Essentials of Maternity, Newborn, and Women’s Health Nursing|2025

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Chapter 14: Nursing Management During Labor and Birth

1.  Desiree, a 28-year-old G2P1, is admitted to the labor and birth unit. Her birth plan indicates that she is planning natural childbirth without pharmacological interventions. She has attended childbirth education classes. Desiree is considered low risk based on her personal and family health history and physical exam. Her pregnancy has progressed without complications. She is approximately 38 weeks pregnant. Vaginal assessment reveals cervical dilation at 10 cm, 100% effaced, and +1 station. Position of the fetus is LOA. The external fetal monitor indicates a reassuring fetal heart rate at 130 beats per minute. Maternal status is stable. (Learning Objectives 1, 2, 6, and 9)

  1. Based on the vaginal assessment, identify the stage of labor and appropriate nursing interventions for this stage of labor.
  2. Explain how the nurse determined that the external fetal monitor would be appropriate for Desiree. What factors would necessitate a change to internal fetal monitoring during labor?
  3. Desiree says, “I’m not sure I can cope with the pain much longer.” How would you respond, considering her birth plan, stage of labor, and assessment data?

2.  Emily, a 26-year-old G3P2, has been in labor for 5 hours and is 7 cm, 90% effaced and +2 station.  She has external fetal monitoring in place, which reveals a baseline fetal heart rate of 120 bpm, minimal variability, and occasional variable decelerations.  Suddenly, as a contraction is beginning to subside, the fetal heart rate drops to a low of 80 bpm and has a slow return to the baseline 1 minute after the contraction has ended.  (Learning Objectives 4 and 5)

A.  What is happening to Emily’s baby at this point in time?  What does this mean?

B.  What role do you, as the nurse, play regarding fetal assessment and what interventions do you need to implement/recommend at this point in time?

Chapter 15: Postpartum Adaptations

1.     You are caring for Linda, who has just delivered her first baby. You are responsible for assessing Linda’s condition during recovery and for doing patient teaching when the opportunity arises. (Learning Objectives 2 and 3)

  1. While she is recovering, you keep checking her fundal height. Linda asks you how her uterus will go back to the way it was before she had the baby. How would you explain this physiologic process? What could impede the process?
  2. Linda wants to know how long she should expect to bleed. What would you tell her?
  3. The next day Linda appears very passive and you have overheard her telling everyone who will listen about her labor experience. What phase of adjustment is Linda going through? What other stages should she go through while adjusting to her new role?

2.     Gretta and Sam just had their first child. Gretta is excited and talkative about her birth experience and wants to keep her baby with her constantly. She tells you his name is Joseph and they will call him “Joey” for short. Gretta is breast-feeding and is attentive to Joey’s needs. You observe that Sam does not initiate contact with the baby but when Gretta insists that he hold Joey, he picks him up slowly and awkwardly and stares at his face for a long period of time. When Joey cries, he immediately returns him to Gretta’s arms. (Learning Objective 4)

A.   Based on your observations of Sam’s interactions with Joey, relate where Sam is developmentally in the process of paternal attachment and bonding.

B.    What nursing interventions could you implement that would assist Sam in the transition to fatherhood?

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Capstone Project Change Proposal Presentation|2025

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Create a professional presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders. Include the intervention, evidence-based literature, objectives, resources needed, anticipated measurable outcomes, and how the intervention would be evaluated. Submit the presentation in LoudCloud for feedback from the instructor.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

You are not required to submit this assignment to LopesWrite.

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Different learning styles|2025

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Details:

Learning styles represent the different approaches to learning based on preferences, weaknesses, and strengths. For learners to best achieve the desired educational outcome, learning styles must be considered when creating a plan. Complete “The VARK Questionnaire,” located on the VARK website, and then complete the following:

  1. Click “OK” to receive your questionnaire scores.
  2. Once you have determined your preferred learning style, review the corresponding link to view your learning preference.
  3. Review the other learning styles: visual, aural, read/write, kinesthetic, and multimodal (listed on the VARK Questionnaire Results page).
  4. Compare your current preferred learning strategies to the identified strategies for your preferred learning style.
  5. Examine how awareness of learning styles has influenced your perceptions of teaching and learning.

In a paper (750-1,000 words), summarize your analysis of this exercise and discuss the overall value of learning styles. Include the following:

  1. Provide a summary of your learning style according the VARK questionnaire.
  2. Describe your preferred learning strategies. Compare your current preferred learning strategies to the identified strategies for your preferred learning style.
  3. Describe how individual learning styles affect the degree to which a learner can understand or perform educational activities. Discuss the importance of an educator identifying individual learning styles and preferences when working with learners.
  4. Discuss why understanding the learning styles of individuals participating in health promotion is important to achieving the desired outcome. How do learning styles ultimately affect the possibility for a behavioral change? How would different learning styles be accommodated in health promotion?

Cite to at least three peer-reviewed or scholarly sources to complete this assignment. Sources should be published within the last 5 years and appropriate for the assignment criteria.

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 LopesWrite. Please refer to the directions in the Student Success Center.

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Case Study: Mrs. J.|2025

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It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mrs. J., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mrs. J. is a 63-year-old married woman who has a history of hypertension, chronic heart failure, and chronic obstructive pulmonary disease (COPD). Despite requiring 2L of oxygen/nasal cannula at home during activity, she continues to smoke two packs of cigarettes a day and has done so for 40 years. Three days ago, she had sudden onset of flu-like symptoms including fever, productive cough, nausea, and malaise. Over the past 3 days, she has been unable to perform ADLs and has required assistance in walking short distances. She has not taken her antihypertensive medications or medications to control her heart failure for 3 days. Today, she has been admitted to the hospital ICU with acute decompensated heart failure and acute exacerbation of COPD.

Subjective Data

  1. Is very anxious and asks whether she is going to die.
  2. Denies pain but says she feels like she cannot get enough air.
  3. Says her heart feels like it is “running away.”
  4. Reports that she is exhausted and cannot eat or drink by herself.

Objective Data

  1. Height 175 cm; Weight 95.5kg.
  2. Vital signs: T 37.6C, HR 118 and irregular, RR 34, BP 90/58.
  3. Cardiovascular: Distant S1, S2, S3 present; PMI at sixth ICS and faint: all peripheral pulses are 1+; bilateral jugular vein distention; initial cardiac monitoring indicates a ventricular rate of 132 and atrial fibrillation.
  4. Respiratory: Pulmonary crackles; decreased breath sounds right lower lobe; coughing frothy blood-tinged sputum; SpO2 82%.
  5. Gastrointestinal: BS present: hepatomegaly 4cm below costal margin.

Intervention

The following medications administered through drug therapy control her symptoms:

  1. IV furosemide (Lasix)
  2. Enalapril (Vasotec)
  3. Metoprolol (Lopressor)
  4. IV morphine sulphate (Morphine)
  5. Inhaled short-acting bronchodilator (ProAir HFA)
  6. Inhaled corticosteroid (Flovent HFA)
  7. Oxygen delivered at 2L/ NC

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mrs. J.’s situation. Include the following:

  1. Describe the clinical manifestations present in Mrs. J.
  2. Discuss whether the nursing interventions at the time of her admissions were appropriate for Mrs. J. and explain the rationale for each of the medications listed.
  3. Describe four cardiovascular conditions that may lead to heart failure and what can be done in the form of medical/nursing interventions to prevent the development of heart failure in each condition.
  4. Taking into consideration the fact that most mature adults take at least six prescription medications, discuss four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients. Provide a rationale for each of the interventions you recommend.
  5. Provide a health promotion and restoration teaching plan for Mrs. J., including multidisciplinary resources for rehabilitation and any modifications that may be needed. Explain how the rehabilitation resources and modifications will assist the patients’ transition to independence.
  6. Describe a method for providing education for Mrs. J. regarding medications that need to be maintained to prevent future hospital admission. Provide rationale.
  7. Outline COPD triggers that can increase exacerbation frequency, resulting in return visits. Considering Mrs. J.’s current and long-term tobacco use, discuss what options for smoking cessation should be offered.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to 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 LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Case Study: Mrs. J.

No of Criteria: 12 Achievement Levels: 5

CriteriaAchievement LevelsDescriptionPercentageUnsatisfactory0.00 %Less Than Satisfactory75.00 %Satisfactory79.00 %Good89.00 %Excellent100.00 %Content80.0

Clinical Manifestations of Mrs. J.10.0Clinical manifestations are omitted.Clinical manifestations are partially presented. There are major omissions and inaccuracies.Clinical manifestations are summarized. An overview of the general symptoms is presented. Some findings are incomplete.Subjective and objective clinical manifestations are described. Overall, the clinical manifestations are accurate and reflect observed and perceived signs and symptoms.Subjective and objective clinical manifestations are detailed. The clinical manifestations are accurate and clearly report the observed and perceived signs and symptoms.Evaluation of Nursing Interventions at Admissions10.0Evaluation of appropriateness of nursing interventions at the time of admission and explanation of the rationale for each of the medications listed are not discussed.Evaluation of appropriateness of nursing interventions at the time of admission is partially presented. An incomplete explanation for each of the medications listed is presented. The discussion contains significant inaccuracies.Evaluation of appropriateness of nursing interventions at the time of admission is summarized. A general explanation and some rationale for each of the medications listed are presented. There are minor inaccuracies.Evaluation of appropriateness of nursing interventions at the time of admission is discussed. An explanation and general rationale for each of the medications listed are presented. Some information is required for accuracy or clarity.Evaluation of appropriateness of nursing interventions at the time of admission is thoroughly discussed. A well-supported explanation for each of the medications listed is presented. Strong and compelling rationale is provided.Cardiovascular Conditions Leading to Heart Failure and Interventions10.0Fewer than three cardiovascular conditions that may lead to heart failure, and medical or nursing interventions to prevent the development of heart failure in each condition, are described.Four cardiovascular conditions that may lead to heart failure are partially described. Medical or nursing interventions to prevent the development of heart failure in each condition are incomplete.

There are significant inaccuracies.Four cardiovascular conditions that may lead to heart failure are summarized. Medical or nursing interventions to prevent the development of heart failure in each condition are generally discussed. There are some inaccuracies.Four cardiovascular conditions that may lead to heart failure are described. Medical and nursing interventions to prevent the development of heart failure in each condition are discussed. There are minor inaccuracies, or information is needed for clarity.Four cardiovascular conditions that may lead to heart failure are clearly described. Medical and nursing interventions to prevent the development of heart failure in each condition are discussed. Overall, the discussion demonstrates insight into medical and nursing interventions used to prevent heart failure.Nursing Interventions for Older Patients to Prevent Problems Caused by Multiple Drug Interactions10.0Fewer than three nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are presented.Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are partially presented.Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are summarized. Overall, the discussion meets assignment criteria but requires more rationale for the interventions. There are minor inaccuracies.Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are discussed. Overall, the discussion meets assignment criteria and general rationale for the interventions is provided.Four nursing interventions that can help prevent problems caused by multiple drug interactions in older patients are discussed. The discussion fulfills the assignment criteria and strong rationale for the interventions is provided.Health Promotion and Restoration Teaching Plan15.0A health promotion and restoration teaching plan for the patient is omitted.A health promotion and restoration teaching plan for the patient is partially presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are omitted or incomplete. An explanation for how rehabilitation resources and modifications assist patient transition to independence is omitted or incomplete.A health promotion and restoration teaching plan for the patient is summarized. Multidisciplinary resources for rehabilitation and any modifications that may be needed are generally presented. A summary for how rehabilitation resources and modifications assist patient transition to independence is presented. There are minor inaccuracies.A health promotion and restoration teaching plan for the patient is presented.

Multidisciplinary resources for rehabilitation and any modifications that may be needed are discussed. An explanation for how rehabilitation resources and modifications assist patient transition to independence is presented.A well-developed health promotion and restoration teaching plan for the patient is presented. Multidisciplinary resources for rehabilitation and any modifications that may be needed are clearly discussed. An strong explanation for how rehabilitation resources and modifications assist patient transition to independence is presented. The overall discussion is well-supported.Method for Providing Education to Prevent Hospital Readmissions15.0A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is omitted. The method is not appropriate for the client or health status.A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is partially summarized. The method may not be relevant to for this situation. More information is needed. There are major inaccuracies.A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is summarized. The method is generally appropriate. Some rationale is provided for support.A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is described. Overall, the method is appropriate. General rationale is provided for support.A method for providing education to the patient for the maintenance of prescribed medications that prevents future hospital admissions is thoroughly described. The method is clearly appropriate for the client and prevents readmission. Strong rationale is provided for support.COPD Triggers and Options for Smoking Cessation10.0COPD triggers exacerbating return visits and options for smoking cessation are omitted.Some COPD triggers exacerbating return visits are partially presented. Options for smoking cessation are incomplete; it is unclear if the options are relevant to the patient.General COPD triggers exacerbating return visits are generally presented. Some options for smoking cessation relevant to the patient are summarized. Some support or information is needed.Key COPD triggers exacerbating return visits are outlined. General options for smoking cessation relevant to the patient are summarized.All appropriate COPD triggers exacerbating return visits are clearly outlined. Strong options for smoking cessation are detailed and are highly relevant to the patient.

Organization, Effectiveness, and Format20.0

Thesis Development and Purpose5.0Paper lacks any discernible overall purpose or organizing claim.Thesis is insufficiently developed or vague. Purpose is not clear.Thesis is apparent and appropriate to purpose.Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.Argument Logic and Construction5.0Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.Mechanics of Writing (includes spelling, punctuation, grammar, language use)5.0Surface errors are pervasive enough that they impede communication of meaning.

Inappropriate word choice or sentence construction is used.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.Writer is clearly in command of standard, written, academic English.Paper Format (use of appropriate style for the major and assignment)2.0Template is not used appropriately, or documentation format is rarely followed correctly.Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.Appropriate template is used. Formatting is correct, although some minor errors may be present.Appropriate template is fully used. There are virtually no errors in formatting style.All format elements are correct.Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)3.0Sources are not documented.Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.Sources are documented, as appropriate to assignment and style, and format is mostly correct.Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.Total Percentage  100

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case study discussion|2025

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Case study 1

Elaine Goodwin is a 38-year-old G5 P5 LC 6 presenting to your clinic today to discuss contraceptive options.  She states that she is not interested in having more children but her new partner has never fathered a child. Her medical history is remarkable for exercise-induced asthma, migraines, and IBS. Her surgical history is remarkable only for tonsils as a child. Her social history is negative for alcohol, tobacco, and recreational drugs.  She has no known drug allergies and takes only vitamin C. Hospitalizations were only for childbirth. Family history reveals that her maternal grandmother is alive with dementia, while her maternal grandfather is alive with COPD. Her paternal grandparents are both deceased due to an automobile accident. Her mother is alive with osteopenia and fibromyalgia, and her dad is alive with a history of skin cancer (basal cell). Elaine has one older sister with no medical problems and one younger brother with no reported medical problems.

· Height 5’ 7” Weight 148 (BMI 23.1), BP 118/72 Pulse 68

· HEENT (head, ears, eyes, nose, throat):  wnl (within normal limit)

· Neck: supple without adenopathy

· Lungs/CV (cardiovascular): wnl

· Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge

· Abd (abdomen): soft, +BS (positive bowel sound), no tenderness

· VVBSU (Vulvar vaginal bartholin skene’s uretha): wnl, except 1st degree cystocele

· Cervix: firm, smooth, parous, without CMT (cervical motion tenderness)

· Uterus: RV (retroverted), mobile, non-tender, approximately 10 cm,

· Adnexa: without masses or tenderness

Based on the case study scenario provided, complete a comprehensive well-woman exam and critically analyze to focus attention on the diagnostic tests (include explanation of the tests you might recommend).

Include your differential diagnosis. Be specific and provide examples. Use your Learning Resources and/or evidence from literature to support your explanations.

Some questions to answer in your post:

1. What other information do you need?

2. What has she used in the past?  Why did she stop a method?  How many partners in past 12 months?

3. What are her current cycles like?

4. When was her last gyn exam and what were the results of the tests?

5. Are her migraines with or without auras?

6. What method has she considered.

7. What are you next steps/considerations?

8. What teaching should you do?

9. What methods are appropriate for Elaine?

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advanced health assessment|2025

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Back pain

A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

 

Respond to this

#1

42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

 

Patient Information:

R.E, 42-year-old African American male

Subjective

CC: “Lower back pain”

HPI: A 42-year-old black African American male who came to the clinic today for complaining of lower back pain which he reported started a month ago. The patient stated that the pain sometimes radiates to his left leg.

 

Location: Lower back

Onset: One month ago

Character: Sharp, constant, radiating to left leg

Associated signs and symptoms: None

Timing: Starts when at work

Exacerbating/ relieving factors: Any movement. Ibuprofen helps to relief the pain temporarily.

Severity: 7/10 pain scale

Medications:

Ibuprofen 200mg 3 tablets every 6 hours PRN for lower back pain.

Amlodipine 10mg daily for hypertension x1 years.

Allergies: No known drug allergy, no food allergy, no seasonal allergy and No known allergy to latex/rubber.

PMHx:

Hypertension diagnosed one year ago.

Influenza vaccine November of 2020.

Tdap vaccine 2018.

Pneumonia: Not yet had any pneumococcal vaccine.

Up to date on all childhood immunizations.

Past surgical history: None.

Social History: Mr. R.E is happily married with three children. He has a bachelor’s degree in medical laboratory and works in the hospital setting. Mr. R.E denies ever smoking, but he drinks Corona beer occasionally and during festive period with friends and family. He denies using any illicit drugs and the thought of suicidal ideation. He goes to the gym at least 1-2 times in a week and walk around his neighborhood to keep him physically active and healthy.  He loves dancing as a hobby and going for vacations with his family. The patient reported that he loves to maintain his activities of daily living and dress according to weather, as for his instrumental Activities of Daily Living he said he manages his finances and financial assets by paying his bills early. Mr. R.E loves his traditional African food and occasionally eat out. The patient reported that he keeps to safety measures by putting on his seatbelt and not texting while driving, he also reported having a working smoke detector and a security camera in his house. He has a good family support system for his wife and children. He sleeps 6-8 hours per night.

Family History:

Mr. R.E mother is still alive, age 70, has hypertension and type 2 diabetes mellitus. The Father is still living; he is 72 years old who has asthma.

Maternal grandmother deceased at age 78, had a stroke, she was diabetic.

Maternal grandfather, deceased at age 80, had prostate cancer.

Paternal grandmother deceased at age 70, from chronic obstructive pulmonary disease (COPD)

Paternal grandfather age 95, still alive had asthma.

Brother age 55 has type 2 diabetes mellitus.

Son, age 20, no health issues

Daughter age 16. No health issues.

Daughter 12, no health issues.

General:

The patient is alert and oriented to place, person, time and situation, appropriate judgement, well-nourished black, African American, dressed according to the weather, no distress noted, mild discomfort due to pain in his lower back. Emotional and behavioral needs are appropriate at the present time considering patient clinical condition, no current home stress or abuse.

HEENT: Denies itching eyes or any discharges. The patient said he uses glasses but does not use contact lens, he denies blurred vision. Denies ringing in his ears, hearing loss and discharged. Denies surgery to his ears and any recent infections. Denies epistaxis, discharges, congestion and sneezing, no loss or decreased sense of smell. Denies any sore throat or infection.

Respiratory: Elevated respiratory rate, 30/min.  Denies difficulty breathing, coughing, and wheezing. Denies secondhand smoking.

Cardiovascular/Peripheral Vascular: Denies chest pain, heaviness, or heart palpitation, denies shortness of breath and edema to both lower extremities.

Gastrointestinal: No complains of abdominal upset, no nausea or vomiting, have regular bowel movement. No changes in his appetite, no recent weight loss.

Genitourinary: Denies difficulty voiding, changes in voiding pattern and denies any penile discharge.

Neurological: Denies light headedness, fainting, seizure, vision changes or weakness to any side of his body. Denise changes in his thinking.

Skin: Negative for skin lesion, eczema, mole or rash and no skin changes.

Musculoskeletal: Lower back pain that radiates to his left leg. Denies joint stiffness or joint pain.

Hematologic: Denies any bleeding.

Endocrine: Denies cold or heat intolerance, excessive thirst, or urination, does not have any issue with his thyroid.

Psychiatry: Mr. R.E said he is fine, does not have any mental problems, denies depression, suicidal thought, patient states he loves his wife and his family and can never kill himself.

OBJECTIVE DATA:

Physical Examination:

Vital signs: BP 120/80 and regular, Heart rate: 65 and regular, Temperature: 98.2 F orally, Respiration 30; pulse oximetry 95% on room air, Weight: 160 lbs.; Height: 5’ 9”; BMI: 26

Neurological: Patient is alert and oriented to place, person, time and situation, appropriate judgement. Speech is clear, no facial drooping, no vision changes, follows movement. Understand clear, complex, comprehensive without cues or repetition.

Skin: Not pale, cyanosis or ashen. Dry and warm to touch. No tear and non-tainting.

Chest/Lungs: Tachypnea, the chest expands symmetrically, bilateral breath sounds are clear.

Heart/Peripheral Vascular: The heart rate is regular with a normal rhythm, S1and S2 sound heard. All peripheral pulses are strong and palpable +3, Negative edema to all extremities. Capillary refill is less than/equal to 2 seconds in all extremities and no cyanosis noted.

Abdomen: Soft and nondistended, bowel sound present and active in all four quadrants, no pain or rebound tenderness noted. Last Bowel movement was this morning.

Musculoskeletal: Lower back pain radiating to the left lower extremity. No evidence of trauma to affected area. Pain increases with flexion, extension, and twisting. Decreased mobility due to pain.

Diagnostic Tests:

Complete blood count (CBC) may point to infections or inflammation.

Erythrocyte sedimentation rate.

HLA-B27

Bone scans

X-Ray of the lumbar spine

Computerized tomography (CT) cervical spine/lumbar w/without contrast.

MRI of the lumbar spine

Assessment.

Differential diagnoses:

· Lumbar disc herniation (LDH): The intervertebral disc consists of an inner nucleus pulposus (NP) and an outer annulus fibrosus (AF). The central NP is a site of collagen secretion and contains numerous proteoglycans (PG), which facilitate water retention, creating hydrostatic pressure to resist axial compression of the spine. The NP is primarily composed of type II collagen, which accounts for 20% of its overall dry weight. In contrast, the AF functions to maintain the NP within the center of the disc with low amount of PG; 70% of its dry weight is comprised of primarily concentric type I collagen fibers. In LDH, narrowing of the space available for the thecal sac can be due to protrusion of disc through an intact AF, extrusion of the NP through the AF though still maintaining continuity with the disc space, or complete loss of continuity with the disc space and sequestration of a free fragment. It is estimated that this condition has approximately 75% heredity origin, other predisposing factors includes dehydration and Axial Overloading. The role of inflammatory signaling in producing nerve pain in LDH has been well-established. The primary signs and symptoms of LDH are radicular pain, sensory abnormalities, and weakness in the distribution of one or more lumbosacral nerve roots. CT myelography and MRI are used to detect this condition (Amin, R. M., Andrade, N. S., & Neuman, B. J. (2017).

· Lumbar spinal stenosis: Lumbar spinal stenosis is a narrowing of the spinal canal in the lower part of the back. Stenosis, which means narrowing, can cause pressure on the spinal cord or the nerves that go from the spinal cord to the muscles. Lumbar spinal stenosis (LSS) is most commonly due to degenerative changes in older individuals. This condition is most usually categorized as either primary when it is caused by congenital abnormalities or a disorder of the postnatal development, or secondary (acquired stenosis) resulting from degenerative changes or as effects of local infection, trauma, or surgery. Degenerative LSS anatomically can involve the central canal, lateral recess, foramina, or any combination of these locations. Central canal stenosis may result from a decrease in the anteroposterior, transversal, or combined diameter secondary to loss of disc height with or without bulging of the intervertebral disc, and hypertrophy of the facet joints and the ligamentum flavum. Fibrosis is the main cause of ligamentum flavum hypertrophy and is caused by accumulated mechanical stress, especially along the dorsal aspect of the ligamentum flavum. The symptom most ascribed to LSS is neurogenic claudication, also known as pseudoclaudication. Neurogenic claudication refers to leg symptoms containing the buttock, groin, and anterior thigh, as well as radiating down the posterior part of the leg to the feet. In addition to pain, leg symptoms can include fatigue, heaviness, weakness and/or paresthesia.  The symptoms can be unilateral or more commonly bilateral and symmetrical. The patient may suffer from accompanying back pain, but leg pain and discomfort are usually more troublesome. (Genevay, S., & Atlas, S. J. (2016).

· Lumbar strain/sprain: The lumbar spine, depends on soft tissues to help hold the body upright and support weight from the upper body. If put under too much stress, the lower back muscles or soft tissues can become injured and painful. Lumbar sprain occurs when ligaments are overstretched or torn. Ligaments are tough, fibrous tissues that connect bones together. The most common symptoms of a lumbar strain are sudden lower back pain, Spasms in the lower back that result in more severe pain and Lower back feels sore to the touch. In addition to a complete medical history and physical exam, diagnostic procedures for low back pain may include X ray, CT scan and MRI. (AANS, August 2020)

· Sciatica: Low back pain is one of the most frequently faced conditions in clinical practice. Low back pain has high direct and indirect costs and is a common reason for missed work. The sciatica also called radiculopathy, is affected, and caused by something pressing on the sciatic nerve that travels through the buttocks and extends down the back of the leg. People with sciatica may feel shock-like or burning low back pain combined with pain through the buttocks and down one leg. (AHRQ, November 15, 2016),

· Ankylosing spondylitis: Ankylosing spondylitis is a type of arthritis of the spine. It causes inflammation between the vertebrae, which are the bones that make up your spine, and in the joints between the spine and pelvis. In certain individual, it can affect other joints. This condition is common and more severe in men, it often runs in families, the cause is unknown, but it is likely that both genes and factors in the environment play a role. Early symptoms of this condition include back pain and stiffness. (MedlinePlus, December 7, 2020).

Reference

American Association of Neurological Surgeon, August 2020. Low Back Strain and Sprain.

Retrieved from ans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Low-

Back-Strain-and-Sprain#:

AHRQ, November 15, 2016) Noninvasive Treatments for Low Back Pain: Current State of the

Evidence. Retrieved from https://effectivehealthcare.ahrq.gov/products/back-pain-

treatment/clinician

 

Amin, R. M., Andrade, N. S., & Neuman, B. J. (2017). Lumbar Disc Herniation.

Current review in musculoskeletal medicine, 10(4), 507–516.

https://doi.org/10.1007/s12178-017-9441-4

Genevay, S., & Atlas, S. J. (2016). Lumbar spinal stenosis. Best practice & research. Clinical

rheumatology, 24(2), 253–265. https://doi.org/10.1016/j.berh.2009.11.001

MedlinePlus, December 7, 2020. Ankylosing Spondylitis. Retrieved from

https://medlineplus.gov/ankylosingspondylitis.html

Back pain

A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

 

Respond to this

#2

Assessing Musculoskeletal Pain

 

Musculoskeletal pain primarily affects an individual’s quality of life through aspects such as sleep deprivation, fatigue, depression, as well as an activity together with participation restrictions. The set effect is also impacted by contextual facets that are also inclusive of comorbidity, arthritis coping efficiency, as well as access to care (Hawker, 2017). This then implies that musculoskeletal (MSK) pain evaluation necessitates set bio-psychosocial perspectives that encompass pain alongside baseline impacts combined with contextual facets.

 

Nerve roots that may be associated with back pain exhibit a set multifaceted, heterogeneous state whereby both the nociceptive alongside neuropathic pain mechanisms may be entailed. The pain is due to activation of the set nociceptors innervating ligaments, joints, muscles, fascia combined with tendons. This is due to the reaction to tissue injury or even inflammation combined with biomechanical stress. The neuropathic pain originates from injury or even illness that impacts the nerve roots innervating the spine together with the spine as well as the lower limbs, as well as pathological invasive innervation within the damaged lumbar discs (Baron et al., 2016).

 

Physical assessment can be undertaken by centralization (change of pain along the far end of the whole-length body region) of symptoms within physical assessments. (A positive test applied in ruling diagnosis). Physical assessment can also be done on the facet joint per centralization and lack of relief from recumbency. The other test is on the sacroiliac joint through centralization (Peterson et al., 2017). The next test is disc herniation together with root involvement whereby the dermatological distribution that mirrors neurological results, enhances the set specificity of the outcomes. Other tests would include spondylolisthesis, fracture, myofascial pain, peripheral nerve, and central sensitization.

 

Other symptoms that can be explored for the lower back pain include pain exhibiting dullness or is achy in nature within the lower back, stinging combined with burning pain from the lower back to the lower thigh back, muscle spasms combined with tightness within the lower back, prolonged pain while standing, as well as problems when standing straight or even walking (Allegri et al., 2016).

 

A differential diagnosis for acute lower back pain includes tailbone pain as a result of pain alongside the bony structure within the lower spine (Mayo Clinic, 2019). Another differential diagnosis is lumbar compression fracture due to the collapsing of the bony block or even the vertebral structure that causes acute pain, deformity as well as weight loss (Genev et al., 2017). Another differential diagnosis is psoriatic arthritis that depicts a state exhibiting red patches of skin alongside silvery scales that causes pain within joints (Mayo Clinic, 2019).

You are required to include at least two evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 6th edition formatting.

 

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Environmental Factors and Health Promotion Presentation|2025

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You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

The growth, development, and learned behaviors that occur during the first year of infancy have a direct effect on the individual throughout a lifetime. For this assignment, research an environmental factor that poses a threat to the health or safety of infants and develop a health promotion that can be presented to caregivers.

Create a 10-12 slide PowerPoint health promotion, with speaker notes, that outlines a teaching plan. For the presentation of your PowerPoint, use Loom to create a voice over or a video. Include an additional slide for the Loom link at the beginning, and an additional slide for references at the end.

In developing your PowerPoint, take into consideration the health care literacy level of your target audience, as well as the demographic of the caregiver/patient (socioeconomic level, language, culture, and any other relevant characteristic of the caregiver) for which the presentation is tailored.

Include the following in your presentation:

  1. Describe the selected environmental factor. Explain how the environmental factor you selected can potentially affect the health or safety of infants.
  2. Create a health promotion plan that can be presented to caregivers to address the environmental factor and improve the overall health and well-being of infants.
  3. Offer recommendations on accident prevention and safety promotion as they relate to the selected environmental factor and the health or safety of infants.
  4. Offer examples, interventions, and suggestions from evidence-based research. At least three scholarly resources are required. Two of the three resources must be peer-reviewed and no more than 6 years old.
  5. Provide readers with two community resources, a national resource, and a Web-based resource. Include a brief description and contact information for each resource.

Refer to the resource, “Creating Effective PowerPoint Presentations,” located in the Student Success Center, for additional guidance on completing this assignment in the appropriate style.

Refer to the resource, “Loom,” located in the Student Success Center, for additional guidance on recording your presentation.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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 LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

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Conceptual – Theoretical – Empirical (CTE) structure|2025

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Details:

Conceptual models, theories, and empirical indicators are linked and provide a nursing knowledge system to apply the model or theory to nursing practice, research, and education. Advanced-practice nurses are required to understand the linkages as applied to nursing and translate the components into practice.  To continue development of nursing knowledge, advanced practice nurses can create structure to test theory.

General Guidelines:

Use the following information to ensure successful completion of the assignment:

  • This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
  • Doctoral learners are required to use APA style for their writing assignments. The APA Style Guide is located in the Student Success Center.
  • This assignment requires that at least two additional scholarly research sources related to this topic, and at least one in-text citation from each source be included.
  • You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Directions:

Write a 1,000-1,250 word paper examining how the Conceptual – Theoretical – Empirical (CTE) structure translates into nursing practice based on one of the middle range theories that has been formulated or derived from your preferred conceptual model of nursing. Translate and apply the selected theory to nursing practice using actual examples. Evaluate the theory using the CTE steps below:

  1. Evaluation of the conceptual-theoretical-empirical linkages.
  2. Evaluation of the selected theory.
  3. Evaluation of the empirical indicators.
  4. Evaluation of research findings.
  5. Evaluation of the utility and soundness of the practice theory.

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Capstone Project Change Proposal|2025

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Benchmark – Capstone Project Change Proposal

 

In this assignment, students will pull together the change proposal   project components they have been working on throughout the course to   create a proposal inclusive of sections for each content focus area in   the course. At the conclusion of this project, the student will be   able to apply evidence-based research steps and processes required as   the foundation to address a clinically oriented problem or issue in   future practice.

Students will develop a 1,250-1,500 word paper that includes the   following information as it applies to the problem, issue, suggestion,   initiative, or educational need profiled in the capstone change proposal:

  1. Background
  2. Problem statement
  3. Purpose of the     change proposal
  4. PICOT
  5. Literature search strategy   employed
  6. Evaluation of the literature
  7. Applicable     change or nursing theory utilized
  8. Proposed implementation     plan with outcome measures
  9. Identification of potential     barriers to plan implementation, and a discussion of how these could     be overcome
  10. Appendix section, if tables, graphs, surveys,     educational materials, etc. are created

Review the feedback from your instructor on the Topic 3 assignment,   PICOT Statement Paper, and Topic 6 assignment, Literature Review. Use   the feedback to make appropriate revisions to the portfolio components   before submitting.

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 LopesWrite. Please refer   to the directions in the Student Success Center.

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Advocating for the Nursing Role in Program Design and Implementation|2025

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As their names imply, the honeyguide bird and the honey badger both share an affinity for honey. Honeyguide birds specialize in finding beehives but struggle to access the honey within. Honey badgers are well-equipped to raid beehives but cannot always find them. However, these two honey-loving species have learned to collaborate on an effective means to meet their objectives. The honeyguide bird guides honey badgers to newly discovered hives. Once the honey badger has ransacked the hive, the honey guide bird safely enters to enjoy the leftover honey.

Much like honeyguide birds and honey badgers, nurses and health professionals from other specialty areas can—and should—collaborate to design effective programs. Nurses bring specialties to the table that make them natural partners to professionals with different specialties. When nurses take the requisite leadership in becoming involved throughout the healthcare system, these partnerships can better design and deliver highly effective programs that meet objectives.

In this Assignment, you will practice this type of leadership by advocating for a healthcare program. Equally as important, you will advocate for a collaborative role of the nurse in the design and implementation of this program. To do this, assume you are preparing to be interviewed by a professional organization/publication regarding your thoughts on the role of the nurse in the design and implementation of new healthcare programs.

To Prepare:

  • Review the Resources and reflect on your thinking regarding the role of the nurse in the design and implementation of new healthcare programs.
  • Select a healthcare program within your practice and consider the design and implementation of this program.
  • Reflect on advocacy efforts and the role of the nurse in relation to healthcare program design and implementation.
  • Review the User Guide for Uploading Media in your Blackboard Classroom by accessing the Kaltura Media Uploader on the Left Navigation Bar in preparation to record your narrated video or audio for this Assignment.

The Assignment: (2–3 pages)

In a 2- to 3-page paper, create an interview transcript of your responses to the following interview questions:

  • Tell us about a healthcare program, within your practice. What are the costs and projected outcomes of this program?
  • Who is your target population?
  • What is the role of the nurse in providing input for the design of this healthcare program? Can you provide examples?
  • What is your role as an advocate for your target population for this healthcare program? Do you have input into design decisions? How else do you impact design?
  • What is the role of the nurse in healthcare program implementation? How does this role vary between design and implementation of healthcare programs? Can you provide examples?
  • Who are the members of a healthcare team that you believe are most needed to implement a program? Can you explain why?

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