Week 11

Chapter 22.

Neurologic System

Lobes and principal fissures of the cerebral cortex, cerebellum, and brainstem (left hemisphere, lateral view).

Make a chart differentiating between descending and ascending spinal tracts.

What occurs if the spinal cord is incompletely severed?

Describe the nervous system.

Name the three major units of the brain.

Differentiate between the descending spinal tracts and the ascending spinal tracts of the spinal cord.

What is the function of the pituitary gland?

Name the fourth cranial nerve and state its function.

List the risk factors for cerebrovascular accidents.

Why is the 5.07 monofilament test used?

Explain the 0 to 4+ scale for scoring deep tendon reflexes. Scoring deep tendon reflexes

You are observing the neurologic examination of a 75-year-old man. You notice that before beginning the physical examination, the examiner asks the patient whether he is currently taking any medication. Why is it important to assess medications used by older adults? 

What is the potential long-range effect on a child if meningitis occurs during the first year of life?

EI, a 44-year-old patient, comes in for a follow-up visit regarding his diabetes. Today he is complaining of numbness, tingling, and burning in his feet. His recent laboratory studies demonstrate an elevated hemoglobin A1c and hyperlipidemia. You diagnose him with peripheral neuropathy.

1- What are the possible etiologies of the peripheral neuropathy? What is the most likely cause?

2- Describe the patient’s objective findings with peripheral neuropathy.

3- What is the best physical assessment technique to determine peripheral neuropathy.  

 

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 introduction and discussion/conclusion.

The final discussion is a concluding argument revealing a “defensible solution” to the healthcare topic, supported by the “evidence” .introduction and discussion/conclusion.

• Scientific, mathematical/analtycal, ethical, cultural perspective of the neurological disorder relating to spinal cancers and tumor.  placing the perspectives in a strategic arrangement that supports the final paper, your argument for a “defensible solution” to the health care issue you have studied, researched, and written about. As a result, this final paper will be comprehensive and summative.
• Important: this final paper should include a newly composed introductory section, and a final conclusion section which presents your discussion of (and argument for) the solution. Your argument for the defensible solution that you propose should be the focus of this paper. 

Your paper must:

• Be 15–20 pages in length 
  • Title page (1 page)
  • Introduction (1–2 pages)
  • Reworked informative papers (10-15 pages)
  • Conclusion (1–2 pages)
  • References page (1–2 pages)
• Reference 12–15 scholarly, peer-reviewed resources (compiled by combining all of the references from your Perspective of Inquiry papers and any additional resources you use in this final paper.)
• Follow all APA formatting guidelines for this paper, with each of your previous four papers being presented as “sections” of this fifth paper, using Level 1 headings.
• Use the provided template.

Refer to the rubric for evaluation details and to assist in preparing the paper.

Due: Submit by 11:59 pm (Pacific time) the evening before the Week 8 onsite class
Points: 150

Team Meeting Notes:

• In your team meetings this week (both in-class and online) focus on sharing your solutions as you develop them.
• Pay attention to (and learn from) the unique aspects of each team member’s solutions, but do not reference them in your final paper. (You will reference one another’s solutions in your final presentation assignment.)

Other Important Notes:

• Use the Learning Resources that address introductions and conclusions to help understand best practices and procedures for argumentative paper
• That being said, realize that this paper is unique, as it is a culmination of Informative Papers (rather than a traditional argumentative essay). Use the aforementioned Learning Modules as guidelines for best practices, not as procedural requirements.
• It is highly recommended that you compose the conclusion section of your paper (your solution) first, then move backward into the introduction, and finally the abstract.
• Use the final paper template provided, adapting the titles of each of your four short papers as headings in this final paper, and following instructions and examples provided in our in-class meeting.
• Make sure to review the SafeAssign report generated when you submit your paper, and address and revise any portions of your work which might be plagiarized.

 

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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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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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