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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