Home>Homework Answsers>Nursing homework helpNURSEcase studyapa format and scholarly references please No cdc Or WHOa year ago18.06.202412Report issuefiles (2)NRNP6552Week4CaseStudyTemplate.docxNRNP6552week4cases.pdfNRNP6552Week4CaseStudyTemplate.docxCase # (1, 2, 3 or 4) and Description of the Case Chosen:·Case 1: Debbie·Case 2: Wendy·Case 3: Randi·Case 4: RobertaOutline 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.NRNP6552week4cases.pdfNRNP 6552 Week 4 case study scenariosCase #1. Debbie.History of Present Illness (HPI): Debbie is a 19-year-old female G1P0010. She presents to your office as anew patient for GYN visit. Her chief complaint is mild lower abdominal pain and a copious amount ofvaginal discharge that started a little over 1 week ago. She is sexually active and reports having four malepartners in the last six months.Prior medical history: Depression, HSV-2. Prior surgical history: Surgical termination of pregnancy 1year agoCurrent medications: Lo loestrin Fe. Allergies: NoneOB- GYN History: Surgical TOP x 1. Menarche age 9, cycle length- 7 days- frequency every 28 days- 3 -4tampons per day. Hx of HSV-2. Never had pap smear.LMP: 2 weeks ago – normal. Contraception history: OCP since TOP 1 year ago.Social history: Lives parents. Denies ETOH or recreational drug use, never smoker. Graduated highschool. Not in college. Works FT as a waitress.Family history: Mother – depression. Father – unknownReview of Systems (ROS): Negative except as noted in HPI.Physical Exam (PE)VS: BP: 112/80, P: 72, RR: 16, T: 98.4, Weight: 110 lbs., Height 54 in, BMI 18.9 kg/m2• General: WDWN female in NAD• Abd: Soft, NT/ND, no masses/HSM• GU: No external lesions, no erythema. Mucopurulent endocervical exudate visible in theendocervical canal, sample obtained – cervix is friable. Mild CMT, no uterine tenderness, noadnexal tenderness, no masses.Case #2. Wendy.History of Present Illness (HPI): Wendy, a 33-year-old woman, presents to the office with c/o of a 7-month history of nipple discharge. She has noticed that her breasts are tender and both nipples producemilky discharge on applying mild pressure. She has not noted any bloody or clear nipple discharge,breast lumps, or skin changes. She also states she has not had a menstrual period for 7 months, and herperiods had been irregular for 8 months before they stopped altogether. Prior to her menstrualirregularities, her menses occurred at a normal frequency and duration. She is sexually active with asingle partner and is trying to conceive.Prior medical history: Headaches (past 6 months). Prior surgical history: NoneCurrent medications: ibuprofen 400mg daily. Allergies: NoneOB- GYN History: Spontaneous VD x 1. Menarche age 14, normal throughout life, until recentcomplaints. No history of sexually transmitted infections (STDs). Last pap smear age 31 years, normal.LMP: 7 months ago. Contraception history: None.Social history: Lives with husband and 5-year-old son. Elementary school teacher. ETOH: 1-2 glasseswine per month. No recreational drug use. Never smoked. Does not exercise. Last travel outside of thecountry – Italy 8 months ago.Family history: Mother – osteoporosis. Father (deceased age 80) – CVAReview of Systems (ROS): General: Fatigue over the past 3 months; Skin – No rash, excessive facial hairor acne; Gynecologic – Decreased libido. Vaginal dryness during sexual intercourse. She has been tryingto conceive for the last 2 years. One full-term, uncomplicated pregnancy 5 years ago; Neuro – 6-monthhistory of dull frontal and occasionally retro-orbital headaches that are increasing in frequency and thatnow occur almost daily. There are no associated neurologic symptoms. She denies nausea, photophobia,or phonophobia. Until 1 month ago, the headaches would resolve completely with ibuprofen, but for thelast month ibuprofen does not work. She denies history of headaches prior to 6 months ago.Physical Exam (PE)VS: BP: 133/68, P: 68, RR: 16, T: 97.3, Weight 134lbs, Height 64 inches, BMI 23 kg/m2Breast – No breast masses or skin changes. No axillary lymphadenopathy. Mild diffuse breast tendernesson palpation. Milky nipple discharge elicited bilaterally with pressure around areola.Skin – Normal color, no rash, hirsutism, or acne.Neuro- Normal and symmetric motor strength and reflexes on extremities. Sensation grossly intact tolight touch. Cranial nerves 2 through 12 intact. Gait and balance normal.Thyroid – no thyromegaly or nodulesCase #3. Randi.History of Present Illness (HPI): Randi, a 22-year-old female, presents to the clinic with c/o of a 3-dayhistory of thick white vaginal discharge, intense vaginal itching, and dysuria. She reports she is sexuallyactive with 1 partner. No history of STI’s. She had a recent sinus infection and was on amoxicillin x 10days.Prior medical history: None.Prior surgical history: None.Current medications: Mirena IUD – inserted last year. Allergies: SulfaSocial history: College student. Lives with mother. Denies smoking or recreational drugs. Vapes daily.Family history: Mother alive and well. Father alive and well. Sister – diabetes: uses insulin pumpOB- GYN History: Menarche age 13, cycle length 5 days – frequency every 28 days. No history ofsexually transmitted infections (STIs). Never had a pap smear.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: AAO x 3, pleasant.• Gynecological: EXTERNAL EXAM: mild erythema, white clumpy discharge. SPECULUM/INTERNALEXAM: Cervix: normal appearance, no lesions, no bleeding, white discharge, no cervicalmovement tenderness. UTERUS: normal size, shape, and consistency, normal mobility,nontender. ADNEXA: no masses or tenderness bilaterally.Case #4. Roberta.History of Present Illness (HPI): Roberta, a 53-year-old mother of two children, presents to your clinicwith c/o vaginal dryness and low sexual desire. She went into surgical menopause at the time of a totalhysterectomy for leiomyomas 5 years ago. She took HRT for severe climacteric symptoms for 2 years,which she discontinued 3 years ago due to breast pain and a fear of breast cancer. She states her sex lifebefore surgery was active and satisfying. After the hysterectomy, her desire diminished considerably,although at first she was not too concerned about it. Lately, however, because of this lack of desire, shenow complains of quite a reduction in sexual activity which is also less satisfying. When she does haveintercourse, she experiences dyspareunia. She is now worried about it because it is affecting her qualityof life and negatively impacting her relationship with her husband.Over this past year, she has had a mammogram and general blood tests which were all normal.Prior medical history: Uterine fibroids. Prior surgical history: TAH 5 years agoCurrent medications: None. Allergies: Sulfa.OB- GYN History: NSVD x 2 (2014 and 2012). Menarche age 12, cycle length was 8 -10 days- frequencyevery 21 days- heavy flow with clots – tampons 5-6/day.LMP: 5 years ago. Contraception history: NoneSocial history: Lives with her husband and 2 children. Works as an attorney. Denies EtOH, smoking, orrecreational drug use.Family history: Mother – osteoporosis, thyroid disease. Father – prostate cancer. MGM – breast cancerdiagnosed at age 81 yo.Review of Systems (ROS): Unremarkable with exception of as noted in HPI.Physical Exam (PE)VS: BP: 134/78, P: 58, RR: 16, T: 98.8 Weight: 144 lbs., Height: 65 inches, BMI 24General 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: sparse hair distribution, pale and shiny – dry labia, no lesions, Mildintroital stenosis noted. SPECULUM/INTERNAL EXAM: Vaginal lining is thin and dry. Cervix: surgicallyabsent. UTERUS: surgically absent. ADNEXA: surgically absent.NRNP6552week4cases.pdfNRNP 6552 Week 4 case study scenariosCase #1. Debbie.History of Present Illness (HPI): Debbie is a 19-year-old female G1P0010. She presents to your office as anew patient for GYN visit. Her chief complaint is mild lower abdominal pain and a copious amount ofvaginal discharge that started a little over 1 week ago. She is sexually active and reports having four malepartners in the last six months.Prior medical history: Depression, HSV-2. Prior surgical history: Surgical termination of pregnancy 1year agoCurrent medications: Lo loestrin Fe. Allergies: NoneOB- GYN History: Surgical TOP x 1. Menarche age 9, cycle length- 7 days- frequency every 28 days- 3 -4tampons per day. Hx of HSV-2. Never had pap smear.LMP: 2 weeks ago – normal. Contraception history: OCP since TOP 1 year ago.Social history: Lives parents. Denies ETOH or recreational drug use, never smoker. Graduated highschool. Not in college. Works FT as a waitress.Family history: Mother – depression. Father – unknownReview of Systems (ROS): Negative except as noted in HPI.Physical Exam (PE)VS: BP: 112/80, P: 72, RR: 16, T: 98.4, Weight: 110 lbs., Height 54 in, BMI 18.9 kg/m2• General: WDWN female in NAD• Abd: Soft, NT/ND, no masses/HSM• GU: No external lesions, no erythema. Mucopurulent endocervical exudate visible in theendocervical canal, sample obtained – cervix is friable. Mild CMT, no uterine tenderness, noadnexal tenderness, no masses.Case #2. Wendy.History of Present Illness (HPI): Wendy, a 33-year-old woman, presents to the office with c/o of a 7-month history of nipple discharge. She has noticed that her breasts are tender and both nipples producemilky discharge on applying mild pressure. She has not noted any bloody or clear nipple discharge,breast lumps, or skin changes. She also states she has not had a menstrual period for 7 months, and herperiods had been irregular for 8 months before they stopped altogether. Prior to her menstrualirregularities, her menses occurred at a normal frequency and duration. She is sexually active with asingle partner and is trying to conceive.Prior medical history: Headaches (past 6 months). Prior surgical history: NoneCurrent medications: ibuprofen 400mg daily. Allergies: NoneOB- GYN History: Spontaneous VD x 1. Menarche age 14, normal throughout life, until recentcomplaints. No history of sexually transmitted infections (STDs). Last pap smear age 31 years, normal.LMP: 7 months ago. Contraception history: None.Social history: Lives with husband and 5-year-old son. Elementary school teacher. ETOH: 1-2 glasseswine per month. No recreational drug use. Never smoked. Does not exercise. Last travel outside of thecountry – Italy 8 months ago.Family history: Mother – osteoporosis. Father (deceased age 80) – CVAReview of Systems (ROS): General: Fatigue over the past 3 months; Skin – No rash, excessive facial hairor acne; Gynecologic – Decreased libido. Vaginal dryness during sexual intercourse. She has been tryingto conceive for the last 2 years. One full-term, uncomplicated pregnancy 5 years ago; Neuro – 6-monthhistory of dull frontal and occasionally retro-orbital headaches that are increasing in frequency and thatnow occur almost daily. There are no associated neurologic symptoms. She denies nausea, photophobia,or phonophobia. Until 1 month ago, the headaches would resolve completely with ibuprofen, but for thelast month ibuprofen does not work. She denies history of headaches prior to 6 months ago.Physical Exam (PE)VS: BP: 133/68, P: 68, RR: 16, T: 97.3, Weight 134lbs, Height 64 inches, BMI 23 kg/m2Breast – No breast masses or skin changes. No axillary lymphadenopathy. Mild diffuse breast tendernesson palpation. Milky nipple discharge elicited bilaterally with pressure around areola.Skin – Normal color, no rash, hirsutism, or acne.Neuro- Normal and symmetric motor strength and reflexes on extremities. Sensation grossly intact tolight touch. Cranial nerves 2 through 12 intact. Gait and balance normal.Thyroid – no thyromegaly or nodulesCase #3. Randi.History of Present Illness (HPI): Randi, a 22-year-old female, presents to the clinic with c/o of a 3-dayhistory of thick white vaginal discharge, intense vaginal itching, and dysuria. She reports she is sexuallyactive with 1 partner. No history of STI’s. She had a recent sinus infection and was on amoxicillin x 10days.Prior medical history: None.Prior surgical history: None.Current medications: Mirena IUD – inserted last year. Allergies: SulfaSocial history: College student. Lives with mother. Denies smoking or recreational drugs. Vapes daily.Family history: Mother alive and well. Father alive and well. Sister – diabetes: uses insulin pumpOB- GYN History: Menarche age 13, cycle length 5 days – frequency every 28 days. No history ofsexually transmitted infections (STIs). Never had a pap smear.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: AAO x 3, pleasant.• Gynecological: EXTERNAL EXAM: mild erythema, white clumpy discharge. SPECULUM/INTERNALEXAM: Cervix: normal appearance, no lesions, no bleeding, white discharge, no cervicalmovement tenderness. UTERUS: normal size, shape, and consistency, normal mobility,nontender. ADNEXA: no masses or tenderness bilaterally.Case #4. Roberta.History of Present Illness (HPI): Roberta, a 53-year-old mother of two children, presents to your clinicwith c/o vaginal dryness and low sexual desire. She went into surgical menopause at the time of a totalhysterectomy for leiomyomas 5 years ago. She took HRT for severe climacteric symptoms for 2 years,which she discontinued 3 years ago due to breast pain and a fear of breast cancer. She states her sex lifebefore surgery was active and satisfying. After the hysterectomy, her desire diminished considerably,although at first she was not too concerned about it. Lately, however, because of this lack of desire, shenow complains of quite a reduction in sexual activity which is also less satisfying. When she does haveintercourse, she experiences dyspareunia. She is now worried about it because it is affecting her qualityof life and negatively impacting her relationship with her husband.Over this past year, she has had a mammogram and general blood tests which were all normal.Prior medical history: Uterine fibroids. Prior surgical history: TAH 5 years agoCurrent medications: None. Allergies: Sulfa.OB- GYN History: NSVD x 2 (2014 and 2012). Menarche age 12, cycle length was 8 -10 days- frequencyevery 21 days- heavy flow with clots – tampons 5-6/day.LMP: 5 years ago. Contraception history: NoneSocial history: Lives with her husband and 2 children. Works as an attorney. Denies EtOH, smoking, orrecreational drug use.Family history: Mother – osteoporosis, thyroid disease. Father – prostate cancer. MGM – breast cancerdiagnosed at age 81 yo.Review of Systems (ROS): Unremarkable with exception of as noted in HPI.Physical Exam (PE)VS: BP: 134/78, P: 58, RR: 16, T: 98.8 Weight: 144 lbs., Height: 65 inches, BMI 24General 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: sparse hair distribution, pale and shiny – dry labia, no lesions, Mildintroital stenosis noted. SPECULUM/INTERNAL EXAM: Vaginal lining is thin and dry. Cervix: surgicallyabsent. UTERUS: surgically absent. ADNEXA: surgically absent.NRNP6552Week4CaseStudyTemplate.docxCase # (1, 2, 3 or 4) and Description of the Case Chosen:·Case 1: Debbie·Case 2: Wendy·Case 3: Randi·Case 4: RobertaOutline 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.NRNP6552week4cases.pdfNRNP 6552 Week 4 case study scenariosCase #1. Debbie.History of Present Illness (HPI): Debbie is a 19-year-old female G1P0010. She presents to your office as anew patient for GYN visit. Her chief complaint is mild lower abdominal pain and a copious amount ofvaginal discharge that started a little over 1 week ago. She is sexually active and reports having four malepartners in the last six months.Prior medical history: Depression, HSV-2. Prior surgical history: Surgical termination of pregnancy 1year agoCurrent medications: Lo loestrin Fe. Allergies: NoneOB- GYN History: Surgical TOP x 1. Menarche age 9, cycle length- 7 days- frequency every 28 days- 3 -4tampons per day. Hx of HSV-2. Never had pap smear.LMP: 2 weeks ago – normal. Contraception history: OCP since TOP 1 year ago.Social history: Lives parents. Denies ETOH or recreational drug use, never smoker. Graduated highschool. Not in college. Works FT as a waitress.Family history: Mother – depression. Father – unknownReview of Systems (ROS): Negative except as noted in HPI.Physical Exam (PE)VS: BP: 112/80, P: 72, RR: 16, T: 98.4, Weight: 110 lbs., Height 54 in, BMI 18.9 kg/m2• General: WDWN female in NAD• Abd: Soft, NT/ND, no masses/HSM• GU: No external lesions, no erythema. Mucopurulent endocervical exudate visible in theendocervical canal, sample obtained – cervix is friable. Mild CMT, no uterine tenderness, noadnexal tenderness, no masses.Case #2. Wendy.History of Present Illness (HPI): Wendy, a 33-year-old woman, presents to the office with c/o of a 7-month history of nipple discharge. She has noticed that her breasts are tender and both nipples producemilky discharge on applying mild pressure. She has not noted any bloody or clear nipple discharge,breast lumps, or skin changes. She also states she has not had a menstrual period for 7 months, and herperiods had been irregular for 8 months before they stopped altogether. Prior to her menstrualirregularities, her menses occurred at a normal frequency and duration. She is sexually active with asingle partner and is trying to conceive.Prior medical history: Headaches (past 6 months). Prior surgical history: NoneCurrent medications: ibuprofen 400mg daily. Allergies: NoneOB- GYN History: Spontaneous VD x 1. Menarche age 14, normal throughout life, until recentcomplaints. No history of sexually transmitted infections (STDs). Last pap smear age 31 years, normal.LMP: 7 months ago. Contraception history: None.Social history: Lives with husband and 5-year-old son. Elementary school teacher. ETOH: 1-2 glasseswine per month. No recreational drug use. Never smoked. Does not exercise. Last travel outside of thecountry – Italy 8 months ago.Family history: Mother – osteoporosis. Father (deceased age 80) – CVAReview of Systems (ROS): General: Fatigue over the past 3 months; Skin – No rash, excessive facial hairor acne; Gynecologic – Decreased libido. Vaginal dryness during sexual intercourse. She has been tryingto conceive for the last 2 years. One full-term, uncomplicated pregnancy 5 years ago; Neuro – 6-monthhistory of dull frontal and occasionally retro-orbital headaches that are increasing in frequency and thatnow occur almost daily. There are no associated neurologic symptoms. She denies nausea, photophobia,or phonophobia. Until 1 month ago, the headaches would resolve completely with ibuprofen, but for thelast month ibuprofen does not work. She denies history of headaches prior to 6 months ago.Physical Exam (PE)VS: BP: 133/68, P: 68, RR: 16, T: 97.3, Weight 134lbs, Height 64 inches, BMI 23 kg/m2Breast – No breast masses or skin changes. No axillary lymphadenopathy. Mild diffuse breast tendernesson palpation. Milky nipple discharge elicited bilaterally with pressure around areola.Skin – Normal color, no rash, hirsutism, or acne.Neuro- Normal and symmetric motor strength and reflexes on extremities. Sensation grossly intact tolight touch. Cranial nerves 2 through 12 intact. Gait and balance normal.Thyroid – no thyromegaly or nodulesCase #3. Randi.History of Present Illness (HPI): Randi, a 22-year-old female, presents to the clinic with c/o of a 3-dayhistory of thick white vaginal discharge, intense vaginal itching, and dysuria. She reports she is sexuallyactive with 1 partner. No history of STI’s. She had a recent sinus infection and was on amoxicillin x 10days.Prior medical history: None.Prior surgical history: None.Current medications: Mirena IUD – inserted last year. Allergies: SulfaSocial history: College student. Lives with mother. Denies smoking or recreational drugs. Vapes daily.Family history: Mother alive and well. Father alive and well. Sister – diabetes: uses insulin pumpOB- GYN History: Menarche age 13, cycle length 5 days – frequency every 28 days. No history ofsexually transmitted infections (STIs). Never had a pap smear.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: AAO x 3, pleasant.• Gynecological: EXTERNAL EXAM: mild erythema, white clumpy discharge. SPECULUM/INTERNALEXAM: Cervix: normal appearance, no lesions, no bleeding, white discharge, no cervicalmovement tenderness. UTERUS: normal size, shape, and consistency, normal mobility,nontender. ADNEXA: no masses or tenderness bilaterally.Case #4. Roberta.History of Present Illness (HPI): Roberta, a 53-year-old mother of two children, presents to your clinicwith c/o vaginal dryness and low sexual desire. She went into surgical menopause at the time of a totalhysterectomy for leiomyomas 5 years ago. She took HRT for severe climacteric symptoms for 2 years,which she discontinued 3 years ago due to breast pain and a fear of breast cancer. She states her sex lifebefore surgery was active and satisfying. After the hysterectomy, her desire diminished considerably,although at first she was not too concerned about it. Lately, however, because of this lack of desire, shenow complains of quite a reduction in sexual activity which is also less satisfying. When she does haveintercourse, she experiences dyspareunia. She is now worried about it because it is affecting her qualityof life and negatively impacting her relationship with her husband.Over this past year, she has had a mammogram and general blood tests which were all normal.Prior medical history: Uterine fibroids. Prior surgical history: TAH 5 years agoCurrent medications: None. Allergies: Sulfa.OB- GYN History: NSVD x 2 (2014 and 2012). Menarche age 12, cycle length was 8 -10 days- frequencyevery 21 days- heavy flow with clots – tampons 5-6/day.LMP: 5 years ago. Contraception history: NoneSocial history: Lives with her husband and 2 children. Works as an attorney. Denies EtOH, smoking, orrecreational drug use.Family history: Mother – osteoporosis, thyroid disease. Father – prostate cancer. MGM – breast cancerdiagnosed at age 81 yo.Review of Systems (ROS): Unremarkable with exception of as noted in HPI.Physical Exam (PE)VS: BP: 134/78, P: 58, RR: 16, T: 98.8 Weight: 144 lbs., Height: 65 inches, BMI 24General 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: sparse hair distribution, pale and shiny – dry labia, no lesions, Mildintroital stenosis noted. SPECULUM/INTERNAL EXAM: Vaginal lining is thin and dry. Cervix: surgicallyabsent. UTERUS: surgically absent. ADNEXA: surgically absent.NRNP6552Week4CaseStudyTemplate.docxCase # (1, 2, 3 or 4) and Description of the Case Chosen:·Case 1: Debbie·Case 2: Wendy·Case 3: Randi·Case 4: RobertaOutline 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.NRNP6552week4cases.pdfNRNP 6552 Week 4 case study scenariosCase #1. Debbie.History of Present Illness (HPI): Debbie is a 19-year-old female G1P0010. She presents to your office as anew patient for GYN visit. Her chief complaint is mild lower abdominal pain and a copious amount ofvaginal discharge that started a little over 1 week ago. She is sexually active and reports having four malepartners in the last six months.Prior medical history: Depression, HSV-2. Prior surgical history: Surgical termination of pregnancy 1year agoCurrent medications: Lo loestrin Fe. Allergies: NoneOB- GYN History: Surgical TOP x 1. Menarche age 9, cycle length- 7 days- frequency every 28 days- 3 -4tampons per day. Hx of HSV-2. Never had pap smear.LMP: 2 weeks ago – normal. Contraception history: OCP since TOP 1 year ago.Social history: Lives parents. Denies ETOH or recreational drug use, never smoker. Graduated highschool. Not in college. Works FT as a waitress.Family history: Mother – depression. Father – unknownReview of Systems (ROS): Negative except as noted in HPI.Physical Exam (PE)VS: BP: 112/80, P: 72, RR: 16, T: 98.4, Weight: 110 lbs., Height 54 in, BMI 18.9 kg/m2• General: WDWN female in NAD• Abd: Soft, NT/ND, no masses/HSM• GU: No external lesions, no erythema. Mucopurulent endocervical exudate visible in theendocervical canal, sample obtained – cervix is friable. Mild CMT, no uterine tenderness, noadnexal tenderness, no masses.Case #2. Wendy.History of Present Illness (HPI): Wendy, a 33-year-old woman, presents to the office with c/o of a 7-month history of nipple discharge. She has noticed that her breasts are tender and both nipples producemilky discharge on applying mild pressure. She has not noted any bloody or clear nipple discharge,breast lumps, or skin changes. She also states she has not had a menstrual period for 7 months, and herperiods had been irregular for 8 months before they stopped altogether. Prior to her menstrualirregularities, her menses occurred at a normal frequency and duration. She is sexually active with asingle partner and is trying to conceive.Prior medical history: Headaches (past 6 months). Prior surgical history: NoneCurrent medications: ibuprofen 400mg daily. Allergies: NoneOB- GYN History: Spontaneous VD x 1. Menarche age 14, normal throughout life, until recentcomplaints. No history of sexually transmitted infections (STDs). Last pap smear age 31 years, normal.LMP: 7 months ago. Contraception history: None.Social history: Lives with husband and 5-year-old son. Elementary school teacher. ETOH: 1-2 glasseswine per month. No recreational drug use. Never smoked. Does not exercise. Last travel outside of thecountry – Italy 8 months ago.Family history: Mother – osteoporosis. Father (deceased age 80) – CVAReview of Systems (ROS): General: Fatigue over the past 3 months; Skin – No rash, excessive facial hairor acne; Gynecologic – Decreased libido. Vaginal dryness during sexual intercourse. She has been tryingto conceive for the last 2 years. One full-term, uncomplicated pregnancy 5 years ago; Neuro – 6-monthhistory of dull frontal and occasionally retro-orbital headaches that are increasing in frequency and thatnow occur almost daily. There are no associated neurologic symptoms. She denies nausea, photophobia,or phonophobia. Until 1 month ago, the headaches would resolve completely with ibuprofen, but for thelast month ibuprofen does not work. She denies history of headaches prior to 6 months ago.Physical Exam (PE)VS: BP: 133/68, P: 68, RR: 16, T: 97.3, Weight 134lbs, Height 64 inches, BMI 23 kg/m2Breast – No breast masses or skin changes. No axillary lymphadenopathy. Mild diffuse breast tendernesson palpation. Milky nipple discharge elicited bilaterally with pressure around areola.Skin – Normal color, no rash, hirsutism, or acne.Neuro- Normal and symmetric motor strength and reflexes on extremities. Sensation grossly intact tolight touch. Cranial nerves 2 through 12 intact. Gait and balance normal.Thyroid – no thyromegaly or nodulesCase #3. Randi.History of Present Illness (HPI): Randi, a 22-year-old female, presents to the clinic with c/o of a 3-dayhistory of thick white vaginal discharge, intense vaginal itching, and dysuria. She reports she is sexuallyactive with 1 partner. No history of STI’s. She had a recent sinus infection and was on amoxicillin x 10days.Prior medical history: None.Prior surgical history: None.Current medications: Mirena IUD – inserted last year. Allergies: SulfaSocial history: College student. Lives with mother. Denies smoking or recreational drugs. Vapes daily.Family history: Mother alive and well. Father alive and well. Sister – diabetes: uses insulin pumpOB- GYN History: Menarche age 13, cycle length 5 days – frequency every 28 days. No history ofsexually transmitted infections (STIs). Never had a pap smear.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: AAO x 3, pleasant.• Gynecological: EXTERNAL EXAM: mild erythema, white clumpy discharge. SPECULUM/INTERNALEXAM: Cervix: normal appearance, no lesions, no bleeding, white discharge, no cervicalmovement tenderness. UTERUS: normal size, shape, and consistency, normal mobility,nontender. ADNEXA: no masses or tenderness bilaterally.Case #4. Roberta.History of Present Illness (HPI): Roberta, a 53-year-old mother of two children, presents to your clinicwith c/o vaginal dryness and low sexual desire. She went into surgical menopause at the time of a totalhysterectomy for leiomyomas 5 years ago. She took HRT for severe climacteric symptoms for 2 years,which she discontinued 3 years ago due to breast pain and a fear of breast cancer. She states her sex lifebefore surgery was active and satisfying. After the hysterectomy, her desire diminished considerably,although at first she was not too concerned about it. Lately, however, because of this lack of desire, shenow complains of quite a reduction in sexual activity which is also less satisfying. When she does haveintercourse, she experiences dyspareunia. She is now worried about it because it is affecting her qualityof life and negatively impacting her relationship with her husband.Over this past year, she has had a mammogram and general blood tests which were all normal.Prior medical history: Uterine fibroids. Prior surgical history: TAH 5 years agoCurrent medications: None. Allergies: Sulfa.OB- GYN History: NSVD x 2 (2014 and 2012). Menarche age 12, cycle length was 8 -10 days- frequencyevery 21 days- heavy flow with clots – tampons 5-6/day.LMP: 5 years ago. Contraception history: NoneSocial history: Lives with her husband and 2 children. Works as an attorney. Denies EtOH, smoking, orrecreational drug use.Family history: Mother – osteoporosis, thyroid disease. Father – prostate cancer. MGM – breast cancerdiagnosed at age 81 yo.Review of Systems (ROS): Unremarkable with exception of as noted in HPI.Physical Exam (PE)VS: BP: 134/78, P: 58, RR: 16, T: 98.8 Weight: 144 lbs., Height: 65 inches, BMI 24General 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: sparse hair distribution, pale and shiny – dry labia, no lesions, Mildintroital stenosis noted. SPECULUM/INTERNAL EXAM: Vaginal lining is thin and dry. Cervix: surgicallyabsent. UTERUS: surgically absent. ADNEXA: surgically absent.12Bids(58)Dr. Ellen RMMISS HILLARY A+Sheryl HoganProf Double RProf. TOPGRADEEmily ClareDr. Sarah BlakeProWritingGurufirstclass tutorDr. Freya WalkerPROF_ALISTERFiona Davasherry proffMUSYOKIONES A+Dr ClovergrA+de pluspacesetters2121Jahky BColeen AndersonIsabella HarvardShow All Bidsother Questions(10)MGT 311 Week 5 Learning Team ReflectionHUM 266 Week 2 Individual Assignment Architecture PaperA public opinion poll that gauges the popularity of the President of the United States is an example of”I used to be indecisive. Now I’m not so sure” Please respond to the following:1. Dickinson’s letters to Higginson suggest that her highest ambition for her poetry is that it be aesthetically vitalpublishabletechnically unique2. Dickinson’s poems 130…”Financial Statement Accuracy”LAB ASSIGNMENT FOR PROGRAMMING CLASSfours hours.RE: rection paperANALYSIS PAPER FOR BLAW 280…I HAVE THE PAPER, AND A MADE AN ANALYSIS

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Home>Homework Answsers>Nursing homework helpAssignment OverviewThis assignment is intended to demonstrate your comprehension of the main principles of health informatics, as well as the primary applications of health informatics in healthcare organizations.For this assignment, you will read a case study that presents difficulties associated with implementing a new computer system in a professional setting. Based on the scenario described in the case study and assignment details, you will create a short PowerPoint presentation.Assignment Details:Perform the following tasks:· Complete the reading assignment and the interactive lesson before attempting this assignment.· To complete this assignment:o Review the case study and select one of the committee roles.o Download the provided PowerPoint template to create a presentation that includes:§ Your selection as a member on the committee§ Identification one or more issues, related to your role on the committee§ Identification of probable cause(s) of identified issue(s)§ Proposed recommendations to resolve the identified issues§ Reference slide – list of academic references, using APA styleo Ensure to support the content of your slides with research from your text or the LRC.ØCase StudyRead the following case studyA good friend of yours is director of nursing at a 220-bed community hospital. Last year the hospital merged with a much larger medical center. One of the upsides, as well as one of the challenges, resulting from this change has been the rapid introduction of new computer systems. The goal is to bring the hospital “up to speed” within 3 years.At present, the Computerized Physician Order Entry (CPOE) is being implemented. The general medical and surgical units went live last month. The ICU, pediatrics, and obstetrics units are scheduled to go live next month. The plan is to work out any kinks or problems on the general units and then go live in the specialty units. Most of the physicians, nurse practitioners, and physician assistants initially complained but are now becoming more comfortable with the computers and are beginning to integrate the CPOE process into their daily routines. Several physicians are now requesting the ability to enter orders from their offices and others are looking into this option. However, three physicians have not commented during this process but are clearly resisting.For example, after performing rounds and returning to their offices they called the unit with verbal orders. After being counseled on this behavior, they began to write the orders on scraps of paper and put these in the patient’s charts or leave them at the nurses’ station. When they were informed that these were not “legal orders,” they began smuggling in order sheets from the non-activated units. In addition, they have been coercing the staff nurses on the units to enter the orders for them. This has taken two forms. Sometimes they sign in and then ask the nurses to enter the orders. Other times they ask the nurses to put the orders in verbally and then they confirm the orders.The nurses feel caught between the hospital’s goals and the need to maintain a good working relationship with these physicians.You suggest to your friend (director of nursing) to create an informal committee to review the issues surrounding the CPOE implementation. The committee would determine methods to address these issues, prior to implementing CPOE within the ICU, pediatrics, and obstetrics units. Your friend appreciates the suggestion and forms a small committee with the following members:· Taylor Terrific, RN – a nurse practitioner· Dr. Dudley Do-Right – a physician who uses the CPOE system routinely and correctly· Dr. Frank Burns – a physician who rarely, if ever, uses the CPOE systemThe director of nursing asks each committee member to create a short PowerPoint presentation for the committee. The presentation would identify issues that occurred during CPOE implementation, identify potential causes of such issues, and list specific recommendations, based on strong rationale and research, to resolve the identified issues prior to the next CPOE implementation. Each committee member will have a unique perspective, based on their position (i.e., nurse, physician).PowerPoint PresentationDirections:1. Review the case study and select one of the committee roles.2. Download the PowerPoint template (Week 2 Assignment Template).· The link to this template can be found in your Blackboard course in Week 2.3. Select one of the following roles on the committee· Taylor Terrific, RN – a nurse practitioner· Dr. Dudley Do-Right – a physician who uses the CPOE system routinely and correctly· Dr. Frank Burns – a physician who rarely, if ever, uses the CPOE system4. Use the PowerPoint template to create slides that:· Identify one or more issues, related to your role on the committee· Identifies probable cause(s) of identified issue(s)· States proposed solutions or processes to address the identified issues§ Solutions are supported by specific rational and research.· Includes a reference slide – a list of academic references, using APA style5. Ensure to support the content of your slides by the case study, research from your text, or the LRC.CMP105_WK2AssignmentTemplate.pptx7 years ago20.07.201810Report issueAnswer(0)Bids(39)PROF washington watsonKATHERINE BECKSAll Works solverDr. Claver-NNmistyeyezMark_TomMaham MalikDr.TotianaDr. Equinox2.0One Touchgivbtrtmwbs1eguru answersTeacher TrumahnLindah-Proffbrilliant answersperfectowangang_akim woodsGlass HousePrincessMary tutorShow All Bidsother Questions(10)Watching “Buying the War”Case Study for International BusinessPublic Health Services QuestionsA+ WorkASS 4Human resource management planningFor Perfecto only H4down there !!Need someone to do a myfinancelab homeworkRisk management and Communications

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Home>Homework Answsers>Nursing homework helpevidencereate a PowerPoint presentation that addresses each of the following points/questions. Be sure to completely answer all the questions for each bullet point. Use clear headings that allow your professor to know which bullet you are addressing on the slides in your presentation. Support your content with at least three (3) sources using APA citations throughout your presentation. Make sure to cite the sources using the APA writing style for the presentation. Include a slide for your references at the end. Follow best practices for PowerPoint presentations related to text size, color, images, effects, wordiness, and multimedia enhancements. Review the rubric criteria for this assignment.Identify an evidence based practice model and change theory that has been defined in Chapters 13 and 14 of the textbook (Melnyk and Fineout-Overholt, 2015). Describe in detail how you would utilize the practice model ( The  Iowa model of evidence based practice.) and change theory ( Roger’s theory of diffusion of innovations) to implement an evidence-based practice change in your clinical practice environment, related to your research topic. Clinical practice guideline towards the prevention of neck pain among adults. therapy  over medication).Title Slide (1 slide)Objective Slide (1 slide)Identify an evidence-based practice model and change theory that has been defined in Chapters 13 and 14 of the textbook (Melnyk and Fineout-Overholt, 2015). (2-3 slides).Describe in detail how you would utilize the practice model and change theory to implement an evidence-based practice change in your clinical practice environment, related to your research topic. (6-8 slides)References (1 slide)Assignment Expectations:Length: 8-14 slidesStructure: Include a title slide, objective slide, content slides, reference slide in APA format. Title/Objective/Reference slides do not count towards the minimum slide count for this assignment.References: Use appropriate APA style in-text citations and references for all resources utilized to answer the questions. A minimum of three (3) scholarly sources are required for this assignment.6 years ago02.04.201920Report issueAnswer(1)Wendy Lewis4.5(2k+)4.8(194)ChatPurchase the answer to view itPracticeModelandChangeTheory.pptx6 years agoplagiarism checkPurchase $20Bids(57)Sheryl HoganMichelle MalkRanju LewisHELPCLICKJah ProvidesTalentedtutorProCastrol01Discount WriterMukul5078GemSTARRosie SeptemberSuper GeekDr_Aabirah_786Doctor Coopersprof. SpeedstarReem HasanKATHERINE BECKSMichelle Owensbrilliant answersWendy Lewisother Questions(10)Perfect answer to DQMAT 510 Case Study 2: Improving E-Mail Marketing Response HelpHR 595 week 4 assignment-Marilyn and Len exchangesKim woods – UnileverOutline for the Final Paper WEEK 2Unit VIII Case Study (For hifsa shaukat Only) Project Management Strategy and TacticsIf you could witness any of the events and locations covered in our readings this week, what would you wish to see and why? Which event do you think is most significant for the development of Western civilization?Anthropology paperFacial RecognitionHistory about Russian Empire

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Home>Homework Answsers>Nursing homework helpIOM Future of Nursing Report and NursingReview the IOM report, “The Future of Nursing: Leading Change, Advancing Health,” and explore the “Campaign for Action: State Action Coalition” website. In a 1,000-1,250 word paper, discuss the influence the IOM report and state-based action coalitions have had on nursing practice, nursing education, and nursing workforce development, and how they continue to advance the goals for the nursing profession.Include the following:Describe the work of the Robert Wood Foundation Committee Initiative that led to the IOM report, “Future of Nursing: Leading Change, Advancing Health.”Outline the four “Key Messages” that structure the IOM Report recommendations. Explain how these have transformed or influenced nursing practice, nursing education and training, nursing leadership, and nursing workforce development. Provide examples.Discuss the role of state-based action coalitions. Explain how these coalitions help advance the goals specified in the IOM report, “Future of Nursing: Leading Change, Advancing Health.”Research the initiatives on which your state’s action coalition is working. Summarize two initiatives spearheaded byyourstate’s action coalition. Discuss the ways these initiatives advance the nursing profession.Describe barriers to advancement that currently exist in your state and explain how nursing advocates in your state overcome these barriers.You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.You are required to submit this assignment to LopesWrite. Refer to theLopesWrite Technical Support articlesfor assistance.IOM and Future of Nursing Report and Nursing ProfessionNo of Criteria: 10 Achievement Levels: 5CriteriaAchievement LevelsDescriptionPercentageUnsatisfactory0.00 %Less Than Satisfactory75.00 %Satisfactory79.00 %Good89.00 %Excellent100.00 %Content80.0Robert Wood Foundation Committee Work and IOM Report10.0A description of the work of the Robert Wood Foundation Committee Initiative that led to the IOM report is omitted.An incomplete description of the work of the Robert Wood Foundation Committee Initiative that led to the IOM report is presented.A summary of the work of the Robert Wood Foundation Committee Initiative that led to the IOM report is presented. There are inaccuracies or misinterpretations.A description of the work of the Robert Wood Foundation Committee Initiative that led to the IOM report is presented. There are slight inaccuracies.A clear and accurate description of the work of the Robert Wood Foundation Committee Initiative that led to the IOM report is presented.Key Messages Transforming Nursing15.0The four key messages are omitted.Fewer than four key messages are presented, and the messages contain inaccuracies. An incomplete discussion on how they transformed nursing is presented.The four key messages that structure the IOM report are generally outlined. A summary of how these transformed some aspects of nursing is presented, but there are some inaccuracies.The four key messages that structure the IOM report are outlined. A description of how these transformed key aspects of nursing is presented.The four key messages that structure the IOM report are clearly outlined. A description of how these transformed nursing practice, nursing education and training, nursing leadership, and nursing workforce development are thoroughly discussed.State-Based Action Coalitions and Their Help in Advancing Goals form IOM Report15.0The role of state-based action coalitions is omitted.The role of state-based action coalitions is incomplete. It is unclear how these advance the goals in the IOM report.The role of state-based action coalitions is summarized. A summary of how they help advance the goals in the IOM report is presented.The role of state-based action coalitions is discussed. A discussion of how they help advance the goals in the IOM report is presented.The role of state-based action coalitions is thoroughly discussed. A detailed and accurate discussion of how they help advance the goals in the IOM report is presented.State Action Coalition Initiatives Advancing Nursing Profession20.0Initiatives spearheaded by a state action coalition are omitted.Only one initiative spearheaded by a state action coalition is presented. The narrative contains omissions and inaccuracies. How these initiatives advance the nursing profession are incomplete.Two initiatives spearheaded by a state action coalition are summarized. How these initiatives advance the nursing profession are generally discussed. There are some inaccuracies.Two initiatives spearheaded by a state action coalition and how they advance the nursing profession are discussed.Two initiatives spearheaded by a state action coalition and how they advance the nursing profession are thoroughly discussed. The discussion demonstrates a clear understanding of the state action committee and the role in advancing the nursing profession.Barriers to Advancement20.0Barriers to advancement that currently exist in the state are omitted. How nursing advocates in the state overcome barriers is omitted.Barriers to advancement that currently exist in the state are unclear. How nursing advocates in the state overcome barriers is incomplete.Barriers to advancement that currently exist in the state are presented. How nursing advocates in the state overcome barriers is summarized. There are inaccuracies, or more information is needed.Barriers to advancement that currently exist in the state and how nursing advocates in the state overcome barriers are described.Barriers to advancement that currently exist in the state are thoroughly explored and how nursing advocates in the state overcome barriers are thoroughly described.Organization, Effectiveness, and Format20.0Thesis Development and Purpose5.0Paper lacks any discernible overall purpose or organizing claim.Thesis is insufficiently developed or vague. Purpose is not clear.Thesis is apparent and appropriate to purpose.Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.Argument Logic and Construction5.0Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.Argument shows logical progression. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.Clear and convincing argument presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.Mechanics of Writing (includes spelling, punctuation, grammar, language use)5.0Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used.Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used.Writer is clearly in command of standard, written, academic English.Paper Format (use of appropriate style for the major and assignment)2.0Template is not used appropriately, or documentation format is rarely followed correctly.Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.Appropriate template is used. Formatting is correct, although some minor errors may be present.Appropriate template is fully used. There are virtually no errors in formatting style.All format elements are correct.Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)3.0Sources are not documented.Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.Sources are documented, as appropriate to assignment and style, and format is mostly correct.Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.Total Percentage  1006 years ago26.10.201925Report issueAnswer(2)Harvard Research(Not rated)(Not rated)ChatPurchase the answer to view itNOT RATEDSolution.docx6 years agoplagiarism checkPurchase $20kim woods4.5(6k+)4.2(157)ChatPurchase the answer to view itNOT RATEDorder_128712_334714.doc6 years agoplagiarism checkPurchase $25Bids(84)Great-WritersProf Double RProf. MintellaQuality AssignmentsMichel Owenns”Madam MichelleGuru OliviaYourStudyGuruDiscount AssignPapersGuruAmanda SmithOriginal GradeDr_Hakuna_MatataProf James KelvinMarissa jonesteacher CharlesPROF washington watsonProfessor LizzUrgent Tutoruniversity workother Questions(10)Philosophy PaperportfolioDQ 1Improve your listeningCity of SmithvilleA project on my class. Introduction to Business in the Global EnvironmentStaffing the Organization 4Human leaningHIS204 Week 2 – Discussion 1 FOR SUZIKANE8 ONLY!!!!!MGT 498 Week 2 Individual Assignment Ethics Paper

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