Neurological Symptoms

      

Episodic/Focused   SOAP Note Exemplar (pls use this template)
 

Focused   SOAP Note for a patient with chest pain

 S.
  CC: “Chest pain”
 

  HPI: The patient is a 65 year old AA male who developed sudden onset of   chest pain, which began early this morning.  The pain is described as   “crushing” and is rated nine out of 10 in terms of intensity. The pain is   located in the middle of the chest and is accompanied by shortness of breath.   The patient reports feeling nauseous. The patient tried an antacid with   minimal relief of his symptoms.
 

  PMH: Positive history of GERD and hypertension is controlled
 

  FH: Mother died at 78 of breast cancer; Father at 75 of CVA.  No   history of premature cardiovascular disease in first degree relatives.
 

  SH : Negative for tobacco abuse, currently or previously; consumes   moderate alcohol; married for 39 years
 

  ROS   
General–Negative for fevers,   chills, fatigue
Cardiovascular–Negative for   orthopnea, PND, positive for intermittent lower extremity edema
Gastrointestinal–Positive for   nausea without vomiting; negative for diarrhea, abdominal pain
Pulmonary–Positive for   intermittent dyspnea on exertion, negative for cough or   hemoptysis  

 

O.

VS:   BP 186/102; P 94; R 22; T 97.8; 02 96% Wt 235lbs; Ht 70”

General–Pt appears diaphoretic and anxious

Cardiovascular–PMI is in the 5th inter-costal   space at the mid clavicular line. A grade 2/6 systolic decrescendo murmur is   heard best at the

second   right inter-costal space which radiates to the neck.

A   third heard sound is heard at the apex. No fourth heart sound or rub are   heard. No cyanosis, clubbing, noted, positive for bilateral 2+ LE edema is   noted.

Gastrointestinal–The abdomen is symmetrical   without distention; bowel

sounds   are normal in quality and intensity in all areas; a

bruit   is heard in the right para-umbilical area. No masses or

splenomegaly   are noted. Positive for mid-epigastric tenderness with deep palpation.

Pulmonary— Lungs are clear to   auscultation and percussion bilaterally 

Diagnostic   results: EKG, CXR, CK-MB (support with evidenced and guidelines)

A.

Differential   Diagnosis:

1)   Myocardial Infarction (provide supportive documentation with evidence based   guidelines).

2)   Angina (provide supportive documentation with evidence based guidelines).

3)   Costochondritis (provide supportive documentation with evidence based   guidelines).

Primary   Diagnosis/Presumptive Diagnosis: Myocardial Infarction

P. This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

Assignment 1: Case Study Assignment: Assessing Neurological Symptoms

Case #2: 

CASE STUDY 2: Numbness and Pain A 47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools

Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates just how impactful brain disorders can be to a patient’s quality of living. Accurately assessing neurological symptoms is a complex process that involves the analysis of many factors.

In this Case Study Assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

To Prepare

·  You will be assigned to a specific case study for this Case Study Assignment (Please see Above)

· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format( as in exampler above) rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.

With regard to the case study you were assigned:

· Review this week’s Learning Resources, and consider the insights they provide about the case study.

· Consider what history would be necessary to collect from the patient in the case study you were assigned.

· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

·  

The Case Study Assignment

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided ( ABOVE). Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each. 

Resource for references

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

  • Chapter 7, “Mental Status”

         This chapter revolves around the mental status evaluation of an      individual’s overall cognitive state. The chapter includes a list of      mental abnormalities and their symptoms.

  • ·Chapter 23, “Neurologic System”

         The authors of this chapter explore the anatomy and physiology of the      neurologic system. The authors also describe neurological examinations and      potential findings.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 4, “Affective Changes”
This chapter outlines how to identify the potential cause of affective changes in a patient. The authors provide a suggested approach to the evaluation of this type of change, and they include specific tools that can be used as part of the diagnosis.

Chapter 9, “Confusion in Older Adults”
This chapter focuses on causes of confusion in older adults, with an emphasis on dementia. The authors include suggested questions for taking a focused history as well as what to look for in a physical examination.

Chapter 13, “Dizziness”
Dizziness can be a symptom of many underlying conditions. This chapter outlines the questions to ask a patient in taking a focused history and different tests to use in a physical examination.

Chapter 19, “Headache”
The focus of this chapter is the identification of the causes of headaches. The first step is to ensure that the headache is not a life-threatening condition. The authors give suggestions for taking a thorough history and performing a physical exam.

Chapter 31, “Sleep Problems”
In this chapter, the authors highlight the main causes of sleep problems. They also provide possible questions to use in taking the patient’s history, things to look for when performing a physical exam, and possible laboratory and diagnostic studies that might be useful in making the diagnosis.

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

  • Chapter 2, “The Comprehensive History      and Physical Exam” (“Cranial Nerves and Their Function” and      “Grading Reflexes”) (Previously read in Weeks 1, 2, 3, and 5)

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical examination objective data checklist. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Mosby’s Guide to Physical Examination, 7th Edition by Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2011 by Elsevier. Reprinted by permission of Elsevier via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Neurologic system: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Neurologic system: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Mental status: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Bearden , S. T., & Nay, L. B. (2011). Utility of EEG in differential diagnosis of adults with unexplained acute alteration of mental status. American Journal of Electroneurodiagnostic Technology, 51(2), 92–104.

This article reviews the use of electrocenographs (EEG) to assist in differential diagnoses. The authors provide differential diagnostic scenarios in which the EEG was useful.

Athilingam, P ., Visovsky, C., & Elliott, A. F. (2015). Cognitive screening in persons with chronic diseases in primary care: Challenges and recommendations for practice. American Journal of Alzheimer’s Disease & Other Dementias, 30(6), 547–558. doi:10.1177/1533317515577127

Sinclair , A. J., Gadsby, R., Hillson, R., Forbes, A., & Bayer, A. J. (2013). Brief report: Use of the Mini-Cog as a screening tool for cognitive impairment in diabetes in primary care. Diabetes Research and Clinical Practice, 100(1), e23–e25. doi:10.1016/j.diabres.2013.01.001

Roalf, D. R., Moberg, P. J., Xei, S. X., Wolk, D. A., Moelter, S. T., & Arnold, S. E. (2013). Comparative accuracies of two common screening instruments for classification of Alzheimer’s disease, mild cognitive impairment, and healthy aging. Alzheimer’s & Dementia, 9(5), 529–537. doi:10.1016/j.jalz.2012.10.001. Retrieved from http://www.alzheimersanddementia.com/article/S1552-5260(12)02463-6/abstract 

 
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Neurotransmitter Transporters As Targets Of Drug Action

Please explain how they work.  This is a paper I am going to contribute in a group assignment.  This is a Psychiatric Mental Health Nurse Practitioner online program.  I will attach the instructions for the entire project.  The section I am responsible for is “How it works”.  Thank you

 
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Neutropenic Sepsis 18947251

  

NEUTROPENIC SEPSIS

 PICOT: Would early assessment, diagnosis of Neutropenic Sepsis in patients post chemotherapy treatment, as well as the immediate administration of broad-spectrum antibiotics and fluids, will be more effective in decreasing septic shock and death compared to delaying treatment 

Students will develop a 1,000-1,250 word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

  1. Background
  2. Problem      statement
  3. Purpose      of the change proposal
  4. Literature      search strategy employed
  5. Evaluation      of the literature
  6. Applicable      change or nursing theory utilized
  7. Proposed      implementation plan with outcome measures
  8. Identification      of potential barriers to plan implementation, and a discussion of how      these could be overcome
  9. Appendix      section, if tables, graphs, surveys, educational materials, etc. are      created
  10. CONCLUSION

You are required to retrieve and assess a minimum of 7 peer-reviewed articles

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

 
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Neutropenic Sepsis Patients Post Chemo

NEUTROPENIC SEPSIS ( PATIENT’S POST CHEMO)

A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.

Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.  

 PICOT format is a helpful approach for summarizing research questions that explore the effect of an intervention.

  • (P) – Population refers to the problem and the population that is effected.
  • (I) – Intervention refers to will be provided to solve or improve the problem
  • (C) – Comparison identifies what you plan on using as a reference to compare with your  intervention
  •  (O) – Outcome represents what result you plan on measuring to examine the effectiveness of your intervention
  •  (T) – Time describes the duration for your data collection.

Make sure to address the following on the PICOT statement:

  1. Evidence-Based Solution
  2. Nursing Intervention
  3. Patient Care
  4. Health Care Agency
  5. Nursing Practice

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

 30.0 %Identification of Clinical Problem/Issue 

 30.0 %Clinical Problem/Issue, Including Description, Evidence-Based Solution, Nursing Intervention, Patient Care, Health Care Agency, and Nursing Practice 

 10.0 %PICOT Statement Focused on Resolution, Improvement, Application, and Intervention 

 10.0 %PICOT Statement Including Population, Intervention, Comparison, Outcomes, and Time 

  WE CAN USE SAME REFERENCES

Butcher, L. (2016). Stepping up against SEPSIS. H&HN: Hospitals & Health Networks, 90(1), 38-42.

Clarke, R., Bird, S., Kakuchi, I., Littlewood, T., & Hamel Parsons, V. (2015). The signs, symptoms and help-seeking experiences of neutropenic sepsis patients before they reach hospital: a qualitative study. Supportive Care in Cancer, 23(9), 2687-2694. doi:10.1007/s00520-015-2631-y

Ford, A., & Marshall, E. (2014). Neutropenic sepsis: a potentially life-threatening complication of chemotherapy. Clinical Medicine (London, England), 14(5), 538-542. doi:10.7861/clinmedicine.14-5-538

Knight, T., Ahn, S., Rice, T. W., & Cooksley, T. (2017). Acute Oncology Care: A narrative review of the acute management of neutropenic sepsis and immune-related toxicities of checkpoint inhibitors. European Journal of Internal Medicine, 4559-65. doi: 10.1016/j.ejim.2017.09.025

Raz, B. (2017). Neutropenic sepsis. Nursing Standard (Royal College of Nursing (Great Britain): 1987), 31(48), 64-65. doi:10.7748/ns.31.48.64. s47

Vossen, M. G., Milacek, C., & Thalhammer, F. (2018). Empirical antimicrobial treatment in haemato-/oncological patients with neutropenic sepsis. ESMO Open, 3(3), e000348. doi:10.1136/esmoopen-2018-000348

Wells, T., Thomas, C., Watt, D., Fountain, V., Tomlinson, M., & Hilman, S. (2015). Improvements in the management of neutropenic sepsis: lessons learned from a district general hospital. Clinical Medicine (London, England), 15(6), 526-530. doi:10.7861/clinmedicine.15-6-526

 
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New 19334185

 History, theory, practice, and research are all ways of knowing in nursing. Choose one and analyze how it interacts with the others to form the basis of the nursing discipline. 

 
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New Assignment With Attachment Template

Indication 

Select a nursing research article from the list below that includes a theoretical or conceptual framework and the exploration of a clinical problem. Identify the nursing research article components using the Week 5 research template.

(All articles are available in the South University Online Library.)

Emotional Work and Diversity in Clinical Placements of Nursing Students 

Nurses’ Preparedness and Perceived Competence in Managing Disasters

The Lived Experiences of People with Chronic Obstructive Pulmonary Disease: A Phenomenological Study

Effects of Multivitamin Supplements on Cognitive Function, Serum Homocysteine Level, and Depression of Korean Older Adults with Mild Cognitive Impairment in Care Facilities

The template will be evaluated on the effectiveness of the discussion of the following components. If a component is not present in the article, its absence should be discussed.

  • Identify the research problem.
  • Identify the research purpose.
  • Summarize the review of literature.
  • Identify the nursing framework or theoretical perspective.
  • Identify the research questions and hypotheses.
  • Identify the variables.
  • Identify and discuss the appropriateness of the design.
  • Discusses the validity and reliability of the instruments, tools, or surveys.
  • Discuss the significance of the study. Did it resolve the question?
  • Discuss the legal and ethical issues of the study. Include the use of human subjects and their protection.
  • Describe any cultural aspects of the study.
  • Describe the final sample.
  • Describe the procedures for data collection.
  • Summarize the results including statistical analysis used or other method of analysis.
  • Describe how the results of the research may impact future nursing practice.
  • Apply the research to the student’s nursing practice.
  • NOTE: If a component is absent, student receives a zero for that component.
 
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New Health Care Delivery Models 3 Dq 1

 New health care delivery models are being presented to accommodate the shift in health care objectives. Many of these models are community based and focused on improving quality outcomes, population health, and reducing readmissions to acute care settings. Describe a new health care delivery model and discuss whether or not it is sustainable. 1 page, 2 sources. APA.

 
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New Models For Evidence Based Practice

  

New Models for Evidence-Based Practice

A professional goal for DNP-prepared nurses is to produce new evidence-based models of care and develop evidence-based guidelines. As you continue to develop and engage in your EBP Project, keep this aim in mind. What could help to facilitate the acceptance of new practices?

As noted in earlier weeks, every specialty area should base practice on research and evidence. For example, in informatics, an informatician who plans to implement a new health information system would be wise to follow a model that research shows has been effective. Similarly, those involved in leadership or management can review change models and theories, exploring current evidence on best practices that produce positive results. For this Discussion, you evaluate evidence-based practice models, change theories, and frameworks that assist with the adoption of new evidence-based practice approaches.

To prepare:

  • Reflect on your hospital setting and the use of      evidence-based practice models. How are these models used? If they are not      used, how might the integration of an evidence-based practice model change      practice?
  • Review the Rosswurm and Larrabee article      presented in the Learning Resources focusing on the model they present for      integrating new evidence-based practices (See  attached file).
  • Research and locate an evidence-based practice      model from nursing or another discipline that could be used in your      specialty area to lead a systematic change to evidence-based practice      approaches. You may also use a model or framework discussed in your course      text, Translation of Evidence into Nursing and Health Care      Practice.
  • Consider how using a model for evidence-based      practice can facilitate adoption of new approaches to practice.

By tomorrow Tuesday 9/25/18 10 pm, write an essay of a minimum of 550 words in APA format, and at least 3 scholarly references from the list of required readings below. Include all level one headings as numbered below:

Post a cohesive response that addresses the following:

1) Discuss the use of evidence-based models in your hospital setting.

2) Describe a model for evidence-based practice or change theories and frameworks that you could utilize to facilitate the adoption of new approaches to practice. Substantiate your selection with evidence from the literature.

Required Readings

Gallagher-Ford, L., Fineout-Overhold, E., Melnyk, B.M. & Stillwell, S.B. (2011). Evidence-based practice step-by-step: Implementing an evidence-based practice change. American Journal of Nursing, 111(3), 54-60.

Rosswurm, M. A., & Larrabee, J. H. (1999). A model for change to evidence-based practice. Journal of Nursing Scholarship, 31(4), 317-322. (See attached file).

Pryse, Y., McDaniel, A., & Schafer, J. (2014). Psychometric analysis of two new scales: The evidence-based practice nursing leadership and work environment scales. Worldviews on Evidence-Based Nursing, 11(4), 240-247.

Sadeghi-Bazargani, H., Tabrizi, J.S., & Azami-Aghdash, S. (2014). Barriers to evidence-based medicine: A systematic review. Journal of Evaluation in Clinical Practice, 20, 793-802.

Schaffer, M.A., Sandau, K.E., & Diedrick, L. (2013). Evidence-based practice models for organizational change: overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209.

 
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New Taxes Within The Nursing Industry

attached are the instructions for the assignment.

7 pages

apa format

must find tax laws that have not been chosen…. the ones that have been are listen in the attachment

all formatting regulations are listed as well

 
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Newsletter 19168115

 will design 2 page health newsletter that would be appropriate for  their workplace. Newsletters should contain content appropriate for  health promotion concerning the workplace that they have chosen for  their project. Also, links for additional facts and information and  graphics should be included.  

look to my project files .. 

 
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