I need 1 reply comment to each post with a credible sources, citation and years above 2013 in APA format.
Post 1
CHIEF COMPLAINT: Shortness of Breath and cough
Subjective: Pt presents with complaints of shortness of breath and productive cough. Pt relates he is coughing up thick green sputum with occasional bloody sputum. Pt relates that he has increased shortness of breath with walking. Patient relates that he is also short of breath at rest. Pt also relates that he has had some chills and sweats and felt like he may have a fever. He states that he has taken Tylenol for those symptoms.
Objective: Temperature 100.9, Respiratory rate 20, Heart rate 82, Blood pressure right arm 128/70, Oxygen saturation 89% on room air, Weight 210 pounds, EKG shows normal sinus rhythm, Chest radiograph
Assessment: Skin is warm and moist. Thorax is symmetrical with diminished breath sounds with rales and expiratory wheezes throughout, negative for rhonchi. Wet productive cough noted during exam. Heart is regular sinus rhythm with rate of 82. Good S1, S2; negative S3 or S4 and negative for murmur. Abdomen protuberant with normoactive bowel sounds auscultated in all four quadrants. No pedal edema noted. 2+ dorsalis pedis pulses bilaterally. Neurologic: Patient is awake, alert and oriented to person, place and time. Chest radiograph shows infiltrate in the right middle lobe.
Priority diagnosis includes 1. Pneumonia 2. Myocardial Infarction 3. Pulmonary embolism 4. Congestive Heart Failure 5. Asthma
1. Pneumonia: The patient presents with productive cough and shortness of breath with exertion. Patient has elevated temperature and low oxygen saturations along with diminished breath sounds, rales and expiratory wheezes which are all consistent symptoms with community acquired pneumonia. (Lynn, 2017). Chest radiograph shows right middle lobe infiltrate which is also consistent with pneumonia. (Kaysin and Viera, 2016).
2. Myocardial Infarction: The patient presents with shortness of breath and low oxygen saturations. Pt states that his shortness of breath is worse with exertion but is present at rest also. Dyspnea is a frequent associated symptom with MI. (Lawesson, Thylen, Ericsson, Swahn, Isaksson and Angerud, 2018). The patient did have an EKG completed that revealed a normal sinus rhythm at a rate of 80 with no obvious signs of ectopy. Evaluation of troponin level would assist in ruling out MI as a diagnosis for this patient. (Berliner, Schneider, Welte and Bauersachs, 2016).
3. Pulmonary Embolism: Dyspnea is the primary symptom for patients with PE. (Garcia-Sanz, Pena-Alvarez, Lopez-Landeiro, Bermo-Dominguez, Fonturbel and Gonzalex-Barcala, 2014). Onset of dyspnea with PE is typically sudden and further history for this patient related to onset of symptoms. Evaluation of any extremity pain and swelling, D-dimer or chest angiography would also assist in determining if this was a more likely diagnosis. (Berliner, Schneider, Welte and Bauersachs, 2016).
4. Congestive Heart Failure: Dyspnea is also a common symptom with congestive heart failure. Fatigue, diminished exercise tolerance and fluid retention are also common symptoms of CHF. (Berliner, Schneider, Welte and Bauersachs, 2016). The patient has rales noted upon auscultation which could be consistent with congestive heart failure however coupled with the remainder of the exam including productive cough with thick green sputum and fever, CHF would not be the primary diagnosis. Further evaluation of extremities of abdomen and extremities for signs of fluid retention would be indicated as well as labs such as BNP.
5. Asthma: The patient has expiratory wheezes and shortness of breath which are both consistent with asthma; however the patient also has fever and productive cough which are not consistent asthma symptoms. (Huether and McCance, 2017).
Plan: Not indicated
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V. & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
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.
Berliner, D., Schneider, N., Welte, T., & Bauersachs, J. (2016). The Differential Diagnosis of Dyspnea. Deutsches Aerzteblatt International, 113(49), 834. doi:10.3238/arztebl.2016.0834
Debasis, D., & David C., H. (2009). Chest X-ray manifestations of pneumonia. Surgery Oxford, (10), 453. doi:10.1016/j.mpsur.2009.08.006
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.
García-Sanz, M., Pena-Álvarez, C., López-Landeiro, P., Bermo-Domínguez, A., Fontúrbel, T., & González-Barcala, F. (2014). Original article: Symptoms, location and prognosis of pulmonary embolism. Revista Portuguesa De Pneumologia, 20194-199. doi:10.1016/j.rppneu.2013.09.006
Post 2
S:
Chief Complaint: “I am having chest pain at this time”
History of Present Illness: Pleasant, Caucasian male experiencing an acute onset of sharp, constant chest pain when taking a deep breath. Denies any alleviating factors. Yesterday his wife noticed his RT leg was edematous with erythema, denies any injury. Recently he returned from a vacation with an 8-hour plane ride. The patient was not asked if his pain radiated or if he had nausea or dizziness.
Past Medical History: Denies taking any medications. Allergies, surgeries, past medical conditions “not provided.” History of cancer or deep vein thrombosis not provided.
Social History: Married
Review of symptoms:
General: Feels short of breath when taking a deep breath, also having sharp lower RT rib pain.
Cardiovascular: Experiencing tachycardia. Peripheral edema started yesterday in RT lower leg.
Pulmonary: Reports having sharp pain when taking a deep breath with no relief measures noted. Complains of dyspnea with productive hemoptysis cough this morning.
Gastrointestinal: “not provided.”
O:
VS: BP 148/88 RT arm; P 112 and irregular; R 32 and labored; T 97.9 orally; Pulse Ox 90% on RA; His current weight is stable at 210 pounds.
General: Well-nourished, a well developed Caucasian male who is alert and cooperative. He is a good historian and answers questions appropriately. Patient sitting upright at the side of the cot appears anxious with labored breathing. Guarding noted in the anterior, distal RT rib area.
Cardiovascular: Skin is pallor, cool and diaphoretic. Heart rate is tachycardic. S1 and S2 irregular with no S3, S4, or murmur auscultated. RT calf with erythema, 2+ edema, warmth, and tender with palpation. LT leg with no edema, tenderness, or erythema noted. Bilateral 2+ dorsalis pedis pulse. Telemetry showing a sinus arrhythmia.
Gastrointestinal: Protuberant abdomen with active bowels x 4 quadrants.
Pulmonary: LT Lung clear to auscultation, RT middle and lower lobes with diminished breath sounds. No rales, rhonchi, or wheezing auscultated. Respirations labored. Respiratory excursion symmetrical.
Diagnostic results: CXR, ECG, venous doppler studies and ultrasound for DVT, V/Q scan, CT of the chest, labs- sputum culture, cardiac enzymes. Telemetry.
A:
Differential Diagnosis:
1.) Pulmonary Embolism
2.) Pneumonia
3.) Lung Cancer
4.) Myocardial Infarction
5.) Cardiac Arrythmia
P: “not required”
Evidence and Justification of Differential Diagnosis and Diagnostic Tests
Gruettner J. et al. (2015) report the Wells risk score assesses the history of a previous
DVT or PE in a patient. Assessment of tachycardia, recent surgeries or immobilization,
observation of DVT signs, an alternative diagnosis less likely than pulmonary embolism,
hemoptysis, and cancer are gathered. Each area is assigned a score and the calculated total score
interprets the probability of having a pulmonary embolism. The patient calculated score
indicated a pulmonary embolism even though the history of cancer was unknown.
The diagnostic test of a CT angiography was found to be successful in the diagnosis of a
pulmonary embolism with Gruettner J. et al. (2015) research. The D-dimer, ABG, EKG, and
computed tomography showed little value in the diagnosis (Gruettner J. et al., 2015).
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016) indicate pneumonia causes the
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Discussion Assessing The Ears Nose And Throat 19170741
/in Uncategorized /by developerDiscussion: Assessing the Ears, Nose, and Throat
Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test.
In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
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, (see soap file) 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.
Case 2: Focused Throat Exam
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn’t take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily’s. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn’t sound congested.
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 5 possible conditions that may be considered in a differential diagnosis for the patient.
Write:
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.
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Discussion Assessing The Heart Lungs And Peripheral Vascular System
/in Uncategorized /by developerI need 1 reply comment to each post with a credible sources, citation and years above 2013 in APA format.
Post 1
CHIEF COMPLAINT: Shortness of Breath and cough
Subjective: Pt presents with complaints of shortness of breath and productive cough. Pt relates he is coughing up thick green sputum with occasional bloody sputum. Pt relates that he has increased shortness of breath with walking. Patient relates that he is also short of breath at rest. Pt also relates that he has had some chills and sweats and felt like he may have a fever. He states that he has taken Tylenol for those symptoms.
Objective: Temperature 100.9, Respiratory rate 20, Heart rate 82, Blood pressure right arm 128/70, Oxygen saturation 89% on room air, Weight 210 pounds, EKG shows normal sinus rhythm, Chest radiograph
Assessment: Skin is warm and moist. Thorax is symmetrical with diminished breath sounds with rales and expiratory wheezes throughout, negative for rhonchi. Wet productive cough noted during exam. Heart is regular sinus rhythm with rate of 82. Good S1, S2; negative S3 or S4 and negative for murmur. Abdomen protuberant with normoactive bowel sounds auscultated in all four quadrants. No pedal edema noted. 2+ dorsalis pedis pulses bilaterally. Neurologic: Patient is awake, alert and oriented to person, place and time. Chest radiograph shows infiltrate in the right middle lobe.
Priority diagnosis includes 1. Pneumonia 2. Myocardial Infarction 3. Pulmonary embolism 4. Congestive Heart Failure 5. Asthma
1. Pneumonia: The patient presents with productive cough and shortness of breath with exertion. Patient has elevated temperature and low oxygen saturations along with diminished breath sounds, rales and expiratory wheezes which are all consistent symptoms with community acquired pneumonia. (Lynn, 2017). Chest radiograph shows right middle lobe infiltrate which is also consistent with pneumonia. (Kaysin and Viera, 2016).
2. Myocardial Infarction: The patient presents with shortness of breath and low oxygen saturations. Pt states that his shortness of breath is worse with exertion but is present at rest also. Dyspnea is a frequent associated symptom with MI. (Lawesson, Thylen, Ericsson, Swahn, Isaksson and Angerud, 2018). The patient did have an EKG completed that revealed a normal sinus rhythm at a rate of 80 with no obvious signs of ectopy. Evaluation of troponin level would assist in ruling out MI as a diagnosis for this patient. (Berliner, Schneider, Welte and Bauersachs, 2016).
3. Pulmonary Embolism: Dyspnea is the primary symptom for patients with PE. (Garcia-Sanz, Pena-Alvarez, Lopez-Landeiro, Bermo-Dominguez, Fonturbel and Gonzalex-Barcala, 2014). Onset of dyspnea with PE is typically sudden and further history for this patient related to onset of symptoms. Evaluation of any extremity pain and swelling, D-dimer or chest angiography would also assist in determining if this was a more likely diagnosis. (Berliner, Schneider, Welte and Bauersachs, 2016).
4. Congestive Heart Failure: Dyspnea is also a common symptom with congestive heart failure. Fatigue, diminished exercise tolerance and fluid retention are also common symptoms of CHF. (Berliner, Schneider, Welte and Bauersachs, 2016). The patient has rales noted upon auscultation which could be consistent with congestive heart failure however coupled with the remainder of the exam including productive cough with thick green sputum and fever, CHF would not be the primary diagnosis. Further evaluation of extremities of abdomen and extremities for signs of fluid retention would be indicated as well as labs such as BNP.
5. Asthma: The patient has expiratory wheezes and shortness of breath which are both consistent with asthma; however the patient also has fever and productive cough which are not consistent asthma symptoms. (Huether and McCance, 2017).
Plan: Not indicated
References
Arcangelo, V. P., Peterson, A. M., Wilbur, V. & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.
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.
Berliner, D., Schneider, N., Welte, T., & Bauersachs, J. (2016). The Differential Diagnosis of Dyspnea. Deutsches Aerzteblatt International, 113(49), 834. doi:10.3238/arztebl.2016.0834
Debasis, D., & David C., H. (2009). Chest X-ray manifestations of pneumonia. Surgery Oxford, (10), 453. doi:10.1016/j.mpsur.2009.08.006
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.
García-Sanz, M., Pena-Álvarez, C., López-Landeiro, P., Bermo-Domínguez, A., Fontúrbel, T., & González-Barcala, F. (2014). Original article: Symptoms, location and prognosis of pulmonary embolism. Revista Portuguesa De Pneumologia, 20194-199. doi:10.1016/j.rppneu.2013.09.006
Post 2
S:
Chief Complaint: “I am having chest pain at this time”
History of Present Illness: Pleasant, Caucasian male experiencing an acute onset of sharp, constant chest pain when taking a deep breath. Denies any alleviating factors. Yesterday his wife noticed his RT leg was edematous with erythema, denies any injury. Recently he returned from a vacation with an 8-hour plane ride. The patient was not asked if his pain radiated or if he had nausea or dizziness.
Past Medical History: Denies taking any medications. Allergies, surgeries, past medical conditions “not provided.” History of cancer or deep vein thrombosis not provided.
Social History: Married
Review of symptoms:
General: Feels short of breath when taking a deep breath, also having sharp lower RT rib pain.
Cardiovascular: Experiencing tachycardia. Peripheral edema started yesterday in RT lower leg.
Pulmonary: Reports having sharp pain when taking a deep breath with no relief measures noted. Complains of dyspnea with productive hemoptysis cough this morning.
Gastrointestinal: “not provided.”
O:
VS: BP 148/88 RT arm; P 112 and irregular; R 32 and labored; T 97.9 orally; Pulse Ox 90% on RA; His current weight is stable at 210 pounds.
General: Well-nourished, a well developed Caucasian male who is alert and cooperative. He is a good historian and answers questions appropriately. Patient sitting upright at the side of the cot appears anxious with labored breathing. Guarding noted in the anterior, distal RT rib area.
Cardiovascular: Skin is pallor, cool and diaphoretic. Heart rate is tachycardic. S1 and S2 irregular with no S3, S4, or murmur auscultated. RT calf with erythema, 2+ edema, warmth, and tender with palpation. LT leg with no edema, tenderness, or erythema noted. Bilateral 2+ dorsalis pedis pulse. Telemetry showing a sinus arrhythmia.
Gastrointestinal: Protuberant abdomen with active bowels x 4 quadrants.
Pulmonary: LT Lung clear to auscultation, RT middle and lower lobes with diminished breath sounds. No rales, rhonchi, or wheezing auscultated. Respirations labored. Respiratory excursion symmetrical.
Diagnostic results: CXR, ECG, venous doppler studies and ultrasound for DVT, V/Q scan, CT of the chest, labs- sputum culture, cardiac enzymes. Telemetry.
A:
Differential Diagnosis:
1.) Pulmonary Embolism
2.) Pneumonia
3.) Lung Cancer
4.) Myocardial Infarction
5.) Cardiac Arrythmia
P: “not required”
Evidence and Justification of Differential Diagnosis and Diagnostic Tests
Gruettner J. et al. (2015) report the Wells risk score assesses the history of a previous
DVT or PE in a patient. Assessment of tachycardia, recent surgeries or immobilization,
observation of DVT signs, an alternative diagnosis less likely than pulmonary embolism,
hemoptysis, and cancer are gathered. Each area is assigned a score and the calculated total score
interprets the probability of having a pulmonary embolism. The patient calculated score
indicated a pulmonary embolism even though the history of cancer was unknown.
The diagnostic test of a CT angiography was found to be successful in the diagnosis of a
pulmonary embolism with Gruettner J. et al. (2015) research. The D-dimer, ABG, EKG, and
computed tomography showed little value in the diagnosis (Gruettner J. et al., 2015).
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016) indicate pneumonia causes the
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Discussion Assessment Tools And Diagnostic Tests In Adults And Children
/in Uncategorized /by developerI need 1 comment per each post in APA with citation and 2 references per comment not older that 2013.
Post 1
For this week’s discussion, I chose the 5-year old girl with normal weight with obese parents. Unfortunately, this topic hits close to home as our youngest daughter is 4 ½ and both my husband and I have gained significant weight over the past few years and are in the obese category. Most children are able to self-regulate diet and balance what they eat with the amount of energy that they are expending. Parental influence at a young age can have a significant effect on the child’s ability to regulate on their own. Obesity places adults and children alike at a higher risk for hypertension and diabetes than those of normal weight. A child who has obese parents is at a higher risk of becoming obese due to unhealthy eating habits that are learned at home. Obesity is defined in the course text as BMI > 95th percentile for age and gender in children ages 2-18 (Ball, Dains, Flynn, Solomon and Stewart, 2015).
During the child’s health assessment the provider needs to be watchful for any signs of malnutrition as well as over-nutrition. In addition to standard screening using height, weight and BMI, additional nutritional screening should be performed. Below are three specific questions that could be utilized to further assess nutrition and risk for obesity.
Describing the foods that the child has eaten over 24-48 hours will provide a more accurate account of overall nutrition. Specifically asking about sugary drinks such as soda and juice can provide opportunity to discuss the health risks that can be associated with too much sugar intake. Specific questions related to amounts of fruits and vegetables are important as well. Determining if the child is receiving adequate nutrients from the food that they are eating is important. If there is concern that the child may not be receiving enough vitamins and minerals from food, it may be necessary to recommend a multi-vitamin to supplement what the child is missing from diet.
There are multiple studies that have shown that an increased amount of screen time can have devastating effects on children’s health. High volume of screen time whether that is from television, video games, computers or other hand-held devices can lead to increased risk of obesity as well as behavioral problems. Asking questions related to screen time also provides the opportunity to determine where the child eats most of their meals. Does the family eat together at the table? Do they eat while watching television? How often do they eat in the car or on the go due to busy schedules? These factors can be used to determine the risk of the normal weight child at age 5 becoming overweight or obese as they get older. These questions also provide an opportunity to educate parents on healthy eating habits that they can utilize as well to improve the overall health of the family.
Another important factor to determine overall health of the child is determining if the child is getting enough sleep each night. Children are in a period of rapid growth in early childhood and the body needs time to rest so that it can develop appropriately. Asking if the child has a standard bedtime and how many hours of sleep the child gets each night can help determine if the child is getting adequate sleep. In relation to screen time it is important to discuss bedtime habits that the child and parents may have as well. Does the child have their own bedroom? Or do they share with an older sibling or parent? Is there a television in the room? Video games in the room? There are many children whose parents will tell providers that their children are in bed by 8 pm each evening and while that may be a true statement, the child may not actually be going to sleep until much later due to television or other distractions present in the room. This again provides the opportunity to educate family members on the importance of a good night sleep for overall family health.
Strategies to encourage parents to be proactive about child’s health
In addition to the above strategies, maintaining a food dairy can be an excellent tool to determine over time whether there is adequate nutrition for both the child and parents. There are many tools that can be utilized to keep a food diary. A simple notebook and pen works well and with all of the technology available, there are multiple apps such as My Fitness Pal that can be used to track more than the type of food. They can help track calories, fat, cholesterol, sugar as well as exercise. These apps are only as good as the information that the user puts in them. “Parents influence a child’s weight through interactions that shape the development of child eating behaviors.” (Pietrobelli and Agosti, 2017). Parents can be educated on modeling good habits of eating such as eating at the table versus in the care or while watching television. Avoid using food as a reward that can lead to child becoming an emotional eater when they are older. (Pietrobelli and Agosti, 2017). Providing good habits that can be passed on to children can also decrease their risk of depression and eating disorders such as anorexia and bulimia.
Reference
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.
Pietrobelli, A., & Agosti, M. (2017). Nutrition in the First 1000 Days: Ten Practices to Minimize Obesity Emerging from Published Science. International Journal Of Environmental Research And Public Health, 14(12), doi:10.3390/ijerph14121491
Rub, G., Marderfeld, L., Poraz, I., Hartman, C., Amsel, S., Rosenbaum, I., & … Shamir, R. (2016). Validation of a Nutritional Screening Tool for Ambulatory Use in Pediatrics. Journal Of Pediatric Gastroenterology And Nutrition, 62(5), 771-775. doi:10.1097/MPG.0000000000001046
Watkins, F., & Jones, S. (2015). Reducing Adult Obesity in Childhood: Parental Influence on the Food Choices of Children. Health Education Journal, 74(4), 473-484
Post 2
Diagnostic Tests: Mammography
Mammography is an effective diagnostic test that can help practitioners identify breast cancer at an early stage (Jerome-D’Emilia & Chittams, 2015). Typically, a mammogram is a series of x-ray images capable of detecting tumors too small to be palpated as well as calcium microcalcifications that are associated with breast cancer growth (National Cancer Institute, 2016). Screening mammograms are performed routinely and diagnostic mammograms, specific targeted imaging, are used when changes are identified on screening exams or when visibility is compromised, for example with breast implants (National Cancer Institute, 2016).
It is important to evaluate the validity and reliability of important screening tests like mammography to ensure proper screening and early diagnosis and treatment in affected patients. This early detection allows for a greater array of treatment options and an improved overall prognosis (Jerome-D’Emilia & Chittams, 2015). The reliability and validity of the mammogram increases when used in accordance to recommendations, for instance, in patients over the age of 30, as younger women have increased breast density that affects the diagnostic value (Dains, Baumann, & Scheibel, 2016). In addition, for best results, it is important to adhere to regularly scheduled mammograms, typically done annually for women over the age of 40 (National Cancer Institute, 2016). The National Health Service Breast Screening Programme has developed national guidelines to standardize image assessments and screening programs (Hill & Robinson, 2015). The Breast Imaging Reporting and Database System provides radiologists a uniform way to describe and report findings from mammograms, which helps physicians to appropriately coordinate necessary plans of care (National Cancer Institute, 2016).
At times, mammogram imaging can lead to false-positive results, when radiologists identify abnormalities without the presence of cancer. This can result in over treatment with follow up diagnostic mammograms, ultrasounds, and biopsies to rule out findings (National Cancer Institute, 2016). Predictive values can change if screening is not done properly, and Taylor et al. describes breast positioning as being the most important factor in producing quality mammography images (2017). Ensuring that diagnostic tests provide valuable, accurate, and useful information is key to preventative health care services and early management and treatment of identified disease processes.
References
Jerome-D’Emilia, B., & Chittams, J. (2015). Validation of a cultural cancer screening scale for mammogram utilization in a sample of African American women. Cancer Nursing, 38(2), 83-88. Retrieved from
https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2015-07872-002&site=eds-live&scope=site
National Cancer Institute. (2016). Mammograms. Retrieved from https://www.cancer.gov/types/breast/mammograms-fact-sheet
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.
Hill, C., & Robinson, L. (2015). Mammography image assessment; validity and reliability of current scheme. Radiography, 21, 304-307. Retrieved from https://ezp.waldenulibrary.org/login
url=https://search.ebscohost.com/login.aspx?direct=true&db=edselp&AN=S1078817415000899&site=eds-live&scope=site
Taylor, K., Parashar, D., Bouverat, G., Poulos, A., Gullien, R., Stewart, E., & … Wallis, M. (2017). Mammographic image quality in relation to positioning of the breast: A multicentre international evaluation of the
assessment systems currently used, to provide an evidence base for establishing a standardised method of assessment. Radiography, 23(4), 343-349. Retrieved from https://ezp.waldenulibrary.org/login
url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=28965899&site=eds-live&scope=site
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Discussion Assignment 19372251
/in Uncategorized /by developerClick [Start a New Thread] to post to the Discussion, then click [Post] once complete. Be sure to post a response to all Discussion topics. Please review the Discussion Board Participation Grading Rubric under Course Resources. This is important information that will ensure that you earn maximum points. Your postings should be qualitative and provide substantive depth that advances the discussion. Please see the Writing Center for assistance with writing, APA, and online communication.
Your patient is a 52-year-old female who presents with a complaint of epigastric pain and burning for the past 6 months. The patient states that the burning and pain improves slightly if she takes “Tums” over the counter. The patient also states that she has taken over-the-counter famotidine, however, still continues with epigastric pain on a daily basis.
Assessment
Her examination shows mild abdominal bloating. Her vital signs are a BP of 110/74, Pulse of 72, Respirations of 18 and Temperature of 98.2. As the provider you ordered an H. Pylori breath test which was positive.
Part 1:
Part 2:
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Discussion Assignment For Domestic Violence And Ipv
/in Uncategorized /by developerhttp://www.womenshealth.gov/violence-against-women/index.html?from=AtoZ
http://www.womenshealth.gov/violence-against-women/types-of-violence/domestic-intimate-partner-violence.html
http://www.cdc.gov/violenceprevention/intimatepartnerviolence/index.html
http://www.cdc.gov/violenceprevention/pdf/ipv-factsheet.pdf
http://www.consultant360.com/article/intimate-partner-violence-silent-epidemic
http://www.cdc.gov/cdcgrandrounds/archives/2012/june2012.htm
You are only assigned the video section presented by Debbie Lee at the CDC Grand Rounds in 2012. This video portion is located from 39:05 through 51:27 (12 minutes). She is presenting interesting topics related to prevention, impact of AFA, and the partnership between numerous agencies to reduce domestic violence.
ASSIGNMENT FOR YOUR GROUP DISCUSSION FORUM:
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Discussion Assignment Stis
/in Uncategorized /by developerBlow Us Away
STI’s
Usually, when instructors lecture about Sexually Transmitted Infections during an in-person course, they talk about some surprising facts about STI’s in addition to the standard facts and photos about them. For this discussion forum, I want you to look through the facts and pictures in the textbook and Learning Objects on STI’s/HIV/AIDS and find THREE facts that surprised you about any of the STI’s presented. For each of the facts you choose, I want you to do the following:
1) Describe each “surprising fact” (it doesn’t have to be surprising to anyone but you, fyi). Be sure to name the STI(s) that it might be associated with and provide a detailed description of the thing that surprised you. It doesn’t have to be an infection itself — it can be a fact, a piece of history, a trend, disturbing scientific fact, etc.
2) For each “surprising fact”, also describe the population of people that should know more about this — be specific. Demographic categories such as Gender, Age, socio-economic group, ethnicity, region, country, education level??? Why should this group of people know more about the “surprising fact” that you’ve chosen.
3) Anything else you can think of? Other thoughts??
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Discussion Assisted Suicide
/in Uncategorized /by developerSeventy-eight-year-old Mr. Harod has been a long-term resident of the retirement community. Although mentally sharp, his condition has declined in the past several months and he has been diagnosed with pancreatic cancer. He has declined treatment, stating that he understands his poor prognosis and would rather spend whatever life he has left unbothered by the stress and side effects of treatment,
Last month Mr. Harod was transferred to the nursing home section of the retirement community. You have noticed several individuals regularly visiting him and learn from another resident that these people are part of a group who support assisted suicide,
A few days later, when entering Mr. Harod’s room for morning rounds, you find him deceased. By his bed are several papers that describe who to contact and what plans to make. You are aware that the people who had been visiting had been there the night before and spent considerable time in a private meeting with Mr. Harod.
One of the residents comments that Mr. Harod “went out on his own terms,” It appears several of the residents support his choice; it was, in fact, suicide.
What should you do in this situation?
*Please note that I live in Texas and assisted suicide is illegal and prohibited in Texas. Please research nursing responsibilities related to this scenario
APA Format and references must be within the past 5 years, no references earlier than 2015 should be used
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Discussion Big Data Risk And Rewards
/in Uncategorized /by developerWhen you wake in the morning, you may reach for your cell phone to reply to a few text or email messages that you missed overnight. On your drive to work, you may stop to refuel your car. Upon your arrival, you might swipe a key card at the door to gain entrance to the facility. And before finally reaching your workstation, you may stop by the cafeteria to purchase a coffee.
From the moment you wake, you are in fact a data-generation machine. Each use of your phone, every transaction you make using a debit or credit card, even your entrance to your place of work, creates data. It begs the question: How much data do you generate each day? Many studies have been conducted on this, and the numbers are staggering: Estimates suggest that nearly 1 million bytes of data are generated every second for every person on earth.
As the volume of data increases, information professionals have looked for ways to use big data—large, complex sets of data that require specialized approaches to use effectively. Big data has the potential for significant rewards—and significant risks—to healthcare. In this Discussion, you will consider these risks and rewards.
To Prepare:
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Discussion Board 18689851
/in Uncategorized /by developerThe Surgical Care Improvement Project (SCIP) is a national quality partnership of organizations interested in improving surgical care by significantly reducing surgical complications. Partners in SCIP believe that a meaningful reduction in surgical complications depends on surgeons, anesthesiologists, perioperative nurses, pharmacists, infection control professionals, and hospital executives working together to intensify their commitment to making surgical care improvement a priority. If you were the administrator in charge of reducing errors related to surgery, what strategies would you implement that enable the different professionals (i.e., surgeons, anesthesiologists, preoperative nurses, pharmacists, infection control professionals, and hospital executives) to receive training? What kind of training and development activities would you implement to change the culture of the hospital in regard to reducing patient care errors? What other HRM activities could be impacted by the training and collaboration? You will create a thread in response to the provided prompt for each forum. Each thread must be at least 600 words and demonstrate course-related knowledge. Each thread and reply must also include a biblical integration and at least 2 peer-reviewed source citations in current APA format in addition to the text.
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Discussion Board 18690647
/in Uncategorized /by developerdiscussion board due Thursday only 250 words use citation correct in assignment
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With the amazing advances in health care in recent decades, one question that continues to stir debate within the political arena and from a personal perspective is: “How to pay for health care” Health care managers must be good stewards of their resources to allow the funds available to do the greatest good for the largest number of people. Health care finance information is critical to assessing the financial condition of an organization, as well as accessing whether the resources being spent are achieving the goals of the organization.
To prepare for this Discussion, select a recent (within 5 years) relevant article from the Walden University library and current information from Centers for Medicare & Medicaid Services, U.S. Department of Health & Human Services, and the Healthcare Financial Management Association, Knowledge Center, that addresses the importance of health care finance information in decision making within the health care setting.
Post a comprehensive response to the following:
How do health care managers depicted in the article and website information you selected apply the principles of financial management to decisions, to the assessment of the financial condition of an entity or stewardship, or to the assessment of the efficiency, effectiveness, and compliance with organization directives?
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RESOURCES
Optional Resources
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