PICOT STATEMENT PAPER

Details:

Review the Topic Materials and the work completed in NRS-433V to formulate a PICOT statement for your capstone project.  

THE DOCUMENT IS ATTACHED BELLOW..

THE ASSIGNMENT HAS TO BE FREE OF PLAGIARISM

A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.

Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project.

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In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Make sure to address the following on the PICOT statement:

Evidence-Based Solution

Nursing Intervention

Patient Care

Health Care Agency

Nursing Practice

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.PICOT STATEMENT PAPER

 

10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

Week Two Assignment Instructions DNP 820

Please read the instructions thoroughly there are strict requirements

I need at least 10 different articles/literature reviews added to the ones in the 815 attachment. I have also included the chart to be filled out All within 5 years and pertinent to the subject.

Tutor MUST have a good command of the English language

The Rubric must be followed, and all the requirements met

This is a thorough professor, and she has strict requirements

I have attached the PICOT and the first 10 points (DNP 815) assignment. This is a continuation of that assignment. Please read the attachments

The following needs to be addressed:

Please note the followings: The introduction and the literature review are complete and thorough. The problem statement is written clearly PICOT is clear and very good Sample: 

· How will you determine the sample size? 

· What are the inclusion/exclusion criteria of the subjects? Methodology: Why is the selected methodology is appropriate? Please justify! 

· Data collection approach needs to be clear. How will you collect your data? What is needed here is to describe the process of collecting data form signing the informed consent until completing the measuring.

· Data analysis-What test will you use to answer your research question? 

Clinical/PICOT Questions:  

“In adult patients with CVC at a Clear Lake Regional Medical Center, does interventional staff education about hub hygiene provided to RN’s who access the CVC impact CLABSI rates compared to standard care over a one-month period?”

P: Patients with Central Venous Catheters

I: Staff re-education related to Hygiene of the hub

C: Other hospitals

O: Reduce probability of CLABSIs

T: Two months

“In Patients > 65 years of age with central line catheters at a Clear Lake Regional Medical Center, how does staff training of key personnel and reinforcement of central line catheter hub hygiene after its insertion, along with the apt cleansing of the insertion site, before every approach compared with other area hospitals, reduce the incidence of CLABSIs (Central Line Associated Blood-stream Infections) over a one-month period?”

P: Patients > 65 years of age with a Central line

I: Staff training and reinforcement of Central Catheter, Hub Hygiene 

C: Other area hospitals 

O: Reduce probability of CLABSIs

“In adult patients, with define CVC (CVC), does interventional staff education about hub hygiene provided to RN’s who access the CVC impact CLABSI rates compared to pre and post-intervention assessments 

1. I used central Missouri as an example, replace with a description of your site. 

2. While you might be interested in CLASBI rates as a primary variable, there are other patient outcomes that would also be important to consider

3. Ensure you can find validity and reliability measures on CLASBI rates if you cannot, we need to determine another question to help

4. How are your two comparison groups different, as they are currently stated the groups seem very much the same, could you state, standard care instead of pre and post intervention assessments? 

5. One month is the longest time you can use for a prospective project

Please note the following regarding the instructors grading

IMPORTANT INFORMATION ABOUT MY GRADING STYLE

As you prepare for written papers and manuscripts I’d like to give you some details about my grading style. I provide significant feedback on your papers, this is because I believe you should be working towards improving your writing so that at the end of this program you are able to successfully write your DPI project. In order to write well, you need feedback and you need to review that feedback and make progress on the next written work. To that end I always grade accordingly. This means that if I provide feedback one an item (for example APA format of your reference page) I expect that this will be improved on the next written submission. Otherwise I will deduct additional points. In addition, some other criteria to get down pat now. References should always

1. Be current, no older than 5 years that means 5 years from your proposed graduation date (2014-2019). Otherwise you will have to redo everything in DNP 955.

2. Be primary sources. You can no longer cite Young declared literary war in 1956 (as cited by Brown 2006). You must cite Young 1956. That means go find that paper and read it and make sure that you agree with what Brown said. What if you don’t agree due to some very valid points? Then the literary war is not what occurred, but instead you have concerns regarding point ____, ____, and ____.

3. You may no longer cite textbooks, they are 1) secondary sources and 2) not current enough, and please use peer reviewed manuscripts. 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

One more item that is not a reference. You may not use direct quotes any longer. There is no need. This may be difficult at first, but you are moving towards a different type of writing. This is manuscript writing (scientific writing). Scientific writing is terse, clear, and concise. No frilly words. In order to avoid the use of direct quotes you will synthesize the literature. There is a great resource for synthesizing the literature under Resources – Add-ons. These are also some other great writing resources there.

Details:

In the prospectus, proposal, and scholarly project there are 10 strategic points that need to be clear, simple, correct, and aligned to ensure the research is doable, valuable, and credible. The 10 strategic points emerge from researching literature on a topic that is based on or aligned with the learner’s personal passion, future career purpose, and degree area. These 10 points provide a guiding vision for DPI Project. In this assignment, you will continue the work begun in DNP-815, working on your draft of a document addressing the 10 key strategic points that define your intended research focus and approach.

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General Requirements:

Use the following information to ensure successful completion of the assignment:

  • Locate      the “The 10 Strategic Points for the      Prospectus, Proposal, and Direct Practice Improvement Project” that      you completed in DNP-815.
  • Doctoral      learners are required to use APA style for their writing assignments. The      APA Style Guide is located in the      Student Success Center. An abstract is not required.
  • This      assignment uses a rubric. Please Review the rubric prior to the beginning to become familiar with the      expectations for successful completion.
  • You      are required to submit this assignment to Turnitin. Please refer to the      directions in the Student Success Center.

Directions:

Use the “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” resource to draft statements for each of the 10 points for your intended research study.

You worked on this last in DNP 815. Pick up from where you left off (if you transferred in and did not complete this, you will have to begin fresh). Please include a copy of your last instructor feedback when you submit this assignment. You can either copy and paste the instructor feedback into your current paper (as an appendix and clearly marked); or upload two separate papers. I expect significant improvement from your last submission.

Please review the 10 Strategic Points document for additional instructions and an example. Add references to this document, I suggest 5-10 at this point. You need to realize that your literature review chapter will need at least 50+ articles by the time you get to DNP 955, so work on expanding your literature search each week, to include more and more to this paper as you move through each course. If you cannot locate 50+ articles you can ask your faculty for assistance or chose a different topic.

For the methodology and design sections. Methodology should cover the broad methods you plan to use (qualitative, quantitative, or mixed methods). The design portion will then go into more detail and discuss the design (i.e. correlational, cross-sectional, pre/posttest, etc.). Describe each and explain why your chosen methodology and design are appropriate to your topic and project questions. You may NOT use qualitative, GCU leadership does not support a qualitative methodology.

Intervention. You must have an intervention that you implement. Since you cannot evaluate a project that has already been implemented, please write up a description of your intervention and what your role will be in implementing this intervention. This is not a section listed on your 10 Strategic Points document as of yet, so add it after the methodology and design sections. Describe step by step what the intervention consists of, how it is evidence based, how you will implement, and your role in implementation. 10 Strategic Points For The Prospectus, Proposal, And Direct Practice Improvement Project

Data collection should go step by step (extremely over-detailed) on how you will collect the data. Tell me about all instruments, surveys, and/or questions you will ask of participants. One MUST be a valid and reliable tool.

Data Analysis. Tell me the specific statistics you will use. Start with descriptive statistics, which ones will you use, why (cite current primary sources). Then tell me how you will compare your data (which statistic), what your p value will be before you start your data collection.

Apply Rubrics

Community Health Field Experience. Topic Obesity In Adults

Task 1: Social Media Campaign

Introduction:

Part of cultural competency is advocating for sensitive patient populations with regard to health issues or needed improvements in the community. A big part of advocacy is uncovering effective stories discovered in your community assessment. Equally important is understanding how to broadcast your discoveries to the larger community. In our society today, social media is a powerful leveraging tool to get a story out, build support, and demonstrate advocacy.

Requirements:

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. Use the Turnitin Originality Report available in Taskstream as a guide for this measure of originality.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

Part 1: Field Experience Project Submission
Note: Your timelog must be submitted with your assessment. If both are not submitted at the same time, your task may be returned to you without evaluation.
A.  Submit a completed “Community Health Field Experience Timelog” by doing the following:

1.  Include the date of each activity.

2.  Include a brief description of each activity.

3.  Include the name of the contact person, a working phone number, and a full physical address.
Note: If an email address is available for the contact person, you may choose to include it. Community Health Field Experience. Topic Obesity In Adults
4.  Include the number of hours spent on each activity (not including preparation time).

5.  Describe how each activity relates to your selected Field Experience topic.

6.  Record a total of 90 hours that meet each of the following requirements:

●  65 student planned activity hours based on the attached “Field Experience Activities List”

●  a maximum of five individual interview hours (i.e., no more than five interviews, no more than one hour per interview)

●  no prep time hours (i.e., prep time is not to be included in reported hours)

Note: If your timelog is returned from evaluation, you are required to do an addendum.  Please use the link below to access the DocuSign addendum document.  Both the original timelog and the addendum timelog must be submitted with the task.

Note: Random audits and verification of time log activities do occur. Violation of the WGU Code of Student Conduct or the Academic Authenticity Policy could result in disciplinary action. 
Part 2: Social Media Campaign

Note: The “CDCynergy” web link provided in the web links section below may be useful in completing your social media campaign. The use of this web link is optional, i.e., not required.
B.  Write your community health nursing diagnosis statement.

1.  Explain how the health concern from your community health nursing diagnostic statement is linked to a health inequity or health disparity within the target population.

a.  Discuss the primary community resources and primary prevention resources currently in place to address the health concern.

b.  Discuss the underlying causes of the health concern.
2.  Discuss the evidence-based practice associated with the Field Experience topic.

a.  Identify data about the selected Field Experience topic from the local (e.g., county), state- Florida, and/or national level.

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C.  Develop a community health nursing social media campaign strategy that will convey your health message and address the Field Experience topic by doing the following:

1.  Describe your social media campaign objective.

2.  Recommend two population-focused social marketing interventions and justify how each would improve the health message related to your selected Field Experience topic.

3.  Describe a social media platform you would use that is appropriate for communicating with the target population-Adults

a.  Discuss the benefits of the selected social media platform in supporting preventative healthcare.
4.  Discuss how the target population will benefit from your health message.
D.  Describe best practices for implementing social media tools for health marketing.
E.  Create a social media campaign implementation plan by doing the following:

1.  Describe stakeholder roles and responsibilities in implementing the plan.

2.  Discuss potential public and private partnerships that could be formed to aid in the implementation of your campaign.

3.  Create a specific timeline for implementing your campaign.

4.  Explain how you will evaluate the effectiveness of the campaign.

5.  Discuss the costs of implementing your campaign.
F.  Reflect on how social media marketing supports the community health nurse’s efforts to promote healthier populations.

1.  Reflect on how your social media campaign could apply to your future nursing practice.
G.  Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.
H.  Demonstrate professional communication in the content and presentation of your submission. Community Health Field Experience. Topic Obesity In Adults

Personal Philosophy Of Nursing Paper

Use the questions in the table in chapter 3 on page 101 of your textbook as a guide as you write your personal philosophy of nursing. The paper should be three typewritten double spaced pages following APA style guidelines. The paper should address the following:

  1. Introduction that includes who you are and where you practice nursing
  2. Definition of Nursing
  3. Assumptions or underlying beliefs
  4. Definitions and examples of  the major domains (person, health, and environment) of nursing
  5. Summary that includes:
    1. How are the domains connected?
    2. What is your vision of nursing for the future?
    3. What are the challenges that you will face as a nurse?
    4. What are your goals for professional development? Personal Philosophy Of Nursing Paper

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Grading criteria for the Personal Philosophy of Nursing Paper:

Introduction                                                                            10%

Definition of Nursing                                                                20%

Assumptions and beliefs                                                         20%

Definitions and examples of domains of nursing                        30%

Summary                                                                               20%

Total              100%

Your paper must be written in APA style

Assignment: Academic Success And Professional Development Plan Part 6: Finalizing The Plan

At some point in every construction project, efforts turn from design and the focus moves to actual construction. With the vision in place and the tools secured, the blueprint can be finalized and approved. Then it is time to put on hardhats and begin work.

Throughout the course you have developed aspects of your Academic and Professional Development Plan. You have thought a great deal about your vision and goals, your academic and professional network of support, research strategies and other tools you will need, the integrity of your work, and the value of consulting the work of others. With your portfolio in place, it is now time to finalize your blueprint for success.

Much as builders remain cognizant of the building standards as they plan and begin construction, nurses must remain mindful of the formal standards of practice that govern their specialties. A good understanding of these standards can help ensure that your success plan includes any steps necessary to excel within your chosen specialty.

In this Assignment you will continue developing your Academic Success and Professional Development Plan by developing the final component–a review of your specialty standards of practice. You will also submit your final version of the document, including Parts 1–5.

To Prepare:

  • Review the standards of practice related to your chosen specialty- Psychiatric Mental Health Nurse practitioner.
  • Download the Nursing Specialty Comparison Matrix.
  • Examine professional organizations related to the specialization you have chosen and identify at least one to focus on for this Assignment.
  • Reflect on the thoughts you shared in the Discussion forum regarding your choice of a specialty, any challenges you have encountered in making this choice, and any feedback you have received from colleagues in the Discussion.

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The Assignment:
Complete the following items and incorporate them into the final version of your Academic Success and Professional Development Plan.

  • Complete the Nursing Specialty Comparison Matrix, comparing at least two nursing specialties that include your selected specialization and second-preferred specialization- Selected specialization is Psychiatric mental health nurse practitioner and the second -preferred specialization is Family nurse practitioner.
  • Write a 2- to 3-paragraph justification statement identifying your reasons for choosing your MSN specialization. Incorporate feedback you received from colleagues in this Module’s Discussion forum. Assignment: Academic Success And Professional Development Plan Part 6: Finalizing The Plan
  • Identify the professional organization related to your chosen specialization for this Assignment, and explain how you can become an active member of this organization.    – American psychiatric nurses association.

Note: Your final version of the Academic Success and Professional Development Plan should include all components as presented the Academic Success and Professional Development Plan template.

Complete the following items and incorporate them into the final version of your Academic Success and Professional Development Plan:

·   Complete the Nursing Specialty Comparison Matrix comparing at least two nursing specialties, including your selected specialization and second-preferred specialization.

·   Write a 2-3 paragraph justification statement identifying your reasons for choosing your MSN specialization. Incorporate feedback you received from colleagues in this week’s Discussion Forum.

·   Identify the professional organization related to the specialization you have chosen to focus on for this Assignment and explain how you can become an active member of this organization.–

Levels of Achievement:  Excellent 77 (77%) – 85 (85%)    Good 68 (68%) – 76 (76%)    Fair 59 (59%) – 67 (67%)    Poor 0 (0%) – 58 (58%)

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance.  A clear and comprehensive purpose statement and introduction is provided which delineates all required criteria.–

Levels of Achievement:  Excellent 5 (5%) – 5 (5%)    Good 4 (4%) – 4 (4%)    Fair 3.5 (3.5%) – 3.5 (3.5%)    Poor 0 (0%) – 3 (3%)

Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation–

Levels of Achievement:  Excellent 5 (5%) – 5 (5%)    Good 4 (4%) – 4 (4%)    Fair 3.5 (3.5%) – 3.5 (3.5%)    Poor 0 (0%) – 3 (3%)

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running head, parenthetical/in-text citations, and reference list.–

Levels of Achievement:  Excellent 5 (5%) – 5 (5%)    Good 4 (4%) – 4 (4%)    Fair 3.5 (3.5%) – 3.5 (3.5%)    Poor 0 (0%) – 3 (3%)  Assignment: Academic Success And Professional Development Plan Part 6: Finalizing The Plan

Soap Note 1 Acute Conditions

Soap Note 1 Acute Conditions

Soap Note 1 Acute Conditions (15 Points) Due 06/15/2019

Pick any Acute Disease from Weeks 1-5 (see syllabus)

Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 50%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

Late Assignment Policy

Assignments turned in late will have 1 point taken off for every day assignment is late, after 7 days assignment will get grade of 0. No exceptions

Follow the MRU Soap Note Rubric as a guide:

Grading Rubric

Student______________________________________

This sheet is to help you understand what we are looking for, and what our margin remarks might be about on your write ups of patients. Since at all of the white-ups that you hand in are uniform, this represents what MUST be included in every write-up.

1) Identifying Data (___5pts): The opening list of the note. It contains age, sex, race, marital status, etc. The patient complaint should be given in quotes. If the patient has more than one complaint, each complaint should be listed separately (1, 2, etc.) and each addressed in the subjective and under the appropriate number.

2) Subjective Data (___30pts.): This is the historical part of the note. It contains the following:

a) Symptom analysis/HPI(Location, quality , quantity or severity, timing, setting, factors that make it better or worse, and associate manifestations.(10pts)

b) Review of systems of associated systems, reporting all pertinent positives and negatives (10pts).

c) Any PMH, family hx, social hx, allergies, medications related to the complaint/problem (10pts). If more than one chief complaint, each should be written u in this manner.

3) Objective Data(__25pt.): Vital signs need to be present. Height and Weight should be included where appropriate.

a) Appropriate systems are examined, listed in the note and consistent with those identified in 2b.(10pts).

b) Pertinent positives and negatives must be documented for each relevant system.

c) Any abnormalities must be fully described. Measure and record sizes of things (likes moles, scars). Avoid using “ok”, “clear”, “within normal limits”, positive/ negative, and normal/abnormal to describe things. (5pts). Soap Note 1 Acute Conditions

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4) Assessment (___10pts.): Diagnoses should be clearly listed and worded appropriately.

5) Plan (___15pts.): Be sure to include any teaching, health maintenance and counseling along with the pharmacological and non-pharmacological measures. If you have more than one diagnosis, it is helpful to have this section divided into separate numbered sections.

6) Subjective/ Objective, Assessment and Management and Consistent (___10pts.): Does the note support the appropriate differential diagnosis process? Is there evidence that you know what systems and what symptoms go with which complaints? The assessment/diagnoses should be consistent with the subjective section and then the assessment and plan. The management should be consistent with the assessment/ diagnoses identified.

7) Clarity of the Write-up(___5pts.): Is it literate, organized and complete?

Comments:

Total Score: ____________ Instructor: __________________________________

1 sample  SAMPLE Block format Soap Note Template.docx

SOAP NOTE SAMPLE FORMAT FOR MRC

 

Name:  LP

Date:

Time: 1315

 

Age: 30

Sex: F

 

SUBJECTIVE

 

CC:  

“I am having vaginal itching and pain in   my lower abdomen.”

 

HPI:  

Pt is a   30y/o AA female, who is a new patient that has recently moved to Miami. She seeks treatment today after   unsuccessful self-treatment of vaginal itching, burning upon urination, and   lower abdominal pain. She is concerned   for the presence of a vaginal or bladder infection, or an STD. Pt denies fever. She reports the itching and burning with   urination has been present for 3 weeks, and the abdominal pain has been   intermittent since months ago. Pt has   tried OTC products for the itching, including Monistat and Vagisil. She denies any other urinary symptoms,   including urgency or frequency. She   describes the abdominal pain as either sharp or dull. The pain level goes as high as 8 out of 10   at times. 200mg of PO Advil PRN   reduces the pain to a 7/10. Pt denies   any aggravating factors for the pain. Pt reports that she did start her menstrual cycle this morning, but   denies any other discharge other that light bleeding beginning today. Pt denies douching or the use of any   vaginal irritants. She reports that   she is in a stable sexual relationship, and denies any new sexual partners in   the last 90 days. She denies any   recent or historic known exposure to STDs. She reports the use of condoms with every coital experience, as well   as this being her only form of contraceptive. She reports normal monthly menstrual cycles that last 3-4 days. She reports dysmenorrhea, which she also   takes Advil for. She reports her last   PAP smear was in 7/2016, was normal, and reports never having an abnormal PAP   smear result. Pt denies any hx of   pregnancies. Other medical hx includes   GERD. She reports that she has an Rx   for Protonix, but she does not take it every day. Her family hx includes the presence of DM   and HTN.

 

Current Medications: 

Protonix   40mg PO Daily for GERD

MTV OTC   PO Daily

Advil   200mg OTC PO PRN for pain

 

PMHx:

Allergies: 

NKA & NKDA

Medication Intolerances: 

Denies

Chronic Illnesses/Major traumas

GERD

Hospitalizations/Surgeries

Denies

 

Family History

Father-   DM & HTN; Mother- HTN; Older sister- DM & HTN; Maternal and paternal   grandparents without known medical issues; 1 brother and 3 other sisters   without known medical issues; No children.

 

Social History

Lives   alone. Currently in a stable sexual   relationship with one man. Works for   DEFACS. Reports occasional alcohol   use, but denies tobacco or illicit drug use.

 

ROS

 

General 

Denies   weight change, fatigue, fever, night sweats

Cardiovascular

Denies   chest pain and edema. Reports rare palpitations that are relieved by drinking   water

 

Skin

Denies   any wounds, rashes, bruising, bleeding or skin discolorations, any changes in   lesions

Respiratory

Denies   cough. Reports dyspnea that accompanies the rare palpitations and is also   relieved by drinking water

 

Eyes

Denies corrective   lenses, blurring, visual changes of any kind

Gastrointestinal

Abdominal   pain (see HPI) and Hx of GERD. Denies   N/V/D, constipation, appetite changes

 

Ears

Denies   Ear pain, hearing loss, ringing in ears

Genitourinary/Gynecological

Reports   burning with urination, but denies frequency or urgency. Contraceptive and STD prevention includes   condoms with every coital event. Current stable sexual relationship with one man. Denies known historic or recent STD   exposure. Last PAP was 7/2016 and normal. Regular monthly menstrual cycle   lasting 3-4 days.

 

Nose/Mouth/Throat

Denies   sinus problems, dysphagia, nose bleeds or discharge

Musculoskeletal

Denies   back pain, joint swelling, stiffness or pain

 

Breast

Denies   SBE

Neurological

Denies syncope,   seizures, paralysis, weakness

 

Heme/Lymph/Endo

Denies   bruising, night sweats, swollen glands

Psychiatric

Denies   depression, anxiety, sleeping difficulties

 

OBJECTIVE

 

Weight   140lb

Temp -97.7

BP 123/82

 

Height 5’4”

Pulse 74

Respiration 18

 

General Appearance

Healthy   appearing adult female in no acute distress. Alert and oriented; answers   questions appropriately.

 

Skin

Skin is   normal color for ethnicity, warm, dry, clean and intact. No rashes or lesions   noted.

 

HEENT

Head is   norm cephalic, hair evenly distributed. Neck: Supple. Full ROM. Teeth are in   good repair.

 

Cardiovascular

S1, S2   with regular rate and rhythm. No extra heart sounds.

 

Respiratory

Symmetric   chest walls. Respirations regular and easy; lungs clear to auscultation   bilaterally.

 

Gastrointestinal

Abdomen   flat; BS active in all 4 quadrants. Abdomen soft, suprapubic   tender. No hepatosplenomegaly.

 

Genitourinary

Suprapubic   tenderness noted. Skin color normal   for ethnicity. Irritation noted at   labia majora, minora, and perineum. No ulcerated lesions noted. Lymph nodes   not palpable. Vagina pink and moist   without lesions. Discharge minimal,   thick, dark red, no odor. Cervix pink   without lesions. No CMT. Uterus normal size, shape, and consistency.  Soap Note 1 Acute Conditions

 

Musculoskeletal

Full   ROM seen in all 4 extremities as patient moved about the exam room.

 

Neurological 

Speech   clear. Good tone. Posture erect. Balance stable; gait normal.

 

Psychiatric

Alert   and oriented. Dressed in clean clothes. Maintains eye contact. Answers   questions appropriately.

 

Lab Tests

Urinalysis   – blood noted (pt. on menstrual period), but results negative for infection

Urine   culture testing unavailable

Wet   prep – inconclusive

STD   testing pending for gonorrhea, chlamydia, syphilis, HIV, HSV 1 & 2, Hep B   & C

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Special Tests- No ordered at this   time.

 

Diagnosis 

 

Differential Diagnoses

  • 1-Bacterial Vaginosis (N76.0)
  • 2- Malignant neoplasm of female genital organ,         unspecified. (C57.9)
  • 3-Gonococcal infection, unspecified. (A54.9)

Diagnosis

o Urinary   tract infection, site not specified. (N39.0) Candidiasis of vulva and vagina.   (B37.3) secondary to presenting symptoms (Colgan & Williams, 2011) & (Hainer   & Gibson, 2011).

 

Plan/Therapeutics

 

  • Plan:
    • Medication –

§ Terconazole cream 1 vaginal application QHS for 7 days for   Vulvovaginal Candidiasis;

§ Sulfamethoxazole/TMP DS 1 tablet PO twice daily for 3 days   for UTI (Woo & Wynne, 2012)

  • Education –

§ Medications prescribed.

§ UTI and Candidiasis symptoms, causes, risks, treatment,   prevention. Reasons to seek emergent care, including N/V, fever, or back   pain.

§ STD risks and preventions.

§ Ulcer prevention, including taking Protonix as prescribed,   not exceeding the recommended dose limit of NSAIDs, and not taking NSAIDs on   an empty stomach.

  • Follow-up         

§ Pt will be contacted with results of STD studies.

§ Return to clinic when finished the period for perform   pap-smear or if symptoms do not resolve with prescribed TX.

 

References

Colgan, R. & Williams, M. (2011). Diagnosis and Treatment of Acute Uncomplicated Cystitis. American Family Physician, 84(7), 771-776.

Hainer, B. & Gibson, M. (2011). Vaginitis: Diagnosis and Treatment. American Family Physician, 83(7), 807-815.

Woo, T. M., & Wynne, A. L. (2012). Pharmacotherapeutics for Nurse Practitioner Prescribers (3rd ed.). Philadelphia, PA: F.A. Davis Company. Soap Note 1 Acute Conditions

2 sample Sample Regular Soap Note Template.docx

PATIENT INFORMATION

Name: Mr. W.S.

Age: 65-year-old

Sex: Male

Source: Patient

Allergies: None

Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime

PMH: Hypercholesterolemia

Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago.

Surgical History: Appendectomy 47 years ago.

Family History: Father- died 81 does not report information

Mother-alive, 88 years old, Diabetes Mellitus, HTN

Daughter-alive, 34 years old, healthy

Social Hx: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone.

SUBJECTIVE:

Chief complain: “headaches” that started two weeks ago

Symptom analysis/HPI:

The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness. He states that he has been under stress in his workplace for the last month.

Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.

ROS:

CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizzeness as describe above. Denies changes in LOC. Denies history of tremors or seizures.

HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing.

Respiratory: Patient denies shortness of breath, cough or hemoptysis.

Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal

dyspnea.

Gastrointestinal: Denies abdominal pain or discomfort. Denies flatulence, nausea, vomiting or

diarrhea.

Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.

MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.

Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.

Objective Data

CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 0/10.

General appearance: The patient is alert and oriented x 3. No acute distress noted. NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and timeSensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.

HEENT: Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,.Lids non-remarkable and appropriate for race.

Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses.

Cardiovascular: S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec.

Respiratory: No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation.

Gastrointestinal: No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no rebound no distention or organomegaly noted on palpation

Musculoskeletal: No pain to palpation. Active and passive ROM within normal limits, no stiffness.

Integumentary: intact, no lesions or rashes, no cyanosis or jaundice.

Assessment

Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed.

Differential diagnosis:

Ø Renal artery stenosis (ICD10 I70.1)

Ø Chronic kidney disease (ICD10 I12.9)

Ø Hyperthyroidism (ICD10 E05.90)

Plan

Diagnosis is based on the clinical evaluation through history, physical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease.

These basic laboratory tests are:

· CMP

· Complete blood count

· Lipid profile

· Thyroid-stimulating hormone

· Urinalysis

· Electrocardiogram

Ø Pharmacological treatment: 

The treatment of choice in this case would be:

Thiazide-like diuretic and/or a CCB

· Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily.

Ø Non-Pharmacologic treatment:

· Weight loss

· Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat

· Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults

· Enhanced intake of dietary potassium

· Regular physical activity (Aerobic): 90–150 min/wk

· Tobacco cessation

· Measures to release stress and effective coping mechanisms.

Education

· Provide with nutrition/dietary information.

· Daily blood pressure monitoring at home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP

· Instruction about medication intake compliance.

· Education of possible complications such as stroke, heart attack, and other problems.

· Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all

Follow-ups/Referrals

· Evaluation with PCP in 1 weeks for managing blood pressure and to evaluate current hypotensive therapy. Urgent Care visit prn.

· No referrals needed at this time.

References

Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017 (25th ed.). Print (The 5-Minute Consult Series).

Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.). ISBN 978-0-8261-3424-0 Soap Note 1 Acute Conditions

Soap Note Asthma Assignment

Topic:    Asthma

Use APA format and must include minimum of 2 Scholarly Citations.

Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

Turn it in Score must be less than 30% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 30%. Copy paste from websites or textbooks will not be accepted or tolerated.

Please use one of the sample templates for you soap note.Just follow the template attach.

PATIENT INFORMATION

Name: Mr. W.S.

Age: 65-year-old

Sex: Male

Source: Patient

Allergies: None

Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime

PMH: Hypercholesterolemia

Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago.

Surgical History: Appendectomy 47 years ago.

Family History: Father- died 81 does not report information

Mother-alive, 88 years old, Diabetes Mellitus, HTN

Daughter-alive, 34 years old, healthy

Social Hx: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone.

SUBJECTIVE:

Chief complain: “headaches” that started two weeks ago

Symptom analysis/HPI:

The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness. He states that he has been under stress in his workplace for the last month.

Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.

 

ROS:

CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizzeness as describe above. Denies changes in LOC. Denies history of tremors or seizures.

HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing. Soap Note Asthma Assignment

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Respiratory: Patient denies shortness of breath, cough or hemoptysis.

Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal

dyspnea.

Gastrointestinal: Denies abdominal pain or discomfort. Denies flatulence, nausea, vomiting or

diarrhea.

Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.

MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.

Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.

Objective Data

CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 0/10.

General appearance: The patient is alert and oriented x 3. No acute distress noted. NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.

HEENT: Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,.Lids non-remarkable and appropriate for race.

 

Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses.

Cardiovascular: S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec.

Respiratory: No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation.

Gastrointestinal: No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no rebound no distention or organomegaly noted on palpation

Musculoskeletal: No pain to palpation. Active and passive ROM within normal limits, no stiffness.

Integumentary: intact, no lesions or rashes, no cyanosis or jaundice.

 

Assessment

Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed.

Differential diagnosis:

  • Renal artery stenosis (ICD10 I70.1)
  • Chronic kidney disease (ICD10 9)
  • Hyperthyroidism (ICD10 E05.90)

Plan

Diagnosis is based on the clinical evaluation through history, physical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease.

These basic laboratory tests are:

  • CMP
  • Complete blood count
  • Lipid profile
  • Thyroid-stimulating hormone
  • Urinalysis
  • Electrocardiogram
  • Pharmacological treatment:

The treatment of choice in this case would be:

Thiazide-like diuretic and/or a CCB

  • Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily.

 

  • Non-Pharmacologic treatment:
  • Weight loss
  • Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat
  • Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults
  • Enhanced intake of dietary potassium
  • Regular physical activity (Aerobic): 90–150 min/wk
  • Tobacco cessation
  • Measures to release stress and effective coping mechanisms.

Education

  • Provide with nutrition/dietary information.
  • Daily blood pressure monitoring at home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP
  • Instruction about medication intake compliance.
  • Education of possible complications such as stroke, heart attack, and other problems.
  • Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all

 

Follow-ups/Referrals

  • Evaluation with PCP in 1 weeks for managing blood pressure and to evaluate current hypotensive therapy. Urgent Care visit prn.
  • No referrals needed at this time.

 

References

Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017 (25th ed.). Print (The 5-Minute Consult Series).

Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.). ISBN 978-0-8261-3424-0 Soap Note Asthma Assignment

 

Common Health Conditions with Implications for Women

 

Select a patient that you examined during the last four weeks as a Nurse Practitioner. Select a female patient with common endocrine or musculoskeletal conditions, Evaluate differential diagnoses for common endocrine or musculoskeletal conditions you chose .With this patient in mind, address the following in a SOAP Note:

 

Subjective: What details did the patient provide regarding or her personal and medical history?

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Objective: What observations did you make during the physical assessment?

 

Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?

 

Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up appointment with the provideras well as a rationale for this treatment and management plan.

Reflection notes: What would you do differently in a similar patient evaluation? And how can you relate this to your class and clinical readings. Common Health Conditions with Implications for Women

References

 

Schuiling, K. D., & Likis, F. E. (2013). Women’s gynecologic health (2nd ed.). Burlington, MA: Jones and Bartlett Publishers.

Chapter 22, “Urinary Tract Infection in Women” (pp. 535–546)

 

Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Women’s health (4th ed.). Burlington, MA: Jones & Bartlett Publishers.

 

Review: Chapter 8, “Primary Care in Women’s Health” (pp. 431–560)

 

Centers for Disease Control and Prevention. (2012b). Women’s health. Retrieved from http://www.cdc.gov/women/

 

National Institutes of Health. (2012). Office of Research on Women’s Health (ORWH). Retrieved from http://orwh.od.nih.gov/

 

U.S. Department of Health and Human Services. (2012a). Womenshealth.gov. Retrieved from http://www.womenshealth.gov/ Common Health Conditions with Implications for Women

 

 

Developing Organizational Policies And Practices

Developing Organizational Policies And Practices

Within a healthcare setting, the needs of the workforce, resources, and patients are often in conflict. Mandatory overtime, implementation of staffing ratios, use of unlicensed assisting personnel, and employer reductions of education benefits are examples of practices that might lead to conflicting needs in practice.

Leaders can contribute to both the problem and the solution through policies, action, and inaction. In this Assignment, you will further develop the white paper you began work on in Module 1 by addressing competing needs within your organization. Developing Organizational Policies And Practices

To Prepare:

Review the national healthcare issue/stressor you examined in your Assignment for Module 1, and review the analysis of the healthcare issue/stressor you selected.( Restrictionsonnursepractitioners.)

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· Identify and review two evidence-based scholarly resources that focus on proposed policies/practices to apply to your selected healthcare issue/stressor.

· Reflect on the feedback you received from your colleagues on your Discussion post regarding competing needs.

The Assignment (4-5 pages):

Developing Organizational Policies and Practices

Add a section to the paper you submitted in Module 1. The new section should address the following:

· Identify and describe at least two competing needs impacting your selected healthcare issue/stressor.

· Describe a relevant policy or practice in your organization that may influence your selected healthcare issue/stressor.

· Critique the policy for ethical considerations, and explain the policy’s strengths and challenges in promoting ethics.

· Recommend one or more policy or practice changes designed to balance the competing needs of resources, workers, and patients, while addressing any ethical shortcomings of the existing policies. Be specific and provide examples.

· Cite evidence that informs the healthcare issue/stressor and/or the policies, and provide two scholarly resources in support of your policy or practice recommendations.

INSTRUCTION

This paper MUST contain a title page, an introduction, a purpose statementbody, and conclusion – all with appropriate citations and references (3 or more references.) Make sure you are using headings so that the content is clear. Developing Organizational Policies And Practices

WK 5 Assignment – Generalized Anxiety Disorder

WK 5 Assignment – Generalized Anxiety Disorder

Case study for Assignment is attached.

Examine Case Study: A Middle-Aged Caucasian Man With Anxiety. 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.

At each decision point stop to complete the following: WK 5 Assignment – Generalized Anxiety Disorder

· Decision #1

o Which decision did you select?

o Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

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o Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?

· Decision #2

o Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?

· Decision #3

o Why did you select this decision? Support your response with evidence and references to the Learning Resources.

o What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.

o Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

Note: Support your rationale with a minimum of three academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. WK 5 Assignment – Generalized Anxiety Disorder