Please, post a response to the following discussion in APA format without cover page, one paragraph, using one reference from peer-reviewed Nursing Journal not older than 5 years.

     Abdominal Assessment

Performing a thorough assessment is an essential skill. The treatment for any client is based on the diagnosis, and that diagnosis relies entirely on the assessment. To assess a 78-year-old male with a chief complaint of abdominal pain, bloody diarrhea, fever, and weight loss; there are many important factors to take into consideration. First, it is crucial to assess more in-depth the chief complaint, known as a history of current illness. These will include an assessment of the abdominal pain following the pqrst. Also, an assessment of his bowel movement (diarrhea), when did it started, what causes it, what makes it subsides; did he took anything to stop it, did he had any changes in his eating habits, ask him to describe his bowel movements, and did any nausea or vomiting accompany it. Next, an assessment of the fever to find out when did start it, what was his highest temperature reading, what causes the fever to subside, was he exposed to any diseases like Clostridium difficile or food poisoning and is it accompanied by chills. Additionally, an assessment of his weight loss to see how much weight did he lost and in how long, was the weight loss intentionally, what type of diet does he follows, is there any cultural or belief factors that affect his diet.  

After the history of the current illness is obtained, the assessment continues into the risk factors. These will include a list of medications, and if the client is taking any NSAIDs or blood thinners; food, drugs, and environmental allergies; use of tobacco, alcohol and recreational drugs; history of vaccinations and traveling out of the country; past medical history (PMH), past surgical history (PSH), family history, previous hospitalizations, history of previous gastrointestinal (GI) problems like GERD, peptic ulcers, inflammatory bowel disease (IBD), anemia, and celiac disease, history of previous diagnostics GI tests and results like endoscopies and lab work. Also, assessment of living conditions, whom does he lives with, who prepares his meals, does he has access to drinking water and electricity. Even though certain diseases are not common in the US, the healthcare provider should never exclude them from the assessment. Assessing for parasitic diseases is a critical component for patients with GI symptoms and fever. Even though is more common in developing countries, it should not be ignored in the US. Commonly caused by ingestion of contaminated food or water, parasitic diseases are often misdiagnosed for tumors. The common symptoms are abdominal pain, diarrhea, bloody stool, fever, and weight loss (Çiftci, Bulut, Özdaş & Yıldırım. 2018). Amebomas are variable in sizes and on assessment are found as a palpable mass that causes obstructive symptoms and mimics many other diseases.

The next step is the physical examination. These start with the inspection, looking for the color, contour, size, shape,  pulsations, and lessions (Jensen, 2015). Then, the assessment continues with the auscultation of the bowel sounds over the four quadrants and the vascular sounds. The next step is percussion of the four abdominal quadrants assessing for the size of the organs and looking for tympanic sounds over the hollow areas and dullness over the organs, masses, fluids or obstructions (Jensen, 2015). The palpation is performed at the end, beginning with light palpation and assessing for pain, then follow by deep palpation to check for organs, masses, or tenderness (Jensen, 2015).

The documentation of the assessment findings is done using the SOAP format. All subjective data is documented under S, and all objective data is documented under O.  The assessment or diagnosis is written under A., And the plan of treatment is documented under P.

I need help with the following question from the book above. 

Ø  Write a critique of the spiritual formation text, 4–6 pages in length.

Ø  Structure

§  Give a general summary of the book’s contents.

§  Assess the book’s strengths and weaknesses.

§  For what type of audience and purpose is the book best suited?

§  How might the book be improved?

OVERVIEW:

Nursing, client, wellness, and environment are defined according the personal attitudes, behaviors, beliefs and values of the professional nurse. State your personal philosophy about the profession of nursing.

PROCESS

1.  APA format 1-2 pages (minimum 1 page)

2.  Develop your personal philosophy based upon one of the Standards of Practice outlines by the American Nurses Assoc.(ANA). 

Standards of Nursing Practice.

i.e., Standards of Care for Critical Care Nursing/Standards of Care for Pediatric Nursing etc.

3. Identify at least three Standards and describe how your personal philosophy is 

congruent with the standards identified

4. Use PEER Reviewed articles from Nursing Journals.

Marquis & Huston (2017).Leadership Roles and Management Functions in Nursing Theory to Application (9th ed.) Wolters Kluwer/Lippincott

The need to improve the nutrition of the elderly living in residential long term care is well recognized. This assignment involves a research review, formulation of questions for your observation of elderly meal times and a final response. 

A. Watch video A holistic approach, when working with people with dementia, leads to an improved quality of life. Eating and Drinking well: supporting people living with dementia (Links to an external site.)Links to an external site.

1. Questions: Food and Drink availability concerns – Food is associated with many activities and events. To improve good nutrition:
   • What was done to help make nutritious foods available to the patient?
   • How is the possibility of dehydration addressed? What is the fluid volume recommended?
   • What are special tools suggested to improve eating?
   • Preferences may change with age. What is done to help improve eating?
   • How does the environment affect eating?
2. Questions: Food and Drink through activity (min 11:30 – 12:00, 14:36)

•  How does knowing the story of the patient help improve overall nutrition?

1. Questions: Communication and relationships (min 20:47 – end)

•  How does good communication with staff improve nutrition?

B. Reading: “Best Practices for Nutrition, Food Service and Dining in Long Term Care Homes.” (http://www.dietitians.ca/Downloads/Public/2013-Best-Practices-for-Nutrition,-Food-Service-an.aspx (Links to an external site.)Links to an external site.)

1. What would you do to ensure texture changes are adequate for dysphagia?
2. How would you reduce polypharmacy regarding laxative use?
3. How would you induce a positive dining experience?
4. What are some tips you would enact to train your servers?

C. Reading: “Effectiveness of mealtime interventions on nutritional outcomes for the elderly living in residential care: A systematic review and meta-analysis“, R. A. Abbott

• Write five observation questions you would focus on based on the reading. Some suggestions are ‘mode of food presentation’ and ‘dining environment.’ Collaborate with the your group to finalize observation questions. 

Observation: You have two choices. Either visit on-site: Extra credit point for observing at Woodland Country Manor, Sommerville Road (Breakfast 7 am, lunch 11:30 am, dinner 4:30 pm) OR find one additional video showing elderly eating at meals. 

Final Response requirements. 

1. What are some of the most important steps needed to improve and/or maintain good nutrition?
2. What assessments/interventions would be important to conduct?
3. What  did you observe either in person or from the additional video? (Summarize your observations and reference the video.)
4. How did your observations compare with the information you gathered in the literature?