Need a discussion post by 11 am EST March 17th - Nursing
please note the underlined info below.
Case Study: Contraception
Scenario 3
Elaine Goodwin is a 38-year-old G5 P5 LC 6 presenting to your clinic today to discuss contraceptive options. She states that she is not interested in having more children but her new partner has never fathered a child. Her medical history is remarkable for exercise-induced asthma, migraines, and IBS. Her surgical history is remarkable only for tonsils as a child. Her social history is negative for alcohol and tobacco; she reports daily marijuana use. She has no known drug allergies and takes only vitamin C. Hospitalizations were only for childbirth. Family history reveals that her maternal grandmother is alive with dementia, while her maternal grandfather is alive COPD. Her paternal grandparents are both deceased due to an automobile accident. Her mother is alive with osteopenia and fibromyalgia, and her dad had a history of skin cancer (basal cell). Elaine has one older sister with endometriosis who was told not to have more children because she had blood clots when she was pregnant with her second child. She also has one younger brother with no reported medical problems.
Height 5’ 7” Weight 148 (BMI 23.1) BP 118/72 P 68
HEENT: wnl
Neck: supple without adenopathy
Lungs/CV: wnl
Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge
Abd: soft, +BS, no tenderness
VVBSU: wnl,
Cervix: firm, smooth, parous, without CMT
Uterus: mid, mobile, non-tender, approximately 8 cm,
Adnexa: without masses or tenderness
QUESTION:
What other information do you need?
Elaine relates to you that she has used birth control pills before but “would keep messing them up.” After that she switched to the patch, which she found worked well but discontinued use for reasons she does not remember. After that she used natural family planning but still conceived her last two children unexpectedly. She has had three partners in last 12 months and has been with her current partner for the previous two months. She believes that he is “the one.”
Elaine relates that her cycles come every 28-32 days, for a duration of 5-8 days, and on her heaviest day she must use a super tampon every hour and get up to change her pad 2-3 times at night. Her last gyn exam was one year ago and she shows you a copy of the results on her patient portal. The results for the pap were NILM, HPV negative, and her cultures for GC/CT were negative.
In further questioning, you ask her about her sister’s blood clots and her father’s PE. She shares that her father was 48 years old and “just died one day.” Her sister was on “shots” for her blood clots and then took a pill. She had some blood test done and they said she had something called heterozygous MTHFR and Factor V Leiden.
She has heard about a pill where she will only get her period four times a year and feels now that she’s older she can remember to take the pill daily and plans on putting a reminder in her phone.
QUESTIONS:
What are your next steps/considerations?
What teaching should you do?
What other information do you need?
Here are the instructions
Case Study Discussion: Gynecologic Health
Case studies provide the opportunity to simulate realistic scenarios involving patients presenting with various health problems or symptoms. Such case studies enable nurse learners to apply concepts, lessons, and critical thinking to interviewing, screening, diagnostic approaches, as well as the development of treatment plans.
Photo Credit: Teodor Lazarev / Adobe Stock
For this Case Study Discussion, you will review a case study scenario to obtain information related to a comprehensive well-woman exam and determine differential diagnoses, diagnostics, and develop treatment and management plans.
To prepare:
By Day 1 of this week, you will be assigned to a specific case study scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your case study assignment from your Instructor.
Review the Learning Resources for this week and pay close attention to the media program related to the basic microscope skills. Also, consider re-reviewing the media programs found in Week 1 Learning Resources.
Carefully review the clinical guideline resources specific to your assigned case study.
Use the Focused SOAP Note Template found in the Learning Resources to support Discussion.
By Day 3
Based on the case study scenario provided, complete a comprehensive well-woman exam and critically analyze to focus attention on the diagnostic tests then,
Post your differential diagnosis. Include the additional questions you would ask the patient. Be sure to include an explanation of the tests you might recommend, ruling out any other issues or concerns and include your rationale. Be specific and provide examples. Use your Learning Resources and/or evidence from the literature to support your explanations.
Read a selection of your colleagues’ responses.Rubric Detail
Select Grid View or List View to change the rubrics layout.
ExcellentPoint range: 90–100
Good
Point range: 80–89
Fair
Point range: 70–79
Poor
Point range: 0–69
Main Posting:
Response to the case study
discussion questions
includes appropriate
diagnoses with explanations
of appropriate diagnostic
tests and treatment options
as directed, is based on
evidence-based research
where appropriate, and is
incorporates syntheses
representative of knowledge
gained from the course
readings for the module and
current credible sources.
40 (40\%) - 44 (44\%)
Thoroughly responds to the
discussion question(s).
Post includes approprite
diagnoses including
explanations of appropriate
diagnostic tests and treatment
options.
Incorporates syntheses
representative of knowledge
gained from the course
readings for the module and
current credible sources, with
no less than 75\% of post the
post having exceptional depth
and breadth.
Supported by at least 3 current
credible sources.
35 (35\%) - 39 (39\%)
Responds to most of the
discussion question(s)
Post includes approprite
diagnoses with explanations of
appropriate diagnostic tests
and treatment options.
Somewhat incorporates
syntheses representative of
knowledge gained from the
course readings for the
module and current credible
sources with no less than 50\%
of the post having exceptional
depth and breadth.
Supported by at least 3
credible references.
31 (31\%) - 34 (34\%)
Responds to some of the
discussion question(s).
Post contains incomplete or
vague diagnoses or
explanations of appropriate
diagnostic tests and treatment
options.
Is somewhat lacking in
synthesis of knowledge gained
from the course readings for
the module and current
credible sources.
Post is cited with fewer than 2
credible references.
0 (0\%) - 30 (30\%)
Does not respond to the
discussion question(s).
Post contains incomplete
diagnoses or explanations of
appropriate diagnostic tests
and treatment options, or
diagnoses and/or explanations
are missing.
Lacks synthesis gained from
the course readings for the
module and current credible
sources.
Contains only 1 or no credible
references.
Main Posting:
Writing
6 (6\%) - 6 (6\%)
Written clearly and concisely.
Contains no grammatical or
spelling errors.
Further adheres to current
APA manual writing rules and
style.
5 (5\%) - 5 (5\%)
Written concisely.
May contain one to two
grammatical or spelling errors.
Adheres to current APA
manual writing rules and style.
4 (4\%) - 4 (4\%)
Written somewhat concisely.
May contain more than two
spelling or grammatical errors.
Contains some APA formatting
errors.
0 (0\%) - 3 (3\%)
Not written clearly or
concisely.
Contains more than two
spelling or grammatical errors.
Does not adhere to current
APA manual writing rules and
style.
Main Posting:
Timely and full participation
9 (9\%) - 10 (10\%)
Meets requirements for timely,
full, and active participation.
Posts main discussion by due
date.
8 (8\%) - 8 (8\%)
Posts main diCase Study: Contraception
Scenario 3
Elaine Goodwin is a 38-year-old G5 P5 LC 6 presenting to your clinic today to discuss contraceptive options. She states that she is not interested in having more children but her new partner has never fathered a child. Her medical history is remarkable for exercise-induced asthma, migraines, and IBS. Her surgical history is remarkable only for tonsils as a child. Her social history is negative for alcohol and tobacco; she reports daily marijuana use. She has no known drug allergies and takes only vitamin C. Hospitalizations were only for childbirth. Family history reveals that her maternal grandmother is alive with dementia, while her maternal grandfather is alive COPD. Her paternal grandparents are both deceased due to an automobile accident. Her mother is alive with osteopenia and fibromyalgia, and her dad had a history of skin cancer (basal cell). Elaine has one older sister with endometriosis who was told not to have more children because she had blood clots when she was pregnant with her second child. She also has one younger brother with no reported medical problems.
· Height 5’ 7” Weight 148 (BMI 23.1) BP 118/72 P 68
· HEENT: wnl
· Neck: supple without adenopathy
· Lungs/CV: wnl
· Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge
· Abd: soft, +BS, no tenderness
· VVBSU: wnl,
· Cervix: firm, smooth, parous, without CMT
· Uterus: mid, mobile, non-tender, approximately 8 cm,
· Adnexa: without masses or tenderness
QUESTION:
What other information do you need?
Elaine relates to you that she has used birth control pills before but “would keep messing them up.” After that she switched to the patch, which she found worked well but discontinued use for reasons she does not remember. After that she used natural family planning but still conceived her last two children unexpectedly. She has had three partners in last 12 months and has been with her current partner for the previous two months. She believes that he is “the one.”
Elaine relates that her cycles come every 28-32 days, for a duration of 5-8 days, and on her heaviest day she must use a super tampon every hour and get up to change her pad 2-3 times at night. Her last gyn exam was one year ago and she shows you a copy of the results on her patient portal. The results for the pap were NILM, HPV negative, and her cultures for GC/CT were negative.
In further questioning, you ask her about her sister’s blood clots and her father’s PE. She shares that her father was 48 years old and “just died one day.” Her sister was on “shots” for her blood clots and then took a pill. She had some blood test done and they said she had something called heterozygous MTHFR and Factor V Leiden.
She has heard about a pill where she will only get her period four times a year and feels now that she’s older she can remember to take the pill daily and plans on putting a reminder in her phone.
QUENRNP 6552: Advanced Nurse Practice in Reproductive Health Care
Episodic/Focused SOAP Note Template
Patient Information:
Initials, Age, Sex, Race
S.
CC (chief complaint): This is a brief statement identifying why the patient is here in the patient’s own words, for instance, “headache,” not “bad headache for 3 days.”
HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start every HPI with age, race, and gender (e.g., 34-year-old African American male). You must include the seven attributes of each principal symptom in paragraph form, not a list. If the CC was “headache,” the LOCATES for the HPI might look like the following example:
Location: head
Onset: 3 days ago
Character: pounding, pressure around the eyes and temples
Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia
Timing: after being on the computer all day at work
Exacerbating/relieving factors: light bothers eyes, Naproxen makes it tolerable but not completely better
Severity: 7/10 pain scale
Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include over-the-counter (OTC) or homeopathic products.
Allergies: Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction versus intolerance.
PMHx: Include immunization status (note date of last tetanus for all adults), past major illnesses, and surgeries. Depending on the CC, more info is sometimes needed.
Soc & Substance Hx: Include occupation and major hobbies, family status, tobacco and alcohol use (previous and current use), and any other pertinent data. Always add some health promotion questions here, such as whether they use seat belts all the time or whether they have working smoke detectors in the house, the condition of the living environment, text/cell phone use while driving, and support systems available.
Fam Hx: Illnesses with possible genetic predisposition, contagious illnesses, or chronic illnesses. The reason for death of any deceased first-degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.
Surgical Hx: Prior surgical procedures.
Mental Hx: Diagnosis and treatment. Current concerns: (Anxiety and/or depression). History of self-harm practices and/or suicidal or homicidal ideation.
Violence Hx: Concern or issues about safety (personal, home, community, sexual—current and historical).
Reproductive Hx: Menstrual history (date of last menstrual period [LMP]), pregnant (yes or no), nursing/lactating (yes or no), contraceptive use (method used), types of intercourse (oral, anal, vaginal, other), and any sexual concerns.
ROS: This covers all
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e. Embedded Entrepreneurship
f. Three Social Entrepreneurship Models
g. Social-Founder Identity
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Outcomes
Subset 2. Indigenous Entrepreneurship Approaches (Outside of Canada)
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https://www.fnu.edu/library/
In order to
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Literature search
You will need to perform a literature search for your topic
Geophysics
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od pressure and hypertension via a community-wide intervention that targets the problem across the lifespan (i.e. includes all ages).
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Conclusions
References (8 References Minimum)
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*** In-Text Citations and References using Harvard style.
*** In Task section I’ve chose (Economic issues in overseas contracting)"
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visual representations of information. They can include numbers
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making the appropriate buying decisions in an ethical and professional manner.
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https://youtu.be/fRym_jyuBc0
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evidence-based primary care curriculum. Throughout your nurse practitioner program
Vignette
Understanding Gender Fluidity
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Affirming Clinical Encounters
Conclusion
References
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Mechanics
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Summary & Evaluation: Reference & 188. Academic Search Ultimate
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With covid coming into place
In my opinion
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· By Day 1 of this week
While you must form your answers to the questions below from our assigned reading material
CliftonLarsonAllen LLP (2013)
5 The family dynamic is awkward at first since the most outgoing and straight forward person in the family in Linda
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4 In order to get the entire family to come back for another session I would suggest coming in on a day the restaurant is not open
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The word assimilate is negative to me. I believe everyone should learn about a country that they are going to live in. It doesnt mean that they have to believe that everything in America is better than where they came from. It means that they care enough
Data collection
Single Subject Chris is a social worker in a geriatric case management program located in a midsize Northeastern town. She has an MSW and is part of a team of case managers that likes to continuously improve on its practice. The team is currently using an
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One thing you will need to do in college is learn how to find and use references. References support your ideas. College-level work must be supported by research. You are expected to do that for this paper. You will research
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3 The first thing I would do in the family’s first session is develop a genogram of the family to get an idea of all the individuals who play a major role in Linda’s life. After establishing where each member is in relation to the family
A Health in All Policies approach
Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum
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Use the bolded black section and sub-section titles below to organize your paper. For each section
Losinski forwarded the article on a priority basis to Mary Scott
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