Discussion Question

Identify two strategies you can implement to provide comfort to maintain function with an ethnically diverse older adult with a chronic disease? This can be nutrition, ADLs, exercise, etc.

Citations should conform to APA guidelines. You may use this APA Citation Helper as a convenient reference for properly citing resources or connect to the APA Style website through the APA icon below.

The Nurse as Advocate  Whether nurses are advocating for their patients, health care, and/or policies that improve people’s lives, the advocacy processes have commonalities that transcend the subject of their advocacy. There are also differences, although these differences may be more nuanced than obvious.  

Tasks:  Write a 5-page brief to answer the following questions. Be sure to use APA guidelines for writing style, spelling and grammar, and citation of sources.  Read the following chapters from your course textbook: 

•Taking Action: Nurse, Educator, and Legislator: My Journey to the Delaware Senate 

•Taking Action: A Nurse in the Board Room  Answer the below questions: •Describe what you believe to be the drivers for each of the individuals? What factors led them to become advocates? 

•Discuss the challenges that each of them identified in their writings. 

•Analyze these drivers and challenges and compare them with your own experience to date as an advocate. In what ways do you believe that you can expand your advocacy skills within the next five years?

No Plegarism please, assignment will be checked with Turnitin. 

Will need minimum of 1 to 1 and 1/2 full content pages, plus title, and reference page APA Style, double spaced, times new romans, font 12, and and 3 references with intext citations. References within 3 years (2016-2018). 

 

Location: XYZ Family Practice

You are an NP student in this practice. Your next patient is the following:

“I had to come in today because I have been coughing for a long time”

Amanda Smith (69 year old, black female) is a retired postal worker. During the visit, she is coughing continually. She states the cough started 5 days ago intermittently but 2 days ago it became constant. Her chart indicates that she has been a patient of the practice for 5 years, gets care regularly and her HTN has been controlled for 4 years.

Social History

Married – 2 adult children A & W

Non-Smoker now. Smoke 1 pack a day for 15 years. Quit x5 years ago

No alcohol or drug use

Baptist, attends church regularly and is a member of the choir

Family History

Mother – Deceased at age 27 from traumatic accident

Father – Deceased age 78 related to renal failure secondary to diabetes type II

Siblings – one brother age 61 A & W

Medical/Surgical/Health Maintenance Hx

Measles, mumps and chicken pox as a child.

Tetanus/Diptheria/Pertussis – Last dose 2 years ago

Influenza – Last dose 9 months ago

Pneumococcal vaccine at age 65

Zostivax at age 60

Chronic diagnoses – HTN x 5 years

Takes HCTZ 25 mg daily

ROS

General

Usual weight has been maintained

Fever for 5 days up to 101

Skin

Dry skin, uses emollient frequently

HEENT

Wears reading glasses

Dentition fair. Partial upper denture

Neck

No swelling or stiffness

Chest

Substernal pain on cough

Respiratory

Began coughing 4 days ago. Started mild, intermittent and non-productive. Two days ago became constant and productive of frothy sputum. Keeps her awake at night. No relief with OTC cough syrup. She states she is short of breath today.

CV

No CP at rest or when not coughing

PV

Some swelling of feet and ankles at end of day, relieved by elevating feet

GI

Decreased appetite for one week

No change in bowel habits

GU

No frequency, hesitancy, nocturia or change in bladder habits

Genitalia

No changes

MS
Stiffness in hands and legs on awakening. Relieved with activity

Psych

No depression, anxiety, or memory change

Neurologic

No numbness, weakness, headache, change in mentation, or paralysis

Hematologic

No past anemia

Endocrine

No change in weight, thirst, heat/cold intolerance.

Your physical exam reveals:

Temp 101.4, Resp 30 labored, no retractions, BP 135/92, HR 110, Pulse Ox 90 Wt 130 lbs

General appearance – Alert in all spheres, in mild respiratory distress, able to answer questions with short sentences, tripod breathing

HEENT –

Eyes ,ear, nose, head wnl

Mouth -mucosa dry

Pharynx – tonsils present not enlarged, normal pink color

Lymph – no enlargement

Skin – Dry and scaly legs and arms. Tenting of skin noted

Heart- regular rhythm at 110 bpm, no murmurs or extra sounds

Lungs – normal breath sound without crackles, bronchophony or egophony

Abdomen – no mass, tenderness, rigidity

Extremities – Hands – no swelling, Feet/legs – +1 edema feet to ankle level

Pedal pulses – wnl

Differential diagnoses:

• CAP
• Acute bronchitis
• Congestive heart failure
• Influenza

Plan – transfer to acute care setting for further work-up 

Assignment Details:

The “Elevator Consult” 

In this activity, you will practice giving a synopsis of your patient to your preceptor. In practice, you may often give this type of report if you are sending a patient for a consultation and your phone the specialist to discuss the patient. This report should be concise and clear. The receiver should, within one minute (slightly less for simple cases, slightly more for complex cases) have a picture of the patient in his/her head. You will report on ONLY items pertaining to the acute problem in this case. Do not include extraneous material or material not directly impacting the decision-making regarding this problem. Remember, this is a FOCUSED visit and assessment to evaluate a focused concern. The history and physical exam applies techniques relevant to the specific complaint for the patient at that visit. Your report should be similarly focused, providing only information that relates specifically to the presenting problem. 

Please review the grading rubric under Course Resources in the Grading Rubric section.

When completing practicum requirements in clinical settings, you and your Preceptor might complete several patient assessments in the course of a day or even just a few hours. This schedule does not always allow for a thorough discussion or reflection on every patient you have seen. As a future advanced practice nurse, it is important that you take the time to reflect on a comprehensive patient assessment that includes everything from patient medical history to evaluations and follow-up care. For this Assignment, you begin to plan and write a comprehensive assessment that focuses on one female patient from your current practicum setting.

To prepare

• Reflect on your Practicum Experience and select a female patient whom you have examined with the support and guidance of your Preceptor.
• Think about the details of the patient’s background, medical history, physical exam, labs and diagnostics, diagnosis, treatment and management plan, as well as education strategies and follow-up care.

To complete

Write an 8- to 10-page comprehensive assessment that addresses the following:

• Age, race and ethnicity, and partner status of the patient
• Current health status, including chief concern or complaint of the patient
• Contraception method (if any)
• Patient history, including medical history, family medical history, gynecologic history, obstetric history, and personal social history (as appropriate to current problem)
• Review of systems
• Physical exam
• Labs, tests, and other diagnostics
• Differential diagnoses
• Management plan, including diagnosis, treatment, patient education, and follow-up care

References

 

Learning Resources

Schuiling, K. D., & Likis, F. E. (2017). Women’s  gynecologic health (3rd ed.). Burlington, MA: Jones and Bartlett  Publishers.

Chapter 5, “Gynecologic Anatomy and Physiology” (pp. 77-93)
This chapter explores female anatomy and physiology with a focus on the female reproductive anatomy. It also describes the physiology of the menstrual cycle, including the hormonal feedback system and the ovarian and endometrial cycles.

Chapter 6, “Gynecologic History and Physical Examination” (pp. 95-133)
This chapter identifies the core knowledge and skill base required for obtaining a gynecologic health history and performing physical examinations such as pelvic and breast exams.

Chapter 7, “Periodic Screening and Health Maintenance” (pp. 135-149)
This chapter explores preventive health services for women such as screening tests, counseling, immunization, and chemoprevention. It also compares screening recommendations from organizations such as the U.S. Preventive Services Task Force, American College of Obstetricians and Gynecologists, and American Cancer Society.

Chapter 13, “Intimate Partner Violence” (pp. 303-322)
This chapter defines intimate partner violence (IPV) and describes the epidemiology and health effects of IPV. It also examines screening tools for assessing IPV and strategies for managing patients experiencing IPV, particularly pregnant women, adolescents, and older women.

Chapter 14, “Sexual Assault” (pp. 327-349)
This chapter examines strategies for identifying sexual violence and providing care to women who are victims of sexual violence. It explores potential health consequences of sexual violence on women, including physical injury, spread of sexually transmitted diseases, and unintended pregnancy.

Tharpe, N. L., Farley, C., & Jordan, R. G. (2017). Clinical practice guidelines for midwifery & women’s health (5th  ed.). Burlington, MA: Jones & Bartlett Publishers.
Chapter 6, “Care of the Well Woman Across the Life Span”
“Primary Preventive” Health Care for Well Women” (pp. 301-303)
This section examines social, mental, and physical issues that affect women during different stages of their lives. It also examines the provider’s role in prevention and care.
“Care of the Well Woman: Health Assessment and Screening for Women of Childbearing Age” (pp. 303-310)
This section provides a list of health information for the health care provider to address during well-woman examinations, as well as an immunization schedule for women across the life span.
“Care of the Well Woman: Health Assessment and Screening During Menopause” (pp. 338-349)
This section explains the physiologic changes that occur during menopause, including health issues that are likely to present. It also examines treatment and management options related to diet, exercise, sleep, and sexual comfort.                   Chapter 8, “Primary Care in Midwifery and Women’s Health”
“Care of the Woman: Prevention of Osteoporosis” (pp. 576-584)
This section explores factors that increase risks of osteoporosis in women, particularly postmenopausal women. It also provides strategies for identifying risk factors of osteoporosis and diagnosing and treating the condition.
“Care of the Woman in Need of Smoking Cessation” (pp. 471-475)
This section outlines factors that impact successful smoking cessation. It also describes treatment options and patient education strategies for women in need of smoking cessation.

U.S. Department of Health and Human Services. (2012b). Screening tests and vaccines. Retrieved from http://www.womenshealth.gov/screening-tests-and-vaccines/screening-tests-for-women/

This article provides guidelines for recommended screening tests for women. The guidelines are categorized by age and type of test.

 

Instructions

Phase 3: Analyzing the Aggregate Strengths and Weaknesses

For Phase 3 of the Capstone project, analyze and describe the strengths and weaknesses of the aggregate
and the community where the aggregate resides.
Be sure to apply Mobilize, Assess, Plan, Implement, Track (MAP-IT) in your assessment process.

• By the due date assigned, submit your response in a 1-page Microsoft Word document.
• Support your responses with examples.
• Cite all sources in APA format.

Phase 4: Risk Assessment

For Phase 4 of your project, you will select a family in your aggregate and complete a risk assessment in
the field using the information from chapter 18 “Community as Client: Assessment and Analysis” and
“Appendix D Friedman Family Assessment Model (Short Form)” as a guide. Describe how the family,
environment, home, and risk assessments were conducted, using your course textbook as a reference.
Describe the results of the assessments, drawing conclusions about the health risks to the aggregate as you
see them.

• By the due date assigned, submit your response in a 2- to 3-page Microsoft Word document.
• Support your responses with examples.
• Cite all sources in APA format.

Submission Details:

Combine Phase 3 and Phase 4 documents into one paper. Use bold sub-headings in the paper to distinguish
Phase 3 from Phase 4.
Phase 3: Analyzing the Aggregate Strengths and Weaknesses and Phase 4: Risk Assessment

• Name your combined document SU_NSG4075_W4_Project_LastName_FirstInitial_Phase3andPhase4.doc.
• Submit your combined document to the Submissions Area by the due date assigned.