APA format 3 peer review article references Due 10/12/18 at 5pm

 

Patient Information:

Mr. H, Age 58, Male, White

S.

CC:  Chest Pain “Shortness of breath with severe pain on deep inhalation” (according to Dains, Baumann, & Scheibel, (2016) before a complete HPI is taken this patient must be a quickly assessed as this complaint can have rapid, life-threatening consequences).

HPI: Reports a constant chest pain for two days ago, taking a full breath makes it worst (inhalation), pain is sharp and severe with a current PIS of 8. Subject feel like his heart is racing. Nothing makes the chest pain better. The patient also has exhibited signs and symptoms of a cough, “spit up blood,” right leg swollen and red. He recalls being stationary for an eight-hour period while on a plane, in the economy section middle row, recently from vacationing in Europe, without bathroom overall usually has a sedentary lifestyle mostly due to working 9 am -5 pm as a customer service representative at a call center. After work he sits in front of the television and watches various programs for about four hours while eating dinner, drinking a can of beer or two and smoking a cigarette before bed. It started two days ago when the patient was running to clock in at work, to avoid being late.

Location: right chest pain

Onset: 2 days ago

Character: Sharp and constant

Associated signs and symptoms: a cough, elevated heart rate, and most recently expectoration of blood.

Timing: running to avoid being late for work

Exacerbating/ relieving factors: activity makes it worst. Nothing relieves the pain.

Severity: 8/10 pain scale

Current Medications: Hydrochlorothiazide 25 mg daily for six months, and Norvasc 5 mg twice daily from one month ago for hypertension, Lipitor 80 mg daily for high cholesterol; However, has not been compliant. The patient also stated that he was taking thiamin 100 mg, folic acid 250 mcg and vitamin D 5000 daily as supplements. Currently, he only takes ginseng to boost sexual performance.    

Allergies: Patient is allergic to latex and mold both cause SOB chest tightening

PMHx: diagnose with hypertension and high cholesterol 10 years ago, left hip replacement 2 years ago. Immunization is up to date.  

Soc Hx: Patient works at a call center as a customer service representative for the past thirty years. Married has no children.  They live in their two-bedroom mortgage-free house.  He currently smokes and has just reduced to 3 cigarettes per day after over forty years of smoking two packs per day. On the weekends he usually goes to the casino with his two college friends to gamble and have a good time. He has no special diet and will eat “anything from anywhere.” Drinks 2 six packs beer per week, and a bottle of vodka on weekends.

Fam Hx: His father died of lung cancer 15 years ago.  

ROS:

GENERAL:  No weight loss, fever, chills, weakness or fatigue. 

Head: Symmetrical, no swollen lymph nodes, no signs of sinus infection

Eyes:  Does wear glasses due to myopia, no blurred vision, double vision or yellow sclerae.

Ear: No hearing loss.

Nose: Cough present, no congestion, runny nose.

Throat: No sore throat or difficulty swallowing.

SKIN:  No rash or itching. Some redness and swelling to right leg.

CARDIOVASCULAR:  Right side chest pain, chest pressure, and chest discomfort. Racing heart palpitations.

RESPIRATORY:  shortness of breath, chest tightening, increased pain when inhaling, labored breathing.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Some frequency in urination, wakes twice at night to urinate.

NEUROLOGICAL: headaches and numbness and tingling of fingers. MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No enlarged nodes. No known history of splenectomy.

PSYCHIATRIC:  Endorse feeling anxious

ENDOCRINOLOGIC:  reports cold sweat

ALLERGIES:  latex and mold

O.

General: steady gait. Flushed face with a facial grimace. Appears anxious

Vital signs:

Temperature: 97.9 oral

Respiratory rate: 32, labored

Heart rate: 112, tachycardic

BP right arm: 148/88

Oxygen saturation: 90% on room air

Weight: 210 lbs., stable

Height: 5’8”

Skin: Cool, diaphoretic

Thorax and lungs: Thorax symmetrical; diminished breath sounds right middle and lower lobes; no rales, rhonchi, or wheezes; breath sounds vesicular with no adventitious sounds to the left lung

Cardiovascular: Heart rate is irregular with good S1, S2; no S3 or S4; no murmur or jugular vein distention.

Abdomen: Protuberant with normoactive bowel sounds auscultated x4 quadrants

Peripheral vascular: Right calf with 2+ edema, erythema; warmth and tenderness

on palpation noted; left lower extremity without edema or erythema; 2+ dorsalis pedis pulses bilaterally

Neurologic: Anxious; awake, alert, and oriented to person, place, and time

Diagnostic results: EKG shows Atrial fibrillation. He is waiting to do an angiography, chest x-ray and a ventilation/perfusion scan (V/Q) to examine blood flow in the lungs. Labs for collection are complete blood count, complete metabolic panel, lipid panel, troponin, creatinine kinase, creatine phosphokinase.  D-dimer test to check for DVT and pulmonary embolism are needed, and a cardiac MRI to fully view the heart. (Dains, et al., loc 3494. 2016)

A.

The provider states that the patient may have a pulmonary embolism. While this may be accurate, it is good to rule out other illnesses before giving a definitive diagnosis without proper analysis as misdiagnosis can cause a delay in treatment leading to great consequences. There are other possible differential diagnoses such as GERD, anxiety, and angina; however, listed below are three sudden, life-threatening differential diagnoses listed below.

Differential Diagnoses:

            Right side Congestive Heart Failure where according to Ball, Dains, Flynn, Solomon, & Stewart, (2015) the heart is unable to properly pump the blood to the body causing backflow to the lung and congestion in the heart. Hussein, A., & Staufenbiel, R. (2014) noted in their study of 59 cows with heart failures, that with right-sided heart failure the blood venous blood returning to heart is disrupted hence patient ends up with edema to the legs, shortness of breath, increased urination, rapid heartbeat which the patient is currently exhibiting and needs to be further investigated so proper treatment can be done.

            Myocardial Infarction occurs due to the heart thickening thus causing decrease blood flow (Ball, et al. p.323. 2016). In Bahall, Seemungal, & Legall, (2018) controlled case study which focused on first time myocardial infarction in the same hospital in Trinidad and their risk factors. The writers look at the risk factors which includes diabetes mellitus, hypertension, hypercholesterolemia, smoking, alcohol consumption, obesity, and sedentary lifestyle, most of which is applicable Mr. H. the writers also reported with myocardial infraction no seen all over the globe therefore region, ethnicity and culture has no bearings on who may fall, victim, especially when they identify with one or more of the listed risk factors.

             Pericarditis is when there is an inflamed pericardium due to infection. (Ball, et al. p.322. 2016). Per Dybowska, Kazanecka, Kuca, Burakowski, Czajka, Grzegorczyk, … Tomkowski, (2015) pericarditis is life-threatening and has a high death rate; urgent care is needed to prevent fatalities. While the patient does not have a fever the presentation of pericarditis symptom of chest pain, shortness of breath and chest pressure which the patient presents with should be completely ruled out as soon as possible.  

References

Bahall, M., Seemungal, T., & Legall, G. (2018). Risk factors for first-time acute myocardial infarction patients in Trinidad. BMC Public Health, 18(1), 161. https://doi-org.ezp.waldenulibrary.org/10.1186/s12889-018-5080-y

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.

Dybowska, M., Kazanecka, B., Kuca, P., Burakowski, J., Czajka, C., Grzegorczyk, F., … Tomkowski, W. (2015). Intrapericardial fibrinolysis in purulent pericarditis–case report. International Journal of Emergency Medicine, (1), 1. https://doi-org.ezp.waldenulibrary.org/10.1186/s12245-015-0087-y

Hussein, A., & Staufenbiel, R. (2014). Clinical presentation and ultrasonographic findings in buffaloes with congestive heart failure. Turkish Journal of Veterinary & Animal Sciences, 38(5), 534–545. https://doi-org.ezp.waldenulibrary.org/10.3906/vet-1404-111

 Hi, the following is the post of another student that i have to reply.  

Male and Female Genitalia Physical Assessment

1. Ovulation refers to the process where the eggs get released from the ovaries in women. Ovulation takes place when the ovarian follicles rupture to release the secondary oocyte ovarian cells. Estrogen levels cause surges in the level of the follicle-stimulating hormones and the luteinizing hormone. The FSH facilitates the maturation of the egg while the luteinizing hormone releases the egg during the ovulation period.
2. The chances of getting pregnant are low, although some women still do get pregnant. There are many factors to assess to determine whether the patient can get a baby. However, age affects women more significantly and affects the ability to get pregnant after menopause (Siegel, Moses, Baldwin & Rodriguez, 2019).
3. The endopelvic fascia is the tissue separating the anterior wall of the vagina from the bladder and urethra.
4. The four bones of the pelvis include the two hip bones, coccyx, and the sacrum (Ball, Dains, Flynn, Solomon & Stewart, 2014)
5. The education will help the mothers learn how to prevent the spread of harmful bacteria from the baby’s’ anus to the genitalia region
6. The signs indicate symptoms of various genitalia conditions, and one of them is sexual abuse due to the bruising and infection due to the foul smell. It is essential o investigate further to determine the cause
7. PMS is a period characterized by mood swings, excessive eating, depression, and fatigue. The symptoms occur due to the fluctuation of hormones in women.
8. The diamond position, the V position, M position, and lateral positions (Ball, Dains, Flynn, Solomon & Stewart, 2014). The positioning will depend on various factors, such as patient comfort, conditions, and preference. Obese women, for example, require a position that will keep tissue from blocking the view of the perineal region
9. He first thing to do is to make sure that the patient is aware of what the examination entails. The patient should also empty her bladder before the examination to reduce discomfort. Telling the patient what one is going to do can help in keeping them relaxed (Ball, Dains, Flynn, Solomon & Stewart, 2014).
10.  Vaginal mucus discharge in a 12-year-old is not something to worry about because the girl is in the puberty stage where there is the onset of menstruation. Probably the girl is about to have her periods
11. The blood-tinged mucus at the newborn is not an unusual thing but a common occurrence after childbirth. The mother should wipe away the discharge as it will disappear with time. The discharge is sometimes referred to as false menses due to the drop in the mother’s estrogen after birth.
12. The additional questions to ask about the discharge include the smell, any color changes, the amount of the discharge, and consistency.

b) stage 1 contains acute endometritis without peritonitis 

stage 2 is with peritonitis

stage 3 comprises of tuboovarian complex

stage 4 is when the tuboovarian abscess ruptures

stage 5 has various etiological agents emulating the acute salpingitis

c) the pelvic examination conducted would reveal tenderness in the ovaries, fallopian tube, cervix, and lower abdomen

1. Men, unlike women, can conceive even at old age. Age in men reduces sperm motility, but the men can still impregnate a young woman. However, there may be a few complications, such as miscarriage or developmental issues in the child (Siegel, Moses, Baldwin & Rodriguez, 2019).
2. The epididymis is the male part that is useful in storage, maturation, and transit of sperms
3. Many of the differentiated genitals start occurring from 8 to 12 weeks. Before that, the fetus’s genitalia is always the same. The males will begin developing into penis, scrotum, and urethra while the female will start developing the vagina, clitoris, labia, and urethra (Simmons & Fitzpatrick, 2019).
4. Advantages

Disadvantages

The circumcision reduces the risk of contracting sexually transmitted infections (STD) and HIV

It may lead to severe complications to the newborn due to the procedure

The risk of developing urinary tract infection reduces

The patient may develop inflammation at the opening of the penis

The risk of cancer in the penis region reduces substantially

The risk of pain and injury to the pain can affect the newborn

1. The growth in the baby is gradually, and each change occurs at its own time. The parent may have to wait a little bit longer for the testicles to appear. In case, the testes do not look after six months; then she should get worried and seek assistance (Simmons & Fitzpatrick, 2019)
2. The first thing is to reduce the anxiety that a child can experience by making them comfortable and making them feel great. The best position for kids is the supine and frog legged position. The room temperature ought to be comfortable to improve relaxation (Ball, Dains, Flynn, Solomon & Stewart, 2014)
3. Erections are not an abnormal occurrence during a physical examination. For patients, however, it may be strange. The nurses should reassure the patients that it is normal.
4. Cremasteric reflex is a reaction caused by stroking the inner male thighs.

References

Ball, J., Dains, J., Flynn, J., Solomon, B., & Stewart, R. (2014). Seidel’s guide to physical

examination. Elsevier – Health Sciences Division

Siegel, M., Moses, S., Baldwin, M., & Rodriguez, M. (2019). A decline in fertility with age: an overlooked and under-addressed topic in women’s health visits. Fertility And Sterility, 112(3), e309. doi: 10.1016/j.fertnstert.2019.07.899

Simmons, L., & Fitzpatrick, J. (2019). Female genitalia can evolve more rapidly and divergently than male genitalia. Nature Communications, 10(1). doi: 10.1038/s41467-019-09353-0

Case

Long-Term Care for All

The newly elected governor of a small state in which the elderly comprise 26% of the total population—twice the national average—is eager to fulfill his campaign promise. He had run for office on the slogan “long-term care for all.” The elderly in the state had overwhelmingly voted for him. Now in office about 9 months, his advisors tell him that providing long-term care services for all citizens in the state will be next to impossible because of high demand for the services. The governor, however, remains undeterred. The cornerstone of his proposed policy includes three things: (1) Develop a state-sponsored long-term care insurance plan. The insurance premiums will be income based, and will cost at least 15% less than a midlevel private long-term insurance plan being sold in the state. (2) Make it mandatory for all citizens, old and young, to purchase LTC insurance, either from the state or from a private insurance company. (3) Place restrictions on the use of nursing home and assisted living services in favor of community-based services.

Questions

1.  Give specific reasons why the governor’s policy may not work, pointing out specific problems that would likely arise.

2.  Will the policy work in a large state, everything else being equal? Give reasons.

In a reflection of 450-600 words, explain how you see yourself fitting into the following IOM Future of Nursing recommendations:

1. Recommendation 4: Increase the proportion of nurses with a baccalaureate degree to 80% by 2020.
2. Recommendation 5: Double the number of nurses with a doctorate by 2020.
3. Recommendation 6: Ensure that nurses engage in lifelong learning.

Identify your options in the job market based on your educational level.

1. How will increasing your level of education affect how you compete in the current job market?
2. How will increasing your level of education affect your role in the future of nursing?

While APA 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, which can be found in the APA Style Guide, located in the Student Success Center. 

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