Requirements:

– 2-3 page (that means a minimum of 2 full pages and no longer than 3 full pages) paper (in APA format with no direct quotes- all writing must be in your own words) with the following:

1. Topic: Anxiety

2. Attached will be ONE peer-reviewed article in EACH of the above three article types about your topic (so three articles total- One study article, one literature review article, one meta analysis article).

3. For each article, describe the following:

– Purpose of the article

– Format of the article (i.e. length, subheadings, etc.)

– What did you learn about your topic from this kind of article?

4. Finally, address the following:

– Which article seems the most informative about your topic overall?

– Which article was easiest to read? Which was the most difficult?

 

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IT IS A SOAP NOTE, PROFESSOR ONLY ACCEPTED CLASS RESOURCES.

Patients are frequently uncomfortable discussing with health care professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

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

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.

GENITALIA ASSESSMENT

Subjective:

• CC: “I have bumps on my bottom that I want to have checked out.”
• HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.
• PMH: Asthma
• Medications: Symbicort 160/4.5mcg
• Allergies: NKDA
• FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD
• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

• VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs
• Heart: RRR, no murmurs
• Lungs: CTA, chest wall symmetrical
• Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia
• Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney
• Diagnostics: HSV specimen obtained

Assessment:

• Chancre
• 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:

Refer to Chapter 5 of the Sullivan text. Analyze the SOAP note case study.  Using evidence based resources, answer the following questions and support your answers using current evidence from the literature. 

• Analyze the subjective portion of the note. List additional information that should be included in the documentation.
• Analyze the objective portion of the note. List additional information that should be included in the documentation.
• Is the assessment supported by the subjective and objective information? Why or Why not?
• Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis? 
• 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. 

CALSS RESOURCES

Learning Resources 

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

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.
Chapter 16, “Breasts and Axillae” (pp. 350-369)
This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.

Chapter 18, “Female Genitalia” (pp. 416-465)
In this chapter, the authors explain how to conduct an examination of female genitalia. The chapter also describes the form and function of female genitalia.

Chapter 19, “Male Genitalia” (pp. 466-484)
The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, the chapter explains how to perform an exam of these areas.

Chapter 20, “Anus, Rectum, and Prostate” (pp. 485-500)
This chapter focuses on performing an exam of the anus, rectum, and prostate. The authors also explain the anatomy and physiology of the anus, rectum, and prostate.

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.
Chapter 5, “Amenorrhea” (pp. 47-60)
Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam.

Chapter 6, “Breast Lumps and Nipple Discharge” (pp. 61-72)
This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam.

Chapter 7, “Breast Pain” (pp. 73-80)
Determining the cause of breast pain can be difficult. This chapter examines how to determine the likely cause of the pain through diagnostic tests, physical examination, and careful analysis of a patient’s health history.

Chapter 27, “Penile Discharge” (pp. 318-324)
The focus of this chapter is on how to diagnose the causes of penile discharge. The authors include specific questions to ask when gathering a patient’s history to narrow down the likely diagnosis. They also give advice on performing a focused physical exam.

Chapter 36, “Vaginal Bleeding” (pp. 419-433)
In this chapter, the causes of vaginal bleeding are explored. The authors focus on symptoms outside the regular menstrual cycle. The authors discuss key questions to ask the patient, as well as specific physical examination procedures and laboratory studies that may be useful in reaching a diagnosis.

Chapter 37, “Vaginal Discharge and Itching” (pp. 434-445)
This chapter examines the process of identifying causes of vaginal discharge and itching. The authors include questions on the characteristics of the discharge, the possibility of the issues being the result of a sexually transmitted infection, and how often the discharge occurs. A chart highlights potential diagnoses based on patient history, physical findings, and diagnostic studies.

Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.
Chapter 3, “Adult Preventative Care Visits” (“Gender Specific Screenings”; pp. 48–49)Note: Download the Physical Examination Objective Data Checklist to use as you complete the Head-to-Toe Physical Assessment Video assignment.

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.

This Physical Examination Objective Data Checklist was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Cucci, E. Santoro, A., DiGesu, C., DiCerce, R., & Sallustio, G. (2015). Sclerosing adenosis of the breast: Report of two cases and review of the literature. Polish Journal of Radiology, 80, 122–127. doi:10.12659/PJR.892706. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356184/ 

Sabbagh, C., Mauvis, F., Vecten, A., Ainseba, N., Cosse, C., Diouf, M., & Regimbeau, J. M. (2014). What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized, controlled study in men. Digestive and Liver Disease, 46(12), 1082–1085. doi:10.1016/j.dld.2014.08.045
Retrieved from the Walden Library Databases. 

Westhoff, C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete? Journal of Women’s Health, 20(1), 5–10.
Retrieved from the Walden Library databases.
This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.

Centers for Disease Control and Prevention. (2012). Sexually transmitted diseases (STDs). Retrieved from http://www.cdc.gov/std/#

This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projects and initiatives, treatment information, and program tools.

University of Virginia. (n.d.). Introduction to radiology: An online interactive tutorial. Retrieved from http://www.med-ed.virginia.edu/courses/rad/index.html

This website provides an introduction to radiology and imaging. For this week, focus on genitourinary radiology, as well as the cross-sectional female pelvis and the cross-sectional male pelvis in abdominal radiology.

Required Media

Online media for Seidel’s Guide to Physical Examination

It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 16 and 18–20 that relate to special examinations, including breast, genital, prostate, and rectal. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/.

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 2, “The Breasts,” pp. 434–444)
Section 2 of this chapter focuses on the anatomy and physiology of breasts. The section provides descriptions of breast examinations and common breast conditions.

Chapter 11, “The Female Genitalia and Reproductive System” (pp. 541–562)
In this chapter, the authors provide an overview of the female reproductive system. The authors also describe symptoms of disorders in the reproductive system.

Chapter 12, “The Male Genitalia and Reproductive System” (pp. 563–584)
The authors of this chapter detail the anatomy of the male reproductive system. Additionally, the authors describe how to conduct an exam of the male reproductive system.

Review of Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527)

 

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Assignment 1: Article Critique 

DNP graduates are expected to apply research findings and integrate nursing science into evidence-based practice. To develop your ability to engage in this high level of nursing practice, you will analyze the strengths and weaknesses of a research study over the next several weeks using the concepts presented throughout Weeks 1 through 9 of the course. Your final analysis will be a 5- to 7-page paper in APA format, that includes the following:

1) Write an introduction ending with a purpose statement (e.g. “the purpose of this study is…).

2) Provide a two paragraph overviews of the study.

3)  Identify three strengths of the study and support your selection (i.e. why is this a

strength)

4)  Identify three weaknesses of the study and support your selection (i.e. why is this a

weakness)

Note: The strengths and weaknesses should be in relation to:

· Design

· Sampling

· Data collection

· Statistical analysis

· Results and discussion.

5)  Propose changes to improve the quality of the study capitalizing on the strengths and

6) improving on the weaknesses you identified in the study.

7)  Summarize the implications for nursing practice. 

8) Write a conclusion for your paper

The purpose of the analysis is to help you develop a deeper understanding of the research process, to inspire you to think critically and deeply about research on a specific topic, and to strengthen your ability to integrate research findings into evidence-based nursing practice. This assignment also gives you practice in analyzing the research literature, which will support you when you begin your DNP project. 

Due Wednesday October 25, 2017 before midnight!

Writing (5 points): Up to 5 points (20%) may be deducted for grammar and APA style errors.

To prepare for this week’s assignment complete the following:

• Select      one of the four research articles cited in this week’s required readings (SEE ATTACHED PDF FILE). 

• Review      the various quantitative research designs presented in the textbook      readings and research articles and discussed in the “Musings: Aligning      Research Question and Methodology” media.
• Consider      the research design used in your selected article. Ask yourself the      following questions. Is the design appropriate for the study? Would a      different design provide better results?

Required Media

Laureate Education, Inc. (Executive Producer). (2011). Research methods for evidence-based practice: Selecting a research topic and developing a hypothesis. Baltimore, MD: Author.

Note: The approximate length of this media piece is 13 minutes.

In this week’s video, Dr. Leiyu Shi discusses the characteristics of a good research hypothesis and details the steps in developing a hypothesis that can be tested through research.

Laureate Education, Inc. (Executive Producer). (2011). Research methods for evidence-based practice: Musings: Aligning research question and methodology. Baltimore, MD: Author.

Note: The approximate length of this media piece is 6 minutes.

This video discusses the importance of having a well-defined research question, which informs the methodology that you use in creating a hypothesis for a research study

Laureate Education. (2011). Important events in clinical research history. Retrieved from http://mym.cdn.laureate-media.com/2dett4d/Walden/CLRA/6100/01/mm/timeline/index.html

This timeline identifies and describes key historical events related to the development of clinical research throughout the ages.

Required Readings

Gray, J.R., Grove, S.K., & Sutherland, S. (2017). Burns and Grove’s the practice of nursing research: Appraisal, synthesis, and generation of evidence (8th ed.). St. Louis, MO: Saunders Elsevier.

Chapter 5, “Research Problem and Purpose”

Chapter 5 outlines how to identify and develop a research problem statement, purpose, and research questions. The chapter also provides examples of both quantitative and qualitative research topics, problems, and purpose.

Chapter 6, “Objectives, Questions, Variables, and Hypothesis”

This chapter explains the different types of hypotheses and assesses how research variables can be used to formulate research objectives in both quantitative and qualitative studies.

Chapter 10, “Quantitative Methodology: Noninterventional Designs and Methods”

Chapter 10 describes the principles of research design and those foundational concepts that influence the selection of an appropriate quantitative design: causality, bias, manipulation, control, and validity.

Chapter 11, “Quantitative Methodology: Interventional Designs and Methods”

This chapter builds on the material presented in Chapter 10 and discusses how to select the most appropriate quantitative research design for addressing a particular research problem.

Select one of the following articles to use for this week’s Assignment:

· Fouquier, K.F. (2011). The concept of motherhood among three generations of African American women. Journal of Nursing Scholarship, 43(2), 145–153. 

· Grey, M., Whittemore, R., Jaser, S., Ambrosino, J., Lindemann, E., Liberti, L., Northrup, V., & Dziura, J. (2009). Effects of coping skills training in school-age children with Type 1 diabetes. Research in Nursing & Health, 32, 405–418. (USE THIS ARTICLE FOR THIS ASSIGNMENT)

· Methey, N.A., Davis-Jackson, J., & Stewart, B.J. (2010). Effectiveness of an aspiration risk-reduction protocol. Nursing Research, 59, 18–25.

· Newhouse, R.P., Morlock. L., Pronovost, P., & Breckenridge-Sproat, S. (2011). Rural hospital nursing: Results of a national survey of nurse executives. Journal of Nursing Administration, 41(3), 129–137.

Handouts

Laureate Education. (2011). Litmus test for a doctoral-level research problem. Baltimore, MD: Author.

Optional Resources

Caress, A., Luker, K., & Chalmers, K. (2010). Promoting the health of people with chronic obstructive pulmonary disease: Patients’ and carers’ views. Journal of Clinical Nursing, 19(3–4), 564–573.

Mbeba, M. M., N., Jere, D. L., Kachingwe, S. I., Crittenden, K. S., McCreary, L. L., … Norr, K. F. (2011). Peer group intervention reduces personal HIV risk for Malawian health workers. Journal of Nursing Scholarship, 43(1), 72–81.

Miller, J., Gaboda, D., Nugent, C., Simpson, T., & Cantor, J. (2011). Parental eligibility and enrollment in state children’s health insurance program: The roles of parental health, employment, and family structure. American Journal of Public Health, 101(2), 274–277.

Su, C., Lu, X., Chen, W., & Wang, T. (2009). Promoting self-management improves the health status of patients having peritoneal dialysis. Journal of Advanced Nursing, 65(7), 1381–1389.

 

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For over 20 years, the Women’s Health Initiative (WHI) study has conducted research trials to examine factors that impact risks and development of conditions that impact women such as heart disease, breast and colorectal cancer, and osteoporotic fractures in postmenopausal women. Health care providers use results from these trials to develop guidelines for delivering care to patients. In your role in clinical settings, you must be familiar with these guidelines, and you must be aware that through clinical practice, guidelines frequently evolve and change. Often, what is considered a best practice today might not be a best practice in the future. For this Assignment, you compare guidelines outlined in the WHI study to current best practices for assessing and managing conditions.

By Day 7 of Week 11

To Prepare:

• Review the Women’s Health Initiative article in this week’s Learning Resources. Select one disorder presented in this study.  Link for article: http://www.nhlbi.nih.gov/whi/background.htm
• Locate and select a research article that addresses current best practices for assessing and managing the disorder you selected. Be sure that the research article you select is from a reputable source.
• Consider the similarities and differences between the best practices presented in the WHI study and the article you selected. Think about the potential impact of differences in best practices on women’s health.
• Consider whether the best practices in the article you selected should be used in clinical practice.

To Complete:

Write a 2- to 3-page paper that addresses the following:

• Describe the disorder you selected from the Women’s Health Initiative study.
• Explain the current best practices for assessing and managing this disorder as suggested in the research article you selected.
• Compare the best practices presented in the WHI study to the current best practices presented in the article. Explain how the differences in best practices might impact women’s health.
• Explain whether you think the current best practices in the article you selected should be used in clinical practice. Support your position with evidence-based research.

Note: The School of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The Sample Paper provided at the Walden Writing Center provides an example of those required elements (available at http://writingcenter.waldenu.edu/57.htm). All papers submitted must use this formatting.

http://www.nhlbi.nih.gov/whi/background.htm

 

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Assignment: 1

In a 2-4 page paper, select a specific population and develop a specific health plan to include strategies to promote health and lifelong learning for all age groups within that specific population.

Use references from scholarly literature (not the assigned course textbooks) to support paper s. a. peer-reviewed Nursing Journal not older than 5 years.

Use APA format & include headings (levels). Cover and reference pages are not included as part of the four (4) page paper.

 

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