1) **********minimum 2 full pages ( not words)**************************** (cover or reference page not included) 

2)¨**********APA norms  ( All paragraphs need to be cited properly. All responses must be in a narrative format and each paragraph must have at least 4 sentences)

3)********** It will be verified by Turnitin and SafeAssign 

4) **********References from the last 5 years  

5) The points don’t be must copied in the work. It must be identified by numbers. 

For example:

1. Refer the patient………………………….

2. non-pharmacological are………………………

3. Patient education…………….

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Chief complaint:  “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.

HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief.  She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin  AF cream and it did not help relief her symptoms. She has not tried other remedies. Denies associated symptoms of fever and chills. 

PMH:

Diabetes Mellitus, type 2.

Surgeries: None

Allergies: Augmentin

Medication: Metformin 500mg PO BID.

Vaccination History:  Immunization is up to date and she received her flu shot this year.

Social history:

College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.

Family history:

Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.

ROS:

Constitutional: Negative for fever. Negative for chills.

Respiratory: No Shortness of breath. No Orthopnea

Cardiovascular: Regular rhythm.

Skin: Right great toe swollen, itchy, painful and discolored.

Psychiatric: No anxiety. No depression.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.

NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.

LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.

HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.

MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.

SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.

PSYCH: Normal affect. Cooperative.

Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Proximal subungual onychomycosis

Differential Diagnosis:  Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis

Special Lab: Fungal culture confirms fungal infection.

________________________________________________________________

Please see below:

      Diagnosis: onychomycosis and labs for baseline

Please address the following:

1. Specify when to refer the patient after therapy and why? Provide rationale.
2. According to the recommended guidelines, what are the non-pharmacological approaches to Onychomycosis?
3. Provide patient education. Keep in mind the past medical history of this patient.

Comment1

In health care and its bases of scientific theory, test, trial, and numerical success in outcomes comes into great conflict when tested by those who are not believers of western government. There is a fine line in which providers face when attempting to initiate treatment in those individuals as well as be open and accepting on those beliefs.

There have been many recent trials in theory and test in which have not been initiated by religion but also have tested and shadowed the rational to medical treatments. Some theories include the debate of vaccines, and the use of chemotherapy.

Other treatments that have been absolutely banned include that of abortion. History presented the length in which Women have fought for the right to make a choice in regards to their bodies, and also the ability to choose to plan their families. There until this day there has been great push back from Christians to perform the sinful act of terminating a birth even past of conception. The lines are set within both sides and in some areas of the world these religious beliefs mold practice, and law.

For providers as us, we have to be proactive in allowing the patient to voice their concerns and in a way explain particular treatment plans. There can also be the opportunity to adapt for the patient and accommodate their belief practice as well

Comment2

Scientism is the belief that the best or only way to have any knowledge of reality is by means of the sciences (Moreland and Craig, 2003, pp. 346-350).  I think this statement about scientism is a little crazy now days.  Maybe a 100 years ago this was an ok way of thinking.  However, with all the world has come to and changes that have been made in science and healthcare, we could have better ways of thinking.  The fact any other claim to knowledge is opinion or false is far stretched as well.  I think as nurses it is important to remember a patient needs to be taken care of as a whole, not just their specific problem.  I think for a while it was shied away from, as no one wanted to touch religion during caring for a patient.  Now anymore it is important and encouraged to take care of a patient not just physically, but emotionally.  Often times that emotional piece for patients requires a religion or some belief they have.  There are lots of different religions and nurses have to remember that and put their personal beliefs aside to help better care for patients.  

You have been invited to assemble a task force to design a medication assistance program. You need to submit a proposal, regarding who you would invite, to the CEO. Consider the perspectives of prescribers, discharge planners, financial navigators, patients, suppliers, bookkeepers, and subsidizers. If you were to seek the input of 5-7 stakeholders, who would you invite to the planning table, and why? Consider the need for a group facilitator. Who would that person be, and why?

Submit a 2-3 page APA style response to this query. Open with a paragraph of purpose, dedicate a paragraph to each stakeholder that you would invite, and close with a summary of what you hope to accomplish with the group, within a designated time frame.

 

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Creative assignment 1 is in accordance with chapter 5 in your textbook: Nutrition: Eating for a Healthier You.

Part 1: For this assignment, you will need to submit your three favorite recipes. The following information must be included for each recipe.

• name of recipe
• all ingredients, including the amounts of each ingredient
• prep time
• preparation instructions
• cooking information, including oven, stove, microwave/cooking  temperature, prep time, amount of time dish needs to cook, what type and  size of dish to use, is cooking spray necessary, etc.
• number of servings your recipe makes
• any other instructions that might be needed for this recipe

 You need to explain why you chose this/each recipe for submission.  You may also provide any (fun) facts regarding the recipe that you would  like to share. BEGIN EACH RECIPE ON A NEW PAGE

Part 2: In  a 2 page summary, explain what modifications can be made to your three  favorite recipes to transform them into healthier, nutrient dense  versions. The following information must be included for each recipe.

• What makes each of your original dishes unhealthy?
• What substitutions can you make for ingredients to make each recipe more healthy?
• What changes can you make to the amounts of ingredients used?
• What different cooking techniques can you use to make each recipe healthier?
• How can you make each recipe more nutrient dense?
• What are the major problems you face when trying to eat right? Describe five actions you could take to improve your eating.

**Responding that a recipe is not  modifiable is not a sufficient answer and you will not receive full  credit. Try your best to answer the questions regarding modifications of  your recipe. If you feel that your recipe cannot be modified, I  strongly suggest that you use an alternate recipe that is modifiable to  complete the assignment.