CASE STUDY

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 during 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. 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, negMcBurney

 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.

Using evidence-based resources from your search, 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 three different references from current evidence-based literature.

Please do not write the paper in soap note format. PLEASE ANSWER ONLY THE QUESTIONS. DO NOT REWRITE THE CASE STUDY. Title page and Reference page required ( APA format ).

1. Due DateMonday, February 8, 20219:00 AMPoints Possible80
2. Week 5 Assignment – Learning Activity: SWOT Analysis
   Using the same health care organization identified in the first assignment, complete a SWOT analysis on the organization over all based on information you gathered when completing the first assignment. Use the provided template and submit the completed version.
   • SWOT Word Template [DOCX].
   • For more information on how to conduct a SWOT Analysis, you may want to watch the video, Conducting a SWOT Analysis.
     Be sure you SWOT Analysis includes each of the following:
     Step 1: Strengths
     First, identity one or two major competitors. Next, consider what does the company/product do better than (or at least equivalent to) the competition. This could be:
   • Specific product attribute advantage.
   • Brand perceived value.
   • Customer service of company.
   • Step 2: Weaknesses
     What does the company/product do that is not as good as the competition? How is this going to affect your customer’s sales?
     Thought needs to be given to how you can compensate for, or overcome these issues. What is the cost of overcoming these issues?
     Is it necessary to overcome the issues or are they something you can accept and deal with?
     Step 3: Opportunities
     What area of the market could you enter with some modifications to the product/service or company? The main elements here could include:
   • Change size, shape, or color.
   • Additional services.
   • New packaging.
   • Different distribution points.
   • New promotional focus.
   • Step 4: Threats
     What actions could threaten the product or standing in the market?
   • New competitor entry.
   • Major product failure.
   • Reduction in promotional spend.
   • Customer changes.
   • Changes in the market.

  Using the learning materials to support your claims, respond to the following prompts in your initial post: 

• Describe what surprised you in the learning materials around the cost of long-term care.
• Explain the financial challenges and realities that older adults face as they age.
• Describe the ways in which long-term care is paid for by aging adults and patterns over time.
• Nursing home care is common and costly. Describe how accountable care organization (ACO) payment models have incentives for care that is better coordinated and less reliant on acute settings.
• Describe ways in which long-term care is reimbursed for services and the impacts of pay-for-performance models. Does this have the potential to improve care for this high-cost population?
• As a leader of a long-term care organization, do you think it is cost effective to provide a more comfortable setting through cultural change?
• Does the pay-for-performance model for reimbursement have advantages?
• How do low reimbursement rates impact the quality of care delivered to aging adults living in a long-term care setting?

Should be 300 to 500 words, with one to two supporting references included.

Discussion 2

After reading Payne (2015), respond to the following prompts in your original post:

• Describe what the author refers to with the phrase Medicaid planning.
• Describe ethical factors related to Medicare planning and spending down assets to qualify. Provide an argument for those who support this and those who oppose.
• What are the consequences to the healthcare industry if an aging adult is allowed to “spend down” to access Medicaid to cover health care costs (that is, increasing costs and diminished quality)?

 should be 300 to 500 words, with one to two supporting references included.

Useful readings

• Braun, R. A., Kopecky, K. A., & Koreshkova, T. (2019). Old, Frail, and Uninsured: Accounting for Features of the U.S. Long-Term Care Insurance Market. Econometrica, 3, 981. Retrieved From: https://doi.org/10.3982/ECTA15295
• Willink, A., Davis, K., Mulcahy, J., Wolff, J. L., & Kasper, J. (2019). The Financial Hardship Faced by Older Americans Needing Long-Term Services and Supports (PDF). Issue Brief (Commonwealth Fund), 2019, 1–12.
• Brenda C. Spillman, & Peter Kemper. (1995). Lifetime Patterns of Payment for Nursing Home Care (PDF). Medical Care, 33(3), 280.
• Lepore, M. J., Shield, R. R., Looze, J., Tyler, D., Mor, V., & Miller, S. C. (2015). Medicare and Medicaid Reimbursement Rates for Nursing Homes Motivate Select Culture Change Practices But Not Comprehensive Culture Change. Journal of Aging & Social Policy, 27(3), 215–231. Retrieved From: https://doi.org/10.1080/08959420.2015.1022102
• Bowblis, J. R., & Applebaum, R. (2017). How Does Medicaid Reimbursement Impact Nursing Home Quality? The Effects of Small Anticipatory Changes. Health Services Research, 52(5), 1729–1748. Retrieved From: https://doi.org/10.1111/1475-6773.12553
• Grabowski, D. C., Stevenson, D. G., Caudry, D. J., O’Malley, A. J., Green, L. H., Doherty, J. A., & Frank, R. G. (2017). The Impact of Nursing Home Pay-for-Performance on Quality and Medicare Spending: Results from the Nursing Home Value-Based Purchasing Demonstration. Health Services Research, 52(4), 1387–1408. Retrieved fRom: https://doi.org/10.1111/1475-6773.12538
• Chang, C.-H., Mainor, A., Colla, C., & Bynum, J. (2020). Utilization by Long-Term Nursing Home Residents Under Accountable Care Organizations. Journal of the American Medical Directors Association. Retrieved From: https://doi.org/10.1016/j.jamda.2020.05.055
• Becker, A. (2004). Deadly Inequality in the Health Care safety net: Uninsured Ethnic Minorities’ Struggle to Live with Life-Threatening Illnesses. Medical Anthropology Quarterly, 18(2), 258–275.
• Ferrara, P. (2015). The Future of Social Security (PDF). National Affairs, 24, 85–99.
• Quinn, J. F., & Cahill, K. E. (2016). The New World of Retirement Income Security in America. American Psychologist, 71(4), 321–333.
• Payne, J. B. (2013). Ethical and Public Policy and Considerations Related to Medicaid Planning. Pennsylvania Bar Association Quarterly, 84(4), 139–150. Retrieved From: https://login.regiscollege.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edshol&AN=edshol.hein.barjournals.pennbarq0084.22&site=eds-live

Epidemiologists are public health professionals who collect and analyze data to address local and global health issues. Key individuals and historical events have helped shape the field of epidemiology. Research the following individuals and their roles in shaping contemporary epidemiology:

1. John Graunt
2. James Lind
3. Edward Jenner
4. Ignaz Semmelweis
5. John Snow

Examine the history, principles, and application of epidemiology and write a 1,000-1,250 paper to explain your findings. Choose one of the individuals from your research and include the following:

1. Define epidemiology and discuss its purpose and importance to public health.
2. Describe the disease and the event. Using descriptive epidemiology, discuss how common the disease was at the time, who was infected, when it occurred (time of year or season), and the mode of transmission. If the individual is not associated with a specific disease, discuss a significant disease happening during that period.
3. Explain how the individual influenced epidemiology and discuss the advanced epidemiological methods and process the individual used to describe and control disease. Discuss how the individual’s contributions helped to inform the application definition of epidemiology in public health.
4. Identify and describe three subspecialties within epidemiology.

You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and public health content.

APA format, no later than Tuesday night