Home>Homework Answsers>Nursing homework helpNURSEapa format and at least 3 scholars references. Picka year ago26.06.202416Report issuefiles (2)NRNP6552Week5Casestudytemplate.docxNRNP6552week5cases.pdfNRNP6552Week5Casestudytemplate.docxCase # (1, 2, 3 or 4) and Description of the Case Chosen:·Case 1: Diana·Case 2: Barbara·Case 3: Vivian·Case 4: StephanieOutline Subjective data.Identify data provided in your chosen case and any additional data needed.OutlineObjective findings.Identify findings provided in your chosen case and any additional data needed.Identify diagnostic tests, procedures, laboratory work indicated.Describe the rationale for each test or intervention with supporting references.Distinguish at least three differential diagnoses.Describe the rationales for your choice of each diagnosis with supporting references.Identify appropriate medications, treatments or other interventions associated with each differential diagnosis.Describe rationales and supporting references for each.Explain keySocial Determinants of Heath (SDoH) for your chosen case.Describe collaborative care referrals and patient education needs for your chosen case.Describe rationales and supporting references for each.NRNP6552week5cases.pdfCase #1. Diana.History of Present Illness (HPI): Diana is a 48-year-old Hispanic G4P1031. She presents to your office asa new patient for GYN visit. Her last visit to a gynecologist was 12 years ago after the birth of herdaughter. Her periods come at variable intervals, sometimes every three months, other times twice in amonth. Flow varies from minimal spotting to heavy bleeding requiring pad changes every hour. Shereports dysmenorrhea with her periods that is relieved with ibuprofen. She reports a 30-pound weightgain over the past 10 years.Prior medical history: Gallstones. Prior surgical history: Lap cholecystectomy (2008)Current medications: None. Allergies: NoneOB- GYN History: Surgical TOP x 3. C-section x 1 at full term for arrest of descent. Menarche age 13,cycle length- 5 days- frequency every 28 days- 4-5 tampons per day, until recently. No history of sexuallytransmitted infections (STDs). No history of abnormal pap smears. Last pap was 12 years ago, reportednormal. HIV negative.LMP: 2 weeks ago – heavy with clots and lasted 10 days. Contraception history: None.Social history: Lives with husband and daughter. Stay at home mom. Denies ETOH or recreational druguse, never smoker. Her family speaks Spanish at home; she is fluent in English.Family history: Mother s/p hysterectomy for fibroids, sister with diabetes mellitus.Review of Systems (ROS): Negative except as noted in HPI.Physical Exam (PE)VS: BP: 155/80, P: 99, RR: 18, T: 98.4, Weight: 206 lbs., Height 66 in, BMI 33.2 kg/m2• General: NAD, well-appearing, obesity in female• Abd: Soft, NT/ND, no masses/HSM• GU: No lesions; normal vaginal mucosa; no CMT; no uterine/adnexal tenderness; uterus 8-weeksize; no adnexal masses• Ext: Good CMS, 1+ edema b/lCase #2. Barbara.History of Present Illness (HPI): Barbara is a 73-year-old Caucasian G2P2002. She is a retiredschoolteacher, lives alone. She complains of 2-year history of ten episodes of daytime frequency withsmall frequent voids, a constant desire to urinate, and nocturia x 3 every night, resulting in poor sleep.More recently, symptoms have worsened and now include a sudden urge to void and occasional urinaryincontinence with structured physical activity. She changes pads three times a day and complains ofsuperficial dyspareunia. She denies OAB meds or hormone replacement therapy in the past. Shecomplains of mild constipation and has had three lower urinary tract infections (UTIs) in the last 12months.Prior medical history: HTN, UTI. Prior surgical history: Appendectomy (1998)Current medications: Cardura 2mg daily, furosemide 20mg daily. Allergies: PenicillinOB- GYN History: Forceps-assisted VD x 2. Menarche age 14, normal throughout life. No history ofsexually transmitted infections (STDs). Last pap smear age 67 years, normal.LMP: Approximately 25 years ago. Contraception history: None.Social history: Lives alone. Retired schoolteacher. ETOH: 1-2 glasses red wine nightly. No recreationaldrug use. Never smoked. Plays bingo 3 times weekly and participates in structured physical activity(pickle ball and Pilates) 3-4 times weekly.Family history: Mother (deceased age 79)- CVA. Father (deceased age 72) – MI/ASHDReview of Systems (ROS): As noted in HPI.Physical Exam (PE)VS: BP: 133/68, P: 68, RR: 16, T: 97.3, Weight 134lbs, Height 64 inches, BMI 23 kg/m2On physical exam, marked urogenital atrophy is noted, no ulcerations noted. Positive urine leakage whenasked to cough. There is uterine descent into vagina up to the introitus, bladder is noted just at theopening of the vagina, and rectum noted halfway to hymen.Case #3. Vivian.History of Present Illness (HPI): Vivian is an 88-year-old Caucasian female brought into the office by hercaregiver. Complains of dark, cloudy, foul-smelling urine, with new confusion and night-timehallucinations. The caregiver reports a history of disturbed night sleep, with hallucinations of spiderscrawling in bed, followed by agitation, lethargy, and poor oral intake the next morning. Other symptomsinclude increased urinary frequency, dysuria, mild fever, and lower abdominal pain. The caregiver alsoreports that Vivian had been treated for suspected UTI twice in the last 12 months.Prior medical history: HTN, CKD stage 2, diverticular disease, vesicovaginal fistula (newly diagnosed),previous indwelling urinary catheter, osteoporosis, left femur fracture s/p fall.Prior surgical history: Left Total Hip Replacement (2012).Current medications: Olmesartan 20mg daily, Alendronate 70mg weekly, Vitamin D3 5,000 IU daily.Allergies: NoneSocial history: Never smoked or drank alcohol. Lives alone with 24-hour caregiver after husband died 3years ago and she had a fall that resulted in femur fracture.Family history: Mother deceased (age 74)- breast cancer. Father deceased (age 70)- CVA.Review of Systems (ROS): As noted in HPI.Physical Exam (PE)VS: BP: 110/70, P: 109, RR: 17, T: 98.9, Weight: 132 lbs., Height 65 inches, BMI 22 kg/m2• General: Restless, oriented to person and place• Cardio: S1 and S2 heart sounds in regular rhythm with no murmurs or extra sounds.• Resp: Lungs CTA, no wheezing or rhonchi. Nonlabored breathing• Abd: Soft, NT/ND, no masses/HSM, no suprapubic tenderness• GU: No CVA tenderness, urine dip in office revealed pH 6.0, 3+ leukocytes, positive nitrites• Ext: Good CMS, no peripheral edemaCase #4. Stephanie.History of Present Illness (HPI): Stephanie is a 15-year-old female G0 who presents to the office with hermother. She c/o heavy bleeding during her periods, anxiety, and mood swings, which had been occurringfor the past 4 months. Her symptoms usually occur a few days before the onset of her menses andimprove by day 3. She uses 2 pads every 1-2 hours and sometimes needs to double up on the pads. Shealso c/o severe bloating, pelvic pain, and back pain during her periods. She has missed numerous days ofschool due to her symptoms, and lacks interest in usual daily activities, staying in bed all day. Around 2months ago, she was seen by an adolescent psychiatrist and was diagnosed with major depression andstarted on sertraline 50mg once daily. She has refused to take the medication because she rejects thediagnosis of depression. She states that she knows she is not depressed and is angry that nobodybelieves her.Prior medical history: Questionable depression. Prior surgical history: NoneCurrent medications: None. Allergies: Sulfa.OB- GYN History: Menarche age 12, cycle length was 5-7 days- frequency every 28 days- 3 pads per day,until the past 4 months.LMP: 1 week ago. Contraception history: NoneSocial history: Lives with her parents. She is an only child. Denies EtOH, smoking, or recreational druguse. Sexually active once (vaginal) – 1 year ago with same partner- none since. Participates in sports:basketballFamily history: Mother alive and well, Father with diabetesReview of Systems (ROS): Unremarkable with exception of as noted in HPI.Physical Exam (PE)VS: BP: 122/74, P: 64, RR: 16, T: 97.8 Weight: 146 lbs., Height: 63 inches, BMI 26.2General Examination: Well developed, well nourished, in no acute distress.Psych: alert and oriented, cooperative with exam, appears frustrated.Abdomen: Soft, NTND, no massesGynecological: EXTERNAL EXAM: normal, appropriate hair distribution, no erythema, no skindiscoloration, no lesions. SPECULUM/INTERNAL EXAM: Cervix: normal appearance, no lesions, nobleeding/discharge, no cervical movement tenderness, nulliparous. UTERUS: normal size, shape, andconsistency, normal mobility, nontender. ADNEXA: no masses or tenderness bilaterally.NRNP6552week5cases.pdfCase #1. Diana.History of Present Illness (HPI): Diana is a 48-year-old Hispanic G4P1031. She presents to your office asa new patient for GYN visit. Her last visit to a gynecologist was 12 years ago after the birth of herdaughter. Her periods come at variable intervals, sometimes every three months, other times twice in amonth. Flow varies from minimal spotting to heavy bleeding requiring pad changes every hour. Shereports dysmenorrhea with her periods that is relieved with ibuprofen. She reports a 30-pound weightgain over the past 10 years.Prior medical history: Gallstones. Prior surgical history: Lap cholecystectomy (2008)Current medications: None. Allergies: NoneOB- GYN History: Surgical TOP x 3. C-section x 1 at full term for arrest of descent. Menarche age 13,cycle length- 5 days- frequency every 28 days- 4-5 tampons per day, until recently. No history of sexuallytransmitted infections (STDs). No history of abnormal pap smears. Last pap was 12 years ago, reportednormal. HIV negative.LMP: 2 weeks ago – heavy with clots and lasted 10 days. Contraception history: None.Social history: Lives with husband and daughter. Stay at home mom. Denies ETOH or recreational druguse, never smoker. Her family speaks Spanish at home; she is fluent in English.Family history: Mother s/p hysterectomy for fibroids, sister with diabetes mellitus.Review of Systems (ROS): Negative except as noted in HPI.Physical Exam (PE)VS: BP: 155/80, P: 99, RR: 18, T: 98.4, Weight: 206 lbs., Height 66 in, BMI 33.2 kg/m2• General: NAD, well-appearing, obesity in female• Abd: Soft, NT/ND, no masses/HSM• GU: No lesions; normal vaginal mucosa; no CMT; no uterine/adnexal tenderness; uterus 8-weeksize; no adnexal masses• Ext: Good CMS, 1+ edema b/lCase #2. Barbara.History of Present Illness (HPI): Barbara is a 73-year-old Caucasian G2P2002. She is a retiredschoolteacher, lives alone. She complains of 2-year history of ten episodes of daytime frequency withsmall frequent voids, a constant desire to urinate, and nocturia x 3 every night, resulting in poor sleep.More recently, symptoms have worsened and now include a sudden urge to void and occasional urinaryincontinence with structured physical activity. She changes pads three times a day and complains ofsuperficial dyspareunia. She denies OAB meds or hormone replacement therapy in the past. Shecomplains of mild constipation and has had three lower urinary tract infections (UTIs) in the last 12months.Prior medical history: HTN, UTI. Prior surgical history: Appendectomy (1998)Current medications: Cardura 2mg daily, furosemide 20mg daily. Allergies: PenicillinOB- GYN History: Forceps-assisted VD x 2. Menarche age 14, normal throughout life. No history ofsexually transmitted infections (STDs). Last pap smear age 67 years, normal.LMP: Approximately 25 years ago. Contraception history: None.Social history: Lives alone. Retired schoolteacher. ETOH: 1-2 glasses red wine nightly. No recreationaldrug use. Never smoked. Plays bingo 3 times weekly and participates in structured physical activity(pickle ball and Pilates) 3-4 times weekly.Family history: Mother (deceased age 79)- CVA. Father (deceased age 72) – MI/ASHDReview of Systems (ROS): As noted in HPI.Physical Exam (PE)VS: BP: 133/68, P: 68, RR: 16, T: 97.3, Weight 134lbs, Height 64 inches, BMI 23 kg/m2On physical exam, marked urogenital atrophy is noted, no ulcerations noted. Positive urine leakage whenasked to cough. There is uterine descent into vagina up to the introitus, bladder is noted just at theopening of the vagina, and rectum noted halfway to hymen.Case #3. Vivian.History of Present Illness (HPI): Vivian is an 88-year-old Caucasian female brought into the office by hercaregiver. Complains of dark, cloudy, foul-smelling urine, with new confusion and night-timehallucinations. The caregiver reports a history of disturbed night sleep, with hallucinations of spiderscrawling in bed, followed by agitation, lethargy, and poor oral intake the next morning. Other symptomsinclude increased urinary frequency, dysuria, mild fever, and lower abdominal pain. The caregiver alsoreports that Vivian had been treated for suspected UTI twice in the last 12 months.Prior medical history: HTN, CKD stage 2, diverticular disease, vesicovaginal fistula (newly diagnosed),previous indwelling urinary catheter, osteoporosis, left femur fracture s/p fall.Prior surgical history: Left Total Hip Replacement (2012).Current medications: Olmesartan 20mg daily, Alendronate 70mg weekly, Vitamin D3 5,000 IU daily.Allergies: NoneSocial history: Never smoked or drank alcohol. Lives alone with 24-hour caregiver after husband died 3years ago and she had a fall that resulted in femur fracture.Family history: Mother deceased (age 74)- breast cancer. Father deceased (age 70)- CVA.Review of Systems (ROS): As noted in HPI.Physical Exam (PE)VS: BP: 110/70, P: 109, RR: 17, T: 98.9, Weight: 132 lbs., Height 65 inches, BMI 22 kg/m2• General: Restless, oriented to person and place• Cardio: S1 and S2 heart sounds in regular rhythm with no murmurs or extra sounds.• Resp: Lungs CTA, no wheezing or rhonchi. Nonlabored breathing• Abd: Soft, NT/ND, no masses/HSM, no suprapubic tenderness• GU: No CVA tenderness, urine dip in office revealed pH 6.0, 3+ leukocytes, positive nitrites• Ext: Good CMS, no peripheral edemaCase #4. Stephanie.History of Present Illness (HPI): Stephanie is a 15-year-old female G0 who presents to the office with hermother. She c/o heavy bleeding during her periods, anxiety, and mood swings, which had been occurringfor the past 4 months. Her symptoms usually occur a few days before the onset of her menses andimprove by day 3. She uses 2 pads every 1-2 hours and sometimes needs to double up on the pads. Shealso c/o severe bloating, pelvic pain, and back pain during her periods. She has missed numerous days ofschool due to her symptoms, and lacks interest in usual daily activities, staying in bed all day. Around 2months ago, she was seen by an adolescent psychiatrist and was diagnosed with major depression andstarted on sertraline 50mg once daily. She has refused to take the medication because she rejects thediagnosis of depression. She states that she knows she is not depressed and is angry that nobodybelieves her.Prior medical history: Questionable depression. Prior surgical history: NoneCurrent medications: None. Allergies: Sulfa.OB- GYN History: Menarche age 12, cycle length was 5-7 days- frequency every 28 days- 3 pads per day,until the past 4 months.LMP: 1 week ago. Contraception history: NoneSocial history: Lives with her parents. She is an only child. Denies EtOH, smoking, or recreational druguse. Sexually active once (vaginal) – 1 year ago with same partner- none since. Participates in sports:basketballFamily history: Mother alive and well, Father with diabetesReview of Systems (ROS): Unremarkable with exception of as noted in HPI.Physical Exam (PE)VS: BP: 122/74, P: 64, RR: 16, T: 97.8 Weight: 146 lbs., Height: 63 inches, BMI 26.2General Examination: Well developed, well nourished, in no acute distress.Psych: alert and oriented, cooperative with exam, appears frustrated.Abdomen: Soft, NTND, no massesGynecological: EXTERNAL EXAM: normal, appropriate hair distribution, no erythema, no skindiscoloration, no lesions. SPECULUM/INTERNAL EXAM: Cervix: normal appearance, no lesions, nobleeding/discharge, no cervical movement tenderness, nulliparous. UTERUS: normal size, shape, andconsistency, normal mobility, nontender. ADNEXA: no masses or tenderness bilaterally.NRNP6552Week5Casestudytemplate.docxCase # (1, 2, 3 or 4) and Description of the Case Chosen:·Case 1: Diana·Case 2: Barbara·Case 3: Vivian·Case 4: StephanieOutline Subjective data.Identify data provided in your chosen case and any additional data needed.OutlineObjective findings.Identify findings provided in your chosen case and any additional data needed.Identify diagnostic tests, procedures, laboratory work indicated.Describe the rationale for each test or intervention with supporting references.Distinguish at least three differential diagnoses.Describe the rationales for your choice of each diagnosis with supporting references.Identify appropriate medications, treatments or other interventions associated with each differential diagnosis.Describe rationales and supporting references for each.Explain keySocial Determinants of Heath (SDoH) for your chosen case.Describe collaborative care referrals and patient education needs for your chosen case.Describe rationales and supporting references for each.NRNP6552week5cases.pdfCase #1. Diana.History of Present Illness (HPI): Diana is a 48-year-old Hispanic G4P1031. She presents to your office asa new patient for GYN visit. Her last visit to a gynecologist was 12 years ago after the birth of herdaughter. Her periods come at variable intervals, sometimes every three months, other times twice in amonth. Flow varies from minimal spotting to heavy bleeding requiring pad changes every hour. Shereports dysmenorrhea with her periods that is relieved with ibuprofen. She reports a 30-pound weightgain over the past 10 years.Prior medical history: Gallstones. Prior surgical history: Lap cholecystectomy (2008)Current medications: None. Allergies: NoneOB- GYN History: Surgical TOP x 3. C-section x 1 at full term for arrest of descent. Menarche age 13,cycle length- 5 days- frequency every 28 days- 4-5 tampons per day, until recently. No history of sexuallytransmitted infections (STDs). No history of abnormal pap smears. Last pap was 12 years ago, reportednormal. HIV negative.LMP: 2 weeks ago – heavy with clots and lasted 10 days. Contraception history: None.Social history: Lives with husband and daughter. Stay at home mom. Denies ETOH or recreational druguse, never smoker. Her family speaks Spanish at home; she is fluent in English.Family history: Mother s/p hysterectomy for fibroids, sister with diabetes mellitus.Review of Systems (ROS): Negative except as noted in HPI.Physical Exam (PE)VS: BP: 155/80, P: 99, RR: 18, T: 98.4, Weight: 206 lbs., Height 66 in, BMI 33.2 kg/m2• General: NAD, well-appearing, obesity in female• Abd: Soft, NT/ND, no masses/HSM• GU: No lesions; normal vaginal mucosa; no CMT; no uterine/adnexal tenderness; uterus 8-weeksize; no adnexal masses• Ext: Good CMS, 1+ edema b/lCase #2. Barbara.History of Present Illness (HPI): Barbara is a 73-year-old Caucasian G2P2002. She is a retiredschoolteacher, lives alone. She complains of 2-year history of ten episodes of daytime frequency withsmall frequent voids, a constant desire to urinate, and nocturia x 3 every night, resulting in poor sleep.More recently, symptoms have worsened and now include a sudden urge to void and occasional urinaryincontinence with structured physical activity. She changes pads three times a day and complains ofsuperficial dyspareunia. She denies OAB meds or hormone replacement therapy in the past. Shecomplains of mild constipation and has had three lower urinary tract infections (UTIs) in the last 12months.Prior medical history: HTN, UTI. Prior surgical history: Appendectomy (1998)Current medications: Cardura 2mg daily, furosemide 20mg daily. Allergies: PenicillinOB- GYN History: Forceps-assisted VD x 2. Menarche age 14, normal throughout life. No history ofsexually transmitted infections (STDs). Last pap smear age 67 years, normal.LMP: Approximately 25 years ago. Contraception history: None.Social history: Lives alone. Retired schoolteacher. ETOH: 1-2 glasses red wine nightly. No recreationaldrug use. Never smoked. Plays bingo 3 times weekly and participates in structured physical activity(pickle ball and Pilates) 3-4 times weekly.Family history: Mother (deceased age 79)- CVA. Father (deceased age 72) – MI/ASHDReview of Systems (ROS): As noted in HPI.Physical Exam (PE)VS: BP: 133/68, P: 68, RR: 16, T: 97.3, Weight 134lbs, Height 64 inches, BMI 23 kg/m2On physical exam, marked urogenital atrophy is noted, no ulcerations noted. Positive urine leakage whenasked to cough. There is uterine descent into vagina up to the introitus, bladder is noted just at theopening of the vagina, and rectum noted halfway to hymen.Case #3. Vivian.History of Present Illness (HPI): Vivian is an 88-year-old Caucasian female brought into the office by hercaregiver. Complains of dark, cloudy, foul-smelling urine, with new confusion and night-timehallucinations. The caregiver reports a history of disturbed night sleep, with hallucinations of spiderscrawling in bed, followed by agitation, lethargy, and poor oral intake the next morning. Other symptomsinclude increased urinary frequency, dysuria, mild fever, and lower abdominal pain. The caregiver alsoreports that Vivian had been treated for suspected UTI twice in the last 12 months.Prior medical history: HTN, CKD stage 2, diverticular disease, vesicovaginal fistula (newly diagnosed),previous indwelling urinary catheter, osteoporosis, left femur fracture s/p fall.Prior surgical history: Left Total Hip Replacement (2012).Current medications: Olmesartan 20mg daily, Alendronate 70mg weekly, Vitamin D3 5,000 IU daily.Allergies: NoneSocial history: Never smoked or drank alcohol. Lives alone with 24-hour caregiver after husband died 3years ago and she had a fall that resulted in femur fracture.Family history: Mother deceased (age 74)- breast cancer. Father deceased (age 70)- CVA.Review of Systems (ROS): As noted in HPI.Physical Exam (PE)VS: BP: 110/70, P: 109, RR: 17, T: 98.9, Weight: 132 lbs., Height 65 inches, BMI 22 kg/m2• General: Restless, oriented to person and place• Cardio: S1 and S2 heart sounds in regular rhythm with no murmurs or extra sounds.• Resp: Lungs CTA, no wheezing or rhonchi. Nonlabored breathing• Abd: Soft, NT/ND, no masses/HSM, no suprapubic tenderness• GU: No CVA tenderness, urine dip in office revealed pH 6.0, 3+ leukocytes, positive nitrites• Ext: Good CMS, no peripheral edemaCase #4. Stephanie.History of Present Illness (HPI): Stephanie is a 15-year-old female G0 who presents to the office with hermother. She c/o heavy bleeding during her periods, anxiety, and mood swings, which had been occurringfor the past 4 months. Her symptoms usually occur a few days before the onset of her menses andimprove by day 3. She uses 2 pads every 1-2 hours and sometimes needs to double up on the pads. Shealso c/o severe bloating, pelvic pain, and back pain during her periods. She has missed numerous days ofschool due to her symptoms, and lacks interest in usual daily activities, staying in bed all day. Around 2months ago, she was seen by an adolescent psychiatrist and was diagnosed with major depression andstarted on sertraline 50mg once daily. She has refused to take the medication because she rejects thediagnosis of depression. She states that she knows she is not depressed and is angry that nobodybelieves her.Prior medical history: Questionable depression. Prior surgical history: NoneCurrent medications: None. Allergies: Sulfa.OB- GYN History: Menarche age 12, cycle length was 5-7 days- frequency every 28 days- 3 pads per day,until the past 4 months.LMP: 1 week ago. Contraception history: NoneSocial history: Lives with her parents. She is an only child. Denies EtOH, smoking, or recreational druguse. Sexually active once (vaginal) – 1 year ago with same partner- none since. Participates in sports:basketballFamily history: Mother alive and well, Father with diabetesReview of Systems (ROS): Unremarkable with exception of as noted in HPI.Physical Exam (PE)VS: BP: 122/74, P: 64, RR: 16, T: 97.8 Weight: 146 lbs., Height: 63 inches, BMI 26.2General Examination: Well developed, well nourished, in no acute distress.Psych: alert and oriented, cooperative with exam, appears frustrated.Abdomen: Soft, NTND, no massesGynecological: EXTERNAL EXAM: normal, appropriate hair distribution, no erythema, no skindiscoloration, no lesions. SPECULUM/INTERNAL EXAM: Cervix: normal appearance, no lesions, nobleeding/discharge, no cervical movement tenderness, nulliparous. UTERUS: normal size, shape, andconsistency, normal mobility, nontender. ADNEXA: no masses or tenderness bilaterally.NRNP6552Week5Casestudytemplate.docxCase # (1, 2, 3 or 4) and Description of the Case Chosen:·Case 1: Diana·Case 2: Barbara·Case 3: Vivian·Case 4: StephanieOutline Subjective data.Identify data provided in your chosen case and any additional data needed.OutlineObjective findings.Identify findings provided in your chosen case and any additional data needed.Identify diagnostic tests, procedures, laboratory work indicated.Describe the rationale for each test or intervention with supporting references.Distinguish at least three differential diagnoses.Describe the rationales for your choice of each diagnosis with supporting references.Identify appropriate medications, treatments or other interventions associated with each differential diagnosis.Describe rationales and supporting references for each.Explain keySocial Determinants of Heath (SDoH) for your chosen case.Describe collaborative care referrals and patient education needs for your chosen case.Describe rationales and supporting references for each.NRNP6552week5cases.pdfCase #1. Diana.History of Present Illness (HPI): Diana is a 48-year-old Hispanic G4P1031. She presents to your office asa new patient for GYN visit. Her last visit to a gynecologist was 12 years ago after the birth of herdaughter. Her periods come at variable intervals, sometimes every three months, other times twice in amonth. Flow varies from minimal spotting to heavy bleeding requiring pad changes every hour. Shereports dysmenorrhea with her periods that is relieved with ibuprofen. She reports a 30-pound weightgain over the past 10 years.Prior medical history: Gallstones. Prior surgical history: Lap cholecystectomy (2008)Current medications: None. Allergies: NoneOB- GYN History: Surgical TOP x 3. C-section x 1 at full term for arrest of descent. Menarche age 13,cycle length- 5 days- frequency every 28 days- 4-5 tampons per day, until recently. No history of sexuallytransmitted infections (STDs). No history of abnormal pap smears. Last pap was 12 years ago, reportednormal. HIV negative.LMP: 2 weeks ago – heavy with clots and lasted 10 days. Contraception history: None.Social history: Lives with husband and daughter. Stay at home mom. Denies ETOH or recreational druguse, never smoker. Her family speaks Spanish at home; she is fluent in English.Family history: Mother s/p hysterectomy for fibroids, sister with diabetes mellitus.Review of Systems (ROS): Negative except as noted in HPI.Physical Exam (PE)VS: BP: 155/80, P: 99, RR: 18, T: 98.4, Weight: 206 lbs., Height 66 in, BMI 33.2 kg/m2• General: NAD, well-appearing, obesity in female• Abd: Soft, NT/ND, no masses/HSM• GU: No lesions; normal vaginal mucosa; no CMT; no uterine/adnexal tenderness; uterus 8-weeksize; no adnexal masses• Ext: Good CMS, 1+ edema b/lCase #2. Barbara.History of Present Illness (HPI): Barbara is a 73-year-old Caucasian G2P2002. She is a retiredschoolteacher, lives alone. She complains of 2-year history of ten episodes of daytime frequency withsmall frequent voids, a constant desire to urinate, and nocturia x 3 every night, resulting in poor sleep.More recently, symptoms have worsened and now include a sudden urge to void and occasional urinaryincontinence with structured physical activity. She changes pads three times a day and complains ofsuperficial dyspareunia. She denies OAB meds or hormone replacement therapy in the past. Shecomplains of mild constipation and has had three lower urinary tract infections (UTIs) in the last 12months.Prior medical history: HTN, UTI. Prior surgical history: Appendectomy (1998)Current medications: Cardura 2mg daily, furosemide 20mg daily. Allergies: PenicillinOB- GYN History: Forceps-assisted VD x 2. Menarche age 14, normal throughout life. No history ofsexually transmitted infections (STDs). Last pap smear age 67 years, normal.LMP: Approximately 25 years ago. Contraception history: None.Social history: Lives alone. Retired schoolteacher. ETOH: 1-2 glasses red wine nightly. No recreationaldrug use. Never smoked. Plays bingo 3 times weekly and participates in structured physical activity(pickle ball and Pilates) 3-4 times weekly.Family history: Mother (deceased age 79)- CVA. Father (deceased age 72) – MI/ASHDReview of Systems (ROS): As noted in HPI.Physical Exam (PE)VS: BP: 133/68, P: 68, RR: 16, T: 97.3, Weight 134lbs, Height 64 inches, BMI 23 kg/m2On physical exam, marked urogenital atrophy is noted, no ulcerations noted. Positive urine leakage whenasked to cough. There is uterine descent into vagina up to the introitus, bladder is noted just at theopening of the vagina, and rectum noted halfway to hymen.Case #3. Vivian.History of Present Illness (HPI): Vivian is an 88-year-old Caucasian female brought into the office by hercaregiver. Complains of dark, cloudy, foul-smelling urine, with new confusion and night-timehallucinations. The caregiver reports a history of disturbed night sleep, with hallucinations of spiderscrawling in bed, followed by agitation, lethargy, and poor oral intake the next morning. Other symptomsinclude increased urinary frequency, dysuria, mild fever, and lower abdominal pain. The caregiver alsoreports that Vivian had been treated for suspected UTI twice in the last 12 months.Prior medical history: HTN, CKD stage 2, diverticular disease, vesicovaginal fistula (newly diagnosed),previous indwelling urinary catheter, osteoporosis, left femur fracture s/p fall.Prior surgical history: Left Total Hip Replacement (2012).Current medications: Olmesartan 20mg daily, Alendronate 70mg weekly, Vitamin D3 5,000 IU daily.Allergies: NoneSocial history: Never smoked or drank alcohol. Lives alone with 24-hour caregiver after husband died 3years ago and she had a fall that resulted in femur fracture.Family history: Mother deceased (age 74)- breast cancer. Father deceased (age 70)- CVA.Review of Systems (ROS): As noted in HPI.Physical Exam (PE)VS: BP: 110/70, P: 109, RR: 17, T: 98.9, Weight: 132 lbs., Height 65 inches, BMI 22 kg/m2• General: Restless, oriented to person and place• Cardio: S1 and S2 heart sounds in regular rhythm with no murmurs or extra sounds.• Resp: Lungs CTA, no wheezing or rhonchi. Nonlabored breathing• Abd: Soft, NT/ND, no masses/HSM, no suprapubic tenderness• GU: No CVA tenderness, urine dip in office revealed pH 6.0, 3+ leukocytes, positive nitrites• Ext: Good CMS, no peripheral edemaCase #4. Stephanie.History of Present Illness (HPI): Stephanie is a 15-year-old female G0 who presents to the office with hermother. She c/o heavy bleeding during her periods, anxiety, and mood swings, which had been occurringfor the past 4 months. Her symptoms usually occur a few days before the onset of her menses andimprove by day 3. She uses 2 pads every 1-2 hours and sometimes needs to double up on the pads. Shealso c/o severe bloating, pelvic pain, and back pain during her periods. She has missed numerous days ofschool due to her symptoms, and lacks interest in usual daily activities, staying in bed all day. Around 2months ago, she was seen by an adolescent psychiatrist and was diagnosed with major depression andstarted on sertraline 50mg once daily. She has refused to take the medication because she rejects thediagnosis of depression. She states that she knows she is not depressed and is angry that nobodybelieves her.Prior medical history: Questionable depression. Prior surgical history: NoneCurrent medications: None. Allergies: Sulfa.OB- GYN History: Menarche age 12, cycle length was 5-7 days- frequency every 28 days- 3 pads per day,until the past 4 months.LMP: 1 week ago. Contraception history: NoneSocial history: Lives with her parents. She is an only child. Denies EtOH, smoking, or recreational druguse. Sexually active once (vaginal) – 1 year ago with same partner- none since. Participates in sports:basketballFamily history: Mother alive and well, Father with diabetesReview of Systems (ROS): Unremarkable with exception of as noted in HPI.Physical Exam (PE)VS: BP: 122/74, P: 64, RR: 16, T: 97.8 Weight: 146 lbs., Height: 63 inches, BMI 26.2General Examination: Well developed, well nourished, in no acute distress.Psych: alert and oriented, cooperative with exam, appears frustrated.Abdomen: Soft, NTND, no massesGynecological: EXTERNAL EXAM: normal, appropriate hair distribution, no erythema, no skindiscoloration, no lesions. SPECULUM/INTERNAL EXAM: Cervix: normal appearance, no lesions, nobleeding/discharge, no cervical movement tenderness, nulliparous. UTERUS: normal size, shape, andconsistency, normal mobility, nontender. ADNEXA: no masses or tenderness bilaterally.12Bids(64)Miss DeannaDr. Ellen RMMISS HILLARY A+Dr. Aylin JMSheryl HoganProf Double REmily ClareDr. Sarah BlakeProWritingGurufirstclass tutorDoctor.NamiraDr. Freya WalkerPROF_ALISTERFiona DavaMUSYOKIONES A+Dr CloverDiscount AssigngrA+de plusJahky BColeen AndersonShow All Bidsother Questions(10)TLMT 600 wk3Statistics homeworkNUR502 Week 5 Applying Theory to a Practice Problem Part 1NUR502 Week 1 Master’s-Prepared Nurse Interview1. Identify an engineering material failure from your everyday life

2. Investigate what kind of material it is, and why it fails. 

3….international marketingACC 573 DISCUSSION 1 WEEK 1work750 wordsChemical Engineering

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Home>Homework Answsers>Nursing homework helpSubmit afour (4) pageanalysis of the case that is outlined below. Spelling and grammar count, so be sure to check/review your paper prior to submission. Use APA formatting for citations and references (at least 3) to support your arguments. The reference page is not included in the page count.In the introduction paragraph, include your position on whether or not the IRB should approve the study.1.  What are the ethical issues and points of conflict in this case? (one full page,double spaced, and bulleted)2.  Who are the interested parties affected by the issues/conflicts and what are their reasonable expectations? (one full page,double spaced, and bulleted)3.  If the interested parties acted on their expectations what would be the probable consequences? REMEMBER: Consequences can be multifaceted. (one full page,double spaced, and bulleted)4.  What are the obligations of the Amazing IRB? (one full page,double spaced, and bulleted)IRB.Case.Presentation.Analysis.Template.docxSampleCasePresentationAnalysis.pdf7 years ago28.01.201830Report issueAnswer(1)Daisy Arabella4.8(342)4.0(6)ChatPurchase the answer to view itNOT RATEDResponsetoInformedconsent.docx7 years agoplagiarism checkPurchase $30Bids(30)Catherine OwensUltimate_WriterTom mutungaTutorgrantonDaisy Arabella5-STAR PROFphyllis youngRey writerHELPCLICKPILOT RIGHTSuzanne123TutorJuddy-PHDDr. MarisoleyBusiness_Expertbrilliant answersProf Allanmagz64Miss ProfessorKATHERINE BECKSANN HARRISother Questions(10)HST 165AccountRACISM ANNOTATED BIBLIOGRAPHYStats Problems Needed ASAPTest your knowledge of cells and cell processes by dragging the name to the appropriate organelle in the three interactive websites Prokaryotes Basic Structure, The Plant Cell: Basic Structure and The Animal Cell: Basic StructurestatisticalA student has some $1 billls and $5 bills in his wallet. He has a total of 15 bills that are…✓ Feb. 20, $450

Determine the due date and the amount of interest due at maturity on the following notes:
 
Date of…question 11Ethics in Friendship

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Home>Homework Answsers>Nursing homework helpSEE THE ATTACHED HOMEWORK TITLED Disc- WK 8 (A)DiscWK8A.docx7 years ago18.04.20188Report issueAnswer(2)farhatullah4.8(1k+)4.8(43)ChatPurchase the answer to view itDementia.docx7 years agoplagiarism checkPurchase $8Clytemnestra4.4(367)3.9(4)ChatPurchase the answer to view ittherapy.edited1.docx7 years agoplagiarism checkPurchase $8Bids(12)Ultimate_WriterTheKingWriterClytemnestraphyllis youngTop-Performerfarhatullahkim woodsSantiago writerbrilliant answersRey writerCharandryCarla Bunnieother Questions(10)Only Katetutor(S#8)Children and stress assignmentIntegrating TheoriesMusic apprecation discussion boardnyanya new six due in 19.05.2016For Prof.Goodman OnlyThe following article from Harvard Business Review argues that good leaders reflect and learn from their reflections; they keep personal journals and write in them daily.Do a Work cited, Paraphrase,Quote, and Short Summary.Writer to choosehomework

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Home>Homework Answsers>Nursing homework helpNo plagiarism will be checked with turnitin.APA style formatting, font 12, double spaced with headers.Will need Title page, content 3 full double spaced  pages in length, plus a minimum of 3 peered reviewed references in the Reference page.  (Total of 5 pages).Assignment: Analysis of Current Evidence Based Practice Guidelines for the Treatment of Otitis MediaThis Assignment requires a current, evidence based practice guideline that is specific to the child in the following scenario. Once you find the appropriate guideline, you will be ready for analysis and evaluation.First, carefully review the case. Then, using the Internet, find a current (no older than 4 years old 2014-2018) relevant evidence based practice guideline for the treatment of otitis media for this particular pediatric patient.There should be a minimum of three current (within the last 5 years) peer-reviewed references including the authors of the guideline.Make sure to address the following in your paper:Use below headings while answering questionsBriefly explain your search strategy. For example, how did you find the correct guideline?Who developed the guideline?Is this a revision of a previous guideline or an original? What is the date of publication?Explain the concept of “systematic review of current best evidence.”How was conflict of interest managed in the development of these guidelines?How is quality of evidence defined?Explain differences among strong recommendation, recommendation, and optionWhat are “key Action statements?”For this particular child, what are the specific treatment recommendations including any diagnostics, medications (include exact dosage, frequency, length of treatment), follow-up, referral, prevention, and pain control.Case:A 5-year-old male is brought to the primary care clinic by his mother with a chief complaint of bilateral ear pain for the last three days. The mother states that the child has been crying frequently due to the pain. Ibuprofen has provided minimal relief. This morning, the child refused breakfast and appeared to be “getting worse.”Vital signs at the clinic reveal HR 110 bpm, 28 respiratory rate, and tympanic temperature of 103.2 degrees F. The mother reports no known allergies. The child has not been on antibiotics for the last year. The child does not have history of OM. The child is otherwise healthy without any other known health problems.After your questioning and examination, you diagnose this child with bilateralAcute Otitis Media.MN581_Unit9AssignmentGradingRubric1.xlsx7 years ago11.11.201835Report issueAnswer(1)Tutor Faith4.9(286)5.0(16)ChatPurchase the answer to view itCurrentEvidenceBas.docx7 years agoplagiarism checkPurchase $35Bids(49)MARTHA92_PHDTutor Faithbonieta123hifsa shaukatProf XavierFavorite PROFYourStudyGuruHELPCLICKprofessor HarveyProf Double RPROF washington watsonResearchProMichelle OwensDaisy ArabellaCatherine OwensProf_DismuzDr. RocalWendy LewisComputer_Science_Expertperfectoother Questions(10)#2Literature Discussion QuestionBESTCONSULTANTSociology 100 Discussionphil101–short answer questions—-250 wordspaper2 pages due tommorrowOutlinereading notesArticles

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Home>Homework Answsers>Nursing homework helpTutor MUST have a good command of the English languageSources need to be journal/scholarly articles.Use only articles that are published between 2015-2018 (except for your theory articles which will be older as you must cite primary sources).No textbook or direct quotesPlease see attached RubricDetails:In this assignment, learners are required to write a case report addressing the personal knowledge and skills gained in this course and potentially solving an identified practice problem.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 LopesWrite. Please refer to the      directions in the Student Success Center.Directions:Construct a 2,500-3,000 word (approximately 10-12 pages) case report that includes a problem or situation consistent with a DNP area of practice.Review      the IOM and Kaiser Commission Report on the uninsured to develop the case      report.Apply      public health concepts to describe understanding      of the problem or situation of focus.Apply      one or more public health concepts to the recommended intervention or      solution being proposed.Develop      the case report across the entire scenario from the identification of the      clinical or health care problem through the proposal for an intervention,      implementation, and evaluation using an appropriate research instrument.Describe      the evaluation of the selected research instrument in the case report.Lastly,      explain in full the tenets, rationale      for selection (empirical evidence), and clear      application using the language of public health concepts within the case      report.Case Report Requirements:In addition, your case report must include the following:Introduction with a problem statement.Brief      literature review.Description      of the case/situation/conditions explained from a theoretical perspective.Discussion that includes a detailed explanation      of the synthesized literature findings.Summary of the case.Proposed solutions to remedy gaps,      inefficiencies, or other issues from a theoretical approach.Identification      of a research instrument to evaluate the proposed solution along with a      description of how the instrument      could be evaluated.Conclusion.Week6Insructions.docx7 years ago04.12.201840Report issueAnswer(2)Catherine Owens4.7(3k+)4.7(183)ChatPurchase the answer to view itNOT RATEDPUBLICHEALTHCONCEPTS.docx7 years agoplagiarism checkPurchase $45Prof sarmwei3.9(41)5.0(1)ChatPurchase the answer to view itNOT RATEDAnswer.docx7 years agoplagiarism checkPurchase $40Bids(65)PROVEN STERLINGHELPCLICKMichelle_MichyGreat-WritersOriginal GradeProf James KelvinProf_Marcos A.Ranchoddas Chanchad PhDDr. Claver-NNPROF washington watsonHonest Business WriterWriting KingDrNicNgaoRosie SeptemberProf. NicholasWendy LewisAngelina MayCatherine OwensThe_Ideas_TeamPhd christineother Questions(10)urban studiesFIN 350 Module 5 DQ 1PERFORMANCE MANAGEMENT AT THE NATIONAL INSTITUTE OF MANAGEMENT CENTRAL INDIA CAMPUS)Search Online for some eye-catching, interesting, and compelling images.1 i need help with my HM (First Aid calss )3\x+2-5\x-1Describe how legitimate, coercive, reward, expert, referent information power can be used ethically and unethically in your workplace (classroom, staff room, school, district). What distinguishes ethical from unethical behavior? Or, consider the behaviorsIdentify a business research project in your own business or locate a business research article in the library. This project should be one that you perceive to be conducted in an ethical manner.ECO 550 Week 10 Discussion Question: Public versus Private Goodsfor tom mutunga only

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