The “Pulse” Check.  Where are you in your journey and how are you doing?

DQ2 of Week 5 is an opportunity for you to self-assess and reflect on your journey. You can write about it or you can share a created video (you-tube) expressing your navigation through the Role course. Model from the scripts in this week, but be specific to your experience.

Evaluate how you have achieved course competencies and your plans to develop further in these areas. The course competencies for this course are as follows:

1. Explore the historical evolution of the advance practice nurse.
2. Differentiate the roles and scope of practice for nurses working in advanced clinical, education, administration, informatics, research, and health policy arenas.
3. Analyze attributes of the practice arena such as access and availability, degree of consumer choice, competition, and financing that impact advanced practice nurses and their ability to effectively collaborate with other health professionals.
4. Integrate evidence from research and theory into discussions of practice competencies, health promotion and disease prevention strategies, quality improvement, and safety standards.
5. Identify collaborative, organizational, communication, and leadership skills in working with other professionals in healthcare facilities and/or academic institutions.
6. Synthesize knowledge from values theory, ethics, and legal/regulatory statutes in the development of a personal philosophy for a career as an advanced practice nurse.

 

For this assignment, perform a complete head-to-toe assessment on one of your chosen participants. Your analysis should include the following:

• Topical headings to delineate systems.
• For any system for which you do not have equipment, explain how you would do the assessment.
• Detailed review of each system with normal and abnormal findings, along with normal laboratory findings for client age.
• An analysis of age-specific risk reduction, health screen, and immunizations.
• Your expectation of normal findings and what might indicate abnormal findings in your review of systems.
• The differential diagnosis (disease) associated with possible abnormal findings.
• A plan of care (including nursing diagnosis, interventions, evaluation).
• Client and age-appropriate evidenced based practice strategies for health promotion.
• Pharmacological treatments that can be used to address health issues for this client.

Provide your answers in a 6- to 7-page Microsoft Word document.

Support your responses with examples.

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

• Use this APA Citation Helper as a convenient reference for properly citing resources.

Discussion # 6

What would be the most appropriate researchable population for use in your research project? What are the challenges of obtaining a sample from this population? How could you address those challenges? (Essential I-IX

Discussion # 7

Find a study published in a nursing journal in 2010 or earlier that is described a s a pilot study. Do you think the study really is a pilot study, or do you think this label was used inappropriately? Search forward for a larger subsequent study to evaluate your response. 

Discussion # 8

Identify a state health policy and the tools used to implement the policy. How do you think the political climate has affected the choice of policy tools and the behavioral assumptions by policymakers?  How have professional nursing organizations been involved in this policy issue? If they have not, what recommendations would you make for them to participate?  Develop a few talking points to inform other health care professionals regarding this issue.

Reading Reflection

Please submit minimum of 250 word statement with references regarding this week chapter reading, explain what are some of the important aspects of this week’s reading, provide examples when possible. Thanks. Jorge 

Ch 26 & 27  

(book Ruth M. Tappen. (2015).  Nursing Research. Advanced Nursing Research: From Theory to Practice. (2nded.). ISBN-13: 9781284048308. ISBN-10: 1284048306. Publisher: Jones & Bartlett Learning)

Objective Reflection

Hello Class

As part of the class objectives, we would like for each student to write a small reflection paragraph and post it on this forum in answering what you have learned from this class, where the objectives that you had for the class met and how do you anticipate to use research. Thanks.

Chapter 23 –  Neurological Disorders.
Chapter 24 –  Mental Health.

Question(s): What is likely to be different in the appearance of depression in a person who is 70 years old compared to its appearance in a person who is 20 years old? (mention at least 3)

Guidelines: The answer should be based on the knowledge obtained from reading the book, no just your opinion. Please, do not mention the signs and symptoms of depression. You need to mention the characteristics / symptoms that are common on a depressed 70 years old person than are different in a 20 years old depressed individual (do a comparison between the depressed 70 years old with the depressed 20 years old) (mention at least 3) (33% each). 

  

Part I : 

a. Soap Note Ankylosing Spondylitis

b. add questions from your case study 

Part II: Ankylosing Spondylitis

a. Pathophysiology

b. Clinical Presentation

c. Physical Examination

d. Diagnostic Testing 

e. Differential Diagnosis

f. Management

g. Education and Health Promotion 

Power point

< 20 % plagiarism

5 References

Sample Regular Soap Note Template

PATIENT INFORMATION

Name: Mr. W.S.

Age: 65-year-old

Sex: Male

Source: Patient

Allergies: None

Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime

PMH: Hypercholesterolemia

Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago.

Surgical History: Appendectomy 47 years ago.

Family History: Father- died 81 does not report information

Mother-alive, 88 years old, Diabetes Mellitus, HTN

Daughter-alive, 34 years old, healthy

Social Hx:No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone.

SUBJECTIVE:

Chief complain: “headaches” that started two weeks ago

Symptom analysis/HPI:

The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness.He states that he has been under stress in his workplace for the last month.

Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting.

ROS:

CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizzeness as describe above. Denies changes in LOC. Denies history of tremors or seizures. 

HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing.

Respiratory: Patient denies shortness of breath, cough or hemoptysis.

Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal

dyspnea.

Gastrointestinal: Denies abdominal pain or discomfort. Denies flatulence, nausea, vomiting or

diarrhea.

Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence.

MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound.

Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus.

Objective Data

CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200lb, BMI 25. Report pain 0/10.

General appearance: The patient is alert and oriented x 3. No acute distress noted.NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5.

HEENT:Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding.Oral mucosa moist without lesions,.Lids non-remarkable and appropriate for race.

Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses.

Cardiovascular: S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec.

Respiratory: No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation.

Gastrointestinal:No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no rebound no distention or organomegaly noted on palpation

Musculoskeletal: No pain to palpation. Active and passive ROM within normal limits, no stiffness.

Integumentary: intact, no lesions or rashes, no cyanosis or jaundice.

Assessment

Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed.

Differential diagnosis:

Ø Renal artery stenosis (ICD10 I70.1)

Ø Chronic kidney disease (ICD10 I12.9)

Ø Hyperthyroidism(ICD10E05.90)

Plan

Diagnosis is based on the clinical evaluation through history, physical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease.

These basic laboratory tests are:

· CMP

· Complete blood count

· Lipid profile

· Thyroid-stimulating hormone

· Urinalysis

· Electrocardiogram

Ø Pharmacological treatment: 

The treatment of choice in this case would be:

Thiazide-like diuretic and/or a CCB

· Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily. 

Ø Non-Pharmacologic treatment: 

· Weight loss

· Healthy diet(DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat

· Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults

· Enhanced intake of dietary potassium

· Regular physical activity (Aerobic): 90–150 min/wk

· Tobacco cessation

· Measures to release stress and effective coping mechanisms.

Education

· Provide with nutrition/dietary information.

· Daily blood pressure monitoringat home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP

· Instruction about medication intake compliance. 

· Education of possible complications such as stroke, heart attack, and other problems.

· Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all

Follow-ups/Referrals

· Evaluation with PCP in 1 weeks for managing blood pressure and to evaluate current hypotensive therapy. Urgent Care visit prn.

· No referrals needed at this time.

References

Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017 (25th ed.). Print (The 5-Minute Consult Series).

CodinaLeik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.). ISBN 978-0-8261-3424-0