All posts by : chebby

video and answer 

You will take on the role of a clinician who is building a health history:

CASE #2

Chief Complaint: “I have pain during intercourse and urination”

History of Present Illness (HPI): A 19-year-old female reports to you that she has “sores” on and in her vagina for the last three months.

Drug Hx: She tries to practice safe sex but has a steady boyfriend and figures she doesn’t need to be so careful since she is on the birth control pill

Subjective: states “I have sores and bumps on the inner creases of my thighs and pelvic area”. “There is yellowish discharge from the sores that comes and goes”

Objective Data: VS temperature: 100.2°F; pulse 92; respirations 18; BP 122/78; weight 156 lbs, 25 lbs overweight; height 5′3″

 General: patient appears to have good hygiene; minimal makeup, pierced ears, no tattoos; well nourished (slightly overweight); no obvious distress noted

HEENT: Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip.

Lungs: within normal limits, appropriate lung sounds auscultated, clear and equal bilaterally

Card: S1S2 without rub or gallop

Breast: • INSPECTION: no dimpling or abnormalities noted upon inspection
• PALPATION: Left breast no abnormalities noted. Right breast: denies tenderness, pain, no abnormalities noted.

Lymph: Inguinal Lymph nodes: tenderness bilaterally, numerous, 1 cm in size

Abd: tender during palpation; the left lower quadrant was very tender during palpation; patient denies nausea or vomiting

GU: labia major and minor: numerous ulcerations, too many to count; some ulcerations enter the vaginal introitus; no ulcerations in the vagina mucosa; cervix is clear, some greenish discharge; bimanual exam reveals tenderness in left lower quadrant; able to palpate the left ovary; unable to palpate the right ovary; no tenderness; uterus is normal in size, slight tenderness with cervical mobility

MS: Muscles are smooth, firm, symmetrical. Full ROM. No pain or tenderness on palpation.

Neuro: No obvious deficits and CN grossly intact II-XII

THEN, answer the following questions:

1. What other subjective data would you obtain?
2. What other objective findings would you look for?
3. What diagnostic exams do you want to order?
4. Name 3 differential diagnoses based on this patient presenting symptoms?
5. Give rationales for your each differential diagnosis.
6. What teachings will you provide?

*Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources

Describe one innovative health care delivery model that incorporates an interdisciplinary care delivery team. Explain how this model is advantageous to patient outcomes.

Due Date Thursday 3

 Assignment: 

Respond to at least two of your colleagues who argued the opposite side as you by countering their argument with evidence. Identify at least two consequences to support your position.

Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format. 

Response Post #1

Against Diagnosing Pediatric Patients with Bipolar Disorder

           Bipolar disorder is genetic, and 60 to 90 percent of studies on twins indicates that it is passed down from generation to generation. Studies indicate that changes in the prefrontal cortex and subcortical area of the brain are associated with bipolar disorder (Sadock & Ruiz 2014).   Bipolar Disorder is a persistent mental health disorder that occurs with severe and single mood swings, either high with a lot of energy or low with a feeling of depression, according to the National Institute of Mental Health (2018).   The genetic aspect of Bipolar Disorder causes signs to be seen in pediatric patients and in the DSM-5 manual without meeting the diagnostic criteria.

           According to the DSM-5 manual, hypomanic or manic episodes (talkative, a flight of thoughts, diminished need for sleep, distractibility, high-energy agitation, and outburst) are the diagnostic criteria for Bipolar Disorder (APA, 2013).  This diagnosis criterion is close to the Attention-Deficit / Hyperactive Disorder criteria. ADHD requirements include (flight of thoughts, concentration difficulty, non-stop conversation, higher energy, etc.) (APA, 2013).  Therefore, an ADHD child with Bipolar Disorder is extremely likely to be misdiagnosed.

           The American Association of Psychology recognized children’s irritability, rage, and mood swings and agreed to add another diagnosis; Destructive Mood Dysregulation Disorder  (APA, 2013). Chronic irritability in between periods of rage or temper tantrums seen in the Bipolar Disorder criteria is the main characteristic of DMDD.  Diagnosis of DMDD is a child-specific symptom that aids in the proper care and removes the controversies in children around Bipolar Disorder.  There is a need to be particular when diagnosing children.  Developmental and hormonal changes in children have their psychological effects and may be temporary.  Therefore, other treatment options should be explored before rushing to diagnose a child with Bipolar Disorder. 

Response Post #2

Against

Pediatric Bipolar Depression Disorder Debate

           Pediatric Bipolar Depression Disorder (PBDD) has been a controversial subject for decades. The concept of PBDD came about by United States researchers in the middle of the 1990s (Duffy, Carlson, Dubicka, & Hillegers, 2020). The following will provide information that supports that PBDD is not an appropriate diagnosis for children.

Against the Diagnosis

According to the diagnostic criteria form the DSM-5, pediatric diagnosis of Bipolar Depression Disorder can be made with irritability rather than depression, sleep disturbances, psychomotor agitation, inappropriate guilt, problems concentrating, fatigue, and/or thoughts of death. The question I present is: How does a provider determine if those symptoms are due to trauma, ADHD, or other mental health concerns? Another question is: Why is the United States the one country who embraces the diagnosis of PBDD?

A case review highlighted by the NCTSN showed that a 12 year old child who had been subjected to extreme neglect, sexual abuse, domestic violence, and parental substance use was diagnosed with Oppositional Defiant Disorder and Pediatric Bipolar Disorder (2019). Further screening and assessment by a trauma-informed clinician found that the symptoms she was presenting was linked to complex trauma. Perry and Levin (2012) highlighted that not only trauma, but ADHD, can lead to the presentation of symptoms that are congruent with the diagnosis of PBDD.

In the facility I work, we provide trauma-informed care. Many of the children we care for are diagnosed with ADHD, anxiety, ODD, and Bipolar Disorder. We are finding that once we have switched to trauma informed care, children are leaving our care with LESS diagnoses. Duffy et al. (2020) highlights that the determination of PBDD does not take into account the environmental factors, social factors, and adverse childhood factors that may be contributing to the presenting symptoms.

Conclusion

           The controversy of over medicating children and causing significant long-term harm has been an issue that all providers need to be aware of. What if a child is diagnosed with PBDD and treated with medications that are not warranted? What if a trauma-informed approach could decrease or even eliminate the symptoms? Are you willing to make a lifelong diagnosis, treat the child with medications that may be unnecessary and harmful, and not take into account the possibility of a childhood disorder or trauma?  I know I am not.

Health history and discussing Testicular self exam or Breast self exam. Template provided to know what questions to ask. Just needs filled in and then a 2 page reflection. 

Due Tuesday 

Chapter 16, 17, and 18

Each chapter has 10 questions and must be answered with 100 words on each question explaining how you arrived at the answer.

Directions

1. Please review the infographic as way to guide you in getting started with your assignment: Developing an Assignment with Integrity (Links to an external site.)
2. View a short tutorial with tips for completing this assignment: iCARE Paper Tutorial (Links to an external site.)
3. Getting Started: Interprofessional teams are part of practice trends we see developing in all aspects of care delivery. Consider you own work environment (or recent clinical setting).
   • For this assignment, consider the concept of interprofessional teamwork and patient outcomes.
   • Look to your current workplace as an example. (If you are not currently employed, look to a past workplace or clinical practice area.)
   • Apply the components of the iCARE concept to interprofessional teams in a short paper. (Body of the paper to be 3 pages, excluding the title page and references page)
   • iCARE components are:
     • C ompassion
     • A dvocacy
     • R esilience
     • E vidence-Based Practice (EBP)
   • How could you contribute to an interprofessional team and patient outcomes through nursing actions of: compassion, advocacy, resilience, and evidence-based practice?
4. Select one scholarly nursing article from CINAHL as a resource for your paper.
   • Additional scholarly sources can be used but are optional.
   • When searching in the CINAHL database, please limit your search word to one component of the paper you wish to emphasize, such as ‘Resilience’.  Searching for the term iCARE will not produce the results you need.
5. Elements of iCARE paper
   • Title page
   • Below are the headings to be used for this assignment.
     • Introduction: (No heading needed here in APA) Explain the type of work setting you are discussing and whether interprofessional teams are currently present. If interprofessional teams are present, indicate a team function that could be improved. If interprofessional teams are NOT present, indicate what type of team you think might be possible in the setting.
     • Describe a nursing action item for each component below that could contribute to: interprofessional team support; how this might impact the culture of your unit or organization; and possible impact on patient outcomes.
       • Compassion
       • Advocacy
       • Resilience
       • Evidence-Based Practice
     • Summary: Include a summary statement of how iCARE components can support interprofessional teams and patient outcomes. Address how you may be able to influence this process of support for interprofessional teams overall in your unit or organization.
     • References: List any references used in APA format.

Templates

The prepared paper template is RECOMMENDED for this assignment.

iCare Assignment Template (Links to an external site.) – APA 6th edition

iCare Assignment Template – APA 7th edition

Best Practices  

• Please use your browser’s File setting to save or print this page.
• The template provided is recommended.
• Spell check for spelling and grammar errors prior to final submission. 
• Use the rubric as a final check prior to submission to ensure all content is clearly addressed. 

Scholarly Sources and Citations 

• Use APA format for citations and references.
• Please paraphrase throughout. One short quote is permitted.

Final Retrospective Research Proposal

Must submit the Retrospective Records Review Research Proposal in (Word Doc) and create a data collection sheet (Excel) showing the variables you would be collecting. ( find excel sample online)

*Reminder*
You are not collecting any data, you are not reviewing patient information. You are creating a proposal as if you were submitting it to an Institutional Review Board.

Find any data online to collect information to match the criteria from the sample attached to this assignment.

This is a nursing-related assignment

Must cite any sources 

Must answer all questions.

Must follow the sample to answer all questions.

Plagiarism free

• Why does the tax law provide preferential rates on certain capital gains?
• Describe three basic tax planning strategies available to taxpayers investing in capital assets.

Initial/Original Post

Please post what you view as the appropriate responses to the above prompts. Your initial post should be 250-300 words. Please provide response with a clear, well-formulated thesis; sentence structure, grammar, punctuation, and spelling count. Support ALL posts with appropriate rationale and citations from readings; document sources using APA format.

Students are required to submit readability statistics of their writing for each of one-page reflection in APA forma.

Address the following reflection prompts:

Define and describe “social determinants of health”. Suggest strategies that nurses can implement to address the effects of these social determinants on the health of a community.