WK #5 DQ:
Apply information from the Aquifer Case Study to answer the following discussion questions:
· Discuss the Mr. Payne’s history that would be pertinent to his genitourinary problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.
· Describe the physical exam and diagnostic tools to be used for Mr. Payne. Are there any additional you would have liked to be included that were not?
· Please list 3 differential diagnoses for Mr. Payne and explain why you chose them. What was your final diagnosis and how did you make the determination?
· What plan of care will Mr. Payne be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?
Forty-five-year-old white male truck driver complaining of two weeks of sharp, stabbing back pain. The pain was better after a couple of days but then got worse after playing softball with his daughter. This morning his pain is so bad that he had trouble getting out of bed.
You and Dr. Lee take a few minutes to review Mr. Payne’s chart:
Vital signs:
· Temperature: 98.6° Fahrenheit
· Heart rate: 80 beats/minute
· Respiratory rate: 12 breaths/minute
· Blood pressure: 130/82 mmHg
· Weight: 170 pounds
· Body Mass Index: 24 kg/m2
Past Medical History: Diabetes, well controlled. Hypertension, fair control. Hyperlipidemia, fair control.
Past Surgical History: None
Social History: Works as a truck driver, which involves lifting 20-35 lbs 4 hours of the day, married with 2 daughters,
Habits: Quit smoking two years ago, drinks 1 to 2 beers occasionally on the weekends, no history of IV drug use.
Medication:
· metformin 500mg 2 twice daily
· glyburide 5mg 2 twice daily
· amlodipine 2.5 mg daily
· lisinopril 40 mg daily
· simavastin 40 mg daily
Allergies: No known drug allergies.
Can you tell me about your back pain?”
“As I told the nurse, the pain started two weeks ago after I lifted a box at work. Right away, I got this sharp pain on the left side of my back. The box wasn’t even that heavy.
“I talked to the nurse at work; she said to ice it and to take ibuprofen. It got better after three days. But, I was playing softball with my daughter last weekend, and the pain came back. This time it was worse than before. This week, the pain is so bad I can hardly get out of bed. I get a sharp pain in my back which goes down my left leg to my ankle.”
“On a scale of 0 to 10, 10 being the worst, how severe is the pain?”
“It’s probably a 7.”
“Have you found anything that improves the pain?”
“Ibuprofen and Naproxen worked at first, but they are not helping much anymore.”
“What about positions that make things better or worse?”
“The pain is worse with any movement of my back or sitting for a long time. It is better when I lie down.”
“Have you had back pain before?”
“Yes, I have back pain from time to time. But I’m usually better after 2 to 3 days. This is the worst pain I have ever had.”
Review of Systems
Mr. Payne does not have numbness or weakness in his legs. The pain is better when he lies down. He denies urinary frequency, dysuria, problems with bowel or bladder control, fever or chills, nausea or vomiting, or weight loss. He denies any specific trauma, except for when he lifted a 10-pound box at work. He denies unrelenting night pain.
Based on your differential, you determine that it is highly likely that Mr. Payne is experiencing a mechanical cause of back pain with nerve involvement such as a disc herniation. It is possible that he has spinal fracture, but a lack of trauma history makes the latter unlikely. It is important to consider cauda equina syndrome, as it calls for immediate surgical investigation, but it is unlikely in the absence of neurological symptoms like loss of bowel or bladder control. Finally, infectious etiology, such as pyelonephritis, is unlikely without fever and chills, urinary frequency and dysuria.
Back Exam – Standing:
Mr. Payne has normal curvature, tenderness on palpation on the left lumbar paraspinous muscle with increase tone. Full range of motion, but has pain with movement. His gait is normal. He can walk on his heels and toes. He can do deep knee bends.
Back Exam – Seated:
Mr. Payne denies feeling pain when checked for CVA tenderness. He has no pain in his right leg with the modified version of SLR. While he does not exhibit a true tripod sign, he does complain of pain when his left leg is raised. Mr. Payne’s reflexes are 2+ and equal at the knees and 1+ at both ankles. The motor exam reveals no weakness of the muscles of the lower extremities. His sensory exam is normal.
Pulmonary Exam: His lungs are clear.
Cardiovascular Exam: His cardiac exam demonstrates a regular rhythm, no murmur or gallop.
Three weeks later, Mr. Payne returns for his follow-up appointment and you discover the following:
Pertinent History
Mr. Payne has had little relief with the treatment prescribed. He is frustrated that he has been in pain for more than a month. His pain has been progressively worse. It radiates down the lateral part of his left leg and side of his left foot. This pain is worse than the back pain. He does not have any problems with bowel or bladder control and there is no weakness of his leg.
Pertinent Exam Findings
Vital signs: stable
Neurologic: Normal gait, but moves slowly due to pain; range of motion is full, with pain on flexion; SLR is positive at 45 degree on the left; motor strength intact; reflexes 2+ bilaterally at the knees, absent at the left ankle, 1+ at the right ankle.
Dr. Lee agrees with your diagnosis of radiculopathy of S1 nerve root with progression. She orders an MRI and sets up an appointment to see Mr. Payne after the MRI.
You and Dr. Lee now return to Mr. Payne’s exam room to talk about treatment options with him. Dr. Lee tells Mr. Payne to avoid strenuous activities but to remain active. Dr. Lee increases the dosage of naproxen to 500 mg BID to take with food. Since his pain is intense (7/10), he is given a prescription for acetaminophen with codeine to take at night, when his pain is severe. Mr. Payne declines a muscle relaxant because they usually make him drowsy. He would like to be referred to physical therapy as it was helpful in the past.
FOLLOW-UP TREATMENT
MANAGEMENT
One week later, Mr. Payne returns for follow-up. You review the results of the MRI report.
MRI report:
1. Moderate-size, herniated disc at L5-S1 with associated marked impingement on the left S1 nerve root and mild to moderate impingement on the right S1 nerve root. There is mild central canal stenosis.
2. Annular tear with a small central disc herniation at L4-5 causing mild central canal stenosis.
You review the findings with Dr. Lee. She agrees with your diagnosis of radiculopathy of S1 nerve root due to a large herniated disc at L5-S1.
You call Mr. Payne two weeks later to see how he is doing. He reports that he is doing quite a bit better. He went to an osteopathic physician who did some manual therapy and started him on a strict walking program. He is very encouraged and plans on losing weight through exercise and diet.
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Market Segments And Distribution Channels For The Mcos
/in Uncategorized /by developerThis week’s chapter discusses the various market segments and distribution channels for the MCOs. Outline the market segments and identify the most successful distribution channels for those markets. Use some outside research to support your statements. Why do you believe each distribution channel successfully reaches the targeted market?
Discussion Board Requirements: 250 word count One original post and two reply posts, APA Format, please include references
Deadline: Saturday, March 2nd at 11:50 pm.
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Marketable Objectives 19000355
/in Uncategorized /by developerPlease have this done by 6pm EST tomorrow. My chosen HCO is Medical University of South Carolina in Charleston, S.C.
The Importance of Marketable Objectives
This week’s assignment will provide information regarding marketable objectives found within the strategic plan for your chosen HCO. The information can be applied to the Introduction portion of the marketing plan for your Final Project. After reading Chapter 7 and reviewing the strategic plan of your chosen healthcare organization, construct a three- to four-page paper in which you discuss the following:
The paper
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Marketing And The Health Care System 19296955
/in Uncategorized /by developerAssignment 1: Marketing and the Health Care System
Due Week 4 and worth 300 points
Select a health care provided with which you are familiar and write a four to six (4-6) page paper in which you:
Your assignment must follow these formatting requirements:
The specific course learning outcomes associated with this assignment are:
Grading for this assignment will be based on answer quality, logic/organization of the paper, and language and writing skills.
Click here to view the grading rubric.
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Marketing Plan 19204367
/in Uncategorized /by developer– Write a 4 pages, APA style with references
– TITLE: Technical Challenges of Digital Image Creation for nuclear medicine technologist.
– Simple English
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Marternal Newborn Teaching Assigment
/in Uncategorized /by developerI need a draft paper to give the professor with all the information is going to be on the Brochure. Please follow the Rubric that I posted it!
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Massage Therapy
/in Uncategorized /by developerplease use apa format
I went to massage envy
the ailments I had was lower back pain
please answer all the questions
use your imagination
I need 2-3 pages
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Mastering In Nursing Advance Nurse Practice 1 Dq
/in Uncategorized /by developerWK #5 DQ:
Apply information from the Aquifer Case Study to answer the following discussion questions:
· Discuss the Mr. Payne’s history that would be pertinent to his genitourinary problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.
· Describe the physical exam and diagnostic tools to be used for Mr. Payne. Are there any additional you would have liked to be included that were not?
· Please list 3 differential diagnoses for Mr. Payne and explain why you chose them. What was your final diagnosis and how did you make the determination?
· What plan of care will Mr. Payne be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?
Forty-five-year-old white male truck driver complaining of two weeks of sharp, stabbing back pain. The pain was better after a couple of days but then got worse after playing softball with his daughter. This morning his pain is so bad that he had trouble getting out of bed.
You and Dr. Lee take a few minutes to review Mr. Payne’s chart:
Vital signs:
· Temperature: 98.6° Fahrenheit
· Heart rate: 80 beats/minute
· Respiratory rate: 12 breaths/minute
· Blood pressure: 130/82 mmHg
· Weight: 170 pounds
· Body Mass Index: 24 kg/m2
Past Medical History: Diabetes, well controlled. Hypertension, fair control. Hyperlipidemia, fair control.
Past Surgical History: None
Social History: Works as a truck driver, which involves lifting 20-35 lbs 4 hours of the day, married with 2 daughters,
Habits: Quit smoking two years ago, drinks 1 to 2 beers occasionally on the weekends, no history of IV drug use.
Medication:
· metformin 500mg 2 twice daily
· glyburide 5mg 2 twice daily
· amlodipine 2.5 mg daily
· lisinopril 40 mg daily
· simavastin 40 mg daily
Allergies: No known drug allergies.
Can you tell me about your back pain?”
“As I told the nurse, the pain started two weeks ago after I lifted a box at work. Right away, I got this sharp pain on the left side of my back. The box wasn’t even that heavy.
“I talked to the nurse at work; she said to ice it and to take ibuprofen. It got better after three days. But, I was playing softball with my daughter last weekend, and the pain came back. This time it was worse than before. This week, the pain is so bad I can hardly get out of bed. I get a sharp pain in my back which goes down my left leg to my ankle.”
“On a scale of 0 to 10, 10 being the worst, how severe is the pain?”
“It’s probably a 7.”
“Have you found anything that improves the pain?”
“Ibuprofen and Naproxen worked at first, but they are not helping much anymore.”
“What about positions that make things better or worse?”
“The pain is worse with any movement of my back or sitting for a long time. It is better when I lie down.”
“Have you had back pain before?”
“Yes, I have back pain from time to time. But I’m usually better after 2 to 3 days. This is the worst pain I have ever had.”
Review of Systems
Mr. Payne does not have numbness or weakness in his legs. The pain is better when he lies down. He denies urinary frequency, dysuria, problems with bowel or bladder control, fever or chills, nausea or vomiting, or weight loss. He denies any specific trauma, except for when he lifted a 10-pound box at work. He denies unrelenting night pain.
Based on your differential, you determine that it is highly likely that Mr. Payne is experiencing a mechanical cause of back pain with nerve involvement such as a disc herniation. It is possible that he has spinal fracture, but a lack of trauma history makes the latter unlikely. It is important to consider cauda equina syndrome, as it calls for immediate surgical investigation, but it is unlikely in the absence of neurological symptoms like loss of bowel or bladder control. Finally, infectious etiology, such as pyelonephritis, is unlikely without fever and chills, urinary frequency and dysuria.
Back Exam – Standing:
Mr. Payne has normal curvature, tenderness on palpation on the left lumbar paraspinous muscle with increase tone. Full range of motion, but has pain with movement. His gait is normal. He can walk on his heels and toes. He can do deep knee bends.
Back Exam – Seated:
Mr. Payne denies feeling pain when checked for CVA tenderness. He has no pain in his right leg with the modified version of SLR. While he does not exhibit a true tripod sign, he does complain of pain when his left leg is raised. Mr. Payne’s reflexes are 2+ and equal at the knees and 1+ at both ankles. The motor exam reveals no weakness of the muscles of the lower extremities. His sensory exam is normal.
Pulmonary Exam: His lungs are clear.
Cardiovascular Exam: His cardiac exam demonstrates a regular rhythm, no murmur or gallop.
Three weeks later, Mr. Payne returns for his follow-up appointment and you discover the following:
Pertinent History
Mr. Payne has had little relief with the treatment prescribed. He is frustrated that he has been in pain for more than a month. His pain has been progressively worse. It radiates down the lateral part of his left leg and side of his left foot. This pain is worse than the back pain. He does not have any problems with bowel or bladder control and there is no weakness of his leg.
Pertinent Exam Findings
Vital signs: stable
Neurologic: Normal gait, but moves slowly due to pain; range of motion is full, with pain on flexion; SLR is positive at 45 degree on the left; motor strength intact; reflexes 2+ bilaterally at the knees, absent at the left ankle, 1+ at the right ankle.
Dr. Lee agrees with your diagnosis of radiculopathy of S1 nerve root with progression. She orders an MRI and sets up an appointment to see Mr. Payne after the MRI.
You and Dr. Lee now return to Mr. Payne’s exam room to talk about treatment options with him. Dr. Lee tells Mr. Payne to avoid strenuous activities but to remain active. Dr. Lee increases the dosage of naproxen to 500 mg BID to take with food. Since his pain is intense (7/10), he is given a prescription for acetaminophen with codeine to take at night, when his pain is severe. Mr. Payne declines a muscle relaxant because they usually make him drowsy. He would like to be referred to physical therapy as it was helpful in the past.
FOLLOW-UP TREATMENT
MANAGEMENT
One week later, Mr. Payne returns for follow-up. You review the results of the MRI report.
MRI report:
1. Moderate-size, herniated disc at L5-S1 with associated marked impingement on the left S1 nerve root and mild to moderate impingement on the right S1 nerve root. There is mild central canal stenosis.
2. Annular tear with a small central disc herniation at L4-5 causing mild central canal stenosis.
You review the findings with Dr. Lee. She agrees with your diagnosis of radiculopathy of S1 nerve root due to a large herniated disc at L5-S1.
You call Mr. Payne two weeks later to see how he is doing. He reports that he is doing quite a bit better. He went to an osteopathic physician who did some manual therapy and started him on a strict walking program. He is very encouraged and plans on losing weight through exercise and diet.
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Masters Prepared Nurse Interview 19105369
/in Uncategorized /by developerMASTERS PREPARED NURSE INTERVIEW.
Interview a nurse who is master’s-prepared in nursing and is using this education in a present position. Select someone who is in a leadership role. The purpose of the interview is to gain insight into the interplay among education, career path, and opportunities. Be certain to identify specific competencies that the MSN-prepared nurse gained, and is presently using, that reflect advanced education. Organize your interview around the topics below:
Ø Overview of the master’s-prepared nurse’s career
Ø Reason for seeking graduate education
Ø Description of present position and role
Ø Usefulness of graduate education for present role
Ø Pearls of wisdom he/she is willing to share
In 1,000 words, write the interview in a narrative format. Use the following guidelines:
– Within the paper’s introduction, explain your interview selection.
– Do not identify the individual by name.
– Use centered headings to separate parts of the interview.
– In the conclusion, identify one or more competencies from the interview that are consistent AACN education essentials.
– In addition, provide a statement that reflects what you gained from the interview.
STRICT APA FORMAT PLEASE WITH IN TEXT CITATION AND REFERENCES.
PLEASE USE THE INTERVIEW GUIDE IS BELOW IN ITALICS:
Master’s Prepared Nurse Interview Guide
Introduction
In this section, provide the general purpose of the paper. State the reasons for selecting this individual as an interviewee. Do not use the actual name of individual.
Overview of Career
In this section, describe the interviewee’s career. Start with their pre-licensure education. It is appropriate to include geographical location, type of institutions(s), and type of position(s) held. In addition, include interesting facts, examples of practice, etc. Place information regarding their graduate program in the Graduate Education section. If the interviewee shared interesting and relevant personal information, this can be included as well.
Graduate Education
In this section, provide information about the graduate program: institution and type of program. Start by providing the reason why the interviewee chose to attend graduate school. Describe additional information that the interviewee may have shared about the graduate program.
Present Position
In this section, describe the interviewee’s present position. Identify specific competencies that the interviewee described as important to this position that were gained from the graduate program. Include other interesting information that the interviewee provided regarding the present position. Mention certification(s) if appropriate to present position.
Pearls of Wisdom
In this section, share special information about the interviewee, including lessons learned and any suggestions/advice the interviewee gave for individuals starting a graduate program.
Conclusion
In this section, summarize what was gained from the interview: what was learned about the effects of graduate education in regards to change in knowledge, skills, and attitudes; and perhaps how this fits with the program outcomes for a specialty. Describe what else may have been learned from the interview. End the conclusion with general comments about the selection of an interviewee and whether the interview developed a clearer idea as to what to expect from graduate education.
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Mat It Project
/in Uncategorized /by developercommunity project
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Maternal Child
/in Uncategorized /by developerPurpose: To recognize that individual culture does impact womans health care, communication,
nutrition, and family influences that shape the families you are caring for.
Concept: Cultural Diversity
Objective: Write a paper regarding a culture and its impact on families, contraception, conception and
birth.
Instructions: Create a cultural diversity paper.
1. This project is to a be written paper 5 pages in length APA format. These 5 pages include a
cover page and a reference page.
2. Refer to Purnells’ Cultural Competency as a guide to assessing the patient in the identified
culture from your Health Assessment course.
3. Is education valued, are boy children preferred over gril children? How do they view families?
Is contraception allowed and who is involved in the decision making regarding birth control
choices?
4. In an unintended pregnancy is adoption allowed? Is assisted reproductive technology accepted?
What about donor sperm or surrogacy?
5. Who attends childbirth? Where do women have babies? What are the special practices
employed to support the new mom and baby? Who in the family system makes decisions
regarding the woman’s health?
6. What implications does culture present to the issues of womens’ health care?
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