Rubric attached below

Paper must be in APA format

Needs 3 pages excluding title and reference pages

Topic: Pressure Ulcer

Please review rubric

 

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APA format 3 peer review references Please follow instructions on assignment 

Due 10/3/18 at 4pm EST

   

Assesment 1: Assessing the A 

Assesment 1: Assessing the Abdomenbdomen

A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis; however, as a precaution, the doctor ordered a CAT scan. The CAT scan revealed a growth on the pancreas, which turned out to be pancreatic cancer—the real cause of the cramping.
Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time-consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen.

In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

Abdominal Assessment

SUBJECTIVE:

• CC: “My stomach hurts, I have diarrhea and nothing seems to help.”
• HPI: JR, 47 yo WM, complains of having generalized abdominal pain that started 3 days ago. He has not taken any medications because he did not know what to take. He states the pain is a 5/10 today but has been as much as 9/10 when it first started. He has been able to eat, with some nausea afterwards.
• PMH: HTN, Diabetes, hx of GI bleed 4 years ago
• Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10 units qhs
• Allergies: NKDA
• FH: No hx of colon cancer, Father hx DMT2, HTN, Mother hx HTN, Hyperlipidemia, GERD
• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

OBJECTIVE:

• VS: Temp 99.8; BP 160/86; RR 16; P 92; HT 5’10”; WT 248lbs
• Heart: RRR, no murmurs
• Lungs: CTA, chest wall symmetrical
• Skin: Intact without lesions, no urticaria
• Abd: soft, hyperctive bowel sounds, pos pain in the LLQ
• Diagnostics: None

ASSESSMENT:

• Left lower quadrant pain
• Gastroenteritis
• PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

To prepare:

With regard to the SOAP note case study provided:

• 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.
• 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.

To complete:

1. Analyze the subjective portion of the note. List additional information that should be included in the documentation.
2. Analyze the objective portion of the note. List additional information that should be included in the documentation.
3. Is the assessment supported by the subjective and objective information? Why or Why not?
4. What diagnostic tests would be appropriate for this case and how would the results be used to make a diagnosis?
5. Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from current evidence based literature.

A 

Assesment 1: Assessing the Abdomen

 

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APA format Please follow directions below need to have done by 10/10/18 at 9 pm. 

3 peer review references.  

Today 10/10/18 is the third day

 This week we have lots to do.  First off you have a discussion.  This should be a SOAP note posted based on the case of your choice.  Please pick the one that you feel you will learn the most from 

here is the SOAP note template

 

his template is for a full history and physical. For this course include only areas that are related to the case.

Patient Initials: _______                Age: _______                                   Gender: _______

Note: The mnemonic below is included for your reference and should be removed before the submission of your final note.

L =location

O= onset

C= character

A= associated signs and symptoms

T= timing

E= exacerbating/relieving factors

S= severity

SUBJECTIVE DATA: Include what the patient tells you, but organize the information.

Chief Complaint (CC): In just a few words, explain why the patient came to the clinic.

History of Present Illness (HPI): This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:

Location: head

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

Severity: 7/10 pain scale

Medications: Include over-the-counter, vitamin, and herbal supplements. List each one by name with dosage and frequency.

Allergies: Include specific reactions to medications, foods, insects, and environmental factors. Identify if it is an allergy or intolerance.

Past Medical History (PMH): Include illnesses (also childhood illnesses), hospitalizations.

Past Surgical History (PSH): Include dates, indications, and types of operations.

Sexual/Reproductive History: If applicable, include obstetric history, menstrual history, methods of contraception, sexual function, and risky sexual behaviors.

Personal/Social History: Include tobacco use, alcohol use, drug use, patient’s interests, ADL’s and IADL’s if applicable, and exercise and eating habits.

Immunization History: Include last Tdap, Flu, pneumonia, etc.

Significant Family History: Include history of parents, grandparents, siblings, and children.

Lifestyle: Include cultural factors, economic factors, safety, and support systems and sexual preference.

Review of Systems: From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History (this includes the systems that address any previous diagnoses). Remember that the information you include in this section is based on what the patient tells you so ensure that you include all essentials in your case (refer to Chapter 2 of the Sullivan text).

General: Include any recent weight changes, weakness, fatigue, or fever, but do not restate HPI data here.

            HEENT:

Neck:

            Breasts:

            Respiratory:

            Cardiovascular/Peripheral Vascular:

            Gastrointestinal:

            Genitourinary:

            Musculoskeletal:

            Psychiatric:

            Neurological:

            Skin:  

Hematologic:

            Endocrine:

            Allergic/Immunologic:

OBJECTIVE DATA: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History unless you are doing a total H&P- only in this course. Do not use “WNL” or “normal.” You must describe what you see.

Physical Exam:

Vital signs: Include vital signs, ht, wt, and BMI.

General: Include general state of health, posture, motor activity, and gait. This may also include dress, grooming, hygiene, odors of body or breath, facial expression, manner, level of consciousness, and affect and reactions to people and things.

HEENT:

Neck:

Chest

Lungs:

Heart

Peripheral Vascular: Abdomen:

Genital/Rectal:

Musculoskeletal:

Neurological:

Skin:

Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses.

ASSESSMENT: List your priority diagnosis (es). For each priority diagnosis, list at least three differential diagnoses, each of which must be supported with evidence and guidelines. For holistic care, you need to include previous diagnoses and indicate whether these are controlled or not controlled. These should also be included in your treatment plan.

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

REFLECTION: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses. Reflect on your clinical experience, and consider the following questions: What did you learn from this experience? What would you do differently? Do you agree with your preceptor based on the evidence?

 

Discussion: Assessing the Heart, Lungs, and Peripheral Vascular System

Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows into your lungs. Feel your chest contract as you exhale. How might this experience be different for someone with chronic lung disease or someone experiencing an asthma attack?

In order to adequately assess the chest region of a patient, nurses need to be aware of a patient’s history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted to determine the causes and severity of abnormalities.

In this Discussion, you will consider how a patient’s initial symptoms can result in very different diagnoses when further assessment is conducted.

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the Episodic/Focused SOAP Note format, rather than the traditional narrative style Discussion posting 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.

To prepare:

With regard to the case study you were assigned:

• Review this week’s Learning Resources and consider the insights they provide.
• Consider what history would be necessary to collect from the patient.
• 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.

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 6”) with “Review of Case Study” identifying the number of the case study you were assigned.

By Day 3

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in week 5 resources. 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. 

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

 

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APA format 1 and half pages 3 references 1 from walden university 

 

Using Evaluations to Prepare For Accreditation

Your course text defines evaluation as “a systematic assessment of all components of a program through the application of evaluation approaches, techniques, and knowledge in order to improve the planning, implementation, and effectiveness of programs” (Billings, 2012, p. 503). When carefully constructed, a master plan of evaluation can run like a well-oiled machine. Data are collected, analyzed, and acted upon. When documented correctly, this data can also help institutions and agencies prepare for accreditation.

In this Discussion, you consider the curriculum components you might include in your team’s evaluation plan. You also consider how information gathered about these components can help your team’s setting prepare for accreditation.

To prepare:

• Review Chapter 26, “Educational Program Evaluation,” in the Billings text. Specifically, examine how Table 28-2 illustrates one piece of an evaluation plan. Then, explore each of the overarching curriculum components nurse educators may choose to evaluate: mission and goals, curriculum organization, course, teaching effectiveness, environment, intervening mechanism, and generalization.
• Reflect on the evaluation models your team discussed for your Course Project.
• Consider the curriculum components you could integrate into these evaluation models. How would feedback on these components help your assigned setting improve the quality of the curriculum? In addition, how might this same information help to prepare for accreditation?

By Day 3

Post a brief description of at least two curriculum components you would include in the evaluation model(s) used in your Course Project and why. Explain how this information, as well as your team’s overall evaluation approach, could help your setting prepare for accreditation, if applicable. Justify your response by providing references to your Course Project and Learning Resources as applicable.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

• Ask a probing question, substantiated with additional background information, evidence, or research.
• Validate an idea with your own experience and additional research.
• Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
• Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

 

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APA format 2 pages 3 references 1 from walden university library

due Thursday 10/10/19 at 7pm EST

 

Simulated Learning Experiences

“We really have to improve the teaching and upgrade the sciences in basic nurse education. We have a problem—classroom and clinical instruction are drifting too far apart. We need to integrate classroom and clinical learning much better. Clinical coaching in practice settings and simulations should correspond to knowledge gained in the classroom. The emphasis on simulation is going to be very useful in developing clinical imagination so that students can be more flexible and astute in their use of knowledge in practice.”
—Patricia Benner, renowned nurse educator and author

Clinical imagination asks students to step outside of the [sometimes] ‘narrow box’ of academia to develop multiple solutions to a situation. In the above quote, Patricia Benner notes how simulations can transition students from knowledge acquisition to knowledge use. However, in order for nurse educators to transform simulations into a teaching technique, they must make every effort to ensure the simulation technology is invisible. To do this, nurse educators should prepare students for the simulation by reiterating that that the goal is not how the simulation works, but rather the how the clinical process works. In addition, highlighting the clinical expertise, critical thinking, collaboration, and technical prowess needed during simulated clinical experiences (SCE) is the true key to bridging the gap between classroom and clinical instruction. Allowing focus to shift too much towards the simulation itself might cause learners to lose sight of the actual objectives of the lesson- thus failing to prepare them for the real demands and consequences of the health care environment.

To prepare

• Review this week’s Learning Resources on simulated clinical experiences (SCE). Specifically, examine how each category of SCE (games, simulations, and simulation games) is tailored towards achieving a certain level of Bloom’s Taxonomy or domain of learning.
• Reflect on your past learning experiences in both academic and clinical settings that did not include a simulation. For example, a specific class, lesson, group project, doctor’s visit, or staff training might come to mind.
• Select one past learning experience to use for this Discussion. Then, identify the learning objectives that your Instructor or health care professional might have had in mind. In addition, identify the type of learning environment in which the lesson was conducted (on-site, online, hybrid).
• Consider how a specific SCE such as interactive games, virtual reality, task trainers (low-fidelity mannequins), human patient simulators (high-fidelity mannequins), etc. might have enhanced your learning during this experience.
• Conduct further research to learn more about a specific SCE technology that might achieve the same learning objectives of your selected learning experience.

 

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