The Assignment

1. Analyze the subjective portion of the note. List additional information that should be included in the documentation.
2. Analyze the objective portion of the note. List additional information that should be included in the documentation.
3. Is the assessment supported by the subjective and objective information? Why or why not?
4. What diagnostic tests would be appropriate for this case, and how would the results be used to make a diagnosis?
5. Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

ABDOMINAL ASSESSMENT

Subjective:

• CC: “My stomach hurts, I have diarrhea and nothing seems to help.”
• HPI: JR, 47 yo WM, complains of having generalized abdominal pain that started 3 days ago. He has not taken any medications because he did not know what to take. He states the pain is a 5/10 today but has been as much as 9/10 when it first started. He has been able to eat, with some nausea afterwards.
• PMH: HTN, Diabetes, hx of GI bleed 4 years ago
• Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10 units qhs
• Allergies: NKDA
• FH: No hx of colon cancer, Father hx DMT2, HTN, Mother hx HTN, Hyperlipidemia, GERD
• Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

• VS: Temp 99.8; BP 160/86; RR 16; P 92; HT 5’10”; WT 248lbs
• Heart: RRR, no murmurs
• Lungs: CTA, chest wall symmetrical
• Skin: Intact without lesions, no urticaria
• Abd: soft, hyperactive bowel sounds, pos pain in the LLQ
• Diagnostics: None

Assessment:

• Left lower quadrant pain
• Gastroenteritis

 

1) Minimum 6 full pages and Template (Follow the 3 x 3 rule: minimum three paragraphs per part)

              Part 1: complet the Template (Literature Evaluation Table _see File 1)

              Part 2: minimum 1 page

              Part 3: minimum 2 pages

              Part 4: minimum 1 page

              Part 5: minimum 2 pages

Submit 1 document per part

2)¨******APA norms

          All paragraphs must be narrative and cited in the text- each paragraphs

          Bulleted responses are not accepted

          Dont write in the first person 

          Dont copy and pase the questions.

          Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

    Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks) 

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 3 references per part not older than 5 years

   Part 1 Minimun 6 References not older than 5 years

   Part 1 Minimun 4 References not older than 5 years

5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.doc 

__________________________________________________________________________________

Part 1:  Nursing Research

Topic: Middle-aged women, type 2 diabetes, and medication

  1) you will create a clinical guiding question know as a PICOT question. 

The PICOT question must be relevant to a nursing practice problem. 

2) To support your PICOT question, identify six supporting peer-revised research articles. 

The PICOT question and six peer-reviewed research articles you choose will be utilized for subsequent assignments.

 They are not allowed :

Systematic Reviews

Literature Reviews

Metanalysis articles 

Use the “Literature Evaluation Table” to complete this assignment.

Format: 

1) Select a nursing practice problem of interest to use as the focus of your research (See topic). 

 

2. Start with the patient population and identify a clinical problem or issue that arises from the patient population. In 200 minimum words, provide a summary of the clinical issue.

3) Write a PICOT question in your selected nursing practice problem area of interest, following the PICOT format,

4) Conduct a literature search to locate six research articles focused on your selected nursing practice problem of interest. 

This literature search should include three quantitative and three qualitative peer-reviewed research articles to support your nursing practice problem.

They are not allowed :

Systematic Reviews

Literature Reviews

Metanalysis articles 

Part 2: Nursing and Ethics

Case: 

  

Last year a jury returned a $20 million negligence verdict against Arkansas Children’s Hospital for surgery performed on the wrong side of the brain of a 15-year-old boy who was left psychotic and severely brain damaged. Testimony showed that the error was not disclosed to his parents for more than a year. The hospital issued a statement saying it deeply regretted the error and had “redoubled our efforts to prevent” a recurrence. 

So, what happened? “Health care has far too little accountability for results … . All the pressures are on the side of production; that’s how you get paid,” said Peter Pronovost, a prominent safety expert and medical director of the Johns Hopkins Center for Innovation in Quality Patient Care. He added that increased pressure to quickly turn over operating rooms has trumped patient safety, increasing the chance of error. 

Kenneth W. Kizer, who coined the term “never event” nearly a decade ago when he headed the National Quality Forum, a leading patient safety organization, said he believes reducing the number of errors will require tougher reporting rules and increased transparency. 

 

Assignment Discussion Questions

1. Discuss the issues of integrity in this case.

2. Should criminal charges be considered in this case, if accurately reported? Discuss your answer. 

3. Why did you choose to respond to this story?

4. How is integrity displayed in your clinical setting?

 

Part 3: Curriculum Design 

Topic: Regulations Paper

Review the California Board of Registered Nursing regulations for nursing education programs (https://www.rn.ca.gov/9. 

For a list of boards, search on this website https://www.ncsbn.org/education.htm

After reviewing the information, compose a paper that addresses the following components. 

1. Describe how these regulations affect the process of curriculum development or redesign in nursing programs.

2. What is the job of the regulatory commission as it pertains to nursing education?

3. What are the guidelines or standards and how do they affect curriculum development?

4. Are there different regulations for curriculum development for a face-to-face course versus online course?

5. How will these regulations affect you as a nurse educator?

Part 4:  Primary Care

 

Topic: Helping and Healing Relationships

Consider the various steps of the nursing process in order to address the following critical thinking questions.

1. As a healthcare provider, discuss ways in which you will establish a helping hand and healing relationship with your patient and their families.

2. How will you develop professional partnerships with health care team members in your clinical practice?

3. What personal behaviors, biases, and attitudes would you have to change to develop these professional relationships?

Part 4:  Health Assessment

 

Case Study:

Sarah Smith is a 28 y/o African American female who presents to the office with c/o wound to her left foot for the past few days. States she had tripped and fell while barefoot scraping the top of her foot on the pavement. She denies any other injury from the incident. Over the past 24 hours the wound has had “smelly” drainage. Has been experiencing generalized achiness, but denies fever and chills. Did not seek medical attention at the time of injury. Has been using hydrogen peroxide to clean her wound. Is unclear of her last tetanus vaccination. Patient PMHx significant for DM II. States that she takes her medications when she remembers, and does not always check her blood sugar. 

Mandatory:

Check Soap Note File 5

 

1. List your differentials for her current problems. Remember you should have at least three different differentials for each problem. Include rationale for each differential.

2. At this time what medical diagnoses are you most concerned about? Do they impact other diagnoses? If so, how?

3. What diagnostic images would you order? Provide your rationale. What are you trying to rule in or out?

4. What laboratory work would you order? What would you anticipate to be abnormal? Provide your rationale for each.

5. What is your comprehensive plan of care? Include your rationales.

In an interesting study I recently read about childhood obesity, a molecular marker in saliva was found to be associated with the emergence of childhood obesity in a group of preschool-aged Hispanic children. Crazy, isn’t it?! The investigators found that methylation of a gene called NRF1, which has roles in adipose tissue inflammation, was associated with childhood obesity. A child with the NRF1 methylation at baseline had a threefold increased odds of being obese three years later, after controlling for maternal BMI and other factors. What do you think would be helpful to families who find out their child has an increased disposition towards obesity? I would be interested in hearing your thoughts.

Module 3 – SLP

MANAGING HUMAN RESOURCES

You have identified your health problem as well as your prospective funding source; in addition, you have outlined your project concept. The next step in the process will be to determine how much you will need to carry out your project, i.e., determine your project budget. This entails not only delineating a “bottom line” but specifically how funds will be used line by line, i.e., budget line items.

Go to this sample budget and budget narrative, an addendum to your budget in which you essentially justify each of your line items.

Some funders provide budget detail sheets that you can use to create your budget:

Example 1.

Example 2.

Please submit your project budget and budget narrative at the conclusion of this module.

Length: The SLP assignment should be 2 pages long (double-spaced).

SLP Assignment Expectations

Assessment and Grading: Your paper will be assessed based on the performance assessment rubric that is linked within the course. Review it before you begin working on the assignment.

Your submission should meet the guidelines on file format, in-text citations and references, scholarly sources, scholarly writing, and use of direct quotes noted under Module 1 Assignment Expectations.