APA format 3 peer review references 

Patient Initials: __JH_____                Age: __60_____                                 Gender: ____M___

Subjective Data:

Chief Complaint: Case #3 “I have a cough that’s getting worse.” (Laureate Education, 2012).

HPI: Mr. Hendricks is a 60 year-year old Caucasian male who presents today complaining of a cough that is progressively getting worse; more frequent over the past three days. He states that his cough is accompanied by expectoration of thick green secretions accompanied by some blood at times. He has associated symptoms of shortness of breath that is aggravated when walking and nothing seems to help. Patient also states that he had difficulty trying to fall asleep last night because he felt like he was getting a fever and had intermittent chills and sweats and took Tylenol. He states “I have never felt like this before and would like to know what’s going.”

Medications: over the counter Tylenol 650mg po at nights.

Allergies: No known drug or food allergies. No seasonal allergies.

Past Medical History: No medical history provided.

Past Surgical History: No surgical history provided.

Immunization history: Up to date with immunizations. Influenza shot received September 2018. Pneumococcal vaccine received October 2018.

Personal/Social History: Patient denies smoking, drinks wine socially, exercise with brisk walking three times weekly and tries to eat a balanced diet. He has a master’s degree in finance and works as an accountant at an accounting firm. He is a safe driver who drives to work daily and always wears seatbelt. He lives with his wife who is a homemaker who helps baby sit twin granddaughters. Patient denies history of recent travel to foreign country within the three months.

Review of Systems

General: productive cough with green phlegm and blood at times; shortness of breath, chills, night sweats, fever and restlessness.

HEENT: Patient denies head or nasal congestion, headache, nasal discharge, dizziness, vertigo. Patient states productive cough with green-colored sometimes bloody phlegm.

Cardiovascular: Patient denies palpations. Has some chest tightness.

Respiratory: Patient states that he has SOB that worsens with walking. Has productive cough with green-colored sputum and occasional hemoptysis. Patient states that he hears whistling noises when he breathes.

Objective Data:

Physical exam:

General: Mr. Hendricks is a 60 year old Caucasian male and a good historian who is relatively healthy and has good hygiene. Alert and oriented x 3, looks age appropriate with normal facial expression and appropriate behavior. He coughed a few times during exam and appears to be in some respiratory distress with shortness of breath.

Vital signs: Ht. 5’9”, Wt. 210 lbs; BMI= 30, blood pressure 128/70, pulse of 82, respirations of 20 and labored, temperature of 100.9 and O2 saturation on room air of 89%.

HEENT: No headache or head masses. No lesions. Wears glasses. Pupils equal and reactive to light; ears symmetrical, no tenderness or discharge. No frontal or maxillary sinus tenderness. No discharge from nose and mucosa pink and moist. Wears partial upper dentures. Throat appears red. Good hygiene.

Neck: No masses, full range of motion. Thyroid size normal.

Integumentary: Warm and most

Respiratory: Thorax symmetrical with diminished breath sounds. B/L rales and expiratory wheezes throughout. Wet productive cough.

Cardiovascular: regular heart rate with good S1 and S2 heart sounds. No S3, S4 or murmur.

Gastrointestinal: abdomen protuberant. Normoactive bowel sounds in all four quadrants.

Peripheral vascular: No peripheral edema. 2+ dorsalis pedis pulses palpated bilaterally.

ASSESSMENT:

Lab Tests and Results:

1. CBC: Blood tests are used to confirm an infection and to try to identify the type of organism causing the infection (Mayo Clinic, 2018.)
2. Sputum culture: is taken after a deep cough and analyzed to help pinpoint the cause of the infection (Mayo Clinic, 2018).
3. O2 saturation: decreased oxygen saturation indications indicates hypoxemia. Normal range should be 95-100% on RA (Mayo Clinic. 2018).

Diagnostics:

1. Chest X-ray: helps your doctor diagnose pneumonia and determine the extent and location of the infection (Mayo Clinic, 2018).

 Differential Diagnoses:

1. Bacterial pneumonia: is an infection of the air sacs in one or both lungs which may fill with fluid or pus, causing cough with phlegm or pus, fever, chills, and difficulty breathing, dullness to percussion, decreased breath sound, fatigue. It is most commonly caused by Streptococcus pneumoniae(Mayo Clinic, 2018). Since the patient appears to have most of these symptoms, this is a great possibility.
2. Acute bronchitis: Acute bronchitis, often called a “chest cold,” is the most common type of bronchitis. It occurs when the airways of the lungs swell and produce mucus which makes one cough. It is caused by a virus and often occurs after an upper respiratory infection. Symptoms include sore throat, soreness in the chest, fever, coughing with or without mucus production, fatigue, mild headaches and watery eyes (CDC, 2017b). This can also be a possibility based on the patient’s symptoms.
3. Asthma exacerbation: Asthma is a disease that affects your lungs. It causes repeated episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. Asthma can be controlled by taking medicine and avoiding the triggers that can cause an attack (CDC, 2017a). This can also be a possibility based on the patient’s symptoms.
4. Bronchiectasis exacerbation: Bronchiectasis is a condition in which the airways (called bronchial tubes) that branch from the trachea into each lung become widened and inflamed. Such damage limits the ability of the airways to clear bacteria and mucus from the lungs, resulting in sputum production, cough, and shortness of breath. Bronchiectasis can be congenital or acquired as a result of an infection. Symptoms include cough, shortness of breath, wheezing, weight loss, fatigue and chronic sinusitis (Mount Sinai, 2018). Based on these symptoms, this can be a possibility for patient diagnosis.
5. COPD exacerbation: chronic obstructive pulmonary disease (COPD) experiences long-term and progressive damage to their lungs. This affects air flow to the lungs. Symptoms include rapid shallow breathing, increasing amounts of mucus, which is often yellow, green, tan, or even blood-tinged, experiencing shortness of breath at rest or with minimal activity, such as walking from one room to another and wheezing more than usual (Healthline.com, 2018). Based on patient symptoms, this can also be a possibility for the patient condition.

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.

Centers for Disease Control and Prevention (2017a). Asthma. Retrieved October 9, 2018 from:

https://www.cdc.gov/asthma/

Centers for Disease Control and Prevention (2017b). Bronchitis. Retrieved October 9, 2018

from: https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/bronchitis.html

Healthline.com (2018). COPD Exacerbation. Retrieved October 9, 2018 from:

https://www.healthline.com/health/copd/exacerbation-symptoms-and-warning-signs

Laureate Education. (Producer). (2012). Advanced health assessment and diagnostic reasoning.

Baltimore, MD: Author.

Mayo Clinic (2018). Pneumonia. Retrieved October 9, 2018 from:

https://www.mayoclinic.org/diseases-conditions/pneumonia/symptoms-causes/syc-20354204

Mount Sinai (2018). What is Bronchiectasis? Retrieved October 9, 2018 from:

http://nationaljewish.mountsinai.org/conditions-we-treat/bronchiectasis-and-ntm/

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

APA format 1 page long 3 references and please include one from discussion post

MSN degree Need ASAP for 9/7/19.

Audience

 First-year nursing students come in an associate degree nursing program have typical prerequisite coursework, yet often come with a high degree of variable life experiences. Nursing students, in general, are academic achievers who could not be admitted to their program without a high grade point average. Prerequisite coursework, such as anatomy and physiology, resides at the knowledge and comprehension level of Bloom’s taxonomy, which requires students to explain, memorize, and describe concepts (Bristol & Kerwekh, 2011).  Early nursing coursework begins to include application and analysis where students must criticize, compare, and develop ideas. For many, this is a big leap. Bradshaw and Hultquist (2017) describe that students’ progress through learning via set steps. The first step is dualistic thinking where concepts are black and white. This progresses to multiplicity, where more diverse ideas are tolerated. Nursing students also experience a difficult transition to understanding the conceptual grey areas.

Learning Need

            Early in the nursing program, students are expected to identify scholarly versus non-scholarly sources of information. Students are expected to include scholarly sources in their self-directed learning and include these in their assignments. Being able to evaluate evidence is critical for patient safety as they advance in their training and career (Horntvedt, Nordsteien, Fermann, & Severinsson, 2018).  The following are two learning objectives for this lesson:

• Summarize the difference between academic and non-academic sources of nursing knowledge
• Provide two examples of academic sources of knowledge

Horntvedt et al. (2018) found that interactive teaching and integration into clinical practice were effective strategies for teaching students to evaluate evidence.  The learning activity will provide necessary information about scholarly sources of information in an online format. This lesson will use a video presentation to highlight critical concepts related to assessing academic sources of information. During the lesson, students will be shown five different sources of information and be asked to rank the sources in order of most reliable to least reliable.

Evaluation

            Shank (2005) emphasizes the need to match the skill level of the learner with the learning objectives and activities. For first-year nursing students, a basic understanding of scholarly versus non-scholarly work is appropriate. An analysis of formal research study validity is beyond the scope of what is needed at their level. The verb summarize corresponds with the knowledge level of learning in Bloom’s taxonomy. The second objective asks the student to provide two examples, which demonstrates comprehension-level understanding in Bloom’s. Both objectives, if successfully met, will allow the student to complete the required work, accessing scholarly work, successfully.

References

Bradshaw, M. J., & Hultquist, B. L.  (2017). Innovative teaching strategies in nursing and

            related health professions (7th ed.). Burlington, MA: Jones and Bartlett.

Bristol, T. J., & Zerwekh, J. (2011). Essentials of e-learning for nurse educators. Philadelphia,

            PA: F. A. Davis Company.

Horntvedt, M.-E. T., Nordsteien, A., Fermann, T., & Severinsson, E. (2018). Strategies for

teaching evidence-based practice in nursing education: a thematic literature review. BMC MEDICAL EDUCATION, 18. https://doi-org.ezp.waldenulibrary.org/10.1186/s12909-018-1278-z

Shank, P. (2005). Writing learning objectives that help you teach and students learn (Part 1).

 Online Classroom, 4–7. Retrieved from the Walden Library databases.

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

APA format 1 1/2 pages long 3 references 1 from the discussions reference list

due 10/24/19 at 7pm

 Incorporating Technology in Community-Based Learning

            Unique learning needs exist in all patient populations.  However, identifying the need and then designing a technology-based intervention requires a careful analysis of both the population and the planned action.  The purpose of this discussion is to describe a community-based population, describe a selected learning need for this population, and explain how I would design a PowerPoint presentation that would address that need. 

Community-Based Population

            I work in a Federally Qualified Health Center (FQHC) that provides primary care to patients across the lifespan.  FQHCs receive funding from the Health Resources and Services Administration Health Center Program to provide care in medically underserved communities (Health Resources & Services Administration [HRSA], 2018).  Over 28 million people receive care at FQHCs in the United States (HRSA, n.d.).  FQHCs use a sliding scale fee, ensuring patients have access to affordable medical care (HRSA, 2018).  While FQHCs are intended to serve the medically uninsured, over 77% of the patients receiving care at FQHCs have private insurance, Medicare, Medicaid, or another governmentally funded health insurance (HRSA, 2019).  Females represent 57.65% of the patient population, with patients between the ages of 25 and 69 years old presenting most frequently (HRSA, 2019).  However, the FQHC patient population possesses unique barriers to care.  A significant hurdle for FQHCs to overcome is language, as 23.63% speak a language other than English (HRSA, 2019).  Additionally, 68.23% of the patient population is at or below the poverty level (HRSA, 2019).  Complicating continuity of care with this patient population is the high number of migratory and seasonal workers and homeless individuals receiving care (HRSA, 2019).  All combined, these factors create a patient population with sub-par health literacy.

Learning Need

            Indigent patient populations are more likely to have decreased health literacy levels (Whitley, Jones, Hansen, & Vora, 2019).  Additionally, patients with diminished health literacy are less likely to return for follow-up care as scheduled (Thompson et al., 2015).  Patients who are chronically under- or uninsured do not return for follow-up appointments as medical is not always viewed as a necessity.  Failure to follow-up for appointments as scheduled has been shown to increase emergency department visits and worsen patient outcomes (Arora et al., 2015).  Therefore, a means to address the FQHC patients’ knowledge deficit of the need to return for follow-up appointments should be identified and implemented. 

Addressing the Learning Need

            As previously identified, members of FQHC patient populations have decreased health literacy resulting in noncompliance with follow-up appointments and poorer patient outcomes.  However, a systematic review of 60 studies identified text messages as an effective intervention to improve patient compliance, thereby increasing patient outcomes (Hirshberg, Downes, & Srinivas, 2018).  Text messages provide a low-cost, highly scalable intervention to improve patient follow-up (Arora et al., 2015).  Additionally, few members of society do not have access to a mobile phone.  Text messages sent seven days, and one day before scheduled appointments are effective intervals for improving patient follow-up (Arora et al., 2015).  Potential obstacles for this intervention include patients changing their mobile numbers, having limited data usage, and the inability to know whether the message was received.  However, using text messages to reinforce the need for compliance with follow-up care will address the learning deficit for this patient population.  Additionally, orientating the office staff and then including them in the implementation of this intervention will address the staff’s learning need.  Therefore, a PowerPoint presentation should be designed to orient the staff to this technology-based, evidence-based intervention.

Summary

            Learning needs exist in all patient populations.  Ongoing advances in technology are providing new methods for addressing these needs.  By taking advantage of these technologies, evidence-based interventions can successfully be implemented in the practice setting.     

Reference

Arora, S., Burner, E., Terp, S., Nok Lam, C., Nercisian, A., Bhatt, V., & Menchine, M. (2015). Improving attendance at post–emergency department follow‐up via automated text message appointment reminders: A randomized controlled trial. Academic Emergency Medicine, 22(1), 31-37.

Health Resources & Services Administration. (2018, May 8). Federally Qualified Health Centers. Retrieved from https://www.hrsa.gov/opa/eligibility-and-registration/health-centers/fqhc/index.html

Health Resources & Services Administration. (2019). 2018 Health Center Data. Retrieved from https://bphc.hrsa.gov/uds/datacenter.aspx?q=tall&year=2018&state=

Health Resources & Services Administration. (n.d.). HRSA Health Center Program. Retrieved October 1, 2019, from https://bphc.hrsa.gov/sites/default/files/bphc/about/healthcenter factsheet.pdf

Hirshberg, A., Downes, K., & Srinivas, S. (2018). Comparing standard office-based follow-up with text-based remote monitoring in the management of postpartum hypertension: A randomised clinical trial. BMJ Quality & Safety, 27(11), 871-877. doi:10.1136/bmjqs-2018-007837

Thompson, A. C., Thompson, M. O., Young, D. L., Lin, R. C., Sanislo, S. R., Moshfeghi, D. M., & Singh, K. (2015). Barriers to follow-up and strategies to improve adherence to appointments for care of chronic eye diseases. Investigative Ophthalmology & Visual Science, 56(8), 4324-4331. doi:10.1167/iovs.15-16444

Whitley, M. Y., Jones, E. M. V. W., Hansen, B. K., & Vora, J. (2019). The impact of self-monitoring blood glucose adherence on glycemic goal attainment in an indigent population, with pharmacy assistance. Pharmacy and Therapeutics, 44(9), 554. doi:10.43 21/s1885-642×2006000400006

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

APA format MSN degree 2 pages 3 references 2 from walden university library 

due 4/11/18 at 7pm EST

Thyroid Disorder

Thyroid disorder can occur as a primary gland disfunction or in result to an associated hormone. It is important to understand the cause of the thyroid disorder for proper treatment and follow up. The content of this post will discuss hypothyroidism, which is the most common thyroid disorder diagnosed. Most commonly seen in women, but men also suffer from the disease process. Hypothyroidism may occur as primary disfunction of the gland or in relation to a secondary cause (Roberts & Ladenson, 2004). 

Hypothyroidism occurs when there is a low level of thyroid hormone (TH). Most commonly this is occurs as a autoimmune response of the body, autoimmune thyroiditis. The thyroid tissue becomes inflamed when T lymphocytes and thyroid autoantibodies are infiltrated. The inflammation destroys viable thyroid tissue. This can be a genetic response. Hypothyroidism can also occur due a secondary response (Huether & McCance, 2017, p. 469). 

Treatment 

Hypothyroidism is diagnosed after looking at the clinical presentation of the patient and after measuring TH levels in the blood. Hormone replacement is achieved when the patient takes levothyroxine. Dosages are determined by looking at the patient’s age, the severity, and other active disease processes (Huether & McCance, 2017, p. 469). 

Behavior

Medication compliance is essential as hypothyroidism is managed. Individuals with hypothyroidism can live normal lives as long as their treatment plan is followed and medications are taken as prescribed. Other exciting patient factors can affect compliance. Depression for example can prevent patients from taking medications as prescribed. When this happens, providers may believe that a higher dosage of medication is needed to alleviate the patient’s other symptoms. When diagnosing and working with patients with a mental health disorder it is imperative to have a close, understanding relationship when adjusting and prescribing medications (Sevinc & Savli, 2004). 

Preventing Negative Side Effects

Hypothyroidism is usually develops over a period of time. Patients usually experience a low level of energy as their metabolism decreases. Lethargy and cold intolerance also follows the disease process. Because TH production is less, thyroid stimulating hormone (TSH) tries to compensate and increases. An increase amount of TSH can cause goiter, myxedema, and even myxedema coma. Myxedema coma is a medical emergency because the patient will be experiencing lethargy, low blood pressure, hypoventilation, low blood sugar, acidosis, and hypothermia without compensation. Often times, elderly patients get their symptoms confused with aging. It is important to remember no signs of hypothyroidism are a normal part of aging (Huether & McCance, 2017, p. 469). 

References 

Huether, S. E., & McCance, K. L. (2017). Understanding  pathophysiology (6th ed.). St. Louis, MO: Mosby.

Roberts, C. P., & Ladenson, P. W. (2004). Hypothyroidism. Lancet (London, England), 363(9411), 793-803.

Sevinc, A., & Savli, H. (2004). Hypothyroidism masquerading as depression: The role of noncompliance. Journal Of The National Medical Association, 96(3), 379-382.

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

APA format 1 and half pages 3 peer review references 2 from walden university library

Pathophysiology:  A urinary tract infection (UTI) is an infection in any part of your urinary system involving your kidneys, ureters, bladder and urethra.  It can be separated into two categories, upper and lower.  The upper urinary tract is composed of the kidneys and ureters.  The lower urinary tract consists of the bladder and the urethra.  Lower UTI’s are more common than upper.  Each type of UTI may result in more-specific signs and symptoms, depending on which part of your urinary tract is infected.  UTI.s typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder.  Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail.  When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract, (Huether & McCance, 2012).

Medications:  Antibiotics usually are the first line treatment for urinary tract infections. Which drugs are prescribed and for how long depend on your health condition and the type of bacteria found in your urine.  Commonly prescribed antibiotics include, Trimethoprim/sulfamethoxazole, Fosfomycin, Nitrofurantoin, Cephalexin, and Ceftriaxone.  The group of antibiotic medicines known as fluoroquinolones like ciprofloxacin, and levofloxacin aren’t commonly recommended for simple UTIs, as the risks of these medicines generally outweigh the benefits for treating uncomplicated UTIs.  In some cases, such as a complicated UTI or kidney infection, your doctor might prescribe a fluoroquinolone medicine if no other treatment options exist.  For a severe UTI, you may need treatment with intravenous antibiotics in a hospital, (Mayo Clinic, 2017).

Gender and advanced age:  The reason women are more likely to develop bladder infections than men comes down to basic anatomy.  Female urethras are much shorter than male urethras.  Approximately an inch and a half in length to be exact.  This means the bacteria doesn’t have to travel nearly as far to reach the bladder.  The population most likely to experience UTIs is the elderly.  Older individuals are more vulnerable for many reasons, including their overall susceptibility to infections due to a weakened immune system.  Elderly men and women also experience a weakening of the muscles of the bladder and pelvic floor, which can lead to increased urine retention and incontinence, (MedlinePlus, 2018).  Many are prescribed multiple daily medications and they aren’t always taken as prescribed.  Patients may forget to take their medications, become confused on when and how to take medication, multiple medications can become overwhelming. 

Patient education:  Patient education should begin with education to help patients prevent recurrent infections.  Patients should practice good hygiene and females should wipe from front to back.  Drink plenty of fluid to flush bacteria out of urinary tract.  Empty your bladder completely as soon as you feel the urge, or at least every three hours. Get plenty of vitamin C. It makes urine acidic and helps keep bacteria down.  Consult a doctor if an infection is suspected and complete the entire amount of prescribed medication. 

References

Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology. Edinburgh: Mosby.

Mayo Clinic. (2017, August 25). Urinary tract infection (UTI) – Diagnosis and treatment – Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/urinary-tract-infection/diagnosis-treatment/drc-20353453

MedlinePlus. (2018, April 10). Urinary Tract Infections | UTI | UTI Symptoms | MedlinePlus. Retrieved from https://medlineplus.gov/urinarytractinfections.html

Planned Parenthood. (2016). What is a Urinary Tract Infection? | Symptoms & Causes. Retrieved from https://www.plannedparenthood.org/learn/health-and-wellness/urinary-tract-infections-utis

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"