APA format 3 peer references and discussion needs to be related to what is posted as response to the persons diagnosis
Patient Initials: RF Age: 15 Gender: M
SUBJECTIVE DATA:
Chief Complaint (CC): A dull pain in both knees with occasional clicking in one or both knees and the sensation of the patella catching.
History of Present Illness (HPI): RF is a 15-year-old male who reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. He states that the pain has been on and off for the last four months and initially only present after intense activity but has gotten worse since starting track this summer and seems to be present more often than before.
The patient states that the clicking comes and goes and isn’t always present in both knees at the same time. The catching sensation under the patella is more pronounced since he started doing the long jump in track. The patient states that he is able to bear weight as the pain is a dull ache. Icing his knees after sports and taking ibuprofen help to reduce the pain and swelling but both occur more frequently now making it difficult to participate in sports. The patient feels that he may be overdoing it with all of the sports he participates in and is worried about not being able to play soccer if it continues to get worse. The patient rates the pain 7/10 after intense activity.
Medications: Ibuprofen 200 mg oral tab, two tabs every 6 hours as needed for pain.
Allergies: No known drug, food, or environmental allergies.
Past Medical History (PMH): None
Past Surgical History (PSH): None
Sexual/Reproductive History: Patient is not sexually active at this time.
Personal/Social History: Patient denies smoking, alcohol use, and illicit drug use. The patient is very active with sports playing soccer, basketball, baseball, and track. He states that he tries to eat well mainly because of sports but doesn’t always make the best choices for snacks. He tries to avoid soda most of the time and reports drinking a lot of water.
Immunization History: Immunizations are up to date. Gets influenza vaccine annually.
Significant Family History:
Paternal grandfather has hypertension, and father has borderline hypertension. Maternal grandfather has type II diabetes.
Lifestyle: RF is a freshman in high school who lives with both of his parents and older sister. RF plays soccer, basketball, baseball and participates in track for high school. RF also plays club soccer playing and traveling most of the year. RF is a good student, athletic, and enjoys being active. He also participates in winter sports and skis during winter break. RF works part-time as a referee during the summers due to his commitment to school and sports.
Review of Systems:
General: No recent weight gain or loss of significance. Patient denies fatigue, fever, or chills.
HEENT: No headaches or dizziness. No changes in vision. He does not wear glasses, and his last eye exam was just under a year ago. Denies eye drainage, pain, or double vision. No changes in hearing. Has had no recent ear infections, tinnitus or ringing in the ears. Denies sinus infections, congestion, and epistaxis. He reports his sense of small is intact. Last dental exam was four months ago for regular cleaning. Denies bleeding gums or a toothache. Denies dysphagia or throat pain.
Neck: No history of trauma, denies recent injury or pain. He denies neck stiffness.
Breasts: Denies any breast changes. Denies history rashes. Denies history of masses or pain.
Respiratory: Denies a cough, hemoptysis, and sputum production. Patient denies any shortness of breath with resting or with exertion. Patient reports no pain with inspiration or expiration.
Cardiovascular/Peripheral Vascular: No history of murmur or chest palpitations. No edema or claudication. Denies chest pain. No history of arrhythmias.
Gastrointestinal: Denies nausea or vomiting. Patient reports no abdominal pain, diarrhea, or constipation. Last bowel movement was this morning. Denies rectal pain or bleeding. Denies changes in bowel habits. Denies history of dyspepsia.
Genitourinary: Denies changes in urinary pattern. No incontinence, no history of STDs or HPV, the patient is heterosexual and not sexually active. Denies hematuria. Denies urgency, frequency, and dysuria.
Musculoskeletal: No limitation in range of motion for all limbs though patient reports difficulty moving knees after excessive strain from sports. No history of trauma or fractures. Patient reports dull pain in both knees. The patient states occasional swelling in knee joints after participating in sports. Patient reports clicking in one knee and sometimes both. The patient states that the pain is worse after participating in the long jump or running long distances. Patient denies history or presence of misalignment of either knee.
Psychiatric: Denies suicidal or homicidal history. No mental health history. Denies anxiety and depression.
Neurological: No dizziness. No problems with coordination. Denies falls or seizures. Denies numbness or tingling. Denies changes in memory or thinking patterns.
Skin: No history of skin cancer. Denies any new rashes or sores. Patient reports many blisters from sports which are treated with Neosporin, band-aids, and NewSkin spray. Denies eczema and psoriasis. Denies itching or swelling.
Hematologic: No bleeding disorders or history of blood transfusion. Denies excessive bruising.
Endocrine: Patient reports no endocrine symptoms. Denies polyuria, polydipsia. Patient denies no intolerance to heat or cold.
Allergic/Immunologic: Denies environmental, food, or drug allergies. No known immune deficiencies.
OBJECTIVE DATA:
Physical Exam:
Vital signs: B/P 118/74; P 65 and regular; T 98.6; RR 16; O2 100% on room air; Wt: 125 lbs.; Ht: 5’7”; BMI 19.1
General: RF is a well-developed, well-nourished Caucasian teenage male who appears to be in no apparent distress.
HEENT: Head: Skull is normocephalic, atraumatic. No masses or lesions.
Eyes: PERRLA, +direct and consensual pupil response. EOM intact, 20/20 vision bilaterally without correction. Fundoscopic exam normal, vessels intact, the optic disc with clear margins.
Ears: Bilateral external ears no lesions, masses, drainage or tenderness. Tympanic membranes intact, pearly gray, no bulging, no erythema, and landmarks appreciated bilaterally. Hearing intact bilaterally.
Nose: No nasal flaring, no discharge, no obstruction, septum not deviated. Turbinates pink and moist. No polyps or lesions bilaterally. Nares patent with no edema or erythema.
Throat: Oropharynx clear and mucosa moist. No erythema or exudate. Uvula midline, palate rises symmetrically.
Mouth: No lesions, no thrush. Moist mucous membranes. Healthy dentition present. Tongue midline.
Neck: Supple, non-tender. Full range of motion. Trachea midline. No masses. Thyroid and lymph nodes not palpable.
Chest/Lungs: Thorax non-tender with symmetric expansion. Respiration regular and unlabored, without a cough. Tactile fremitus equal bilaterally and greater in upper lung fields. Breath sounds clear with adventitious sounds. All lung fields with resonant percussion tones.
Heart: Regular rate and rhythm; normal S1, S2; no murmurs, rubs, or gallops. Apical pulse not visible. Apical pulse was barely palpable. JVP appears to be approximately less than 6 cm with HOB elevated to 45 degrees. No carotid bruits or JVD appreciated.
Peripheral Vascular: Pulses 2+ bilateral pedal and 2+ radial bilaterally. No pedal edema. Popliteal pulses 2+ bilaterally.
Abdomen: Abdomen round, soft, and non-tender without rash, palpable mass or organomegaly. Active bowel sounds. Tympany over most quadrants with areas of dullness noted upon percussion. No abdominal bruits.
Genital/Rectal: Adequate tone, no masses noted, eternal genitalia intact.
Musculoskeletal: Normal passive and active ROM in upper and lower extremities. No focal joint inflammation or abnormalities appreciated in upper extremities. + tenderness to palpation at the inferior pole of the patella bilaterally. + Q angle greater than 10 degrees bilaterally. Clicking present with movement in right knee. Normal alignment of the knees bilaterally. All upper and lower extremity joints without effusions or erythema. Spine without tenderness and range of motion is full. Greater tenderness was noted in knees bilaterally when extended, and quadriceps are relaxed. Normal muscle strength present against resistance.
Neurological: CN ll-Xll grossly intact. Awake, alert, and oriented to person, place and time. The patient can move all limbs on command and spontaneously.
Skin: Warm, moist, and intact. Skin is pale. + edema right knee. No peripheral cyanosis. No clubbing. No rashes or bruises present.
ASSESSMENT:
Lab Tests and Results:
CBC- Normal
Erythrocyte sedimentation rate (ESR) – Normal
Diagnostic test:
Passive extension-flexion sign- positive- which is tenderness on palpation of the tendon at the inferior pole of the patella.
McMurray test- Negative for locking during joint movement.
X-ray- negative
MRI- Showed high signal intensity within the proximal posterior central aspect of the tendon at its origin.
Differential Diagnosis:
- Patellar tendinitis: This is the most likely diagnosis based on the patients HPI, ROS, physical assessment, and diagnostic studies. The patient’s chief complaint was a dull pain in the knees with occasional clicking in one or both knees. The patient is athletic and participates in many sports that continuously put a strain on his knees. The quadriceps angle was greater than ten which suggests patellar tendinitis. The patient plays sports that include a lot of running and jumping which adds strain to the knee joints. The patient was also positive for tenderness on palpation at the inferior pole of the patella bilaterally. Lastly, the MRI was positive for high signal intensity within the proximal posterior central aspect of the tendon where it originates from.
- Osgood Schlatter’s disease: A possible diagnosis as it is a common problem which typically occurs during times of fast growth usually in fit, active boys. Osgood Schlatter’s disease is associated with pain just below the kneecap in one or both knees, often worse after sports especially high impact activities using the quadriceps muscles. However, limping is often a present, and the patient denied limping in the ROS. Pain is greater with stair climbing and kneeling, and the patient did not admit to either. Flexion and extension will increase pain in the tibial tubercle which was not present upon physical exam of the patient.
- Chondromalacia patellae: This is a possible diagnosis due to the presence of knee pain upon palpitation and increased pain with activity. However, chondromalacia patellae are more common in females or persons with a history of knee trauma. The patient is male and denied trauma to either knee. The patient denied a history of misalignment which is also related to chondromalacia patellae. An x-ray of the knee would show irregularities of the patellofemoral joint.
- Medial meniscus tear: This diagnosis is a possibility because it can occur after a twisting injury and the patient participates in sports such as soccer, basketball, and skiing that involve twisting movements. Clicking may be present with a medial meniscus tear which the patient reported and was also appreciated upon physical assessment in the right knee. McMurray test was negative for locking during joint movement. The patient denied difficulty with weight bearing.
- Juvenile rheumatoid arthritis (JRA): Possible due to knee joint soreness and stiffness, however, both typically improve with activity. Joint swelling may also present with JRA and was reported by the patient in his ROS. The patient denied weight loss and fatigue which are common symptoms. The patient also denied night pain. A CBC would show anemia, leukocytosis, and thrombocytosis. The ESR would be elevated.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Huether, S. E., & McCance, K. L. (2017). Disorder of the joints. In alterations of musculoskeletal function (6th ed., pp. 991-1038).
Rath, E., Schwarzkopf, R., & Richmond, J. (2010). Clinical signs and anatomical correlation of
patellar tendinitis. Indian Journal of Orthopaedics, 44(4), 435-437 3p. doi:10.4103/0019-
5413.6931
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Need Response For Below Discussion 19182477
/in Uncategorized /by developerAPA format 1 page long 3 references 1 from walden university and please use one from the references below
This is for a MSN degree
Our team´s selected setting is Suncrest Home Care and Hospice located in rural Iowa. The focus of our proposed curriculum is to provide hospice caregivers and patients with the education needed to adequately manage pain at the end-of-life. The hospice nurse would provide the education to family, caregivers, and patients during their initial and follow up visits with patients. Our audience will largely consist of mature learners at a highly emotional time, therefore I will look at strategies that fall under the adult learning theory.
The first strategy I would apply is that of self-directed learning. Initially, information would be provided to caregivers and patients, giving them the opportunity to review the education on their own time and develop questions, reinforcing that the information provided will be useful when caring for their hospice patient. As stated by Keating, “adults are self-directed and will learn information that is useful and relevant to them” (Keating & DeBoor, 2018, p. 111). This strategy allows the teacher to encompass the role of mentor or coach, encouraging active learning by the participants (Keating & DeBoor, 2018).
The second strategy I would utilize is that of hands-on, or direct demonstration and practice of skills. As hospice care providers, medication management and symptom recognition are two very important skills to have when caring for a loved one at the end of life (Lau et al., 2009). An example of utilizing this strategy, would be to utilize pillboxes to dispense medications, as well as keeping a log of symptoms in order to evaluate efficacy. Adequate pain control and management is a Community Health Accreditation Partner (CHAP) hospice care standard (2018). Although the hospice nurse will be available for support and as a guide, the main provider of symptom relief will be family or caregivers in the patient´s home; education that will increase medication management knowledge and skill is imperative to provide relief (Chi & Demiris, 2017).
References
Chi, N.-C., & Demiris, G. (2017). Family Caregivers’ Pain Management in End-of-Life Care: A Systematic Review. AMERICAN JOURNAL OF HOSPICE & PALLIATIVE MEDICINE, 34(5), 470–485. https://doi-org.ezp.waldenulibrary.org/10.1177/1049909116637359
Community Health Accreditation Partner [CHAP]. (2018). About our history. Retrieved from https://chapinc.org/contact-about-us/
Keating, S. B., & DeBoor, S. S. (Ed.). (2018). Curriculum development and evaluation in nursing (4th ed.). New York, NY: Springer.
Lau, D. T., Kasper, J. D., Hauser, J. M., Berdes, C., Chang, C. H., Berman, R. L., Masin-Peters, J., Paice, J., & Emanuel, L. (2009). Family caregiver skills in medication management for hospice patients: a qualitative study to define a construct. The journals of gerontology. Series B, Psychological sciences and social sciences, 64(6), 799–807. doi:10.1093/geronb/gbp033
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Need Response For Below Discussion 19371095
/in Uncategorized /by developerAPA format 1 page 3 references one from the discussion below 1 from walden university library. Due 10/4/2019 ASAP
Lesson Title: Medication Administration Checkoff
The selected video demonstrates how to correctly administer medication using the 5 Medication Rights.
Intended Audience: Pre-licensure nursing students
Objectives:
A key strategy in nursing education is to help students connect class time with clinical time (Bristol, n.d.). A significant aspect of this is bringing clinical to class. The video mentioned above, can be used to prepare the learners for the on-site clinical lab as students are able to view the video as many times as needed to familiarize themselves with the content presented. The visual and auditory nature of videos appeals to a wide audience and allows each user to process information in a way that’s natural to them (Next Thought Studios, n.d.). As students review medication administration in their textbooks, they can view the video as a visual to see how to correctly perform a med pass. When the students arrive to class, they are prepared for the skill review and check off. This concept mirrors the flipped classroom approach. “Students gain first-exposure learning prior to class and focus on the processing part of learning in class” (Andrew, n.d.).
When the students arrive to class, the instructor would do a brief overview of the lesson and state the objectives. The students will be given an opportunity to asks any questions they may have about the video or textbook content. They will then role play giving medications at bedside. During checkoffs with the instructors, the students will demonstrate how to correctly give medications as well as explain the rationale about each step during the role playing. The instructor could also have the students record their own video administering medications in class as a way to evaluate the students.
Overall, the referenced video is a good video to use to demonstrate how to correctly administer medications.
Andrew, S. (n.d.). The flipped classroom: preparing students for in-class learning with online activities. Retrieved from https://americanenglish.state.gov/files/ae/resource_files/2.2_presentation_slides_-_final_for_ae_website_-_.pdf
Bristol, T. (n.d.). Help student learn how to learn with clinical skills videos. Retrieved from https://evolve.elsevier.com/education/nursetim/videos-help-students-learn-how-to-learn-with-clinical-skills/
Next Thought Studios. (n.d.). Why videos are important in education. Retrieved from https://www.nextthoughtstudios.com/video-production-blog/2017/1/31/why-videos-are-important-in-education
Nurse Buff Nursing Humor & Lifestyle Blog. (2019). Medication administration checkoff. Retrieved from https://www.nursebuff.com/nursing-skills-video/
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Need Response For Below Discussion On Case Study
/in Uncategorized /by developerAPA format 3 peer references needs to review case study and document on differential diagnosis as to agreeing or disagreeing Due October 20.2018 at 5pm
Episodic/Focused SOAP Note Template
Patient Information:
A.S., 46 F, Caucasain
S.
CC “ankle pain in both ankles; worse in right ankle, after hearing ‘pop’ while playing soccer.”
HPI: A.S. is a 46 year old Caucasian female who presents with bilateral ankle pain which she describes as chronic for the last 3 months. She acutely injured her right ankle 3 days ago while playing soccer. The pain is described as aching with intermittent sharp characteristics. Associated symptoms include limited ROM. The pain is worse with weight bearing and OTC pain medications have included alternating doses of Tylenol and Motrin with moderate relief.
Current Medications:
Motrin 200 mg by mouth every 4-6 hours as needed for pain
Hydrochlorothiazide 12.5mg by mouth daily for 6 months for HTN
Allergies: PCN- rash, no known food/environmental allergies
PMHx: HTN; immunizations are up to date- last tetanus 12/2017; flu shot 10/2018 cholecystectomy 2015
Soc Hx: A.S. is employed as a Registered Nurse and remains active by playing soccer three times a week. She is married with two teenage daughters. She denies tobacco and alcohol use.
Fam Hx: Maternal grandmother deceased at age 56 from MI. Maternal father deceased at age 75 from complications of COPD. Paternal grandparents unknown. Father history is unknown. Mother is alive with type 2 diabetes that is well controlled with oral agents. Sibling age 43 alive and well. Children are alive and well with no medical hx.
ROS:.
GENERAL: No weight loss, fever, chills, weakness or fatigue.
HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema,
RESPIRATORY: No shortness of breath, cough or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.
GENITOURINARY: No burning on urination.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.
MUSCULOSKELETAL: pain and swelling to right ankle, limited weight bearing and ROM in b/l ankles, worse in the right ankle. No muscle cramping. No back pain.
HEMATOLOGIC: No anemia, bleeding or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
PSYCHIATRIC: No history of depression or anxiety.
ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.
ALLERGIES: No history of asthma, hives, eczema or rhinitis.
O.
GENERAL: AAOx 3, limping gait, no distress. No fever. Skin is warm, dry, and intact. Skin of the lower extremities is warm and pink in color.
CARDIOVASCULAR: chest is symmetric with symmetrical expansion, PMI noted at fifth intercostal space at the midclavicular line, normal S1 and S2, no m/r/g, no edema in legs, dorsalis pedis 2/4 bilaterally, normal hair distribution in legs and no pigmentation of b/l legs.
MUSCULOSKELETAL: limited ROM and weight bearing in b/l ankles, worse in right ankle. No clubbing, cyanosis, or edema.
NEUROLOGICAL: mood and affect appropriate, CN II-XII intact. Motor: 5/5 in upper and lower extremities, DTRs 2+ bilaterally.
Diagnostic results:
Ankle x-ray- If the Ottawa ankle rule is positive (bone tenderness at posterior malleolus, bone tenderness at posterior medial malleolus, or inability to bear weigh > 4 steps) ankle radiographs are indicated (Polzer, Kanz, Prall, Haasters, Ockert, Mutschler, & Grote, 2012).
If ankle radiographs negative- assess ligament in affected extremity as compared to un-injured extremity by doing the crossed leg test, squeeze test, external rotation test, anterior drawer test, and talar tilt test. These tests will assist in determining the need for an MRI and also grading the sprain (Polzer, Kanz, Prall, Haasters, Ockert, Mutschler, & Grote, 2012).
Labs may include a uric acid level which is elevated with gout and a WBC which would be elevated with osteomyelitis. MRI imaging may also be indicted.
A.
Sprain- because the patient heard the “pop” sound, her injury is likely related to an ankle sprain in which the ligaments and tissue that surround the bones of the ankle are injured causing swelling, pain, and limited ROM (PubMed Health, 2018).
Fracture- a fracture would be unlikely if the patient was able to bear weight after the injury. The area would also become ecchymotic with limited to no ROM (PubMed Health, 2018).
Osteomyelitis- the extremity would be warm, erythematous, not usually associated with an acute injury, potential fever present, usually associated with a systemic infection or a wound (Ball, Dains, Flynn, Solomon, & Stewart, 2015)
Gout- associated with hot, swollen joints, pain and limited ROM (Ball, Dains, Flynn, Solomon, & Stewart, 2015)
Bursitis- limited ROM, swelling, pain, warmth, and point tenderness (Ball, Dains, Flynn, Solomon, & Stewart, 2015)
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Polzer, H., Kanz, K. G., Prall, W. C., Haasters, F., Ockert, B., Mutschler, W., & Grote, S. (2012).
Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthopedic Reviews, 4(1), e5. http://doi.org/10.4081/or.2012.e5
PubMed Health. (2018). Ankle sprains: overview. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072736/
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Need Response For Below Discussion Post 19362963
/in Uncategorized /by developerAPA format 3 references please use 2 from discussion references and 1 from walden university library and 1 and half pages Due 9/28/19 at 10 am EST
Hybrid learning environments are gradually infiltrating face-to-face teaching environments. Wolpert-Gowron states it plainly, “It is not a question of if; it is a question of how” (2011, para. 3). Blending online and face-to-face content can satisfy the need for flexibility and self-direction, yet also includes the facilitative relationship of the student and instructor (Bradshaw & Hultquist, 2017). The two modalities, if carefully structured, can complement each other.
In the associate degree nursing skills laboratory environment, students show up for a six-hour block of didactic and hand-on learning. The students are often fatigued by the need to be active learners for that amount of time. Indeed, the design of the nursing laboratory is intended to emphasize the application of skills rather than acquiring new knowledge. This environment seems ideal for blended classroom methods. Bradshaw and Hultquist (2017) warn that adequate planning is essential for blended classrooms to be successful. In particular, there is a tendency to expect more work from the students compared with traditional face-to-face learning. In my view, blended environments demand that the instructor be well prepared and very clear with their expectations with the students. The increased work needed by the instructor has been a barrier to implementing blended classroom methods in my institution.
The nursing skills laboratory is where students accomplish psychomotor learning of their nursing skills. The way instructors teach in this environment is not guided by evidence because there is not much research on the topic. Staykova, Stewart, and Staykov (2017) compared traditional methods (PowerPoint lecture, hands-on practice with checklists, and quizzes) against innovative methods in the nursing skills laboratory environment. The innovative strategies included the use of admission tickets (ATs) to class. ATs require home pre-learning to include online or textbook reading and a brief online assignment. Staykova, Stewart, and Staykov (2017) found that active learning is achieved through a combination of traditional and innovative approaches. The use of ATs is particularly intriguing to me in order to make sure all learners arrive with the same necessary information and to help create an engaged learning environment when they are present in class. I hope to use this blended teaching strategy in the future.
References
Bradshaw, M. J., & Hultquist, B. L. (2017). Innovative teaching strategies in nursing and
related health professions (7th ed.). Burlington, MA: Jones and Bartlett.
Educause Learning Initiative. (2012). Things you should know about flipped classrooms.
Retrieved from https://library.educause.edu/-/media/files/library/2012/2/eli7081-pdf.pdf
Staykova, M. P., Stewart, D. V., & Staykov, D. I. (2017). Back to the Basics and Beyond:
Comparing Traditional and Innovative Strategies for Teaching in Nursing Skills Laboratories. Teaching and Learning in Nursing, 12(2), 152–157. https://doi-org.ezp.waldenulibrary.org/10.1016/j.teln.2016.12.001
Wolpert-Gawron, H. (2011, April 28). Blended learning combining face-to-face and online
education. Retrieved January 21, 2015 from https://www.edutopia.org/blog/blended-online-learning-heather-wolpert-gawron
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Need Response For Below Discusssion Post
/in Uncategorized /by developerAPA format 3 references 1 from walden library, 1 page long
Learning activity for Scenario Two
Learning needs
In this scenario, type I and type II diabetic patients will need education on the benefit and use of an insulin pump. When compared to insulin injections, a pump more closely mimics the bodies pancreas in supplying a continuous infusion of insulin (Reece & Hamby Williams, 2014).
Learning objectives
The learning objectives are defined as “specific, measurable, achievable, realistic and timebound” (McKimm & Swanwick, 2009, p. 409). When developing objectives for educating patients on insulin pump use, it is important to address adjustment of pump setting, counting carbohydrates, ability to troubleshoot pump, and recognition of complications, such as diabetic ketoacidosis (Reece & Hamby Williams, 2014).
Learner centered activity
Being that the audience for this course will be already diagnosed diabetics with a basic understanding of the disease and treatment, it would be appropriate to adapt a learner centered course with unstructured learning experiences. Once acquiring the knowledge of how the pump is set up and attached, patients would follow an unstructured learning experience and be asked to “apply their previous experiences …to a situation of their choice” (Billings & Halstead, 2016, p. 164). This type of learning motivates learners to retain knowledge, promotes critical thinking, and apply the information to real life scenarios (Billings & Halstead, 2016).
Measuring learning objectives
One method to measure if the learning outcomes are met, is to provide a post class survey to participants. This patient feedback would provide the information needed to determine if learning objectives were met. The survery would specifically ask if patients felt comfortable managing their insulin pump, if their questions were answered, and if they have the tools needed to improve their glycemic control (Reece & Hamby Williams, 2014).
References
Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (5th ed.). St. Louis, MO: Elsevier.
Reece, S. W., & Hamby Williams, C. L. (2014). Insulin Pump Class: Back to the Basics of Pump Therapy. Diabetes spectrum : a publication of the American Diabetes Association, 27(2), 135–140. doi:10.2337/diaspect.27.2.135
McKimm, J., & Swanwick, T. (2009). Setting learning objectives. British Journal of Hospital Medicine, 70(7), 406–409.
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Need Response For Below Discusssion
/in Uncategorized /by developerAPA format for SOAP NOTE 3 peer review articles 1 and half pages long please follow below instructions
Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition and justify your reasoning
case Study #3 Martha brings her 11-year old grandson, James, to your clinic to have his right ear checked
S
Cc: “Earache right ear”
HPI: Patient is an 11-year-old Caucasian boy who was brought in by his grandmother after complaining about having a mild earache for the past two days. Patient states that the pain is worse when he falls asleep and that it has become harder for him to hear, grandmother believes that he feels warm but has not taken his temperature
Medications: Patient does not take any medications
PMH: No significant illnesses, shots are up to date
FH: No history of previous ear concerns no family history of ear disease. During the school year, patient lives at home with his mother, father and he does not have pets. Patient is staying with grandmother and grandfather most of summer
SH: Student in public school and is currently on summer break, has been spending a lot of time this summer in the pool per his grandmother that he is spending the summer with.
ROS: general: negative for chills fever currently
EENT: complains of mild right ear pain and mild hearing loss, denies tinnitus, denies pain in throat, or eye pain
O
VS: T 100.8, P 94, R 18, BP 98/64
General: Patient appears to be in mild pain, holding head to right side slightly
HEENT: right tympanic membrane obscured, ear canal is read and has a musty odor from ear canal with small amount of watery drainage, head is normocephalic without signs of trauma, no nasal drainage, PEARL, no complaints of sore throat, no redness in throat
SKIN: Warm and dry, good skin turgor, prominent tan
NECK: No lymph node edema or signs of pain on palpation
NEUROLOGICAL: No complaints of headache or dizziness
Diagnostic results. WBC slightly elevated, low grade temp
A
Differential Diagnoses:
1) Acute Otitis Externa
2) Acute Otitis Media
3) Pharyngitis
Primary diagnoses/presumptive diagnoses: Acute otitis media
P – not indicated per template
Assessing for a possible ear infection would require additional information from the patient in addition to a physical assessment of the ear and the patient. Obtaining background information including recent travel, activities, family history, trauma, history of previous illnesses and treatments that have been used for treatment that were successful or not successful.
Diagnostic studies used to diagnose the specific pathogen would include obtaining a culture of purulent drainage, simple otoscopy was mostly used for diagnosing AOM (D’silva, 2013) or a more invasive way of evaluating white blood cell elevation is by completing a CBC which is not used as often as visual inspection of the ear canal. White blood cell count (WBC), a classical inflammation marker, is also used in many scoring systems during routine daily clinical practice (Kutlucan et al., n.d.). Using data from a CBC can also provide information about the patient’s overall health.
Otitis externa
Acute otitis externa is the most common infection of the external auditory canal (Demirel et al., 2018). Ball describes (2015) symptoms of otitis externa as having watery to purulent and thick drainage mixed with pus with a musty odor and usually occurs after swimming.
Acute otitis media
Acute otitis media is one of the most frequent bacterial infections in children, and one of the primary reasons for the prescription of antibiotics by pediatricians (Intakorn, n.d.). Otitis media can have an abrupt onset with fever, feeling of a blockage, and interferes with sleep. The middle ear fills with pus causing conductive hearing loss (Ball).
Acute pharyngitis:
Acute respiratory infections are one of the most common diseases, accounting for one of the main causes of patient visits to community health centers and hospitals (Yuniar, 2017). Ball (2015) describes a patient with acute pharyngitis as having a sore throat with deferred pain in ears and dysphagia with fever, malaise, fetid breath, abdominal pain and headache.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., Stewart, R. W. (2015). Seidel’s guide to
physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Demirel, H., Arlı, C., Özgür, T., İnci, M., & Dokuyucu, R. (2018). The Role of Topical
Thymoquinone in the Treatment of Acute Otitis Externa; an Experimental Study in
Rats. Journal of International Advanced Otology, 14(2), 285–289. https://doi-
org.ezp.waldenulibrary.org/10.5152/iao.2017.4213
D’silva, L., Parikh, R., Nanivadekar, A., & Joglekar, S. (2013). A Questionnaire-Based Survey
of Indian ENT Surgeons to Estimate Clinic Prevalence of Acute Otitis Media, Diagnostic
Practices, and Management Strategies. Indian Journal of Otolaryngology & Head & Neck
Surgery, 65, 575–581. https://doi-org.ezp.waldenulibrary.org/10.1007/s12070-012-0545-2
Intakorn, P., Sonsuwan, N., Noknu, S., Moungthong, G., Pircon, J.-Y., Liu, Y., … Hausdorff, W.
P. (n.d.). Haemophilus influenzae type b as an important cause of culture-positive acute
otitis media in young children in Thailand: a tympanocentesis-based, multi-center, cross-
sectional study. BMC PEDIATRICS, 14. https://doi-org.ezp.waldenulibrary.org
/10.1186/1471-2431-2431-14-157
Kutlucan, L., Kutlucan, A., Basaran, B., Dagli, M., Basturk, A., Kozanhan, B., … Kos, M. (n.d.).
The predictive effect of initial complete blood count of intensive care unit patients on
mortality, length of hospitalization, and nosocomial infections. EUROPEAN REVIEW
FOR MEDICAL AND PHARMACOLOGICAL SCIENCES, 20(8), 1467–1473.
Retrieved from
https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=t
rue&db=edswsc&AN=000380260000006&site=eds-live&scope=site
Yuniar, C. T., Anggadiredja, K., & Islamiyah, A. N. (2017). Evaluation of Rational Drug Use for
Acute Pharyngitis Associated with the Incidence and Prevalence of the Disease at Two
Community Health Centers in Indonesia. Scientia Pharmaceutica, 85(2), 1–10.
https://doi-org.ezp.waldenulibrary.org/10.3390/scipharm85020022
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Need Response For Below Post 19225811
/in Uncategorized /by developerAPA format 1 page with 3 references one from the reference at end of post.
Due 5/11/19 1200 EST
When looking to establish an evaluation model, it is necessary to look at the curriculum design and analyze its effectiveness (Billings & Halstead, 2016). Our team selected both formative and summative models of evaluation. Formative evaluation occurs during the individual sessions, allowing the educator and learner to give feedback on the curriculum as it is presented (Klenowski, 2010). The summative evaluation looks at our program as a whole, and looks at adherence of program mission, vision and philosophy.
The two curriculum components to include in the evaluation model are those of organization and goals. Our curriculum sessions are organized in logical order; we establish a simple to complex model of learning. When evaluating our sessions, we would look at “increasing depth and complexity to determine whether the sequencing was useful to learning and progressed to the desired (program) outcomes” (Billings & Halstead, 2016, p. 475). In addition, with a summative model, evaluating if the program goals have been met at the conclusion of the program will look at the effectiveness of the curriculum (Klenkowski, 2010).
As a Community Health Accreditation Partner (CHAP), our facility meets the requirements for accreditation, specifically adequate management of pain (CHAP, 2017). The program we have developed will cover the educational needs of the family and caregivers, as well as provide hospice nurses with the necessary tools to implement and evaluate the management of pain in the home.
References
Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (5th ed.). St. Louis, MO: Elsevier.
Community Health Accreditation Partner. (2017). Standards of excellence: Hospice. Retrieved from https://education.chaplinq.org/chap-standards-of-excellence
Klenowski, V. (2010). Curriculum Evaluation: Approaches and Methodologies. Elsevier, Inc. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edsgvr&AN=edsgcl.1504700072&site=eds-live&scope=site
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Need Response For The Below Case Study Discussion
/in Uncategorized /by developerAPA format 3 peer references and discussion needs to be related to what is posted as response to the persons diagnosis
Patient Initials: RF Age: 15 Gender: M
SUBJECTIVE DATA:
Chief Complaint (CC): A dull pain in both knees with occasional clicking in one or both knees and the sensation of the patella catching.
History of Present Illness (HPI): RF is a 15-year-old male who reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. He states that the pain has been on and off for the last four months and initially only present after intense activity but has gotten worse since starting track this summer and seems to be present more often than before.
The patient states that the clicking comes and goes and isn’t always present in both knees at the same time. The catching sensation under the patella is more pronounced since he started doing the long jump in track. The patient states that he is able to bear weight as the pain is a dull ache. Icing his knees after sports and taking ibuprofen help to reduce the pain and swelling but both occur more frequently now making it difficult to participate in sports. The patient feels that he may be overdoing it with all of the sports he participates in and is worried about not being able to play soccer if it continues to get worse. The patient rates the pain 7/10 after intense activity.
Medications: Ibuprofen 200 mg oral tab, two tabs every 6 hours as needed for pain.
Allergies: No known drug, food, or environmental allergies.
Past Medical History (PMH): None
Past Surgical History (PSH): None
Sexual/Reproductive History: Patient is not sexually active at this time.
Personal/Social History: Patient denies smoking, alcohol use, and illicit drug use. The patient is very active with sports playing soccer, basketball, baseball, and track. He states that he tries to eat well mainly because of sports but doesn’t always make the best choices for snacks. He tries to avoid soda most of the time and reports drinking a lot of water.
Immunization History: Immunizations are up to date. Gets influenza vaccine annually.
Significant Family History:
Paternal grandfather has hypertension, and father has borderline hypertension. Maternal grandfather has type II diabetes.
Lifestyle: RF is a freshman in high school who lives with both of his parents and older sister. RF plays soccer, basketball, baseball and participates in track for high school. RF also plays club soccer playing and traveling most of the year. RF is a good student, athletic, and enjoys being active. He also participates in winter sports and skis during winter break. RF works part-time as a referee during the summers due to his commitment to school and sports.
Review of Systems:
General: No recent weight gain or loss of significance. Patient denies fatigue, fever, or chills.
HEENT: No headaches or dizziness. No changes in vision. He does not wear glasses, and his last eye exam was just under a year ago. Denies eye drainage, pain, or double vision. No changes in hearing. Has had no recent ear infections, tinnitus or ringing in the ears. Denies sinus infections, congestion, and epistaxis. He reports his sense of small is intact. Last dental exam was four months ago for regular cleaning. Denies bleeding gums or a toothache. Denies dysphagia or throat pain.
Neck: No history of trauma, denies recent injury or pain. He denies neck stiffness.
Breasts: Denies any breast changes. Denies history rashes. Denies history of masses or pain.
Respiratory: Denies a cough, hemoptysis, and sputum production. Patient denies any shortness of breath with resting or with exertion. Patient reports no pain with inspiration or expiration.
Cardiovascular/Peripheral Vascular: No history of murmur or chest palpitations. No edema or claudication. Denies chest pain. No history of arrhythmias.
Gastrointestinal: Denies nausea or vomiting. Patient reports no abdominal pain, diarrhea, or constipation. Last bowel movement was this morning. Denies rectal pain or bleeding. Denies changes in bowel habits. Denies history of dyspepsia.
Genitourinary: Denies changes in urinary pattern. No incontinence, no history of STDs or HPV, the patient is heterosexual and not sexually active. Denies hematuria. Denies urgency, frequency, and dysuria.
Musculoskeletal: No limitation in range of motion for all limbs though patient reports difficulty moving knees after excessive strain from sports. No history of trauma or fractures. Patient reports dull pain in both knees. The patient states occasional swelling in knee joints after participating in sports. Patient reports clicking in one knee and sometimes both. The patient states that the pain is worse after participating in the long jump or running long distances. Patient denies history or presence of misalignment of either knee.
Psychiatric: Denies suicidal or homicidal history. No mental health history. Denies anxiety and depression.
Neurological: No dizziness. No problems with coordination. Denies falls or seizures. Denies numbness or tingling. Denies changes in memory or thinking patterns.
Skin: No history of skin cancer. Denies any new rashes or sores. Patient reports many blisters from sports which are treated with Neosporin, band-aids, and NewSkin spray. Denies eczema and psoriasis. Denies itching or swelling.
Hematologic: No bleeding disorders or history of blood transfusion. Denies excessive bruising.
Endocrine: Patient reports no endocrine symptoms. Denies polyuria, polydipsia. Patient denies no intolerance to heat or cold.
Allergic/Immunologic: Denies environmental, food, or drug allergies. No known immune deficiencies.
OBJECTIVE DATA:
Physical Exam:
Vital signs: B/P 118/74; P 65 and regular; T 98.6; RR 16; O2 100% on room air; Wt: 125 lbs.; Ht: 5’7”; BMI 19.1
General: RF is a well-developed, well-nourished Caucasian teenage male who appears to be in no apparent distress.
HEENT: Head: Skull is normocephalic, atraumatic. No masses or lesions.
Eyes: PERRLA, +direct and consensual pupil response. EOM intact, 20/20 vision bilaterally without correction. Fundoscopic exam normal, vessels intact, the optic disc with clear margins.
Ears: Bilateral external ears no lesions, masses, drainage or tenderness. Tympanic membranes intact, pearly gray, no bulging, no erythema, and landmarks appreciated bilaterally. Hearing intact bilaterally.
Nose: No nasal flaring, no discharge, no obstruction, septum not deviated. Turbinates pink and moist. No polyps or lesions bilaterally. Nares patent with no edema or erythema.
Throat: Oropharynx clear and mucosa moist. No erythema or exudate. Uvula midline, palate rises symmetrically.
Mouth: No lesions, no thrush. Moist mucous membranes. Healthy dentition present. Tongue midline.
Neck: Supple, non-tender. Full range of motion. Trachea midline. No masses. Thyroid and lymph nodes not palpable.
Chest/Lungs: Thorax non-tender with symmetric expansion. Respiration regular and unlabored, without a cough. Tactile fremitus equal bilaterally and greater in upper lung fields. Breath sounds clear with adventitious sounds. All lung fields with resonant percussion tones.
Heart: Regular rate and rhythm; normal S1, S2; no murmurs, rubs, or gallops. Apical pulse not visible. Apical pulse was barely palpable. JVP appears to be approximately less than 6 cm with HOB elevated to 45 degrees. No carotid bruits or JVD appreciated.
Peripheral Vascular: Pulses 2+ bilateral pedal and 2+ radial bilaterally. No pedal edema. Popliteal pulses 2+ bilaterally.
Abdomen: Abdomen round, soft, and non-tender without rash, palpable mass or organomegaly. Active bowel sounds. Tympany over most quadrants with areas of dullness noted upon percussion. No abdominal bruits.
Genital/Rectal: Adequate tone, no masses noted, eternal genitalia intact.
Musculoskeletal: Normal passive and active ROM in upper and lower extremities. No focal joint inflammation or abnormalities appreciated in upper extremities. + tenderness to palpation at the inferior pole of the patella bilaterally. + Q angle greater than 10 degrees bilaterally. Clicking present with movement in right knee. Normal alignment of the knees bilaterally. All upper and lower extremity joints without effusions or erythema. Spine without tenderness and range of motion is full. Greater tenderness was noted in knees bilaterally when extended, and quadriceps are relaxed. Normal muscle strength present against resistance.
Neurological: CN ll-Xll grossly intact. Awake, alert, and oriented to person, place and time. The patient can move all limbs on command and spontaneously.
Skin: Warm, moist, and intact. Skin is pale. + edema right knee. No peripheral cyanosis. No clubbing. No rashes or bruises present.
ASSESSMENT:
Lab Tests and Results:
CBC- Normal
Erythrocyte sedimentation rate (ESR) – Normal
Diagnostic test:
Passive extension-flexion sign- positive- which is tenderness on palpation of the tendon at the inferior pole of the patella.
McMurray test- Negative for locking during joint movement.
X-ray- negative
MRI- Showed high signal intensity within the proximal posterior central aspect of the tendon at its origin.
Differential Diagnosis:
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Huether, S. E., & McCance, K. L. (2017). Disorder of the joints. In alterations of musculoskeletal function (6th ed., pp. 991-1038).
Rath, E., Schwarzkopf, R., & Richmond, J. (2010). Clinical signs and anatomical correlation of
patellar tendinitis. Indian Journal of Orthopaedics, 44(4), 435-437 3p. doi:10.4103/0019-
5413.6931
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Need Response To Below Discussion 19159885
/in Uncategorized /by developerMSN APA format 3 references 1 from Walden University Library,
Due 3/14/19 7pm EST
Needs Assessment: External Factors that Impact Curriculum and Program Development
When a potential student is deciding on attending a new college or university, there are many factors that could change that decision. The desire to attend a nationally accredited school can play a large part in the decision-making process. Potential employers know that accredited institutions undergo rigorous processes to achieve and maintain the high quality standards set by accrediting bodies that looks great on a student’s resume. During this weeks post, I will post a brief description of the setting my team selected for the course project. I will explain which accrediting body or agency they have accreditation from and why. Then I will identify the standards I selected and explain if the setting meets the outlined expectations.
Accrediting Body
The northeast region team has selected Seton Hall University for this course’s project. The main campus of Seton Hall is located in South Orange, New Jersey with their health and sciences campus in Clifton and Nutley, New Jersey. This university has accreditation from the Commission on Collegiate Nursing Education, or CCNE. This agency is the national voice for academic nursing education and works to, influence the nursing profession to improve healthcare, establish quality standards for nursing education while assisting schools in implementing them, and promotes public support for research, practice, and professional nursing education (American Association of Colleges of Nursing, 2012). It is the responsibility of the educators in the facility to make sure that the curriculum components such as the mission, vision, philosophy, organizational framework, student-learning outcomes, and the program of study are well outlined and taught appropriately (Keating & DeBoor, 2018). Seton Hall continues to use this accrediting agency to make sure that their education is up to date and they are preparing students for the world of nursing.
Standards
The CCNE accreditation process is based on core values, I will discuss a few of them in this post and describe if Seton Hall meets the expectations. The first is to foster an educational climate that supports program students, graduates, and faculty in their pursuit of lifelong learning (Billings & Halstead, 2016). According to the Seton Hall University website (2019), students and faculty are encouraged to pursue their education and continue learning with multiple graduate nursing programs, graduate courses, doctoral programs, and certificate courses. The second standard is to encourage programs to develop graduates who are effective professionals and socially responsible citizens (Billings & Halstead, 2016). Seton Hall University obliges with this standard in a few different ways. They offer multiple clinical settings to allow the student to become an effective professional, and they have classes discussing legal issues, research, leadership, and management. Giving a student these tools will provide them with the skills to be socially responsible citizens as well as effective professionals. The final standard is to facilitate and engage is self-assessment. The University has a department whose sole focus is on self-assessment. They consistently perform assessments on programs in the university and recommend improvements that should be made within each program (Seton Hall University, 2019). As we continue to explore this university’s curriculum, I will continue to evaluate how Seton Hall is doing as a nursing program, and see what changes need to be made. The CCNE standards discussed are currently being met, but there is much more to explore, and there are always improvements that could be made.
References
American Association of Colleges of Nursing. (2012). CCNE accreditation. Retrieved
from http://www.aacn.nche.edu/ccne-accreditation
Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (5th
ed.). St. Louis, MO: Elsevier.
Keating, S. B., & DeBoor, S. S. (Ed.). (2018). Curriculum development and evaluation
in nursing (4th ed.). New York, NY: Springer.
Seton Hall University. (2019). Retrieved from http://www.shu.edu/nursing/
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Need Response To Below Discussion 19160921
/in Uncategorized /by developerAPA format 2 pages 3references 1 from Walden University Library
Due 3/15/19 at 6pm EST
escription of setting
Our midwest group has chosen Suncrest Hospice and Home care located in Ames and Des Moines, Iowa. It is a a home based agency which provides care for patients who are terminally ill. The employees consist of nurses, home health aides, social workers, counselors and others. In addition to medical needs, the team focuses on the emotional, physical, social and spiritual needs of the patients, as well as supporting family members (Hospice.io, n.d.).
Accreditation
There are three agencies that provide accreditation for home care and hospice; The Joint Commission (TJC), Community Health Accreditation Program (CHAP), and Accreditation Commission for Healthcare (ACHC) (Devoti, 2018). Suncrest Hospice and Home Care received accrediation approval from Community Health Accredition Partner (CHAP), which is valid through August 26th, 2021 (CHAP, 2018). CHAP was “created in 1965, and …was the first accrediting body for home and community-based healthcare organizations in the United States” (CHAP, 2018). By being CHAP accredited, Suncrest meets the regulatory requirment to be Medicare certified, which means that hospice services are covered by Medicare/Medicaid (Office of the Federal Register, 2018).
Three CHAP standards selected for review
After review of the CHAP hospice standards (2018), I selected the following three to review:
According to Suncrests´ Mission, they are committed to “…provide the highest quality of care and customer service to (their) patients, their families and (their) referring sources” (2018). The mission statement does not clearly detail the goal of hospice and palliative care in addressing the multiple aspects of care of a terminally ill patient, therefore not clearly meeting the first standard selected.
On the Suncrest website, hospice is described as treatment provided by “…qualified and compassionate physicians, nurses, aides, social workers, and spiritual advisors” (Suncrest, 2018). This statement does comply with the second standard selected, in that a team is providing and implementing a plan of care for each patient.
Looking at the career webpage of Suncrest Hospice, there are two opening for employment at the Des Moines location. This meets the third standard selected of adequate staff.
References
Community Health Accreditation Partner [CHAP]. (2018). CHAP accredited organization locator. Retrieved from
https://locator.chaplinq.org/
Community Health Accreditation Partner [CHAP]. (2018). About our history. Retrieved from https://chapinc.org/contact-about-us/
Devoti, A.L., (2018) Accreditation services for home care and hospice. Retrived from
https://www.homecaremag.com/may-2018/accreditation-home-health-hospice
Hospice.io, (n.d.) Suncrest Hospice, Llc west des moines. Retrieved March 12th, 2019 from
https://hospice.io/care/suncrest-hospice-llc-west-des-moines-ia/
Office of the Federal Register. (2018). Continued approval of the community health accreditation partner’s hospice accreditation program. Retrieved from https://www.federalregister.gov/documents/2018/11/16/2018-25066/medicare-and-medicaid-programs-continued-approval-of-the-community-health-accreditation-partners
Suncrest. (2018). Our mission. Retrieved from
https://suncrestcare.com/our_mission/
Suncrest. (2018). What is hospice? Retrieved from
https://suncrestcare.com/hospice/
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