Pharmacokinetics And Pharmacodynamics

Pharmacokinetics And Pharmacodynamics

As an advanced practice nurse assisting physicians in the diagnosis and treatment of disorders, it is important to not only understand the impact of disorders on the body, but also the impact of drug treatments on the body. The relationships between drugs and the body can be described by pharmacokinetics and pharmacodynamics.

Pharmacokinetics describes what the body does to the drug through absorption, distribution, metabolism, and excretion, whereas pharmacodynamics describes what the drug does to the body.

hen selecting drugs and determining dosages for patients, it is essential to consider individual patient factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes. These patient factors include genetics, gender, ethnicity, age, behavior (i.e., diet, nutrition, smoking, alcohol, illicit drug abuse), and/or pathophysiological changes due to disease.

For this Discussion, you reflect on a case from your past clinical experiences and consider how a patient’s pharmacokinetic and pharmacodynamic processes may alter his or her response to a drug.

To Prepare
  • Review the Resources for this module and consider the principles of pharmacokinetics and pharmacodynamics.
  • Reflect on your experiences, observations, and/or clinical practices from the last 5 years and think about how pharmacokinetic and pharmacodynamic factors altered his or her anticipated response to a drug.
  • Consider factors that might have influenced the patient’s pharmacokinetic and pharmacodynamic processes, such as genetics (including pharmacogenetics), gender, ethnicity, age, behavior, and/or possible pathophysiological changes due to disease.
  • Think about a personalized plan of care based on these influencing factors and patient history in your case study.
 

Post a description of the patient case from your experiences, observations, and/or clinical practice from the last 5 years. Then, describe factors that might have influenced pharmacokinetic and pharmacodynamic processes of the patient you identified. Finally, explain details of the personalized plan of care that you would develop based on influencing factors and patient history in your case. Be specific and provide examples.

Rubric:

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

References:

Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.

  • Chapter 1, “Prescriptive Authority” (pp. 1–3)
  • Chapter 2, “Rational Drug Selection and Prescription Writing” (pp. 5–9)
  • Chapter 3, “Promoting Positive Outcomes of Drug Therapy” (pp. 11–16)
  • Chapter 4, “Pharmacokinetics, Pharmacodynamics, and Drug Interactions” (pp. 17–40)
  • Chapter 5, “Adverse Drug Reactions and Medical Errors” (pp. 41–49)
  • Chapter 6, “Individual Variation in Drug Response” (pp. 51–56)

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Please Rephrase Answers And Answer 1 Question.

Please Rephrase Answers And Answer 1 Question.

1) Cultural competence and diversity are often considered to have the same meaning in healthcare facilities. What is the difference between these two terms and their applicability in terms of healthcare professionals in various healthcare settings? 

Although cultural competence and diversity are often considered to have the same meaning in healthcare facilities they are different. Diversity is in fact a component of cultural competency. This includes ethnic and racial backgrounds, age, physical and cognitive abilities, family status, religion, sexual orientation, etc… cultural competency wouldnt exist without diversity . It is important for healthcare professionals to be culturally competent for the sake of the patient’s comfort in receiving services. Lack of cultural competence can lead to noncompliance, missed appointments, and patients seeking care from non-professionals. In the cultural compliance training video an older Hispanic women spoke on how her physician said they’d schedule her a new appointment and she basically said that she wouldn’t show up because it would be the same thing that happened to her at her current appointment; a miscommunication and nothing being resolved. Health professionals who are diverse tend to have a better work ethic and connection with their patients because they’re most likely to be understand certain cultural distinctions, treatment seeking behaviors, etc… (cultural  compentency for the health professional)

2) Explain the unique circumstances under which the ancestors of most Black/African American people arrived in the Americas. Why is it important for health service professionals to understand this history?

The first Africans in the New World arrived with Spanish and Portuguese explorers and settlers. By 1600 an estimated 275,000 Africans, both free and slave, were in Central and South America and the Caribbean area. Africans first arrived in the area that became the United States in 1619, when a handful of captives were sold by the captain of a Dutch man-of-war to settlers at Jamestown. Others were brought in increasing numbers to fill the desire for labor in a country where land was plentiful and labor scarce. By the end of the 17th century, approximately 1,300,000 Africans had landed in the New World. From 1701 to 1810 the number reached 6,000,000, with another 1,800,000 arriving after 1810. Some Africans were brought directly to the English colonies in North America. Others landed as slaves in the West Indies and were later resold and shipped to the mainland. (African  American History: Scholastic , n.d.) However many “black” colored individuals rather identify themselves with their family-related nationality rather than where they were born or raised. Some rather the term black when being identified and some rather be identified as African American. This is very complex. I know, myself, I do not like to identified as Black I prefer to identify myself and Haitian/Bahamian because I consider the Black culture as people who only speak English and are just Americans with darker colored skin, who eat American meals and have American traditions. I speak English and Creole, I eat Haitian meals and follow Haitian traditions. I was born in America but my parents and older sisters were born in Bahamas and had the Haitian culture bestowed in them so I identify as that. It is important for health service professionals to understand the history of how most Black/African Americans were brought to the Americas so they’d be able to establish a positive relationship with their patients. The best way to approach patients on the matter would be to just humbly ask the person how they identify themselves. (cultural compentency for the  health professional)

3) Is Hispanic a racial or ethnic category? Explain. How might this impact the status of the African/Black group, for example, in terms of whether it is the largest or second largest minority group?

Many people confuse racial and ethnic categories when it comes to the Hispanic group. But that is because many people do not know the difference between one’s race and one’s ethnicity. Unlike with ethnicity, one can only belong to one race. See, race is your biologically engineered features. It can include skin color, skin tone, eye and hair color, as well as a tendency toward developing certain diseases. It is not something that can be changed or disguised. People can however change or impersonate ethnicities through choice and principles. Ethnicity is about tradition, learned behavior and customs. It is about learning where you come from, and celebrating the traditions and ideas that are part of that region.(difference  between ethnicity and race, n.d.). Thus, Hispanic would fall more into the ethnic category because the Hispanic group has no permanent physical characteristics, language or cultural norms. So a person of Hispanic decent can be Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race. Since Hispanic is not a racial group but an ethnic group, the Hispanic group comprise the largest minority group and the African/Black group comes in second as the second largest minority group. (cultural competency for the  health professional)

4) List the racial categories based on the OMB classification in the United States. Explain the geographic origins of the people designated for each of the categories. Why is it important for health professionals to understand cultural differences among and between groups?

The racial categories based on the OMB classification in the United States are as follows:

· Native Americans or Alaskan Native: A person having origins in any of the original peoples of North America and who maintains cultural identification through tribal affiliations or community recognition.

· Asian/Pacific Islander: A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands.

· African American/Black: A person having origins in any of the black racial groups of Africa.

· White: A person having origins in any of the original peoples of Europe, North Africa, or the Middle East. (cultural  competency for the health professional)

In the healthcare setting it is very important for health professionals to understand cultural differences among and between groups. In health care settings, cultural alertness, compassion, and competence conducts are essential because even such concepts as health, illness, suffering, and care mean different things to different people. Being knowledgeable of cultural customs enables health care providers to provide better service and help avoid misconstructions among staff, residents/patients, and families. Health care providers trained in cultural competency:

– Demonstrate greater understanding of the central role of culture in healthcare

-Recognize common barriers to cultural understanding among providers, staff, and residents/patients

-Identify characteristics of cultural competence in health care settings

-Interpret and respond effectively to diverse older adults’ verbal and nonverbal communication cues

– Assess and respond to differences in values, beliefs, and health behaviors among diverse populations and older adults

-Demonstrate commitment to culturally and linguistically appropriate services

-Work more effectively with diverse health care staff.

-Act as leaders, mentors, and role models for other health care providers (Dawn Lehman, Paula Fenza, &  and Linda Hollinger-Smith)

5. A physical therapy office in “Little Haiti” in Miami, Florida is  closed due to lack of funds. All patients’ appointments are routed to a  nearby hospital’s physical therapy department in which the predominant  population served is Cuban. List and describe a minimum some steps you  believe the department has to take to meet the needs of the patients  from a culturally competent prospective.

510 week 7 & 8Top of Form

Discussion Board prompt 1

What is the difference between a protocol, standard of care delivery, and policy at the practice, state, and federal level? Briefly outline each. What are the perceptions of the health care delivery system from the perspectives of patients, providers, payers, and policy makers? Discuss at least one perception from one of the populations listed: patient, provider, payer, and policy maker.

Due date 08/22/2020

2 replies. References and APA

Bottom of Form

Reply 1 Ingrid

Protocols can be defined as an official procedures or system process’ implemented by a facility, institution, or government establishment. Standards of care delivery is defined as a diagnostic and/or treatment process that a health care provider or professional must adhere to base on a certain type of condition, condition, and/or circumstance. Policy is defined as course of action adopted by a business, corporation, hospital, and/or government establishment (Shiel, 2018).

At the practice level, protocols are what healthcare workers must perform as a guide to a management of a clinical situation and is incorporated into systems as a way healthcare professionals to provide the best evidenced-based care to their patients (n.d.). At the state level and federal level, professional expectations are established and provide the consistency to ensure quality of care. Nurses are expected to follow state and federal level regulations to protect the patient. If the standards of care according to state and federal levels are not met, legal implications can occur as the nurse can be found violating the standard of care. The legal implications can lead to malpractice on the health care professional (n.d.).

A perception that patients have regarding health care delivery system is that health care professionals are held to a standard and must be competent to perform their duties. Patients understand their condition with expectations regarding their treatments, if their treatments are not met, Patients know well enough to file complaints or legal action against the health care employee. From a provider perspective, health care professionals must attend proper schooling and complete a license exam. Having that license ensures that you are competent. The license can be revoked if you are unable to perform your duties therefore a health professional must be responsible and accountable for their actions.

Reply 2 Kristopher

Protocols are an agreed framework outlining the care that will be provided to patients in a designated area of practice. An example of this is a protocol to evaluate and discontinue unnecessary urinary catheters. This protocol has a set of guidelines that can be followed and carried out without a physicians order.

Standard of care delivery describes the care patients should be offered by health professionals and health services for a specific clinical condition or defined clinical pathway in line with current best evidence. (Clinical Care Standards, n.d.)

Health policy refers to decisions, plans, and actions that are undertaken to achieve specific health care goals within a society. An explicit health policy can achieve several things: it defines a vision for the future which in turn helps to establish targets and points of reference for the short and medium term. It outlines priorities and the expected roles of different groups; and it builds consensus and informs people. (Health policy, 2013)

Patient wants satisfactory health treatment, providers focus on patient safety, payers are responsible for enabling the process of patient access and policy makers have viewpoint to provide services, plan and manage health care policies.

Among all, patients’ perception needs to be discuss in detail here because insights of providers, payers and policy makers are concerned with them and their treatment. In a patient’s viewpoint, he or she is expecting, competent, compassionate and ethical care.

2 Board Discussion.

Due date 08/22/250250

APA, references.

Discussion Prompt 1

Describe how the educational level achieved by a nurse or the entry point into professional nursing practice affects the quality and competence of a nurse’s participation in policy making.Why it is important for registered nurses to influence the regulatory process? Does the nurses education have influence on their ability to make an impact?

Discussion Prompt 2

Reflect on what you have learned in this course. What were your major takeaways? Surprises? How will you apply what you have learned to your career?

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Experiment 1: Design An Experiment LAB

Experiment 1: Design An Experiment LAB

Materials 100 Beans (10) 5 x 8 in. Bags Permanent Marker Masking Tape *Paper Towels *Water Note: You must provide the materials listed in *red. EXPERIMENT 1: DESIGN AN EXPERIMENT The following experiment is to be designed by you with the beans provided in the kit. You will design and execute the experiment to test factors that influence seed germination. Whatever your experimental design, be sure to include controls, both positive and negative, and make sure it is reproducible! NOTES ABOUT BEAN GERMINATION • The time to germinate will decrease if you soak the beans overnight before beginning the experiment. • It may take 7 – 10 days for the beans to “sprout.” • Make sure the paper towels remain moist for the duration of your experiment. PROCEDURE 1. Identify 10 – 20 variables that may affect seed germination. Record the variables in Table 5. 2. From your list of variables, select one to test. Form a hypothesis regarding why this variable affects seed germination. 3. Determine the positive and negative controls for your experiment. 4. To germinate the beans, place one folded paper towel into the 5 x 8 in. plastic bag. The paper towel should be moistened, but not soaking wet. Place ten beans in a horizontal line on each enclosed paper towel. Then, seal the bag completely. 5. Prepare three bags of beans for each condition (positive control, negative control, variable). 6. Use masking tape to hang each bag in the environment you select. 7. Collect data, and then create a table, including title, units, and any other useful information. 8. Select the appropriate type of graph, and report the data you collected. 9. Write a lab report for this experiment.

 

Instructions: Read the following experiment and download the lab report template form supplied below.
Once you have completed your experiment and gathered all required data, upload the completed lab report and save a copy for your own reference and safe-keeping. Also, along side your lab report submission record and submit a brief (1 to 2 minute) video on your experiment/observation experience summary. For example, how did you feel while performing this experiment, what was the difficulty level, any obstacles you may have run into, etc..

Introduction to ScienceExperiment 1Design An Experiment Experiment Inventory

Materials 100 Beans

(10) 5 x 8 in. Bags

Permanent Marker

Masking Tape

*Paper Towels

*Water

Note: You must provide the materials listed in *red.

EXPERIMENT 1: DESIGN AN EXPERIMENT

The following experiment is to be designed by you with the beans provided in the kit. You will design and execute the experiment to test factors that influence seed germination. Whatever your experimental design, be sure to include controls, both positive and negative, and make sure it is reproducible!

NOTES ABOUT BEAN GERMINATION

• The time to germinate will decrease if you soak the beans overnight before beginning the experiment.

• It may take 7 – 10 days for the beans to “sprout.”

• Make sure the paper towels remain moist for the duration of your experiment.

PROCEDURE

1. Identify 10 – 20 variables that may affect seed germination. Record the variables in Table 5.

2. From your list of variables, select one to test. Form a hypothesis regarding why this variable affects seed germination.

3. Determine the positive and negative controls for your experiment.

4. To germinate the beans, place one folded paper towel into the 5 x 8 in. plastic bag. The paper towel should be moist-

ened, but not soaking wet. Place ten beans in a horizontal line on each enclosed paper towel. Then, seal the bag com-

pletely.

5. Prepare three bags of beans for each condition (positive control, negative control, variable).

6. Use masking tape to hang each bag in the environment you select.

7. Collect data, and then create a table, including title, units, and any other useful information.

8. Select the appropriate type of graph, and report the data you collected.

9. Write a lab report for this experiment.

© eScience Labs, 2016

Data SheetExperiment 1 Data Sheet Table 5: Experiment Variables

Variables

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Education Assignment

Education Assignment

This assignment is focused on exploring the educational system in Sentinel City®. By completing this assignment, health professional students will identify social ecological frameworks used for health promotion and gain an understanding of how the educational system within a community can have an impact on the health of its residents. Mayor Franklin Hill is available to share his perspective about the education system in Sentinel City®(SC).

Assignment Instructions

1. Review the following resources:

a. Course textbook and/or other assigned readings

b. Meet with Mayor Hill to obtain information about the education system in SC in general.

c. Review the demographics of your selected SC comminuty, including reportable infectious diseases as well as birth and death rates

2. Recommended Supplemental Resources:

a. Golden, D. S. & Earp, J. L. (2012). Social ecological approaches to individuals and their contexts: Twenty years of health. Health Education & Behavior, 39(3), 364-372. DOI: 10.1177/1090198111418634

b. Social Ecological Model /orders/www.cdc.gov/cancer/crccp/sem.htm

c. The Institute of Medicine (2014). Understanding the relationship between education and health: A review of the evidence and an examination of community perspectives. Zimmerman, E. & Woolf, S.H. (2014). Understanding the relationship between education and health. /orders/nam.edu/wp-content/uploads/2015/06/BPH-UnderstandingTheRelationship1.pdf

d. Download and review the free pdf: Promoting health: Intervention Strategies from Social and Behavioral Research (2000). /orders/www.nap.edu/catalog/9939/promoting-health-intervention-strategies-from-social-and-behavioral-research

3. Enter SC® and begin the bus tour.

4. As you tour your community, consider the following: the number of public or private schools and the physical condition of the schools if present. If not present where is the closest school for the community residents? Is here an indication that children walk or take the bus to school? Do parents transport their children to school? Is there a public library? If not, where is the closest? Are there public and/or private daycare centers or preschools? If not, where do the residents find these services?

5. What role does the educational system have on determinants of health?

6. What is not apparent that you would expect to see in a community related to the subsystem-education?

7. Based on your observations, make two recommendations to Mayor Hill that may strengthen this subsystem and provide a rationale for each of your recommendations.

8. Develop an individual and/or community-level intervention related to a health concern that can be impacted by the educational system.

9. For questions, contact your Academic Coach.

Learning Objectives

· Recognize the relationship between education and health

· Identify health indicators related to education

· Discuss the benefits of education at the individual and community level

· Identify social, ecological models of health promotion

· Develop individual and community level interventions related to education

Subsystem: Education
Observations related to the education system in Sentinel City® Two Recommendations to Strengthen Education Subsystem

Evidence-Based Rationale

*Cite sources & create a reference list

Impact or Relationship to Determinants of Health
1.      
2.      
Individual Level Educational Intervention

Population:

Health Concern:

Proposed Intervention:

Community Level Educational Intervention

Population:

Health Concern:

Proposed Intervention:

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.

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Digital Clinical Experience: Focused Exam

Assignment 2: Digital Clinical Experience: Focused Exam: Cough

Review this week’s Learning Resources and consider the insights they provide related to ears, nose, and throat.
Review the Shadow Health Resources provided in this week’s Learning Resources specifically the tutorial to guide you through the documentation and interpretation within the Shadow Health platform. Review the examples also provided.
Review the DCE (Shadow Health) Documentation Template for Focused Exam: Cough found in this week’s Learning Resources and use this template to complete your Documentation Notes for this DCE Assignment.
Access and login to Shadow Health using the link in the left-hand navigation of the Blackboard classroom.
Review the Week 5 Focused Exam: Cough Rubric provided in the Assignment submission area for details on completing the Assignment in Shadow Health.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Focused Exam: Cough Assignment:
Complete the following in Shadow Health:

Respiratory Concept Lab (Required)
Episodic/Focused Note for Focused Exam: Cough
HEENT (Recommended but not required)
Note: Each Shadow Health Assessment may be attempted and reopened as many times as necessary prior to the due date to achieve a total of 80% or better (this includes your DCE and your Documentation Notes), but you must take all attempts by the Week 5 Day 7 deadline.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Weeks 1, 3, 4, and 5)
Bedell, H. E., & Stevenson, S. B. (2013). Eye movement testing in clinical examination. Vision Research 90, 32–37. doi:10.1016/j.visres.2013.02.001. Retrieved from /orders/www.sciencedirect.com/science/article/pii/S0042698913000217
Rubin, G. S. (2013). Measuring reading performance. Vision Research, 90, 43–51. doi:10.1016/j.visres.2013.02.015. Retrieved from http://www.sciencedirect.com/science/article/pii/S0042698913000436
Harmes, K. M., Blackwood, R. A., Burrows, H. L., Cooke, J. M., Harrison, R. V., & Passamani, P. P. (2013). Otitis media: Diagnosis and treatment. American Family Physicians, 88(7), 435–440.
Otolaryngology Houston. (2014). Imaging of maxillary sinusitis (X-ray, CT, and MRI). Retrieved from http://www.ghorayeb.com/ImagingMaxillarySinusitis.html

This website provides medical images of sinusitis, including X-rays, CT scans, and MRIs (magnetic resonance imaging).
Document: Episodic/Focused SOAP Note Exemplar (Word document)

Document: Episodic/Focused SOAP Note Template (Word document)
I HAVE DANNY RIVERA INFORMATION FOR YOU UPLOADED.

Week 5 – Focused Exam: Cough Danny Rivera

Subjective

8-year-old Latino male patient presents today with abuela (grandmother) for c/o cough the past 5 days, sore throat since yesterday along with right ear pain. denies fever, chills, HEENT: denies headache or dizziness, EYES: vision unremarkable, denies eye pain, drainage or redness. EARS: +pain- right ear- 3/10, denies drainage or hearing loss, NOSE: denies sinus pain, +clear thin nasal drainage, reports almost always has runny nose, worse since cough started. THROAT: sore, 2/10, reports started after cough.

ROS CHEST/LUNGS: coughing every couple minutes, “worse at night”-keeps him from falling asleep easily. describes cough as “gurgled and watery”. reports “sometimes” coughing up “slimy, clear stuff”, reports mom gave cough medicine this am, denies any aggravating factors for cough. denies chest pain with or without cough, denies trouble breathing with cough.+tired from cough at night, denies heat/cold intolerance, takes multivitamin, NKDA or environmental allergies, no surgeries, no hospitalizations, PN last year- treated at urgent care- missed 2 wks. of school, HX ear infections, childhood immunizations up to date, no flu vaccine this past year, multivitamin daily, lives with mom, dad, grandparents, primary language is English- some Spanish, +smoke exposure in the home.

Objective V/S: 120/76, HR 100, R 28, T 37.2c Spo2 96%. Noted pediatric male patient sitting upright on table, alert/oriented- answers questions appropriately, pleasant affect, dressed appropriately.

Exam HEENT: no abnormal findings to orbital area- no edema, erythema, sclera white, conjunctiva moist, pink and without erythema or drainage, NOSE: frontal and maxillary sinuses palpated- nontender, not palpable, nares passages pink, patent/intact, clear drainage noted, no wounds/sores, polyps or bleeding noted. EARS: right ear canal erythema, tympanic membrane erythema, cone of light at 5:00, no bulging, intact, no drainage, no obstruction. Left ear canal pink, tympanic membrane intact, pearly/gray, no drainage, no bulging, cone of light at 7:00. THROAT: oral mucosa moist/pink, tonsils +erythema- without edema, no exudate, posterior oropharynx with notable cobble stoning and erythema, no post-nasal drainage noted. NECK: symmetric, no visible abnormality noted, palpable cervical nodes to right lat.

This study source was downloaded by 100000822253261 from CourseHero.com on 03-31-2021 15:15:37 GMT -05:00

/file/54465579/Focus-SOAP-note-Documentationdocx/

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CHEST/LUNGS: supraclavicular and axillary lymph nodes not palpable, palpable equal fremitus bilat, no visible retractions or accessory musculature used during respiration, -Bronchophony, all areas resonant with percussion- no dullness, chest symmetrical, no lesions or rash noted. Lung sounds present, CTA AP/bilat, CARDIAC: RRR, no rubs, palpitations, clicks, gallops, or murmur noted, S1 and S2 audible.

ABD/GU/RECTAL, MUSKULOSKELETAL – deferred.

Assessment Differential Diagnoses 1)Upper Respiratory infection

2)Ear infection

3)Pneumonia

Lab- CBC, rapid strep test, Chest x-ray, sputum culture

Plan Based on labs/diagnostics- antibiotics versus symptomatic care. relieve cough, rhinorrhea, ear and throat pain. humidifier, Tylenol/Advil, cough suppressant/expectorant. return PRN for new or worsening sx’s- n/v/d, febrile, increased malaise/fatigue.

Rest, eat regularly, hydrate with water, take medications as directed, continue with multivitamin- instruct caregiver to monitor to make sure patient only takes as directed.

Wash hands frequently, avoid smoke exposure, refer ENT for frequent rhinorrhea/past HX frequent ear infections eval.

This study source was downloaded by 100000822253261 from CourseHero.com on 03-31-2021 15:15:37 GMT -05:00

/file/54465579/Focus-SOAP-note-Documentationdocx/

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Assignment 2: Digital Clinical Experience: Focused Exam: Cough

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compare physical assessment of child to that of adult

compare physical assessment of child to that of adult

Compare the physical assessment of a child to that of an adult. In addition to describing the similar/different aspects of the physical assessment, explain how the nurse would offer instruction during the assessment, how communication would be adapted to offer explanations, and what strategies the nurse would use to encourage engagement.

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Nursing Assessment

Nursing Assessment

Nursing Assessment

Nursing Assessment

A 50-year-old woman is admitted with chief complaints of headache and decreased range of motion in her neck. She also complains of vertigo, hearing loss in one ear, profuse sweating, and uncontrollable eye movements. Her past medical history indicates that she was in a motor vehicle accident three day before her admission.

What specific diagnostic examinations would you recommend? Why?

What conditions should be ruled out? Why?

How would you distinguish between these conditions? What are the possible causes of these symptoms?

With chief complaints of headache and neck stiffness post MVA, I would first order a CT of the brain and cervical spine. This imaging would be pertinent to rule out possible CVA, brain injury, and neck fracture. There is also a strong chance that the patient has whiplash or a concussion. More information would have to be given to determine if the patient actually hit her head, or if she was rear-ended, to direct plan of care.

The patient does exhibit some symptoms of a concussion, so this must be ruled out. “The signs of a concussion may include: memory problems, confusion, drowsiness or feeling sluggish, dizziness, double vision or blurred vision, abnormal eye movement, headache, nausea or vomiting, sensitivity to light or noise, balance problems, slowed reaction to stimuli, post traumatic vertigo, or dizziness that lasts up to several months” (Healthline Media Editorial Team, 2017). A traumatic brain injury must be ruled out as well especially since the patient exhibits with the symptom of profuse sweating. “Sweating disorders after traumatic brain injury are common with multifactorial causes including injuries, tumors, infarcts, or hemorrhages of the brain or medulla” (Garg, A. Malhotra, R., 2016). Whiplash would also be a possible diagnosis and is very common after MVAs. This would be the less severe diagnoses. “About 80% of the cases of whiplash injuries recover within a few months. However, about 15-20% (about 40,000 cases per year) develop “late whiplash injury syndrome”. This syndrome involves complaints including neck pain, headache, vertigo, hearing loss and tinnitus. Hearing loss, tinnitus and dizziness are the main ontological symptoms of whiplash” (Arches Natural Products, 2018).

Along with imaging, it would be priority to conduct a thorough neuro exam and assess cranial nerves. I would ask if the patient is on any anticoagulants and have basic blood work drawn. Once this data is gathered, the physician should be able to narrow it down and form an accurate diagnosis to treat the patient.

Arches Natural Products (2018). Tinnitus Library: Head and Neck Injuries Cause Tinnitus: Part Two. Retrieved from: /orders/www.tinnitusformula.com/library/head-and-neck-injuries-cause-tinnitus-part-two/

Garg A, Malhotra R (2016) Sweating Disorder after Traumatic Brain Injury. J Anesth Clin Res 7:695. doi: 10.4172/2155-6148.1000695

Healthline Media Editorial Team (2017). Healthline Newsletter: Concussion. Retrieved from /orders/www.healthline.com/health/concussion

Jarvis, C. (2016). Physical Examination and Health Assessment, 7th Edition. [South University]. Retrieved from /orders/digitalbookshelf.southuniversity.edu/#/books/9781455728107/

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SOAP Note Assignemnt

SOAP Note Assignment

SOAP Note Assignemnt

SOAP Note Assignemnt

Click here to download and analyze the case study for this week. Create a SOAP note for disease prevention, health promotion, and acute care of the patient in the clinical case. Your care plan should be based on current evidence and nursing standards of care.

Visit the online library and research for current scholarly evidence (no older than 5 years) to support your nursing actions. In addition, consider visiting government sites such as the CDC, WHO, AHRQ, Healthy People 2020. Provide a detailed scientific rationale justifying the inclusion of this evidence in your plan.

Next determine the ICD-10 classification (diagnoses). The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-10-CM) is the official system used in the United States to classify and assign codes to health conditions and related information.

Click here to access the codes.

Download the SOAP template to help you design a holistic patient care plan. Utilize the SOAP guidelines to assist you in creating your SOAP note and building your plan of care. You are expected to develop a comprehensive SOAP note based on the given assessment, diagnosis, and advanced nursing interventions. Reflect on what you have learned about care plans through independent research and peer discussions and incorporate the knowledge that you have gained into your patient’s care plan.  If the information is not in the provided scenario please consider it normal for SOAP note purposes, if it is abnormal please utilize what you know about the disease process and write what you would expect in the subjective and objective areas of your note.

Format

  • Your care plan should be formatted as a Microsoft Word document. Follow the current APA edition style. Your paper should be no longer than 3-4 pages excluding the title and the references and in 12pt font.
  • Name your document: SU_NSG6001_W2A2_LastName_FirstInitial.doc.
  • Submit your document to the Submissions Area by the due date assigned

    Week 2: Respiratory Clinical Case

    Patient Setting:

    65 year old Caucasian female that was discharged from the hospital 10 weeks ago after a motor vehicle

    accident presents to the clinic today. States she is having severe wheezing, shortness of breath and

    coughing at least once daily. She can barely get her words out without taking breaks to catch her breath

    and states she has taken albuterol once today.

    HPI

    Frequent asthma attacks for the past 2 months (more than 4 times per week average), serious MVA 10

    weeks ago; post traumatic seizure 2 weeks after the accident; anticonvulsant phenytoin started – no

    seizure activity since initiation of therapy.

    PMH

    History of periodic asthma attacks since early 20s; mild congestive heart failure diagnosed 3 years ago;

    placed on sodium restrictive diet and hydrochlorothiazide; last year placed on enalapril due to

    worsening CHF; symptoms well controlled the last year.

    Past Surgical History

    None

    Family/Social History

    Family: Father died age 59 of kidney failure secondary to HTN; Mother died age 62 of CHF

    Social: Nonsmoker; no alcohol intake; caffeine use: 4 cups of coffee and 4 diet colas per day.

    Medication History

    Theophylline SR Capsules 300 mg PO BID

    Albuterol inhaler, PRN

    Phenytoin SR capsules 300 mg PO QHS

    HTCZ 50 mg PO BID

    Enalapril 5 mg PO BID

    Allergies

    NKDA

    ROS

    Positive for shortness of breath, coughing, wheezing and exercise intolerance. Denies headache,

    swelling in the extremities and seizures.

    Physical exam

    BP 171/94, HR 122, RR 31, T 96.7 F, Wt 145, Ht 5’ 3”

    VS after Albuterol breathing treatment – BP 134/79, HR 80, RR 18

    Gen: Pale, well developed female appearing anxious. HEENT: PERRLA, oral cavity without lesions, TM

    without signs of inflammation, no nystagmus noted. Cardio: Regular rate and rhythm normal S1 and S2.

    Chest: Bilateral expiratory wheezes. Abd: soft, non-tender, non-distended no masses. GU:

    Unremarkable. Rectal: Guaiac negative. EXT: +1 ankle edema, on right, no bruising, normal pulses.

    NEURO: A&O X3, cranial nerves intact.

    Laboratory and Diagnostic Testing

    Na – 134

    K – 4.9

    Cl – 100

    BUN – 21

    Cr – 1.2

    Glu – 110

    ALT – 24

    AST – 27

    Total Chol – 190

    CBC – WNL

    Theophylline – 6.2

    Phenytoin – 17

    Chest Xray – Blunting of the right and left costophrenic angles

    Peak Flow – 75/min; after albuterol – 102/min

    FEV1 – 1.8 L; FVC 3.0 L, FEV1/FVC 60%

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Women’s and Men’s Health, Infectious Disease

Women’s and Men’s Health, Infectious Disease, and Hematologic Disorders

HH is a 68 yo M who has been admitted to the medical ward with community-acquired pneumonia for the past 3 days. His PMH is significant for COPD, HTN, hyperlipidemia, and diabetes. He remains on empiric antibiotics, which include ceftriaxone 1 g IV qday (day 3) and azithromycin 500 mg IV qday (day 3). Since admission, his clinical status has improved, with decreased oxygen requirements. He is not tolerating a diet at this time with complaints of nausea and vomiting.

Ht: 5’8” Wt: 89 kg

Allergies: Penicillin (rash)

Health Needs

Nutrition status. The patient is not tolerating diet, related to nausea (N) and vomiting (V). It is unclear in the case scenario when the patient first complained of N and V. It is less likely to be caused by CAP (Baer, 2019). It can be a side effect of the antibiotics (Rxlist, 2018), or related to a condition undiscovered by the provider yet. Further physical examination and a KUB are necessary to determine if the N and V are a side effect of the medications or caused by a different condition.

Hydration status of the patient. The patient has been having N and V. It is essential to maintain the patient well hydrated during recovery time because hydration loosens up the secretion, which makes it easier for the patient to breathe by coughing and clearing up their airway (Ausmed, 2017). Strict intake and output measurement are essential to prevent dehydration.

Length of IV antibiotic therapy. The Infectious Diseases Society of America (IDSA) recommends treating CAP patients who are hospitalized with five to seven days of empiric antibiotics (File, 2020). IDSA recommends to re-evaluate patients by the fifth to the seventh day before stopping the antibiotic, extend the therapy needed if the patient is febrile, needs supplemental oxygen (unless required for a preexisted condition), and patient clinically unstable (HR>100, RR>24, and SBP<90) (File, 2020).

Treatment Regimen

Metoclopramide 10 mg IV Q6H to control the N and V if no underlining condition was found (Entringer, 2019).

If the patient is unable to drink, start the patient on IV fluid replacement therapy with normal saline 0.9 at 75 ml/hr.

Total fluid volume per day [weight (kg) x 20 ml/kg/day] = 89 x 20= 1780 ml

Infusion rate = total fluid volume per day ÷ 24 hour = 1780 ÷ 24= 74.1= 75 ml/hr (EBM Consult, n.d.).

I would recommend continuing the patient’s current antibiotic until day 7. Then, re-evaluate the patient before stopping them. I do not feel the need to change the current antibiotic because the patient’s status is improving, and he requires less O2.

Reconcile the patient’s home medications except for the diabetes medications. The most important medication to reconcile is the COPD medication, to prevent COPD exacerbation, which can lead to an increase risk of mortality (Braeken et al., 2014).

Sliding-Scale Insulin (SSI) to treat the patient’s high blood sugar. Studies show SSI has better ability to keep patients’ blood sugar within or close to target during hospitalization by administrating short-acting insulin frequently (Ambrus & O’Connor, 2019)

Encourage the patient using incentive spirometer (IS). IS can help him practice taking deep breaths, which can help open the airways, prevent fluid or mucus from building up in the lungs, make it easier for the patient to breathe, and lower the O2 supplement demand (Healthwise, n.d.).

Education

Take Metoclopramide before a meal to prevent N and V and to improve the nutrition status, and hydration status.

Teach the patient how to use IS and the benefit of using IS.

The patient is above the age of 65 years old and has COPD, which increases the risk of CAP. Educate the patient about getting the pneumonia vaccine before discharge to lower the risk of recurrent pneumonia in the future (Centers for Disease Control and Prevention, 2019).

References

Ambrus, D. B., & O’Connor, M. J. (2019). Things We Do For No Reason: Sliding-Scale Insulin as Monotherapy for Glycemic Control in Hospitalized Patients. Journal of Hospital Medicine, 14(2), 114-116. doi:10.12788/jhm.3109

Ausmed. (2017). Pneumonia Symptoms, Signs and Treatment. Retrieved July 26, 2020, from /orders/www.ausmed.com/cpd/articles/pneumonia-explained

Baer, S. L. (2019). Community-Acquired Pneumonia in Adults. Retrieved July 26, 2020, from /orders/www.cedars-sinai.org/health-library/diseases-and-conditions/c/community-acquired-pneumonia-in-adults.html

Braeken, D., Franssen, F., Schütte, H., Pletz, M., Bals, R., Martus, P., & Rohde, G. (2014). Increased Severity and Mortality of CAP in COPD: Results from the German Competence Network, CAPNETZ. Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation, 2(2), 131-140. doi:10.15326/jcopdf.2.2.2014.0149

Centers for Disease Control and Prevention. (2019, November 21). Pneumonia Can Be Prevented-Vaccines Can Help. Retrieved July 26, 2020, from /orders/www.cdc.gov/pneumonia/prevention.html

Entringer, S. (2019). Reglan Uses, Dosage & Side Effects. Retrieved July 26, 2020, from /orders/www.drugs.com/reglan.html

EBM Consult. (n.d.). Maintenance Fluid Calculator. Retrieved July 26, 2020, from /orders/www.ebmconsult.com/app/medical-calculators/maintenance-fluid-calculator?change_to_si=NO

File, T. M. (2020). Treatment of community-acquired pneumonia in adults who require hospitalization. Retrieved July 26, 2020, from /orders/www.uptodate.com/contents/treatment-of-community-acquired-pneumonia-in-adults-who-require-hospitalization

Healthwise. (n.d.). Breathing Exercises: Using a Manual Incentive Spirometer. Retrieved July 26, 2020, from /orders/www.healthlinkbc.ca/health-topics/abj5949

Rxlist. (2018, December 21). Side Effects of Ceftriaxone (Ceftriaxone Sodium and Dextrose Injection ), Warnings, Uses. Retrieved July 26, 2020, from /orders/www.rxlist.com/ceftriaxone-side-effects-drug-center.htm

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Women’s and Men’s Health Infectious Disease and Hematologic Disorders

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Case Study Topic: Meeting The Health Needs For Mrs. Smith

Case Study Topic: Meeting The Health Needs For Mrs. Smith

Directions:

1. To complete this assignment:

· Read the case study above.

· Assume the role as the Public Relations Director for Purple Cross of North Carolina.

o The CEO directs you to interview the Telehealth Director regarding the use of Telehealth with Mrs. Smith. The CEO directs you to create one thought-provoking question for each of the following topics:

· Meeting the health needs of Mrs. Smith

· Decision-making process for technology selected for Mrs. Smith

· Benefits and risks in using Telehealth technology for Mrs. Smith

· Cost and staff involved in using Telehealth technology for Mrs. Smith

o Note: Your questions must be original; not copied or modified from any source, including your textbook. Your questions cannot simply rephrase the topic.

o For each question, the CEO requires that you provide your rationale. Describe how the question will yield a thorough response, and not simply a “yes” or “no” answer.

· Any cited sources to support your rationale statements must be identified, using APA formatting.

· Prior to submission, review your responses to ensure that they contain no spelling or grammatical errors.

2. Submit the Week 4 Assignment via Blackboard by clicking on the “Week 4 Assignment” link.

3. Include the proper file naming convention:

· CMP105_wk4_assn_jsmith_mmddyyyy.

For each topic, write your question and rationale.

CMP105: Week 4 Assignment Page 4

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Case Study: Telehealth

Assignment Overview

This assignment is intended to demonstrate your comprehension of how using efficient eHealth tools and expert system applications assists health professionals in decision-making.

For this assignment, you will read a case study that describes the steps taken to help an elderly woman remain independent in the comfort of her own home. Based on the scenario described in the case study, you will create a set of interview questions to ask the Telehealth Director.

Assignment Details:

Perform the following tasks:

· Complete the reading assignment and the interactive lesson before attempting this assignment.

· To complete this assignment:

· Read the case study located in the Assignment Worksheet section below.

· Assume the role as the Public Relations Director for Purple Cross of North Carolina.

· The CEO requests that you interview the Telehealth Director about the use of Telehealth with Mrs. Smith. The CEO requests that you create one thought-provoking question for each of the following topic areas:

· Meeting the health needs of Mrs. Smith

· Decision-making process for technology selected for Mrs. Smith

· Benefits and risks in using Telehealth technology for Mrs. Smith

· Cost and staff involved in using Telehealth technology for Mrs. Smith

· Note: Your questions must be original; not copied or modified from any source, including your textbook. Your questions cannot simply rephrase the above criteria.

· For each question, the CEO requires that you provide your rationale. Describe how the question will yield a thorough response, and not simply a “yes” or “no” answer.

· Any cited sources to support your rationale statements must be identified, using APA formatting.

· Prior to submission, review your responses to ensure that they contain no spelling or grammatical errors.

· Submit the Week 4 Assignment via Blackboard by clicking on the “Week 4 Assignment” link.

· Include the proper file naming convention:

· CMP105_wk4_assn_jsmith_mmddyyyy.

Grading:

Grading Criteria Points Possible Points Earned
Created unique thought-provoking question for each topic area.
· Meeting the health needs of Mrs. Smith 5  
· Decision-making process for technology selected for Mrs. Smith 5  
· Benefits and risks in using Telehealth technology for Mrs. Smith 5  
· Cost and staff involved in using teleheath technology for Mrs. Smith 5  
Provided valid rationale for each question, supported by research
· Meeting the health needs of Mrs. Smith 5  
· Decision-making process for technology selected for Mrs. Smith 5  
· Benefits and risks in using Telehealth technology for Mrs. Smith 5  
· Cost and staff involved in using teleheath technology for Mrs. Smith 5  
Questions are original, requiring a thorough response. 5  
No spelling or grammatical errors. 5  
Total Points 50  

Assignment Worksheet

· Case Study

Mrs. Smith is 82 years old and is diagnosed with hypertension, diabetes, and congestive heart failure. Her two children live in California, while she lives in North Carolina in a small family home on 10 acres of land in the Blue Ridge Mountains. Mrs. Smith has been in the hospital four times in the last year due to congestive heart failure. As her eyesight and mobility get worse with age, she has found it a challenge to stay on her medical plan and to do her shopping for the right foods she knows she should be eating. Mrs. Smith’s health plan, Purple Cross of North Carolina, assigned a nurse case manager to address her situation. Purple Cross provided a digital scale and a remote monitoring device that recorded Mrs. Smith’s condition every day by uploading her weight and transmitting the answers to a series of questions on a touch screen kiosk. The case manager also coordinated delivery of Meals on Wheels, providing low-sodium, diabetic-compliant dinners to Mrs. Smith on an ongoing basis. The case manager calls Mrs. Smith twice a week, taking the time to educate her about her medications, her activities, and the disease-specific elements that will keep her healthy and out of the hospital. When the case manager identifies that Mrs. Smith can no longer organize her daily medications, a digital medication dispenser will be provided that will keep her on her medication regimen. The medication dispenser will be preloaded with Mrs. Smith’s medications and will issue a subtle doorbell tone when it is time to take them. With the combination of remote and real-time (telephonic) support persons and technologies, Mrs. Smith can remain in her home and avoid further inpatient admissions.

Directions:

1. To complete this assignment:

· Read the case study above.

· Assume the role as the Public Relations Director for Purple Cross of North Carolina.

· The CEO directs you to interview the Telehealth Director regarding the use of Telehealth with Mrs. Smith. The CEO directs you to create one thought-provoking question for each of the following topics:

· Meeting the health needs of Mrs. Smith

· Decision-making process for technology selected for Mrs. Smith

· Benefits and risks in using Telehealth technology for Mrs. Smith

· Cost and staff involved in using Telehealth technology for Mrs. Smith

· Note: Your questions must be original; not copied or modified from any source, including your textbook. Your questions cannot simply rephrase the topic.

· For each question, the CEO requires that you provide your rationale. Describe how the question will yield a thorough response, and not simply a “yes” or “no” answer.

· Any cited sources to support your rationale statements must be identified, using APA formatting.

· Prior to submission, review your responses to ensure that they contain no spelling or grammatical errors.

2. Submit the Week 4 Assignment via Blackboard by clicking on the “Week 4 Assignment” link.

3. Include the proper file naming convention:

· CMP105_wk4_assn_jsmith_mmddyyyy.

For each topic, write your question and rationale.

Topic: Meeting the health needs for Mrs. Smith

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Case Study Topic: Meeting The Health Needs For Mrs. Smith

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