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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Lifestyle Changes for Weight Loss|2025

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Case Study 9-2: Lifestyle Changes for Weight Loss

 

 

 

Sally is a 43-year-old mother of two who has gained 50 pounds over the past five years. She is 64 inches tall and weighs 180 pounds with a BMI of 30.8. Her waist circumference is 37 inches. She acknowledges that she is not as physically active as she would like to be. She also notes how recent stresses in her life have affected her sleep and seem to have triggered her appetite for sweets. Sally’s father recently died from complications of type 2 diabetes and her mother and sisters are overweight. Sally says she is very motivated to “not get diabetes” and is disturbed that her recent physical exam revealed mildly elevated blood pressure, glucose, and cholesterol levels.

 

1.   How does Sally’s family history influence her weight and risk for diabetes? What lifestyle choices may influence her genetic predisposition to be overweight?

 

2.   Using information in this chapter, what is a reasonable goal weight for Sally? How long would you estimate it would take her to safely lose this amount of weight?

 

3.   What weight-loss strategies may help curb Sally’s stress-related eating?

 

4.   Sally has determined that—to lose weight—she needs to limit her daily caloric intake to 1400 kcalories. Use Table 9-2 and show a one-day plan for meals and snacks that meet her nutritional needs within this calorie level.

 

5.   What are some advantages to Sally keeping a food and exercise record? What other factors besides food intake and physical activity may be useful for Sally to record?

 

6.   Why might strength training be an important addition to Sally’s exercise regimen?

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Discussion on Priority Actions to Take When Floating|2025

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Participation Requirement: You are required to post a minimum of three (3) times in each discussion. These three (3) posts must be on a minimum of two (2) separate days. You must respond to the initial discussion question by 11:59 p.m. on Wednesday.  On additional days, respond to your peers’ posts as well as additional faculty posts. Responses to peers must be posted by 11:59 p.m. on Sunday each week a discussion is due.

Step 1: Read the following articles

American Nurse Association. The American nurse. On less familiar ground. Strategies aim to reduce random floating, improve the experience. August 31, 2017. (Attached to discussion)  (Links to an external site.)

Brown T. Nurses are talking about: floating and rapid response duty. Medscape Sunday September 17, 2017. http://blog.diversitynursing.com/blog/nurses-are-talking-about-floating-and-rapid-response-duty (Links to an external site.)

Davies K. Advance healthcare networks for nurses. Float assignments. Nursing advisor. http://nurseadvisormagazine.com/nurse-advisor/in-the-breakroom/float-nursing-to-reduce-healthcare-costs/ (Links to an external site.)

Nurse.com. Do registered nurses have to float to areas where they have not been trained or feel comfortable working? Is this legal? December 11, 2013. https://www.nurse.com/blog/2013/12/11/do-rns-have-to-float-to-units-where-they-have-not-been-trained-or-feel-comfortable-working-is-this-legal/ (Links to an external site.)

O’Connor K, Dugan LJ. Addressing floating and patient safety. RN Nursing February 2017-Vol 47-Issue2-page 57-58 doi:10.1097/01. NURSE.0000511820.95903-78. https://journals.lww.com/nursing/Fulltext/2017/02000/Addressing_floating_and_patient_safety.15.aspx#:~:text=%20Addressing%20floating%20and%20patient%20safety%20%201,nurses%20may%20perceive%20floating%20negatively%2C%20it%27s…%20More%20 (Links to an external site.)

RN responsibility when floating to new patient care unit or assigned to new population. https://www.rn.ca.gov/pdfs/regulations/npr-b-21.pdf (Links to an external site.)

Priority Actions to take when Floating

Floating is defined as “the reassignment of staff from one nursing unit to another based upon the patient census and acuities”. Floating is difficult and has always been a problem for nurses but safe patient care is always the goal. Floating is a reality that often cannot be avoided, particularly in the hospital setting. Floating may cause anxiety, stress, overwhelming, scary, draining, dissatisfaction, disruptive, and feeling of frustration even to a very experienced and skillful nurse to be pulled to work on a unit outside her/ his comfort zone. This might be caused by discomfort from unfamiliarity related to diverse patient population, staff, unit, and the processes to a work on a different department. Working in unfamiliar area makes nurses uneasy by not knowing what to expect. Yes, they know how to take care of the patients but without proper orientation to the unit/ area one will be floating is not easy. Whenever staff members are sent to float to an unfamiliar unit, it is expected that at least they will be able to perform the basic assessment and skills.

What Should the Registered Nurse Do When She/He Has to Float?

Before accepting patient assignment when floating to a different unit…

  1. Make sure you have the necessary knowledge, judgement, skills, and ability to provide the required patient care. The nurse should not accept any patient care assignment he/ she is not competent to deliver the care but instead accept limited assignment of nursing care duties you can utilize your current competence.
  2. Remember that the department you are floating will be glad to have you to help them decrease their patient work load. You will be responsible for your own actions and will be the one to face disciplinary action by a State Board of Nursing if you are not competent to perform the assignment delegated to you.
  3. Talk to the Charge Nurse of the unit you are floating if you refuse the assignment being given to you and discuss the reason of your refusal. Let him/ her know that you are there to help but they should give you patient assignments that you are competent and comfortable to handle. The Charge Nurse of your permanent unit may be able to help you as well in talking to the unit you are floating If they insist for you to take the assignment. You may seek the help of the Nursing Supervisor. You can write an incident report to cover yourself.

According to American Nurses Association (ANA), “Registered Nurses must have the professional right to accept, reject, or object in writing to any assignment that puts patients or themselves at serious risk for harm.” The Joint Commission on floating clearly states that when an employee is asked to float to a different unit, that unit must be similar to his or her own and that the nurse must demonstrate competencies specific to that unit. Furthermore, the assigned employees should be floated to areas of comparable clinical diagnoses and acuities.

Initial Discussion Assignment:

You are a nurse on a medical-surgical unit that is currently well staffed with each nurse at a 3:1 ratio. There were two call outs in the oncology unit and it is your turn to float. The charge nurse informs you that you are being floated to the oncology unit and that you have been assigned to care for four patients.

Your discussion posting must address all of the following issues:

  1. Summarize the concepts of floating that were addressed in the attached articles.
  2. What steps would you take in this scenario to ensure a safe transition into the unfamiliar unit?
  3. Why are these steps important?
  4. What are some of the legal ramifications that can occur if you accept an assigned that is out of your scope of practice?

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concept map patient scenario|2025

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Patient Case #4

 

Patient: Vernon Russell

Diagnosis: Right-sided stroke (mild left hemiplegia)

Brief Summary :

Vernon Russell is a 55-year-old Native American male who was admitted with a stroke with mild left hemiplegia yesterday. The patient is nothing by mouth except medications. Chest-x-ray confirmed possible aspiration pneumonia on the right side.

Medications:

· Losartan 50 mg PO BID

· Aspirin 81 mg PO daily

· Metformin 500 mg PO BID

· Chlorthalidone 25 mg PO daily

Orders:

· Vital signs and neuro checks every 4 hours

· Activity: Up to chair, up to the bathroom with assistance

· Nothing by mouth except medications until swallow study completed tomorrow

· Speech therapist swallow study

· Fall risk assessment

· Labs: CBC, chemistry panel, and prothrombin time

· Bedside blood glucose twice a day

SBAR Report :

S: Mr. Russell is a 55-year-old Native American male who was admitted with a stroke with mild left hemiplegia yesterday afternoon. He had a head CT and received thrombolytic therapy in the ED. He is nothing by mouth except for medications until the speech therapist has completed a video swallow study, which is scheduled for later this morning. He is scheduled for physical therapy later today.

B: Mr. Russell has a history of hypertension, coronary artery disease, and diabetes mellitus type 2. He has smoked over a pack of cigarettes per day for the past 35 years and does not exercise.

A: We have already checked his blood glucose level this morning. His vital signs have been stable and he slept well last night. He was able to get up to go to the bathroom with the use of a walker. His neurological checks are stable and he continues to have mild left hemiplegia. His hand grasps are almost equal but a little weaker on the left side. His pupils are equal and react to light. Swallow reflex is intact but impaired. He is oriented x2. Patient is slow to respond and noted to have some periods of slurred or delayed speech. I have already done a Morse Fall Risk assessment with a total high risk score of 60. Fall precautions implemented. Upon bedside RN swallow evaluation, the patient was noted to have frequent coughing when given a small sip of water. Chest x-ray done in the ED reveals that the patient has right-sided pneumonia, possibly due to aspiration.

R: You should do a vital signs assessment, perform a neurological assessment, and talk about safety with Mr. Russell. His morning medications are up and should be administered with caution. Maintain NPO status until video swallow performed. Patient was able to stand on side of bed with physical therapist, but weakness noted. Patient unable to take steps. Continue fall and aspiration precautions.

 

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WORK WITH DIVERSE PEOPLE ASSESSMENT|2025

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ASSESSMENT INFORMATION for students

Throughout your training we are committed to your learning by providing a training and assessment framework that ensures the knowledge gained through training is translated into practical on the job improvements.

You are going to be assessed for:

Your skills and knowledge using written and observation activities that apply to your workplace.

Your ability to apply your learning.

Your ability to recognise common principles and actively use these on the job.

All of your assessment and training is provided as a positive learning tool. Your assessor will guide your learning and provide feedback on your responses to the assessment materials until you have been deemed competent in this unit.

How you will be assessed

The process we follow is known as competency-based assessment. This means that evidence of your current skills and knowledge will be measured against national standards of best practice, not against the learning you have undertaken either recently or in the past. Some of the assessment will be concerned with how you apply your skills and knowledge in your workplace, and some in the training room as required by each unit.

The assessment tasks have been designed to enable you to demonstrate the required skills and knowledge and produce the critical evidence to successfully demonstrate competency at the required standard.

Your assessor will ensure that you are ready for assessment and will explain the assessment process. Your assessment tasks will outline the evidence to be collected and how it will be collected, for example; a written activity, case study, or demonstration and observation.

The assessor will also have determined if you have any special needs to be considered during assessment. Changes can be made to the way assessment is undertaken to account for special needs and this is called making Reasonable Adjustment.

 

 

What happens if your result is ‘Not Yet Competent’ for one or more assessment tasks?

Our assessment process is designed to answer the question “has the desired learning outcome been achieved yet?” If the answer is “Not yet”, then we work with you to see how we can get there.

In the case that one or more of your assessments has been marked ‘NYC’, your trainer will provide you with the necessary feedback and guidance, in order for you to resubmit your responses.

 

What if you disagree on the assessment outcome?

You can appeal against a decision made in regards to your assessment. An appeal should only be made if you have been assessed as ‘Not Yet Competent’ against a specific unit and you feel you have sufficient grounds to believe that you are entitled to be assessed as competent. You must be able to adequately demonstrate that you have the skills and experience to be able to meet the requirements of units you are appealing the assessment of.

Your trainer will outline the appeals process, which is available to the student. You can request a form to make an appeal and submit it to your trainer, the course coordinator, or the administration officer. The RTO will examine the appeal and you will be advised of the outcome within 14 days. Any additional information you wish to provide may be attached to the appeal form.

 

What if I believe I am already competent before training?

If you believe you already have the knowledge and skills to be able to demonstrate competence in this unit, speak with your trainer, as you may be able to apply for Recognition of Prior Learning (RPL).

 

Assessor Responsibilities

Assessors need to be aware of their responsibilities and carry them out appropriately. To do this they need to:

Ensure that participants are assessed fairly based on the outcome of the language, literacy and numeracy review completed at enrolment.

Ensure that all documentation is signed by the student, trainer, workplace supervisor and assessor when units and certificates are complete, to ensure that there is no follow-up required from an administration perspective.

Ensure that their own qualifications are current.

When required, request the manager or supervisor to determine that the student is ‘satisfactorily’ demonstrating the requirements for each unit. ‘Satisfactorily’ means consistently meeting the standard expected from an experienced operator.

When required, ensure supervisors and students sign off on third party assessment forms or third party report.

Follow the recommendations from moderation and validation meetings.

How should I format my assessments?

Your assessments should be typed in a 11 or 12 size font for ease of reading. You must include a footer on each page with the student name, unit code and date. Your assessment needs to be submitted as a hardcopy or electronic copy as requested by your trainer.

How long should my answers be?

The length of your answers will be guided by the description in each assessment, for example:

Type of Answer Answer Guidelines

 
Short Answer 4 typed lines = 50 words, or

5 lines of handwritten text
Long Answer 8 typed lines = 100 words, or

10 lines of handwritten text = of a foolscap page
Brief Report 500 words = 1 page typed report, or

50 lines of handwritten text = 1foolscap handwritten pages
Mid Report 1,000 words = 2 page typed report

100 lines of handwritten text = 3 foolscap handwritten pages
Long Report 2,000 words = 4 page typed report

200 lines of handwritten text = 6 foolscap handwritten pages

 

How should I reference the sources of information I use in my assessments?

Include a reference list at the end of your work on a separate page. You should reference the sources you have used in your assessments in the Harvard Style. For example:

Website Name – Page or Document Name, Retrieved insert the date. Webpage link.

For a book: Author surname, author initial Year of publication, Title of book, Publisher, City, State

assessment guide

The following table shows you how to achieve a satisfactory result against the criteria for each type of assessment task.

Assessment Method Satisfactory Result Non-Satisfactory Result
You will receive an overall result of Competent or Not Yet Competent for the unit. The assessment process is made up of a number of assessment methods. You are required to achieve a satisfactory result in each of these to be deemed competent overall. Your assessment may include the following assessment types.
Questions All questions answered correctly Incorrect answers for one or more questions
  Answers address the question in full; referring to appropriate sources from your workbook and/or workplace Answers do not address the question in full. Does not refer to appropriate or correct sources.
Third Party Report Supervisor or manager observes work performance and confirms that you consistently meet the standards expected from an experienced operator Could not demonstrate consistency. Could not demonstrate the ability to achieve the required standard
Written Activity The assessor will mark the activity against the detailed guidelines/instructions Does not follow guidelines/instructions
  Attachments if requested are attached Requested supplementary items are not attached
  All requirements of the written activity are addressed/covered. Response does not address the requirements in full; is missing a response for one or more areas.
  Responses must refer to appropriate sources from your workbook and/or workplace One or more of the requirements are answered incorrectly.

Does not refer to or utilise appropriate or correct sources of information
Observation All elements, criteria, knowledge and performance evidence and critical aspects of evidence, are demonstrated at the appropriate AQF level Could not demonstrate elements, criteria, knowledge and performance evidence and/or critical aspects of evidence, at the appropriate AQF level
Case Study All comprehension questions answered correctly; demonstrating an application of knowledge of the topic case study. Lack of demonstrated comprehension of the underpinning knowledge (remove) required to complete the case study questions correctly. One or more questions are answered incorrectly.
  Answers address the question in full; referring to appropriate sources from your workbook and/or workplace Answers do not address the question in full; do not refer to appropriate sources.

 

Assessment Cover Sheet
Student’s name:  
Assessors Name:   Date:
Is the Student ready for assessment? Yes No
Has the assessment process been explained? Yes No
Does the Student understand which evidence is to be collected and how? Yes No
Have the Student’s rights and the appeal system been fully explained? Yes No
Have you discussed any special needs to be considered during assessment? Yes No
The following documents must be completed and attached
Written Activity Checklist

The student will complete the written activity provided to them by the assessor.

The Written Activity Checklist will be completed by the assessor.

 S NYS
Observation / Demonstration

The student will demonstrate a range of skills and the assessor will observe where appropriate to the unit.

The Observation Checklist will be completed by the assessor.

 S NYS
Questioning Checklist

The student will answer a range of questions either verbally or written.

The Questioning Checklist will be completed by the assessor.

 S NYS
I agree to undertake assessment in the knowledge that information gathered will only be used for professional development purposes and can only be accessed by the RTO:
Overall Outcome Competent Not yet Competent
Student Signature: Date:
Assessor Signature: Date:

Assessment cover sheet

 

written activity

For this assessment, you will need to perform the following tasks. These tasks will need to be completed and submitted in a professional, word processed, format. Each task must be 500 words minimum in length.

1. Reflect on your own perspectives. The following questions are used as a guide to the answer:

a. What are your social and cultural perspectives and biases? Why?

b. Have you identified any limitations in self and social awareness?

c. Identify and plan for ways to improve your own self and social awareness.

 

 

2. How do you appreciate diversity and inclusiveness, and their benefits within your work? Use the following questions as a guide to your answer:

a. How do you value and respect diversity and inclusiveness across all areas of your work?

b. How do you contribute to the development of work place and professional relationships based on appreciation of diversity and inclusiveness?

c. What work practices do you use that make environments safe for all?

 

 

If you do not currently work, discuss how you would appreciate the benefits of diversity and inclusiveness in your ideal role.

3. How do you communicate with people from diverse backgrounds and situations? The following questions are used as a guide to the answer:

a. How do you show respect for diversity in communication with all people?

b. What are the verbal and non-verbal communication methods you use to establish, develop and maintain effective relationships, mutual trust and confidence?

c. What are the strategies you employ when a language barrier exists?

d. How would you seek assistance from interpreters or other persons?

 

 

4. How do you promote understanding across diverse groups? The following questions are used as a guide to the answer:

a. Identify issues that may cause communication misunderstandings or other difficulties.

b. Discuss the impact of social and cultural diversity where difficulties or misunderstandings occur.

c. Discuss how you could make an effort to sensitively resolve differences, taking account of diversity considerations.

 

 

5. Think about a time you have worked with diverse people. Outline the situation; what was the scenario, how many people were involved etc. Was the experience a positive or a negative experience? If it was positive, discuss why; how was everyone included? If the experience was negative, discuss why, and discuss some strategies that could have been employed to help include everyone.

 

 

6. How cultural awareness, cultural safety and cultural competence impact different work roles?

 

 

7. What is the definition of diversity? Please give a detailed definition.

 

 

8. How do different cultures and the community attitudes impact on different people and groups?

 

 

9. Discuss 4 features of diversity in Australia and how they impact on different areas of work and life?

 

 

10. How does anti-discrimination legislation impact the way you would work and what are the consequences of breaching this legislation?

 

 

11. What are human rights? Discuss this in relation to the universal declaration of human rights and your workplace or community sector.

 

 

12. What rights and responsibilities do you and your clients have if your human rights are being infringed?

 

 

13. Briefly discuss each of the key areas of diversity and their characteristics, including:

a. Culture, race, ethnicity

b. Disability

c. Religious or spiritual beliefs

d. Gender, including transgender/intersex/Gay/Lesbian etc.

e. Generational

 

 

14. What are the potential needs of marginalised groups, including:

a. The protective factors

b. The physical, mental and emotional health issues/care needs?

 

 

15. How do discrimination, trauma, exclusion and negative attitudes impact on people?

 

 

16. How can an organisation be supported to respond to diversity?

 

 

17. What are the influences and changing practices in Australia that impact on the diverse communities that make up Australian society?

 

 

18. What social, political and economic issues affect Aboriginal and/or Torres Strait Islander people?

 

 

19. What western systems and structures impact Aboriginal and/or Torres Strait Islander people and their engagement with services?

 

 

20. What is the impact of diversity practices and experience on others?

 

 

21. What is the relationship between human needs and human rights?

 

 

written/verbal QUESTIONS

The following questions may be answered verbally with your assessor or you may write down your answers. Please discuss this with your assessor before you commence. Short Answers are required which is approximately 4 typed lines = 50 words, or 5 lines of handwritten text.

Your assessor will take down dot points as a minimum if you choose to answer them verbally.

Answer the following questions either verbally with your assessor or in writing.

 

1. Your assessor will take down dot points as a minimum if you choose to answer them verbally.

 

 

2. Answer the following questions either verbally with your assessor or in writing.

 

 

3. What is discrimination?

 

 

4. Discuss three things that an organisation’s commitment to creating a working environment that values the diversity of people will include.

 

 

5. Discuss the Steps for Becoming Culturally Competent.

 

 

6. List four tips for responding to diversity in the workplace.

 

 

7. What are the key valuing diversity behaviours? List four

 

 

8. What are the four Commonwealth Acts which cover discrimination in the workplace?

 

 

9. What is discrimination in language, and how can you avoid it at work?

 

 

10. What is nonverbal communication and body language?

 

 

11. List four ways to help overcome communication difficulties across cultural and linguistic bonds.

 

 

12. In what situations might you use a professional interpreter?

 

 

13. List four of the issues that may cause conflict in a culturally diverse environment.

 

 

14. What steps should you take to respond to cross-cultural conflict in your workplace?

 

 

15. Discuss the process for communicating with a complaining client.

 

 

 

Developed by Enhance Your Future Pty Ltd 11 CHCDIV001 Work with diverse people Version 2 Course code and name

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