APA format 3 peer references and response needs to agree or disagree with differential diagnosis and explain why

 

Week 9: Review of case study 1

Patient Initials: _AS__                       Age: __20___                         Gender: __M_

SUBJECTIVE DATA:

Chief Complaint (CC): an Unbearable headache

History of Present Illness (HPI): 20-year-old Caucasian male presented with a chief complaint of intermittent headaches. The patient reports that a headache is so bad and unrelenting that he feels it in his eyes with great intensity, nose, cheekbones, and jaw. The patient states “The headache ache comes and goes.” The patient reported that his headache started two days ago and had increased in severity of a 10/10 on the pain scale as the pressure in the eyes creating the sensitivity to light, the feeling of having toothache makes it too hard to bear. While the patient was not able to pinpoint when his headache started, he reports that he was so overwhelmed with school and work over the past couple of weeks, it may have precipitated the headache.  The patient reporting taking Tylenol which is ineffective; he has tried to get more sleep and use dimmed lights while awake. He states, “while the sleeping for a longer time helps a little, the headaches return as the day progress and gradually gets worse with each passing minute. The only thing that stops the headache is passing time.”.

Medications: Tylenol 650 mg every 4 to 6 hours.

Allergies: Ibuprofen- angioedema

Past Medical History (PMH): Mumps -resolved

Past Surgical History (PSH): Appendectomy at age 16 due to a ruptured appendix.

Sexual/Reproductive History: Not sexually active.

Personal/Social History: Reports going to church on Saturdays (worship sunset to sunset), Saturday after sabbath worship; sometimes going bowling or roller skating and socializes with peers from church or school. Denies tobacco use, alcohol use, and drug use. Patient reports at least three mornings per week approximately one hour of exercise at the work gym.

Immunization History: reports immunization up to date and will get his annual flu shot at work October 25, 2018.

Significant Family History: grandfather died one year ago (72) from heart failure. Grandmother 68 alive and living with hypertension.

Lifestyle: Patient is newly as a mental health counselor at a hospital psychiatric unit. He just started studying law part-time at the local university; current course is online. He currently lives alone in a two-bedroom apartment, as parents live in another country. His support system is his family who is a phone call away, and his best friend who lives 20 minutes away from his home. He does not drink, smoke or do drugs. He attends church on Saturday. Socializes with church friends and or best friend after sunset some Saturday at the local bowling alley, skating rink, or “hang out” at a local diner. Currently is not involved in a relationship and is not sexually active.

Review of Systems:

General: Patient reports having an “unbearable headache” Patient is unaware of any changes in weight, eating preference or activities; however, reports a decrease in appetite.

            HEENT: “except for the increasing headache no problem.”, reports wearing shades due to an increased sensitivity to lights; no hearing impairment; reports stuffy nose in the morning in the morning but no runny nose; denies difficulty chewing or swallowing, pain or discomfort.

 Neck: Endorses stiffness, reports “may be due to tension.”

            Respiratory: denies any respiratory distress

            Cardiovascular: denies palpitation, denies heart problems

            Gastrointestinal: Reports decreased appetite, some nausea, no vomiting no change in bowel pattern noted.

            Genitourinary: No change in urinary function

            Musculoskeletal: Denies problem with range of motion, walking or gait.

            Psychiatric: Denies having any psychiatric history

            Neurological: Reports feeling less alert, unfocused at times.

            Skin: Denies any dermatological problems

OBJECTIVE DATA:

 Physical Exam:

Vital signs: temp: 98.4, b/p 130/74, RR 18, pulse 88, SPO2 100% ht. 5’7” weight 140 BMI 21.9.

General: Patient is an alert and oriented *4, 20-year-old Caucasian male who appears to be in good health. He is appropriately groomed, no odor and looks clean. Erect posture, steady gait. Facial expression looks strained and sad; mood appears dysphoric. He is speaking English fluently and clearly. Voice is low and calm. Speech appear slowed and forced. The patient was able to count from 1-20 backward and repeat a series of words without hesitation. Reports having a headache for a long time, “maybe age 11, really not sure, but they weren’t this awful or frequent.”. For the past four months he has been having headaches for at least four days straight per month; but, this latest bout of headaches has been the worst experienced. He denies any head injury or trauma, and chronic illnesses. Patient report at its worst the pain is 10/10, and at its best, it is 7/10. He also states, “while I take Tylenol, I don’t think it effective; I think time passing makes it goes away, the problem is times seem to go too slow.”.

HEENT: head is symmetrical and normocephalic, no depression, swelling but reported tenderness. Denies head injury or trauma. No facial drooping, Patient endorses headache that is currently a 7/10. Reports pain is to present at forehead bilateral, temporal artery has no bruit, patient reports feeling like a “pressured weight” on his head. Patient does report some pulsating pain with movement. He also endorses feeling the pain behind the eyes, nose, cheekbones and jaw. His forehead is creased. Eyes are symmetrical.  Left eye appears glossy, no crusting, no nicking of arteries, optic disc is reddish orange, no microaneurysm, neovascularization.  Patient states, “pain can be felt in the eyes and vision in the left eyes sometimes vision seems blurred or doubled and funny”. On evaluation the patient can read clearly at 20/20 on the Snellen eye chart. Pupils are equal, rounded, reactive to light and accommodation. Peripheral vision is intact. No excess blinking, denies pain on examination. No wax in the ear, symmetrical, clean, no difficulty hearing bilaterally during whisper, Weber and Rinne test, no infection or lesion noted, the handle of malleus, light reflex, and the umbo is visualized as the membrane is pearly gray. Nose is midline, no stuffiness, no redness, no drainage noted. Lips are pink and moist, no cavities noted, reports last dental exam and cleaning was September 2018. Tongue is light pink and moist, no problem with swallowing, hard and soft palate gag reflex. Tongue is flexible and resistant to force. Salivary glands are functional. No pain reported on examination.

Neck: Good range of motion, lymph nodes are not palpable; however, tension can be felt in the neck, appears as if the patient has difficulty relaxing. The trachea is midline; thyroid is non-palpable.

Chest: No wheezing, rhonchi, or rales

Lungs: clear in all four quadrants

Heart: no murmurs or abnormal heart sound

Abdomen: flat and no tender, bowel sounds present in all four quadrants, no reports of difficulty in bowel movement or change in the pattern

Musculoskeletal: range of motion is good, no curvature noted. No swelling, redness or tenderness. Some stiffness in the neck but not related to the range of motion but to the patient not being able to relax/ patient is tense. No difficulty in standing, walking in a straight line, stopping or turning suddenly. Balance and gait are exceptional. Patient report having frequent muscle contraction.

Psychiatric: While presently dysphoric, no indication of depression on assessment, the patient appears future-oriented. Denies suicidal and homicidal ideation as well as auditory and visual hallucination. Headache complaint does not appear somatic.

Neurological: Cranial nerve assessment finds all nerve intact with no impairment. The patient is alert and oriented to person, place, time and situation. He can do serial addition and multiplication; repeat a series of words after having a different line of conversation. Count from 1-20 backward. No numbness or tingling in fingers, toes, or face. Muscle strength is (5) good as there is active motion against full resistance, reflex is 2+ normal. Patient can recognize writing on skin, interpret hard and soft with eyes closed. While no sensory issue is present patient reports based on the increased level of activity on the unit at the increase stimuli has been affecting his concentration; he feels overstimulated believes he cannot process new information right now, only wanting to concentrate on one task at a time. He also reiterates that bright light bothers his eyes and the combination with the increased stimulants makes the headache worst. Patient reports feeling less alert and unfocused; however, while this may occur, this neurological exam does not correlate.

24 Hour diet and activity recall: – woke 5:30 or work 8-hour work day which begins at 7 am. 10 am, Breakfast 2 boiled eggs, a slice of toast with a slice of cheese, a bowl of cereal and a glass of coffee. Lunch, chicken Caesar salad. No dinner, went straight at 4pm home after work headache was too intense. Slept for 3 hours, headache was still present but less intense, spent 4 hours on school work then went back to sleep, slept until 5:30 am, then got ready for work. Reports drinking on average four to five glasses of water per day. Patient does not cook, will sometimes eat frozen tv dinners or ramen noodles; sometimes snacks heavily, his favorite snacks are chocolate ice-cream, eclairs, Cheetos and Doritos.

Diagnostic test MRI, and or CT-scan, and complete blood count to rule out inflammation.

 ASSESSMENT:

Tension Headache- Per Dains, Baumann & Scheibel, (2016) Tension headache is the most common type of headache in adults, and the pain is bilateral, and last for hours to days, and it can form a cycle that may last for months. The text also notes that factors such as stress, hunger and depression can trigger this headache. Based on information gained from AS, stress is likely a contributing factor to AS headaches. However, results from imaging and testing are needed to determine his type of headache. In a randomized clinical study conducted by Omidi, & Zargar, (2015) they found that the use of psychotherapy dubbed mindfulness-based stress reduction was helpful in reducing pain and stress and would be a useful tool in relieving the tension headache.

Migraine- Per Dains, Baumann & Scheibel, (2016) migraine without aura is seen in 20% of the population, has a unilateral throbbing pain with symptoms of nausea and photophobia. According to Tai, Yap, & Goh, (2018) dietary intake can trigger migraine headaches. They conducted a study that found that coffee, chocolate and monosodium rich foods such as broth, flavored snacks, frozen foods, and pasta sauce can trigger a migraine. It is clear from AS description he is experiencing throbbing pain and is experiencing nausea and photophobia, however, he does states that his headache is bilateral. Hence a leaning towards mixed headache diagnosis. However, this differential diagnosis cannot be ruled out as the patient may also have a migraine with aura as well. In any event, diet change and food choices must be discussed with the patient has some of AS choices is likely a trigger to his headache.

Mixed headache- According to Dains, Baumann, & Scheibel, (2016) is a combination of tension and migraine whereby the effect is a combination of throbbing, tightness, pressure and constant pain is felt.  Based on AS description this may be what he is experiencing, therefore, this is an important differential diagnosis Krøll, Hammarlund, Westergaard, Nielsen, Sloth, Jensen, & Gard, (2017) performed a study on mixed headaches; the writers noted that while this type of headache is common, very little study is done, so there are not many tailored interventions exist to help the patient. Therefore, more studies are needed to help understand mixed headaches and proper medication modalities, and alternative remedies, to help alleviate and manage the pain.

Conclusion

Per Dain, Baumann, & Scheibel, “headache and nausea are associated with head trauma, stroke, and tumor.” While this may true in many cases, headaches do not seem to have a definitive cause and appear to be puzzling as some headaches have no underlying factors and give no warning. As always pain is what the patient says, so determinants are based mostly on the information provided by the patient. Therefore, asking the right questions is very important. Diagnostic tests, lab test, and physical assessment is done to ensure patient body systems; neurological functionalities are not affected as headaches could be secondary, as a result of many other medical issues; such as sinusitis, meningitis, optic neuritis, or a tumor.

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.

Krøll, L. S., Hammarlund, C. S., Westergaard, M. L., Nielsen, T., Sloth, L. B., Jensen, R. H., & Gard, G. (2017). Level of physical activity, well-being, stress and self-rated health in persons with migraine and co-existing tension-type headache and neck pain. The Journal of Headache and Pain, 18(1), 46.

Omidi, A., & Zargar, F. (2015). Effects of mindfulness-based stress reduction on perceived stress and psychological health in patients with tension headache. Journal of Research in Medical Sciences, 20(11), 1058–1063

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

Tai MLS, Yap JF, & Goh CB. (2018). Dietary trigger factors of migraine and tension-type headache in a South East Asian country. Journal of Pain Research, Vol Volume 11, Pp 1255-1261 (2018), 1255

Social media plays a significant role in the lives of nurses in both their professional and personal lives. Additionally, social media is now considered a mainstream part of the process for recruiting and hiring candidates. Inappropriate or unethical conduct on social media can create legal problems for nurses as well as the field of nursing.

Login to all social media sites in which you engage. Review your profile, pictures and posts. Based on the professional standards of nursing, identify items that would be considered unprofessional and potentially detrimental to your career and that negatively impact the reputation of the nursing field.

In 500-750 words, summarize the findings of your review. Include the following:

1. Describe the posts or conversations in which you have engaged that might be considered inappropriate based on the professional standards of nursing.
2. Discuss why nurses have a responsibility to uphold a standard of conduct consistent with the standards governing the profession of nursing at work and in their personal lives. Include discussion of how personal conduct can violate HIPAA or be considered unethical or unprofessional. Provide an example of each to support your answer.
3. Based on the analysis of your social media, discuss what areas of your social media activity reflect Christian values as they relate to respecting human value and dignity for all individuals. Describe areas of your social media activity that could be improved.

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. 

Comment 1

An effective leader is empathetic, understands multiple leadership skills as well as flexible. Leadership skills involve an ability to understand emotional intelligence and skills needed to become a nursing leader. Self-awareness involves the ability to understand one’s emotions and feelings and how these affects and influences others. Self-awareness is significant to leadership effectiveness, and many leaders exercise it. It is a way of exploring tendencies, beliefs, individual personalities, natural inclinations as well as value system (Huber, 2018). People react to things, synthesize and learn differently. Self-awareness help to spend time occasionally in self-reflection to achieve a better insight in ourselves. It assists the managers to determine the gaps in management skills that promote skill development. It assists managers in stress management and motivation, with intuitive decision-making and finds most effective situations. Self-awareness helps people to strengths as well as cope with the weaknesses.

An example, a person good in seeing the big picture surrounding the decision but not good in concentrating at the details may need to consult the subordinates or the colleagues who are more detail-oriented in making main decisions. Combining detail-oriented and big picture oriented decision makers may produce high quality decisions. In a team, a good leader is important (Huber, 2018). For instance, in the hospital nurses may be busy and the patient may require multiple things, some have a change in condition, and some may be in great pain. Nurses who are well-organized, manage time and help other colleagues make differences, enables him or her to run smoothly and less stressful. Nurses using the self-awareness are able to use their feelings and emotions as a guide in decision-making. As nursing, one needs to understand how his/her emotions and attitude affects and influences other employees.

Comment 2

Self-awareness means knowing your values, personality, needs, habits, emotions, strengths, weaknesses, etc. Human beings are complex and diverse. To become more self-aware, we should develop an understanding of ourselves in many areas. Key areas for self-awareness include our personality traits, personal values, habits, emotions, and the psychological needs that drive our behaviors. Individual leaders who are able to regulate their own emotions are better equipped to provide a “holding environment” for the people who work for and with them, creating a culture where people feel at ease.

In our highly competitive culture, this can seem counterintuitive. In fact, many of us operate on the belief that we must appear as though we know everything all the time or else people will question our abilities, diminishing our effectiveness as leaders. If you’re honest with yourself, you’ll admit that really the opposite is true. Because whether you acknowledge your weaknesses or not, everyone still sees them. So rather than conceal them, the person who tries to hide weaknesses actually highlights them, creating the perception of a lack of integrity and self-awareness.

Self-awareness helps managers identify gaps in their management skills, which promotes skill development. But self-awareness also helps managers find situations in which they will be most effective, assists with intuitive decision making, and aids stress management and motivation of oneself and others.

 

Topic 1: Child and Adolescent Health Risks

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Obesity is not exclusive to adults. Each day, more and more children are finding themselves at risk for overweight and obesity. Childhood obesity often accompanies many of the obesity-related conditions adults affected by obesity often experience, such as type 2 diabetes, hypertension, sleep apnea and more. Recent data shows that up to 80 percent of children affected by obesity will continue to be affected by obesity into adulthood (Lobstein, et all, 2015). Obesity impacts children in a variety of ways. First and foremost, a child’s health is impacted as they have now opened themselves up to a wide variety of health issues – issues that most of us didn’t experience until middle-age. In addition to health implications, there’s also one other area that children face which can be very serious – weight bias and bullying. Kids impacted by obesity often find themselves the target of bullying. This bullying can take place in the classroom, in your neighborhood and even in your own home. It is very important to recognize this type of behavior and address it quickly (Lobstein, et all, 2015). The Obesity Action Coalition (OAC), a nonprofit dedicated to educating and advocating for those affected by obesity, provides valuable resources on weight bullying.

Over the last decades, food has become more affordable to larger numbers of people as the price of food has decreased substantially relative to income and the concept of ‘food’ has changed from a means of nourishment to a marker of lifestyle and a source of pleasure. Clearly, increases in physical activity are not likely to offset an energy rich, poor nutritive diet. It takes between 1–2 hours of extremely vigorous activity to counteract a single large-sized (i.e., >=785 kcal) children’s meal at a fast food restaurant (Lobstein, et all, 2015). Frequent consumption of such a diet can hardly be counteracted by the average child or adult.

It has been hypothesized that a steady decline in physical activity among all age groups has heavily contributed to rising rates of obesity all around the world. Physical activity strongly influenced weight gain in a study of monozygotic twins (Rivera, et all, 2014). Numerous studies have shown that sedentary behaviors like watching television and playing computer games are associated with increased prevalence of obesity. Furthermore, parents report that they prefer having their children watch television at home rather than play outside unattended because parents are then able to complete their chores while keeping an eye on their children (Rivera, et all, 2014). In addition, increased proportions of children who are being driven to school and low participation rates in sports and physical education, particularly among adolescent girls, are also associated with increased obesity prevalence.

Almost all public health researchers and clinicians agree that prevention could be the key strategy for controlling the current epidemic of obesity. Prevention may include primary prevention of overweight or obesity itself, secondary prevention or avoidance of weight regains following weight loss, and prevention of further weight increases in obese individuals unable to lose weight (Rivera, et all, 2014). Until now, most approaches have focused on changing the behavior of individuals on diet and exercise and it seems that these strategies have had little impact on the growing increase of the obesity epidemic.

 

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

2)¨**********APA norms  (All paragraphs must be narrative and cited in the text- each paragraphs)

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

4) References not older than 5 years

_______________________________________________________

 

You must answer (1) one question2 times. 

You must submit 2 documents (each one 1 page).

Copy and paste will not be admitted. 

You should address the questions with different wording, different references, but always, objectively answering the questions.

______________________________________________________–

Question:

 

Suppose you were planning to conduct a statewide study of the work plans and intentions of nonemployed registered nurses in your state (Florida). 

1) Would you ask mostly open-ended questions or closed-ended questions? 

Defend your answer (Mandatory).