With Mood Disorders

When pediatric clients present with mood disorders, the process of assessing, diagnosing, and treating them can be quite complex. Children not only present with different signs and symptoms than adult clients with the same disorders, but they also metabolize medications much differently. As a result, psychiatric mental health nurse practitioners must exercise caution when prescribing psychotropic medications to these clients. For this Assignment, as you examine the client case study in this week’s Learning Resources, consider how you might assess and treat pediatric clients presenting with mood disorders.

Note: This Assignment is the first of 10 assignments that are based on interactive client case studies. For these assignments, you will be required to make decisions about how to assess and treat clients. Each of your decisions will have a consequence. Some consequences will be insignificant, and others may be life altering. You are not expected to make the “right” decision every time; in fact, some scenarios may not have a “right” decision. You are, however, expected to learn from each decision you make and demonstrate the ability to weigh risks versus benefits to prescribe appropriate treatments for clients.

Learning Objectives

Students will:

• Assess client factors and history to develop personalized plans of antidepressant therapy for pediatric clients
• Analyze factors that influence pharmacokinetic and pharmacodynamic processes in pediatric clients requiring antidepressant therapy
• Evaluate efficacy of treatment plans
• Analyze ethical and legal implications related to prescribing antidepressant therapy to pediatric clients

 

 

Examine Case Study: An African American Child Suffering From Depression. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes. Psychiatric Nursing Assignment

• At each decision point stop to complete the following:
  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
  • Decision #2
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?
• you can do a new assignment or edit this.  use the same format .NOTE Plagiarism must be less than 20 % for this to be accepted . reference not counted . thx

 

The assessing and Treating Pediatric Clients with Mood Disorders Introduction Depression is the most common mental disorder for young people, and it is associated with educational underachievement, self-harm, and suicidality. The depression rate among children this day is so disturbing. The effect of depression is devastating since it leads to a variety of physical and emotionally problems. 1 Depression can reduce the child ability to function at academically (American Psychiatric Association, 2018).

We can categorize depression in children into two types, the 1st is major depression in this type of depression the child will be in depression for less than a month and the child might experience it again sometime in life. Dysthymia depression is a less form of severe chronic depression that last for two years in total (American Psychological Association, 2016). This is the most serious and considered the leading cause of suicide death, and disability in adolescent in this age group (WHO, 2014) Selective serotonin reuptake inhibitors (SSRIs) is antidepressant and helps children and adolescent to get back into a stable mood from mood disorder. It is important to monitor children at a closely at the first four weeks of administering this medication, this help identify a change in behavior.Some sign to watch for include sleeplessness, withdrawal from social gathering or unnecessary agitation (Anxiety and Depression Association of America, 2016).

2 This paper is my opportunity to examine An African American Child Suffering From Depression. What is, what treatment options are available and the effects of the stigma of MDD on the African American child and family. 3 African Americans are no different when its comes to prevalence of mental health conditions when compared to the rest of the population. Poverty level affects mental health status. 1 African Americans living below the poverty level, as compared to those over twice the poverty level, are 3 times more likely to report psychological distress Decision Selected # 1 I will choose Zoloft 25mg as my first choice of medication Reason for Selection: I have work with a diverse group of patient in including African American in the course of my experience working in children in hospitals unit several years .I have to start with Zoloft 25mg. most provider I worked with will not want to give much medication because of this age group. 1 Zoloft is considered “off-label meaning it is not approve by the Food and Drug Administration (FDA) to treat depression in children and adolescents; randomized controlled trials (RCTs) approved it because the benefits. 1 According to the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP, 2016), Zoloft is safes and is the best option to treat mood disorders in children in this age group.

Expected Results In the 1st two weeks of therapy, we expect some progress as the child is expected to exhibit that there is evident in physical symptoms like increase in appetite, and sleep. We should also expected increase is the child concentration within a month, and an increase peer group interactions, and expected to withdraw less from peers. If all things work as expected and absent of adverse reaction, will continue with the treatment (IACAPAP, 2016), Differences between Expected outcome and Actual outcome After two weeks, he patient is expected to come back for a visit to be evaluated for the medication effectiveness. If the goal of the medication is met, and there is no symptom for side effect, then the medication and the dosage will remain the same until the next appointment. If expected result is not not met and there is no sign or symptom of adverse effect, the medication will be increased to Zoloft 50mg. I have to be aware that, the difference between the expected outcome and actual outcome is the dosage being low or higher than the needed therapeutic level for the patient (National Alliance on Mental Illness, 2017).

Decision Selected # 2 Reason for Selection: Decision one within four weeks follow-up, my expected outcome has not been achieved. The child is still presented with depressive symptoms. The patient and parent denies any side effect of Zoloft., but the child is still showing signs of major depressive disorder (MDD). I will increase Zoloft to 50mg to attain medication therapeutic effect. 1 This will be done after addressing the effect with patient and family and documented after discussing the risks, benefits and education about MDD and the planned of treatment by increasing the dosage, goals for this client remain the same. We will continue to monitor any side effects, like suicidality risk (National Alliance on Mental Illness, 2017). Psychiatric Nursing Assignment

Expected Results My client should be able to verbalize some positive changes like reduce in depressive symptoms of Zoloft 50mg. If the higher dose help in reducing depression with no side effect of medication. 1 I will now encourage patient and reassure parents.This improvement should include participating in groups, peers interaction , improve sleep, appetite and academic improvement (American Psychiatric Association, 2018).

4 Differences between Expected outcome and Actual outcome There should be appositive noticeable change with therapeutic of Zoloft 50mg, a decrease in depression symptoms with and no adverse reaction that indicate otherwise that patient is tolerating the therapeutic medication adjustment well. 1 Since at this level, there is no difference between the expected result and the actual result therefore the patient will continue with the Zoloft 50mg. Patient should be monitoring continue, and the next schedule appointment.

Decision Point Three Maintain current dose of Zoloft 50mg orally daily Reason for Selection When the patient shows improvement, we have to keep schedule medication especially when there is no side effect of medication. My patient has shown great degree of improvement, and there is no side effect to this patient with the dose of Zoloft 50mg. 1 The monitoring of the side effect will include suicidal thought (National Alliance on Mental Illness, 2017).

Expected Results Treatment of depression, and monitoring is a continues process. 1Patient improvement should daily, and the signs of depression will be eliminated gradually with dosage of Zoloft 50mg. Patient peer interaction, sleep, appetite, should gradually improve.

Differences between Expected Results and Actual Results Choosing Zoloft 50mg on my African American child patient seems to be working, with no problem. Patient is responding well to therapy. I will continue patient with current dose. With this gradual improvement, I have no reasons to change medication or dosage. I will schedule an appointment and the dose might be increase if depression increases. 1 The expected result would be in treating any side effect to the medication so that maximum therapeutic effects can be achieved. The actual result is that there is an achievement in medication therapeutic effect that is needed by the patient (National Alliance on Mental Illness, 2017).

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5 Ethical Considerations Suicidal ideation or behavior is only one reason for which close monitoring is important for children started on antidepressant therapy (Mitchell et al., 2014). Therefore, providers who are considering the use of antidepressants in children, adolescents, and young adults must first balance the risk of suicidality with the clinical need for an antidepressant (Mitchell et al., 2014). 1 The ethic consideration can be classified as an accumulation of reasoning and principle of treatment of depression.The suicidal tendency in the used of antidepressant medication has led the FDA to require that all antidepressant medicine should be labeled by pharmaceutical companies with the caution of suicidal on the label (Sondheimer, 2010). Any child that is below the age of 18years old cannot take decision on depression treatment without the parent approval according to FDA regulation (Sondheimer,2010). Therefore, it is paramount to educate the parent of the treatment given to the child as well the consent of the parent.In case of danger, the consent advice of the parent may be ignored (Sondheimer, 2010).The Zoloft is “off-label” so a greater precaution and parent approval needs to be obtain before dispensing.

6 This lack of knowledge leads many to believe that a mental health condition is a personal weakness or some sort of punishment from God. Many African Americans also have trouble recognizing the signs and symptoms of mental health conditions, leading to underestimating the effects and impact of mental health conditions. 3 Faith and spirituality can help in the recovery process but should not be the only option you pursue. If spirituality is an important part of your life, your spiritual practices can be a strong part of your treatment plan. Your spiritual leaders and faith community can provide support and reduce isolation.

7 Conclusion The FDA advises that doctors prescribe the smallest quantity of pills possible to help reduce the risk of deliberate or accidental overdose. A careful monitoring by parents, caregivers and health care professionals is important for any child or teenager taking an antidepressant for depression or any other condition. 1 Food and Drug Administration (FDA or USFDA) has a rule and regulation set for the treatment of behavioral disorder in children, the guideline which must be follow to the letter (National Alliance on Mental Illness, 2017). Supervising and safe monitoring of the child is very important during therapy (National Alliance on Mental Illness, 2017). 1 The legality guiding the treatment of a child with psychiatric problem has increase because of increase national awareness. As a psychiatric nurse, I strive to increase my knowledge of the legal and ethical implications of prescribing psychotropic medications for children.and adolescents with major depression and anxiety disorders. 3 African Americans are no different when its comes to prevalence of mental health conditions when compared to the rest of the population, depression one of the mental health issues in African American community.

1 References American Psychiatric Association (2018). Practice guideline for the treatment of patients with the major depressive disorder (3rd ed., pp. 152). Arlington (VA): 1 American Psychiatric Association (APA). 2 Retrieved from https://www.guideline.gov/summaries/summary/24158?

1 American Psychological Association. (2016). 1 Psychotropic Medications for Children and Adolescents. Retrieved from:

1 http://www.apa.org/pi/families/resources/child-medications.pdf.

Anxiety and Depression Association of America. (2016). 1 Anxiety and Depression in Children. Retrieved from:https://adaa.org/living-with-anxiety/children/anxiety-and-depression International Association for Child and Adolescent Psychiatry and Allied Professions.

Bennet, N. (2016). 5 Legal and ethical issues related to the prescription of psychiatric medication to children (and teens). Retrieved from https://www.ohsu.edu/xd/health/for-healthcare-professionals/telemedicine-network/for-healthcare-providers/ohsu-echo/upload/Legal-and-Ethic-issues-treating-C-and-A-mental-health-Bennett-N-2016.pdf De Vries, Y. A., De Jonge, P., Kalverdijk, L., Bos, J. H., Schuiling-Veninga, C. C., & Hak, E. (2016). 5 Poor guideline adherence in the initiation of antidepressant treatment in children and adolescents in the Netherlands: choice of antidepressant and dose. European Child & Adolescent Psychiatry, 25(11), 1161-1170. Retrieved from https://web-b-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=4&sid=2505bbce-c8cf-4f53-9c28-70e0106cb774%40sessionmgr120 Department of Human and Health Services. (2013). Antidepressant Medications: 5 Use in Pediatric Patients. Retrieved from https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Pharmacy-Educatio

Mitchell, A. 5 M., Davies, M. A., Cassesse, C., & Curran, R. (2014). 5 Antidepressant Use in Children, Adolescents, and Young Adults: 10 Years After the Food and Drug Administration Black Box Warning. The Journal for Nurse Practitioners, 10(3), 149-156.Retrieved from https://www-sciencedirect-com.ezp.waldenulibrary.org/science/article/pii/S1555415513004856?via%3Dihub Sheridan, D. C., Lin, A., & Zane Horowitz, B. (2017). 5 Suicidal bupropion ingestions in adolescents: increased morbidity compared with other antidepressants. Clinical Toxicology, 1-5. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/15563650.2017.1377839 Stahl, S. M. (2017). 5 Stahl’s essential psychopharmacology: The prescriber’s guide (6th ed.). New York, NY: Cambridge University Press. Psychiatric Nursing Assignment

Overview

Communities are composed of the core, which are the people and eight subsystems. A community assessment typically starts with a windshield survey where each of the eight community subsystems are explored. This assignment is focused on helping health professional students explore the relationship of safety and transportation to determinants of health. Mayor Franklin Hill has information about safety and transportation in Sentinel City^®. Officer Cooper in Acer Tech has information about neighborhood crime rates.

 

Learning Objectives

1. Identify safety and transportation features in a specific community
2. Describe how safety and transportation is related to a specific determinant of health
3. Describe the health impact of positive and negative characteristics of a community
4. Use current literature to provide rationale for determinant of health identified related to safety and transportation. Subsystem: Safety & Transportation

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Assignment Instructions

1. Review the following resources:
   1. Course textbook and/or other assigned readings
   2. Determinants of Health
   3. Review Table 4 from the FBI 2016 Crime in the United States report at https://ucr.fbi.gov/crime-in-the-u.s/2017/preliminary-report/home
2. Meet with Mayor Hill and Officer Cooper to discuss safety and transportation as well as neighborhood crime rates.
3. Enter Sentinel City^® and begin the bus tour.
4. As you tour the city, note anything in the assigned neighborhood or entire city related to safety and transportation.
5. Address each of the features in the far-left column and add two additional features. Fill in the each of the remaining columns.
6. For questions, contact your instructor.

 

Subsystem: Safety & Transportation
Safety	Observed/Not Observed	Neighborhood		Relationship to Social Determinants of Health	Evidence-Based Rationale (How Safety Impacts Health) Citations here Reference on the page below
Police Presence
Signs of Criminal Activity
Graffiti
Street Lighting
Crime Rates
Other
Crime Rate Comparisons Compare the crime rates in Sentinel City® with the crime rates for a city of similar size in your home state, and with national crime rates. Use Table 4 data from the FBI 2016 Crime in the United States semi-annual report to find crime rates for your selected city at  https://ucr.fbi.gov/crime-in-the-u.s/2017/preliminary-report/home Note: You are comparing Sentinel City by community with a comparable city in your state. Don’t get stuck in the numbers. See the learning objective #4 above.
Sentinel City® Crime Rate by Neighborhood: Talk to the officer at City Hall.				Crime Rate for City in Your Home State
Acer Tech:   Casper Park:   Industrial Heights:   Nightingale Square:				City:   Crime Rate:
Transportation	Observed/Not Observed		Neighborhood	Relationship to Social Determinants of Health	Evidence-Based Rationale (How Safety Impacts Health) Citations here Reference on the page below
Fire Station/Fire Hydrants
Public Transportation
Highways
Location of Bus Stops
Other

 

References 

AACN Public Health Essentials 

This assignment addresses the following AACN Public Health Essentials:

• Essential II: Basic Organizational and Systems Leadership for Quality Care and Patient Safety
  • Apply systems theory to PHN practice with individuals, families, and groups.
• Essential III: Essential III: Scholarship for Evidence-Based Practice
  • Use epidemiologic data and the ecological perspective to identify health risks for a population.
• Essential VII: Clinical Prevention and Population Health for Optimizing Health
  • Practice evidence-based public health nursing to promote the health of individuals, families, and groups.
• Essential IX: Baccalaureate Generalist Nursing Practice
  • Use basic descriptive epidemiological methods when conducting a health assessment for individuals, families, and groups. Subsystem: Safety & Transportation

 

Case study 1

Elaine Goodwin is a 38-year-old G5 P5 LC 6 presenting to your clinic today to discuss contraceptive options.  She states that she is not interested in having more children but her new partner has never fathered a child. Her medical history is remarkable for exercise-induced asthma, migraines, and IBS. Her surgical history is remarkable only for tonsils as a child. Her social history is negative for alcohol, tobacco, and recreational drugs.  She has no known drug allergies and takes only vitamin C. Hospitalizations were only for childbirth. Family history reveals that her maternal grandmother is alive with dementia, while her maternal grandfather is alive with COPD. Her paternal grandparents are both deceased due to an automobile accident. Her mother is alive with osteopenia and fibromyalgia, and her dad is alive with a history of skin cancer (basal cell). Elaine has one older sister with no medical problems and one younger brother with no reported medical problems.   Nursing homework help

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· Height 5’ 7” Weight 148 (BMI 23.1), BP 118/72 Pulse 68

· HEENT (head, ears, eyes, nose, throat):  wnl (within normal limit)

· Neck: supple without adenopathy

· Lungs/CV (cardiovascular): wnl

· Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge

· Abd (abdomen): soft, +BS (positive bowel sound), no tenderness

· VVBSU (Vulvar vaginal bartholin skene’s uretha): wnl, except 1st degree cystocele

· Cervix: firm, smooth, parous, without CMT (cervical motion tenderness)

· Uterus: RV (retroverted), mobile, non-tender, approximately 10 cm,

· Adnexa: without masses or tenderness

Based on the case study scenario provided, complete a comprehensive well-woman exam and critically analyze to focus attention on the diagnostic tests (include explanation of the tests you might recommend).

Include your differential diagnosis. Be specific and provide examples. Use your Learning Resources and/or evidence from literature to support your explanations.

Some questions to answer in your post:

1. What other information do you need?

2. What has she used in the past?  Why did she stop a method?  How many partners in past 12 months?

3. What are her current cycles like?

4. When was her last gyn exam and what were the results of the tests?

5. Are her migraines with or without auras?

6. What method has she considered.

7. What are you next steps/considerations?

8. What teaching should you do?

9. What methods are appropriate for Elaine? Nursing homework help