Iron Deficiency Anemia

Case Study: Iron Deficiency Anemia Patient Information:

• Name: John Doe • Age: 35 • Gender: Male • Occupation: Construction Worker • Medical History: No significant medical history reported.

Presenting Complaint: John Doe presents to the clinic with complaints of fatigue, weakness, and shortness of breath on exertion for the past few months. He reports feeling unusually tired, even after a full night’s sleep, and has noticed increased paleness of his skin and conjunctiva.

Physical Examination Findings:

• Vital Signs: BP 120/80 mmHg, HR 80 bpm, RR 16 breaths/min, Temp 98.6°F

• General: Pale skin and conjunctiva, fatigue apparent

• Cardiovascular: Regular rhythm, no murmurs or abnormal sounds

• Respiratory: Clear lung fields bilaterally

• Abdomen: Soft, non-tender, no organomegaly

• Neurological: Intact cranial nerves, normal motor and sensory functions

Laboratory Investigations: • Hemoglobin (Hb): 9.5 g/dL (Normal range: 13.5-17.5 g/dL) • Hematocrit (Hct): 29% (Normal range: 40-50%) • Mean Corpuscular Volume (MCV): 75 fL (Normal range: 80-100 fL) • Serum Iron: 25 mcg/dL (Normal range: 60-170 mcg/dL) • Total Iron Binding Capacity (TIBC): 400 mcg/dL (Normal range: 250-450 mcg/dL) • Ferritin: 10 ng/mL (Normal range: 30-400 ng/mL)

Diagnosis: John Doe is diagnosed with iron deficiency anemia based on his clinical presentation, physical examination findings, and laboratory results.

Questions for Students:

1. What are the common signs and symptoms of iron deficiency anemia?

2. Explain the laboratory findings in John Doe’s case and how they support the diagnosis of iron deficiency anemia.

3. What are the potential causes of iron deficiency anemia in adults, and how would you approach further investigations in this patient?

4. Discuss the treatment options for iron deficiency anemia, including dietary recommendations and pharmacological intervention.

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references

All answers to case studies must-have reference cited in the text for each answer and a minimum of 2 Scholarly References (Journals, books) (No websites)  per case Study

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EENT Focused SOAP Note

Raymond Pinkowski is an 18-year-old who presents to your outpatient clinic with a 3-day history of painful left ear. He has a recent history of swimming in a friend’s pond over this past weekend. He is generally in good health, no significant medical history other than seasonal allergies and has ADHD which was diagnosed when he was in middle school. He recently started a part time job at Target but doesn’t work enough hours to qualify for any health insurance, he will be paying out of pocket for the visit and any medications. HPI/PMH: as presented in the case.

Vital signs: BP 118/70 P 84 R 14 T 99.9 oral Pulse ox 98% on room air Allergies: NKDA Medications: Tylenol 500mg 1 or 2 PRN. Not taking medications for ADHD since completing his GED 1 year ago.

ROS: Occasional headaches, left ear pain, states it is 8-9/10 today. PE: Lungs clear, Heart regular rate and rhythm. Right ear shows clear ear canal, TM with normal light reflex, no fluid noted. Left ear canal red, swollen, unable to perform thorough ear exam due to edema and pain. Some greenish discharge noted from Left ear. Social History: Lives with his mother in an apartment, has one younger sister also at home. Obtained his GED last year. Drinks alcohol on weekends occasionally, smokes marijuana 1 or 2 times a month with friends, no other reported drug use, no use of tobacco or vaping. Drinks 2 – 3 energy drinks daily. No history of interaction with law enforcement, no DUI’s.

As you review the case and write your SOAP note please review the following questions and incorporate them into the note.

 

1. What is the likely cause of this issue for Raymond?

2. Write at least 3 differential diagnoses for this issue.

3. Describe in detail the physical exam you would complete for this visit.

4. What are some of the risk factors for individuals to develop this issue?

5. Name the pathogens most likely involved.

6. How would you describe the severity of Raymonds issue – mild, moderate or severe? 7. What treatment options would you prescribe?

8. List the cost of the medication you prescribe for Raymond – you can use sources like GoodRx or others available on the web to review costs in your area.

9. What other health promotion topics would you review with Raymond at this visit? 10. What social determinants of health (SDOH) are affecting Raymond’s care at this time?

11. What CPT code and E&M code would you use for this visit – this can be added to the? end of the SOAP note.

12. What is your follow up plan and any need for referral for Raymond after this visit, also are there any free clinics in your area – if so list them?

 

 

Focused SOAP Note Template

 

Patient Information:

Initials, Age, Sex, Race

S.

CC (chief complaint): A brief statement identifying why the patient is here, stated in the patient’s own words (for instance “headache,” not “bad headache for 3 days”).

HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form, not a list. If the CC was “headache,” the LOCATES for the HPI might look like the following example:

Location: head

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

Severity: 7/10 pain scale

Current Medications: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products

Allergies: include medication, food, and environmental allergies separately (A description of what the allergy is, i.e., angioedema, anaphylaxis, etc. This will help determine a true reaction as opposed to intolerance).

PMHx: include immunization status (note date of last tetanus for all adults), past major illnesses and surgeries. Depending on the CC, more information is sometimes needed. Soc & Substance Hx: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here, such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.

Fam Hx: illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first-degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren, if pertinent.

Surgical Hx: prior surgical procedures

Mental Hx: diagnosis and treatment. Current concerns: Anxiety and/or depression. History of self-harm practices and/or suicidal or homicidal ideation.

Violence Hx: concern or issues about safety (personal, home, community, sexual . . . current & historical)

Reproductive Hx: menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns

ROS: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: General: HeadEENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

RESPIRATORY: No shortness of breath, cough, or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

GENITOURINARY: Burning on urination. Last menstrual period, MM/DD/YYYY.

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

HEMATOLOGIC: No anemia, bleeding, or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

PSYCHIATRIC: No history of depression or anxiety.

ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

REPRODUCTIVE: Not pregnant and no recent pregnancy. No reports of vaginal or penile discharge. Not sexually active.

ALLERGIES: No history of asthma, hives, eczema, or rhinitis.

O.

Physical exam: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head-to-toe format, i.e., General: Head: EENT: etc.

Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidence and guidelines)

A .

Differential Diagnoses: List a minimum of three differential diagnoses. Your primary, or presumptive, diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence-based guidelines.

P.

Includes documentation of diagnostic studies that will be obtained, referrals to other healthcare providers, therapeutic interventions, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner.

Include a discussion related to health promotion and disease prevention, taking into consideration patient factors such as age and ethnic group; PMH; and other factors, such as socio-economic and cultural background.

The reflection also is included in this section. Reflect on this case and discuss what you learned. Were there any “aha” moments or connections you made?

References

You are required to include at least three evidence-based, peer-reviewed journal articles or evidence-based guidelines that relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

 

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Nursing homework help

General instruction:

Locate a news story or other resource from the last six months regarding an issue in healthcare and answer all questions/criteria with explanations and detail.

Include the following sections:

  1. Application of Course Knowledge
    • Summarize the issue.
    • Discuss how the issue may impact nursing practice at the micro-, meso-, and macro-levels of the healthcare system.
    • Analyze how healthcare policy impacts the issue.
    • Include a link to the news story or resource.
  2. Integration of Evidence: Integrate relevant scholarly sources as defined by program expectations:
    • Cite a scholarly source in the initial post

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Discussions

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Care coordination

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DE-PRESCRIBING

**PLEASE FOLLOW THE RUBRIC ATTACHED IN FILES!!**

What is the importance of de-prescribing? How might you assist a patient to taper from a medication safely or transition to a new medication?

In this Assignment, you will use the following patient examples to write a 5- to 6-p P on considerations you have for how you might de-prescribe. Support your answers with five (5) evidence-based, peer-reviewed scholarly literature resources outside of Required Learning Resources in this course.

Note: APA style format

Patient Examples:

Patient 1: A 36-year-old male presents to your office being prescribed by his primary care physician (PCP) for the past 3 years an opioid analgesic medication for a work accident. He has chronic pain and is attending a pain clinic. It is determined the best course of treatment for pain is to remain on opioid medication. The patient is also being prescribed clonazepam 1mg BID for “relaxation” and panic attacks.

Patient 2: A 42-year-old female on alprazolam 1mg BID for panic attacks. Panic attacks have been in remission and the patient wants to taper off the medication. But, every time she has attempted to do so in the past, she experienced withdrawal effects. She is wondering how to safely taper off the benzodiazepine medication without having withdrawal effects.

Patient 3: A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder. She recently found out she is pregnant (9 weeks gestation). She was referred to you by her OB-GYN to discuss this medication for her current situation. The patient is wondering if she can stay on the lorazepam through her pregnancy and postpartum, as it is an effective medication for anxiety symptoms. She plans to exclusively breastfeed for the first 6 months postpartum. She has not had any other trials of medication to treat anxiety as lorazepam has been effective.

Patient 4: A 71-year-old-male who comes to see you at the insistence of his daughter. His daughter expresses concern of memory loss and is wondering if he has the beginning stages of dementia. He is forgetful and seems to be tripping on things or walking into walls, although he has lived in the same home for the past 35 years. The patient does not agree with his daughter but does admit he has had a “few stumbles and falls” lately. Medication reconciliation shows the following medications: metoprolol ER 50mg q day, omeprazole 20mg q day, clonazepam 1mg TID, levothyroxine 75mcg q am. His daughter is wondering if he should be started on a “dementia medication.”

TO PREPARE FOR THIS ASSIGNMENT:

  • Review the assigned Learning Resources for this week.
  • Review the definitions presented in your text and resources for de-prescribing and tapering.
  • Consider the importance of de-prescribing.
  • Based on the example(s) provided, consider how you might de-prescribe a patient.

Answer the following questions using the patient examples described above.

Patient 1

  • What are the concerns of the patient remaining on the opioid medication and clonazepam?
  • How might you educate the patient about these risks and concerns?

The patient agrees that he should not continue both medications in combination. He would like to “get off” the clonazepam but worries about “bad withdrawals” that he’s heard about from stopping clonazepam “cold turkey” and is concerned about re-occurring panic attacks. How might you respond to the following:

  • How would you instruct the patient to taper off clonazepam?
  • What other medication would you recommend for the patient for the treatment of his panic attacks? Keep in mind, he will continue the opioid medication for pain relief.
  • How would you start the new recommended psychotropic medication for the patient?
  • Discuss one legal, ethical, or social consideration with the treatment plan.

Patient 2

  • The patient reports withdrawal symptoms when previously tapering off the alprazolam. What symptoms are common withdrawal symptoms from this medication?
  • Provide the patient education of withdrawal symptoms that range from common and less serious to withdrawal symptoms that are a cause for concern and that should prompt patient should seek medical attention.
  • Given the patient’s history of having withdrawal effects from attempting to taper off alprazolam, what longer-acting benzodiazepine would you choose to convert the patient to?
  • What is the dose you would prescribe and how would you taper off the medication?

Patient 3

  • Review the potential risks, benefits, and side effects of continuing lorazepam throughout the pregnancy and postpartum for both the patient and fetus.
  • Review other alternative medications to treat generalized anxiety disorder. Include risks, benefits, and potential side effects to both the patient and the developing fetus. Keep in mind, the patient is looking to breast feed for 6 months postpartum.
  • The patient agrees that it would be safest for her pregnancy and fetus to discontinue the lorazepam. How would you recommend she discontinue lorazepam? Provide education on potential side effects from tapering off the medication, including common side effects to more serious side effects and when to seek medical attention.
  • The patient would like to forgo medications at this time, given she is early in her pregnancy and is concerned about “damage” to the fetus if she were to continue medications. Provide education to the patient about the risks of untreated anxiety symptoms during pregnancy for both the patient and the fetus.

Patient 4

  • Review potential side effects for elderly on benzodiazepines providing education to both the patient and the patient’s daughter. What are the risks of continuing the benzodiazepine for this patient?
  • How would you evaluate the patient for these side effects?
  • The patient and daughter agree he will need to taper off the clonazepam given the risks of continuing this medication. How would you recommend tapering off this medication?
  • Review with the patient and daughter potential side effects of tapering off the medication. Review with them common side effects to more serious side effects and when to seek medical attention.

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4k25 research

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Nursing homework help

Select two health care service providers.

Write a 700- to 1,050-word paper discussing the health care service providers selected and the products and support they provide.

Providers of Service Options:

  • Preventative care or public health
  • Ambulatory or primary care
  • Subacute or long-term care
  • Acute care
  • Auxiliary services
  • Rehabilitative services
  • End-of-life care
  • Mental health services
  • Emergency management or disaster preparedness
  • Dental services
  • Military and veteran services
  • Indian health services

Include the following in your paper:

  • Identify the selected health care service provider.
  • Identify two services and products they provide to help with quality of care.

Cite at least one peer-reviewed or scholarly reference and your textbook to support your information. For additional information on how to properly cite your sources check out the Reference and Citation Generator resource in the Center for Writing Excellence.

Format your paper according to APA guidelines. Your paper must include an introduction, conclusion, and a reference page.

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Interpreting Statistical Output for Data Analysis PowerPoint Presentation

Assignment – Interpreting Statistical Output for Data Analysis PowerPoint Presentation

Purpose:

The purpose of this Assignment is to enable you to present the information that you gather from a systematic review on your PICOT topic. This activity will give you the experience to present what your research findings to others.

My PICOT question is: The Benefits of a Kidney Transplant versus Dialysis

 

Directions:

  1. Define the clinical key questions based on PICOT.
  2. Briefly review the database selected for key clinical questions.
  3. Identify the studies of the database search that are a Level I or II evidence.
  4. Interpret the statistical results of the studies identified in Step 3.
  5. Design a presentation.
    1. Place results /overview of research in PowerPoint.
    2. Length of the presentation should be 12–15 slides.
  6. Follow APA format.

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Proposal for Change Paper

 This paper is a proposal for change paper, meaning how and what Nurse Practitioners (a leader) can do to enact the change. attached you will see a list of change theories, you have to select a change theory and use it as a framework for the change you want to implement. Make sure in the first part of the paper you discuss the topic licensing/credentialing issues, why its a problem, and the change model you chose, the purpose statement/ thesis.
the second part would be about how to enact the change, how you will communicate with people, how to get peoplel to collaborate, what strategies will you use. and the 3rd part is about the disadvantages and advantages.
please include an intro and conclusion

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