For this assignment you will be given a case study about a young lady named Sarah Smith. Review the information provided and answer the questions following. Be sure to cite your references. Look at Sarah as if she is a patient in your office seeking care. What are your immediate concerns? What needs to be done for her? Be thorough and succinct in your responses.

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.

PMHx:

Asthma: no hospitalizations for exacerbation.

DM II

PSHx:

Denies

SHx:

Former tobacco user: ceased smoking 2 years ago. Had smoked 1ppd x 5 years

ETOH: socially

Illicit drugs: denies

FHx:

Significant for paternal DM, otherwise unremarkable

Medications:

Metformin: 500mg BID po – did not take the last few days

Albuterol MDI: 2 puffs every 6 hours prn – last use just PTA

Singulair: 10mg po daily

Trinessa: 1 tab po daily – last taken this am

Allergies:

PCN: hives

LNMP: 2 weeks ago.

G0p0

ROS:

General: denies any weight changes, fatigue or fever; + body aches

Skin: denies any rashes; + wound to left foot

HEENT: denies headache, head injury, dizziness, lightheadedness;

            Denies any vision changes

            Denies any hearing changes, tinnitus, vertigo, earache

            Denies any nasal congestion, discharge, nose bleeds or sinus tenderness

            Denies any sore throat, difficulty swallowing

Neck: denies any swollen glands, pain

Breasts: denies any pain, discharge

Respiratory: denies any dyspnea; positive cough and wheezing

CV: denies any chest pain, edema

GI: denies any nausea/vomiting/diarrhea/constipation; denies bloody stools

PV: denies claudication, swelling to LE

GU: denies frequency, urgency, burning;

            Denies vaginal discharge, itching, sores

            Denies penile discharge, itching or sores

MS: positive pain to left foot

Psych: denies nervousness, depression

Neuro: denies Headache, dizziness, vertigo, syncope, weakness; + numbness to right LE

Heme: denies any easy bruising

Physical Exam:

Vital signs: 100.5 (tympanic), 162/88, 118, 22, O2 sat 95% on RA

                        Height: 5’5”     Weight: 250 lbs.

            Blood glucose: 230 (Fasting; states has not eaten yet today)

patient awake, alert, oriented x 4 in NAD

Skin: warm, dry, color WNL. 4 cm lesion noted to anterior left foot with crusting and purulent drng; + surrounding erythema extending up 7 cm proximally

HEENT: head nontraumatic, normocephalic

Pupils PERRLA, EOMs intact; disc margins sharp, without hemorrhages, exudates; no AV nicking noted

Ears: bilateral TM with good cone of light and intact

Nose: mucosa pink, septum midline; no sinus tenderness appreciated

Mouth: mucosa pink, moist; tongue midline; tonsils 1+ without exudate

Neck: supple; trachea midline; no LAD

Resp: regular and unlabored; lungs with end expiratory wheezing throughout

CV: RRR, S1 and S2 noted; no s3, s4 or murmur appreciated

Abdomen: soft, non-distended; Bs + x 4; no tenderness with palpation; no CVA tenderness with percussion

Genitalia: deferred

Rectal: deferred

Extremities: warm and without edema; calves supple, non-tender

PV: no LE edema

MS: + swelling to left foot; + tenderness of 2-4th left metatarsals; + left pedal pulse; CMS intact; Cap refill < 2 sec.

Neuro: alert, cooperative; thought coherent; oriented x 4; cranial nerves II-XII intact

Questions:

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.

To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Resources.

Assignment Requirements

Before finalizing your work, you should:

• be sure to read the Assignment description carefully (as displayed above)
• consult the Grading Rubric to make sure you have included everything necessary; and
• utilize spelling and grammar check to minimize errors.

 Heroes have always been a part of written stories. Heroes from Greek mythology often had super-human characteristics, but also had fatal flaws, and often met with tragic ends because of these flaws. The era post World War I and II created comic book heroes that did not seem to have any flaws. The current super-heroes all seem to be dark heroes – heroes that may not always do acceptable (legal) things, but overall may have good intentions. One similarity that many hero stories share is the monomyth, or hero’s journey, as you read about in this week’s unit. 

Be sure to address the following in your presentation:

• Discuss how the character of one Hero or Superhero (fictional) reflects the times that they are written. You may select a fictional hero from any era, however, you should be comfortable describing that era’s culture as well.
• Explain why this hero would resonate with the general era in which they were written.
• Describe the elements of the monomyth that are apparent in this hero’s story. HINT! Utilize a template to break down each part of the monomyth.

Specifications:

Submission: A 10-12 slide PowerPoint presentation or Prezi that answers the questions posed above. Include speaker notes or a voice-over, images, and videos where applicable.

 In your presentation:

• Provide speaker’s notes on the PowerPoint to accompany each slide. If you choose speaker’s notes, the total word count of your notes should be 800-1000 words.
• Include a title slide and include your references page in APA format on the last slide of the presentation.

COMPETENCIES

734.3.4 : Healthcare Utilization and Finance

The graduate analyzes financial implications related to healthcare delivery, reimbursement, access, and national initiatives.

INTRODUCTION

It is essential that nurses understand the issues related to healthcare financing, including local, state, and national healthcare policies and initiatives that affect healthcare delivery. As a patient advocate, the professional nurse is in a position to work with patients and families to access available resources to meet their healthcare needs. 

REQUIREMENTS

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A. Compare the U.S. healthcare system with the healthcare system of Great Britain, Japan, Germany, or Switzerland, by doing the following:

1. Identify one country from the following list whose healthcare system you will compare to the U.S. healthcare system: Great Britain, Japan, Germany, or Switzerland.

2. Compare access between the two healthcare systems for children, people who are unemployed, and people who are retired.

a. Discuss coverage for medications in the two healthcare systems.

b. Determine the requirements to get a referral to see a specialist in the two healthcare systems.

c. Discuss coverage for preexisting conditions in the two healthcare systems.

3. Explain two financial implications for patients with regard to the healthcare delivery differences between the two countries (i.e.; how are the patients financially impacted).

B. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

C. Demonstrate professional communication in the content and presentation of your submission.

File RestrictionsFile name may contain only letters, numbers, spaces, and these symbols: ! – _ . * ‘ ( )
File size limit: 200 MB
File types allowed: doc, docx, rtf, xls, xlsx, ppt, pptx, odt, pdf, txt, qt, mov, mpg, avi, mp3, wav, mp4, wma, flv, asf, mpeg, wmv, m4v, svg, tif, tiff, jpeg, jpg, gif, png, zip, rar, tar, 7z
RUBRICA1:COUNTRY TO COMPARE

NOT EVIDENT

A country for comparison is not identified.

APPROACHING COMPETENCE

The identified country for comparison is not from the given list.

COMPETENT

The identified country for comparison is from the given list.

A2:ACCESS

NOT EVIDENT

A comparison of healthcare system access is not provided.

APPROACHING COMPETENCE

The comparison does not accurately describe access to healthcare systems in both the U.S. and the country chosen in A1 for one or more of the given groups of people, or the comparison does not logically describe both the similarities and differences between access to each of the healthcare systems for all of the given groups of people.

COMPETENT

The comparison accurately describes access to healthcare systems in both the U.S. and the country chosen in part A1 for children, people who are unemployed, and people who are retired. The comparison logically describes the similarities and differences between access to each of the healthcare systems for all of the given groups of people.

A2A:COVERAGE OF MEDICATIONS

NOT EVIDENT

A discussion of medication coverage in both healthcare systems is not provided.

APPROACHING COMPETENCE

The discussion of coverage is not accurate or is not relevant to one or more of the healthcare systems.

COMPETENT

The discussion of coverage for medications is accurate and relevant to both the U.S. healthcare system and the healthcare system of the country chosen in part A1.

A2B:REFERRAL TO SEE A SPECIALIST

NOT EVIDENT

A determination of specialist referral requirements is not provided.

APPROACHING COMPETENCE

The submission does not accurately determine the requirements to get a referral to see a specialist for one or more of the healthcare systems.

COMPETENT

The submission accurately determines the requirements to get a referral to see a specialist for both the U.S. healthcare system and the healthcare system of the country chosen in part A1.

A2C:COVERAGE FOR PREEXISTING CONDITIONS

NOT EVIDENT

A discussion of preexisting condition coverage is not provided.

APPROACHING COMPETENCE

The discussion of coverage for preexisting conditions is not accurate or does not relate to one or more of the healthcare systems.

COMPETENT

The discussion of coverage for preexisting conditions is accurate and relevant to both the U.S. healthcare system and the healthcare system of the country chosen in part A1.

A3:FINANCE IMPLICATIONS FOR HEALTHCARE DELIVERY

NOT EVIDENT

An explanation of 2 financial implications for the patient is not provided.

APPROACHING COMPETENCE

The explanation does not logically discuss 2 financial implications for the patient in regards to healthcare delivery differences, or the explanation does not include both the U.S. healthcare system and the healthcare system of the country chosen in part A1.

COMPETENT

The explanation logically discusses 2 financial implications for the patient in regards to the delivery differences in both the U.S. healthcare system and the healthcare system of the country chosen in part A1.

B:SOURCES

NOT EVIDENT

The submission does not include both in-text citations and a reference list for sources that are quoted, paraphrased, or summarized.

APPROACHING COMPETENCE

The submission includes in-text citations for sources that are quoted, paraphrased, or summarized and a reference list; however, the citations or reference list is incomplete or inaccurate.

COMPETENT

The submission includes in-text citations for sources that are properly quoted, paraphrased, or summarized and a reference list that accurately identifies the author, date, title, and source location as available.

C:PROFESSIONAL COMMUNICATION

NOT EVIDENT

Content is unstructured, is disjointed, or contains pervasive errors in mechanics, usage, or grammar. Vocabulary or tone is unprofessional or distracts from the topic.

APPROACHING COMPETENCE

Content is poorly organized, is difficult to follow, or contains errors in mechanics, usage, or grammar that cause confusion. Terminology is misused or ineffective.

COMPETENT

Content reflects attention to detail, is organized, and focuses on the main ideas as prescribed in the task or chosen by the candidate. Terminology is pertinent, is used correctly, and effectively conveys the intended meaning. Mechanics, usage, and grammar promote accurate interpretation and understanding.

Responses to at least two classmates’ postings should be approximately 200 words and should be thoughtful, substantial, polite and more extensive than a simple “well done” phrase or “I agree.” Consider points of agreement, disagreement, assumptions, and value judgments. You will be able to respond to others after you submit your initial post. Your grade will be affected by how thoughtful your replies and initial questions are answered.

MY PICOT QUESTION IS ABOUT FALL IN HOSPITAL AND NURSING HOME.

Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention used to address the problem must be a nursing practice intervention. Include a comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and specify the timeframe needed to implement the change process.  Formulate a PICOT question using the PICOT format (provided in the assigned readings) that addresses the clinical nursing problem.

The PICOT question will provide a framework for your capstone project change proposal.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Describe the problem in the PICOT question as it relates to the following:

1. Evidence-based solution
2. Nursing intervention
3. Patient care
4. Health care agency
5. Nursing practice

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.