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Systems Theory – 2025 Application Systems Theory As noted in the Learning Resources systems theory provides a meaningful and beneficial means of

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Systems Theory – 2025

Application: Systems Theory

As noted in the Learning Resources, systems theory provides a meaningful and beneficial means of examining challenges in health care organizations. To do this effectively, however, it is essential to assess all system components, as some may be relatively healthy while others are problematic.

For this Assignment, you apply systems theory to the examination of a problem in a department or a unit within a health care organization. (Note: You may use the same problem you identified for the Discussion as long as it meets the criteria for this assignment.)

To prepare:

Review the Meyer article, “Nursing Services Delivery Theory: An Open System Approach,” in this week’s Learning Resources. Focus especially on the information presented in Table 1 (p. 2831) and Figure 2 (p. 2833).
Reflect on your organization or one with which you are familiar ( Refer to the first discussion you did for me, My organization is a hospital University of Maryland Medical center) . Within a particular department or unit in this organization, identify a problem the staff is encountering.
Using Table 1 in the Meyer article as a guide, analyze the department or unit, identifying inputs, throughput, output, cycles of events, and negative feedback. Consider whether the problem you have selected relates to input, throughput, output, cycles of events, and/or negative feedback.
Think about how you could address the problem: Consider what a desired outcome would be, then formulate related goals and objectives, and translate those goals into policies and procedures.
Research professional standards that are pertinent to your identified problem.
Reflect on the organization’s mission statement and values. In addition, consider how addressing this problem would uphold the mission and values, while improving the organizational culture and climate. (Depending on the organization you have selected, you may have explored these in the Week 1 Discussion.)

To complete:

Write a 4- to 5-page paper (page count does not include title and reference page) that addresses the following:

(1) Describe a department or unit within a health care organization using systems theory terminology. Include a description of inputs, throughput, output, cycles of events, and negative feedback.
(2) Describe the problem you identified within the department or unit using an open- systems approach, and state where the problem exists using the systems theory model (input, throughput, output, cycles of events, or negative feedback).
(3) Based on this information, explain how you would address the problem as follows:

(a) Formulate a desired outcome.

(b) Identify goals and objectives that would facilitate that outcome.

(d) Describe relevant professional standards.

(4) Explain how your proposed resolution to the problem would uphold the organization’s mission and values and improve the culture and climate.

Guidance for Application Assignments:

Application Assignments require a title page, introduction, body of the paper, conclusion, and reference page. The title page needs to follows APA style and includes a title, student name, course number and section, and date. An abstract is not required. APA style headings are to be used appropriately to separate and organize sections of the paper. The use of direct quotes is discouraged and should only be used when the source material uses language that is particularly striking or notable. The introduction should provide an overview of the topic, the purpose of the paper, and topics that will be addressed. The body of the paper needs to address all required topics. The conclusion ought to provide closure for the reader, synthesize the content, and tie everything together to help clarify the main points of the paper. The reference page should include all references cited in the assignment in correct APA format.. Credible sources include scholarly peer-reviewed journal articles, evidence based resources, and professional (.org), educational (.edu), and government websites (.gov). Commercial websites (.com) are not considered credible sources. Please note: When selecting articles for course assignments, you are advised (unless you are referencing seminal information) to focus on work published within the past five years.

Required Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Readings

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
- Review Chapter 7, “Strategic and Operational Planning”
  
  See especially Figure 7.1 on page 147.
- Chapter 8, “Planned Change”
  - Organizational Change Associated With Nonlinear Dynamics (pp. 172–176)
    
    Read this section of Chapter 8 on planned change. Consider the role of leaders in effectively managing planned change.
- Chapter 12, “Organizational Structure”
  - “Organizational Culture” (pp. 274–276)
    
    There are many structures organizations take, and these structures influence how the organization functions. This chapter discusses many different organizational structures and provides insights into how these structures influence the change process, as well as leadership and management.
Johnson, J. K., Miller, S. H., & Horowitz, S. D. (2008). Systems-based practice: Improving the safety and quality of patient care by recognizing and improving the systems in which we work. Retrieved from http://www.ahrq.gov/downloads/pub/advances2/vol2/Advances-Johnson_90.pdf

This article addresses the importance of systems-based practice (SBP) in health care workplaces. The authors state that SBP knowledge is one of six core competencies that physicians have to know in order to provide safe and proper care for their patients.
Manley, K., O’Keefe, H., Jackson, C., Pearce, J., & Smith, S. (2014). A shared purpose framework to deliver person-centred, safe and effective care: Organisational transformation using practice development methodology. FoNS 2014 International Practice Development Journal 4 (1) [2].

Except from Abstract: A shared purpose is an essential part of developing effective workplace cultures and one of the founding principles of practice development in establishing person-centred, safe and effective practices that enables everyone to flourish. When units within health care organizations recognize their interdependence, they can create an interdisciplinary practice through systems integration.
Meyer, R. M., & O’Brien-Pallas, L. L. (2010). Nursing services delivery theory: An open system approach. Journal of Advanced Nursing, 66(12), 2828–2838.
Retrieved from the Walden Library databases.

In this article, the authors examine the effects of nursing services delivery theory in large-scale organizations. Among other benefits, this theory supports multilevel phenomena and cross-level studies, and it can guide future research and the management of nursing services.

Optional Resources

Glennister, D. (2011, July). Towards a general systems theory of nursing: A literature review. Paper presented at the 55th Annual Meeting of the International Society for the System Sciences, Hull, United Kingdom. Retrieved from http://journals.isss.org/index.php/proceedings55th/article/viewFile/1717/569
Hayajneh, Y. (2007). Management for health care professionals series: Systems & systems theory. Retrieved from http://www.hayajneh.org/a/readings/Systems-Theory.pdf

research the tympanic membrane and the thyroid gland. Based on your findings, create a 5- to 6-page Microsoft Word document that includes: Information about a minimum of two health assessment histories. The possible findings for the tympanic membrane. I – 2025 research the tympanic membrane and the thyroid gland Based on your findings

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research the tympanic membrane and the thyroid gland. Based on your findings, create a 5- to 6-page Microsoft Word document that includes: Information about a minimum of two health assessment histories. The possible findings for the tympanic membrane. I – 2025

research the tympanic membrane and the thyroid gland. Based on your findings, create a 5- to 6-page Microsoft Word document that includes:

Information about a minimum of two health assessment histories.

The possible findings for the tympanic membrane.

Information on how to examine the thyroid gland using both the anterior and posterior methods.

A concise note in the subjective, objective, assessment, and plan (SOAP) format with each patient’s encountered findings.

Information about laboratory tests that may be used for screening clients and the expected normal levels for each test.

Support your responses with examples.

On a separate references page, cite all sources using APA format.

Organizational Values Presentation – 2025 Prepare a 10 minute presentation 10 15 slides not including title or reference slide on

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Organizational Values Presentation – 2025

Prepare a 10-minute presentation (10-15 slides, not including title or reference slide) on organizational culture and values.

Describe how alignment between the values of an organization and the values of the nurse impact nurse engagement and patient outcomes.
Discuss how an individual can use effective communication techniques to overcome workplace challenges, encourage collaboration across groups, and promote effective problem solving.
Identify a specific instance from your own professional experience in which the values of the organization and the values of the individual nurses did or did not align. Describe the impact this had on nurse engagement and patient outcomes.

While APA style format is not required for the body of this assignment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines.

This assignment uses a grading rubric. should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment. IT IS MANDATORY TO FOLLOW THE RUBRIC

Here is thr rubric

Organizational Values Presentation (Benchmark Assessment)

80.0 %Content
26.0 %Describes how alignment between the values of an organization and the values of the nurse impact nurse engagement and patient outcomes.	A description to how alignment between the values of an organization and the values of the nurse impact nurse engagement and patient outcomes is not provided.	A description to how alignment between the values of an organization and the values of the nurse impact nurse engagement and patient outcomes is provided; however, relevant information is missing as indicated in the assignment instructions.	A description to how alignment between the values of an organization and the values of the nurse impact nurse engagement and patient outcomes is provided and meets the basic criteria for the assignment as indicated in the assignment instructions.	A description to how alignment between the values of an organization and the values of the nurse impact nurse engagement and patient outcomes is offered in detail.	A description to how alignment between the values of an organization and the values of the nurse impact nurse engagement and patient outcomes is offered in detail, while demonstrating higher level thinking by incorporating prior learning or reflective thought.
26.0 %Discusses how an individual can use effective communication techniques to Overcome Workplace Challenges, Encourage Collaboration Across Groups, and Promote Effective Problem-Solving.	A discussion to how an individual can use effective communication techniques to overcome workplace challenges, encourage collaboration across groups, and promote effective problem-solving is not provided.	A discussion to how an individual can use effective communication techniques to overcome workplace challenges, encourage collaboration across groups, and promote effective problem-solving is not provided. is offered; however, relevant information is missing as indicated by the assignment instructions.	A discussion to how an individual can use effective communication techniques to overcome workplace challenges, encourage collaboration across groups, and promote effective problem-solving is not provided. is offered and meets the basic criteria for the assignment as indicated by the assignment instructions.	A discussion to how an individual can use effective communication techniques to overcome workplace challenges, encourage collaboration across groups, and promote effective problem-solving is offered in detail.	A discussion to how an individual can use effective communication techniques to overcome workplace challenges, encourage collaboration across groups, and promote effective problem-solving is offered in detail, while demonstrating higher level thinking by incorporating prior learning or reflective thought.
28.0 %Identify a specific instance from your own professional experience in which the values of the organization and the values of individual nurses did or did not align. Describe the impact this had on nurse engagement and patient outcomes.	Identification of a specific instance from your own professional experience in which the values of the organization and the values of the individual nurses did or did not align is not provided.	Identification of a specific instance from your own professional experience in which the values of the organization and the values of the individual nurses did or did not align is offered; however, relevant information is missing such as a description of the impact this had on nurse engagement and patient outcomes.	Identification of a specific instance from your own professional experience in which the values of the organization and the values of the individual nurses did or did not align meets the basic criteria for the assignment as indicated in the assignment instructions.	An example from your professional experience is offered in detail.	An example from your professional experience is offered in detail, while demonstrating higher level thinking by incorporating prior learning or reflective thought.
15.0 %Organization and Effectiveness
5.0 %Layout	The layout is cluttered, confusing, and does not use spacing, headings, and subheadings to enhance the readability. The text is extremely difficult to read with long blocks of text, small point size for fonts, and inappropriate contrasting colors. Poor use of headings, subheadings, indentations, or bold formatting is evident.	The layout shows some structure, but appears cluttered and busy or distracting with large gaps of white space or a distracting background. Overall readability is difficult due to lengthy paragraphs, too many different fonts, dark or busy background, overuse of bold, or lack of appropriate indentations of text.	The layout uses horizontal and vertical white space appropriately. Sometimes the fonts are easy to read, but in a few places the use of fonts, italics, bold, long paragraphs, color, or busy background detracts and does not enhance readability.	The layout background and text complement each other and enable the content to be easily read. The fonts are easy to read and point size varies appropriately for headings and text.	The layout is visually pleasing and contributes to the overall message with appropriate use of headings, subheadings, and white space. Text is appropriate in length for the target audience and to the point. The background and colors enhance the readability of the text.
15.0 %Organization and Effectiveness
5.0 %Language Use and Audience Awareness (includes sentence construction, word choice, etc.)	Inappropriate word choice and lack of variety in language use are evident. Writer appears to be unaware of audience. Use of ?primer prose? indicates writer either does not apply figures of speech or uses them inappropriately.	Some distracting inconsistencies in language choice (register) and/or word choice are present. The writer exhibits some lack of control in using figures of speech appropriately.	Language is appropriate to the targeted audience for the most part.	The writer is clearly aware of audience, uses a variety of appropriate vocabulary for the targeted audience, and uses figures of speech to communicate clearly.	The writer uses a variety of sentence constructions, figures of speech, and word choice in distinctive and creative ways that are appropriate to purpose, discipline, and scope.
15.0 %Organization and Effectiveness
5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)	Slide errors are pervasive enough that they impede communication of meaning.	Frequent and repetitive mechanical errors distract the reader.	Some mechanical errors or typos are present, but are not overly distracting to the reader.	Slides are largely free of mechanical errors, although a few may be present.	Writer is clearly in control of standard, written academic English.
5.0 %Format
5.0 %Mechanics of Writing (includes spelling, punctuation, grammar, language use)	Contains no title slide, no references section, and no correctly cited references within the body of the presentation.	Title slide is incomplete or inaccurate. References section includes sources, but many citation errors. Citations are included within the body of the presentation but with many errors.	Title slide has minor errors. References section includes sources, but they are not consistently cited correctly. Citations are included within the body of the presentation but with some errors.	Title slide is complete. References section includes correctly cited sources with minimal errors. Correct citations are included within the body of the presentation.	Title slide is complete. References section includes correctly cited sources. Correct citations are included within the body of the presentation.
100 %Total Weightage

Assessing the Heart, Lungs, and Peripheral Vascular System – 2025 Required Readings Note To access this week s required library resources please click on the link to the

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Assessing the Heart, Lungs, and Peripheral Vascular System – 2025

Required Readings

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materialssection of your Syllabus.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 13, “Chest and Lungs” (pp. 260-293)

This chapter explains the physical exam process for the chest and lungs. The authors also include descriptions of common abnormalities in the chest and lungs.

Chapter 14, “Heart” (pp. 294-331)

The authors of this chapter explain the structure and function of the heart. The text also describes the steps used to conduct an exam of the heart.

Chapter 15, “Blood Vessels” (pp. 332-349)

This chapter describes how to properly conduct a physical examination of the blood vessels. The chapter also supplies descriptions of common heart disorders.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 8, “Chest Pain” (pp. 81–96)

This chapter focuses on diagnosing the cause of chest pain and highlights the importance of first determining whether the patient is in a life-threatening condition. It includes questions that can help pinpoint the type and severity of pain and then describes how to perform a physical examination. Finally, the authors outline potential laboratory and diagnostic studies.

Chapter 11, “Cough” (pp. 118-147)

A cough is a very common symptom in patients and usually indicates a minor health problem. This chapter focuses on how to determine the cause of the cough through asking questions and performing a physical exam.

Chapter 14, “Dyspnea” (pp. 159–173)

The focus of this chapter is dyspnea, or shortness of breath. The chapter includes strategies for determining the cause of the problem through evaluation of the patient’s history, through physical examination, and through additional laboratory and diagnostic tests.

Chapter 26, “Palpitations” (pp. 310-317)

This chapter describes the different causes of heart palpitations and details how the specific cause in a patient can be determined.

Chapter 33, “Syncope” (pp. 390-397)

This chapter focuses on syncope, or loss of consciousness. The authors describe the difficulty of ascertaining the cause, because the patient is usually seen after the loss of consciousness has happened. The chapter includes information on potential causes and the symptoms of each.

Sullivan , D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.

Chapter 6, “Outpatient Charting and Communications” (pp. 119–141)

Note: Download these Adult Examination Checklists and Physical Exam Summaries to use during your practice cardiac and respiratory examination.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Blood vessels. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.

This Blood Vessels Physical Exam Summary was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for cardiovascular assessment. In Mosby’s guide to physical examination(7th ed.). St. Louis, MO: Elsevier Mosby.

This Adult Examination Checklist: Guide for Cardiovascular Assessment was published as a companion to Seidel’s guide to physical examination(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for chest and lung assessment. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.

This Adult Examination Checklist: Guide for Chest and Lung Assessment was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Chest and lungs. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.

This Chest and Lungs Physical Exam Summary was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Heart. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.

This Heart Physical Exam Summary was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

McCabe, C., & Wiggins, J. (2010a). Differential diagnosis of respiratory disease part 1. Practice Nurse, 40(1), 35–41.

Retrieved from the Walden Library databases.

This article describes the warning signs of impending deterioration of the respiratory system. The authors also explain the features of common respiratory conditions.

McCabe, C., & Wiggins, J. (2010b). Differential diagnosis of respiratory diseases part 2. Practice Nurse, 40(2), 33–41.

Retrieved from the Walden Library databases.

The authors of this article specify how to identify the major causes of acute breathlessness. Additionally, they explain how to interpret a variety of findings from respiratory investigations.

SkillStat Learning, Inc. (2014). The 6 second ECG. Retrieved from http://www.skillstat.com/tools/ecg-simulator#/-home

This interactive website allows you to explore common cardiac rhythms. It also offers the Six Second ECG game so you can practice identifying rhythms.

University of Virginia. (n.d.). Introduction to radiology: An online interactive tutorial. Retrieved from http://www.med-ed.virginia.edu/courses/rad/index.html

This website provides an introduction to radiology and imaging. For this week, focus on cardiac radiography and chest radiology.

Required Media

Laureate Education. (Producer). (2012). Advanced health assessment and diagnostic reasoning. Baltimore, MD: Author.

Note: You will use the case studies presented in the media, Advanced Health Assessment and Diagnostic Reasoning, to complete this week’s Discussion.

Online media for Seidel’s Guide to Physical Examination

In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 13, 14, and 15 that relate to the assessment of the heart, lungs, and peripheral vascular system. Refer to Week 4 for access instructions on https://evolve.elsevier.com/.

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009). DeGowin’s diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.

Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 1, “Chest Wall, Pulmonary, and Cardiovascular Systems,” pp. 302–433)

Note:Section 2 of this chapter will be addressed in Week 10.

This section of Chapter 8 describes the anatomy of the chest wall, pulmonary, and cardiovascular systems. Section 1 also explains how to properly conduct examinations of these areas.

Discussion: Assessing the Heart, Lungs, and Peripheral Vascular System

Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows into your lungs. Feel your chest contract as you exhale. How might this experience be different for someone with chronic lung disease or someone experiencing an asthma attack?

In order to adequately assess the chest region of a patient, nurses need to be aware of a patient’s history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted to determine the causes and severity of abnormalities.

In this Discussion, you will consider how a patient’s initial symptoms can result in very different diagnoses when further assessment is conducted.

Note: By Day 1 of this week, your Instructor will have assigned you to one of the video case studies in this week’s Learning Resources titled Advanced health assessment and diagnostic reasoning. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

To prepare:

With regard to the case study you were assigned:

Review this week’s Learning Resources and consider the insights they provide.
Consider what history would be necessary to collect from the patient.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 6”) with “Review of Case Study” identifying the number of the case study you were assigned.

Post:

scenario #2 Advanced health assessment and diagnostic reasoning.

1. a description of the health history you would need to collect from the patient in the case study you were assigned.

2.Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis.

3. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

SOAP SAMPLE:

Patient Initials: _JM___ Age: __46__ Gender: __M__

SUBJECTIVE DATA:

Chief Complaint (CC): New onset of rash

History of Present Illness (HPI): Jerry Morgan is a 46-year-old Caucasian male who presents today with complaints of a new onset of a red rash that has developed over the past few days on his trunk area. He has noticed no associated symptoms, aggravating or relieving factors, and has not attempted any treatments of this rash. He states that the rash is not severe or impacting his daily life, but he is concerned that it may be something serious.

Medications:

Metoprolol 25mg PO BID
Pravastatin 40mg PO at bedtime
Xarelto 20mg PO daily with dinner
Over-the-Counter Pepcid AC 10mg PO daily

Allergies: Penicillins- rash, Sulfa drugs-rash, bees.

Past Medical History (PMH):

Hypertension- well controlled
Atrial Fibrillation- well controlled
Gastroesophageal Reflux (GERD) – takes daily OTC acid reducer
Dyslipidemia- well controlled

Past Surgical History (PSH):

Tonsillectomy (1976)

Vasectomy (2005)

Cholecystectomy (2010)

Total Knee Replacement (2014)

Sexual/Reproductive History: Patient denies any reproductive issues or risky sexual behavior. Currently married with 4 children and has had a vasectomy. No history of STIs.

Personal/Social History: Patient has smoked 1.5 packs of cigarettes/day x 30 years; drinks 5-10 beers/week; admits to regular marijuana use x 30 years. Patient does not have regular exercise habits but considers himself fairly active through outdoor work and occasional kayaking/hiking trips; his diet is regular and he admits is not healthy, mainly consisting of fried, fatty foods.

Immunization History: His last Tdap was in 2006 and he declines the Flu and Pneumonia vaccinations.

Significant Family History:

Father- Atrial Fibrillation, Hypertension, Myocardial Infarction, Diabetes-Type 2, Dyslipidemia –died at age 68 of heart attack.

Mother- Ischemic Stroke, Hypertension, Dyslipidemia-died at age 70 from complications of stroke.

Siblings- two sisters with history of hypertension and diabetes-type 2, one with history of breast cancer in 2006.

Children-all healthy with no medical issues

Lifestyle: He currently owns and operates his own pest control business and has for the past 15 years. He has been married once and has 4 children with his wife. They live in a suburban middle-class neighborhood with good transportation and school systems. He enjoys outdoor activities and often works on household issues in his free time. He has a strong support system through family and friends. He gets yearly check-ups for physical, vision, and dental health maintenance.

Review of Systems: From head-to-toe, include each system that covers the Chief Complaint, History of Present Illness, and History (this includes the systems that address any previous diagnoses). Remember that the information you include in this section is based on what the patient tells you so ensure that you include all essentials in your case (refer to Chapter 2 of the Sullivan text).

General: Negative for recent weight changes, fever, chills, night sweats, or changes in energy levels

Respiratory: + for occasional productive cough with dark sputum in the mornings, denies any shortness of breath on exertion or exposure to tuberculosis

Cardiovascular/Peripheral Vascular: Negative for chest pain, palpitations, edema, claudication, exercise intolerance.

Gastrointestinal: + for heartburn; negative for nausea, vomiting, bowel changes

Skin: + for ruby red papular rash on trunk, denies pruritus, pain, eruptions, or pigmentation changes.

Hematologic: + for prolonged bleeding times and easy bruising, negative for anemia

Allergic/Immunologic: + for drug allergies to penicillin and sulfa drugs, bees. Denies any recent new drug use. No current issues.

OBJECTIVE DATA:

Physical Exam:

Vital signs: T- 98.9 oral; P- 72, irregular; BP- 128/72 left arm, sitting, long cuff; RR- 18; Pain 0/10 Ht: 6’2” Wt: 210 lbs BMI: 27

General: AAO x3, moves all extremities, gait normal, well developed, well nourished, not malodorous. Appears comfortable and not in any apparent distress.

Chest/Lungs: Breath sounds clear and equal AP&L bilaterally

Heart/Peripheral Vascular: Irregular rhythm, controlled rate. No murmur, rub, or gallop. Pulses +2 bilateral radials and +2 bilateral pedals.

Abdomen: Bowel sounds present x4 quadrants. Soft, non-tender, non-distended. No organomegaly.

Skin: Ruby red papular rash on the trunk with no itching or pain present. No edema, clubbing, or cyanosis. No palpable nodules.

Lab Tests and Results:

CBC- RBC 5.7, PLT 250, HGB 15, HCT 44

PT/INR- 22/2.1

PTT- 27 sec.

ASSESSMENT:

Priority Diagnosis: Cherry Angioma

Differential Diagnoses:

Drug eruption
Pityriasis Rosea
Thrombocytopenic purpura

The primary diagnosis selected in this patient is cherry angioma, as the clinical presentation and history best supports this diagnosis. The patient presented with a non-painful, non-pruritic papular rash limited to the trunk of the body with no other negative symptoms. A drug eruption could be responsible for a red rash on the patient’s trunk, but the patient denies any use of new medications and the rash is not generalized, pink, and morbilliform, how drug rashes usually are presented (Ball et al., 2015). Pityriasis Rosea meets some of the criteria, but the rash is not itchy, scaly, or in oval patches, and the patient denies any recent illnesses (Dains, Baumann, & Scheibel, 2016). Thrombocytopenic purpura is a contender for a priority diagnosis since the patient is on blood thinners and at risk for increased bleeding, but lab results show that platelet and other blood counts are within normal limits, and the rash is not generalized (Ball et al., 2015).

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

Ely, J. W., & Stone, M. S. (2010). The generalized rash: Part I. Differential diagnosis. American Family Physician, 81(6), 726-734. Retrieved from http://www.aafp.org/afp/2010/0315/p726.html

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Systems Theory – 2025 Application Systems Theory As noted in the Learning Resources systems theory provides a meaningful and beneficial means of

Organizational Values Presentation – 2025 Prepare a 10 minute presentation 10 15 slides not including title or reference slide on

Assessing the Heart, Lungs, and Peripheral Vascular System – 2025 Required Readings Note To access this week s required library resources please click on the link to the

Required Readings

Required Media

Optional Resources

Discussion: Assessing the Heart, Lungs, and Peripheral Vascular System

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