GERD

If you can not do it please don’t accept

 

Mrs. B is a 55-year-old, white, female

Source: Self, reliable source

Subjective:

Chief complaint: “I have acid reflux.”   

HPI:  Patient states she has been having burning in her chest over the past 2-3 weeks. It is worse with consumption of spicy foods, alcohol and caffeinated beverages. She denies any nausea, vomiting, abdominal pain, blood in stools, food getting caught in throat or painful swallowing. She denies any chills or fever. She states she has been more stressed at work, which seemed to coincide with the onset of her symptoms. She has been taking Tums, which helps “a little.”

Allergies: NKA

Current Mediations:

Ferrous sulfate, 325 mg, daily

Clopidogrel, 75 mg, daily

Aspirin, 81 mg, daily

Ramipril, 5 mg, daily

Rosuvastatin, 20 mg, daily

Oxybutynin, 3.9 mg/24 patch

Fluoxetine, 10 mg, daily

Ibandronate, 150 mg, monthly

Tums, PRN                                                                                                                

Pertinent History: Iron deficiency anemia, STEMI (two months ago), hypertension, hyperlipidemia, urge incontinence, depression, osteoporosis

Health Maintenance. Immunizations: Immunizations and pertinent screening up-to-date

Family History:

            Father – Myocardial infarction (deceased age 52)

            Mother – Atrial fibrillation (deceased age 79)

Social History: Patient lives with her husband. She smokes 1ppd (40 pack year history). She drinks a glass of wine each evening with dinner. She denies drug use.

ROS: Incorporated into HPI

Objective:

VS – BP: 145/92, HR: 86, RR: 16, Temp 97.6, oxygenation 96%, weight: 240 lbs, height: 54 inches.

Mrs. B is alert, awake, oriented x 3.  Patient is clean and dressed appropriate for age.

ENT: The tympanic membranes are pearly gray. The nasal mucosa is pink with no discharge. The oropharynx is pink with no tonsillar erythema or exudate. There is no evidence of abnormal masses or leukoplakia. No cervical lymphadenopathy

Cardiac: No cardiomegaly or thrills; regular rate and rhythm, no murmur or gallop. No peripheral edema or jugular vein distention

Respiratory: Clear to auscultation, but decreased breath sounds

Abdomen: Bowel sounds positive. Soft, nontender, nondistended, no hepatomegaly      

ECG: Sinus rhythm

CBC: Hematocrit and hemoglobin within normal range

H pylori breath test: Negative    

Assessment:

Diagnosis: Gastro-esophageal reflux, ICD-10: K21.9

Please answer the following:

1. What is your prescribed treatment plan (include specific dosage, frequency)? Why did you choose this treatment plan? In your answer, please describe, briefly, the pharmacodynamics (1 point) and pharmacokinetics (1 point) of your treatment choice and how they influenced your choice. Please describe how the patient comorbidities influenced your choice as well (1 point).  Are there any medical interactions to your choice (1 point)? 
2. Document the education you would provide for this patient, specific to the prescribed medication. Please include information pertinent to the patient (2 points) and common potential adverse effects (2 points).

Module 2 – Case

HEALTHY PEOPLE 2020: UNDERSTANDING AND IMPROVING HEALTH

Case Assignment

Healthy People 2020: Understanding and Improving Health

For this assignment, I would like for you to expand your knowledge and understanding of the goals and mission of Healthy People 2020 and its predecessor Healthy People 2010.

Please answer the following questions:

1. Discuss whether or not you believe that the mission and goals for Healthy People 2020 are reasonable given the major health concerns facing our communities. Of the 2020 topics, choose one and discuss its impact on public health—support your discussion with at least 2 articles using ProQuest.
2. Please compare and contrast the focus areas for Healthy People 2010 with the topics for Healthy People 2020. What are their similarities? Are there any differences? In your opinion and given the current health trends, what might be a single most important health priority or topic for Healthy People 2020?
3. Briefly discuss how a commitment by a state and/or local health department to meet the objectives of Healthy People 2020 can affect public policy. Use one of the assigned readings as a reference.
4. What is the role of “Healthier US” and what are the policy and environmental changes that are directed toward achieving a healthier lifestyle? Identify a policy of environmental change that you believe will result in actually achieving a healthier lifestyle. Justify your position.
5. Do you consider it to be appropriate for a state or county health department to set objectives which are not compatible with CDC’s Healthy People 2020 topics and objectives? Please support your position. Use one of the assigned readings as a reference.

Please submit your Case Assignment by the end of Module 2. Please refer to the Trident calendar for exact due dates. Please contact me at any time should you have any questions.

Assignment Expectations

1. You are expected to consult the scholarly literature in preparing your paper; you are also expected to incorporate relevant background readings.
2. Your paper should be written in your own words. This will enable your instructor to assess your level of understanding.
3. In order to earn full credit, you must clearly show that you have read ALL required Background materials.
4. Be sure to cite your references in the text of all papers and on the reference list at the end. For examples, look at the way the references are listed in the modules and on the Background reading list. Remember, any statement that you make that is not common knowledge or that originates from your synthesis or interpretation of materials you have read must have a citation associated with it. For guidelines on in-text citations, visit the following website: https://owl.english.purdue.edu/owl/resource/560/02/
5. Proofread your paper to be sure grammar and punctuation are correct and that each part of the assignment has been addressed clearly and completely.
6. Your assignment will not be graded until you have submitted an Originality Report with a Similarity Index (SI) score <15% (excluding direct quotes, quoted assignment instructions, and references). Papers not meeting this requirement by the end of the session will receive a score of 0 (grade of F). Papers with a lower SI score may be returned for revisions. For example, if one paragraph accounting for only 10% of a paper is cut and pasted, the paper could be returned for revision, despite the low SI score. Please use the report and your SI score as a guide to improve the originality of your work.

Length: Your paper should be 4-6 double-spaced pages (800-1,300 words) in length, excluding title page and references.

Note: Wikipedia is not an acceptable source of information. 

A 5th grader is staying home from school because of Tourette syndrome. The specific tic bothering her is licking her lips and around her oral area. As described by her mother, the area is raw and red and she is embarrassed and does not want to attend school. Please educate yourself about Tourette syndrome from the textbook. Briefly describe what Tourette syndrome is. Secondly, how would you work with the student, then collaborate with her family and possibly physician, her classmates and other staff to work to get her back in school and to stay in school. Give specific details and plans for each one. What would be a reason why you could not collaborate with the physician?

350 words

Think about disasters your community has or could potentially face. Now, think about how your community is helping its members prepare.

1. Explore your community and find an advertisement that represents helping community members be prepared for a disaster.
   • Examples could be a billboard, poster at a bus stop, marquee sign, flyer, yard sign and more. Example: Sign advertising ‘free’ flu vaccinations at a local pharmacy.
2. Upload that picture into the discussion.
   • To have it display in your post:
     
     1. Click the embed image (looks like a picture of a mountain),
     2. Choose the header Canvas
     3. Go to My files, choose the Upload file
     4. Click on the image you want to display
     5. Choose Open
     6. Click Update
3. Describe the message the advertisement is conveying.
   • Describe how the message impact preparedness.
4. If you cannot find any advertisement in your community, describe a type of advertisement for disaster preparedness you think would be most beneficial to your community and how it would be best conveyed.
5. Next, identify one community setting that is impacted by the disaster advertisement you shared
   1. Settings:
      • Correctional facilities
      • Home health
      • Schools
      • Forensic areas
      • Hospice
      • Faith communities
      • Occupational health
6. Analyze at least one nursing role (refer to Week 6 lesson) related to disaster preparedness in that setting. Example: In the school setting, what actions and interventions would be involved with the nurse as coordinator of disaster preparedness?
7. Identify at least one key stakeholder related to the setting that a CHN could collaborate with regarding disaster preparedness. Include why this collaboration is important.

Your discussion post should look like:

• Uploaded picture
• Paragraph one: Describe the message the advertisement is conveying and how the message impact preparedness.
• Paragraph two: Identify one community setting that is impacted by the disaster advertisement you shared. Analyze at least one nursing role related to disaster preparedness in that setting.
• Paragraph three: Identify at least one key stakeholder related to the setting that a CHN could collaborate with regarding disaster preparedness. Include why this collaboration is important.
• Resources: Where did you find your data?

Instructions

Informatics in the Clinical Setting

Conduct an interview with someone in an informatics role in a clinical setting. Then, in a Microsoft Word document of 5-6 pages formatted in APA style, discuss each of the following criteria:

·  Role description and education level required for the role.

·  Describe their views on how their role affects patient safety and improves the quality of patient care.

·  Describe the human factors faced in the role and other challenges.

·  Express insights gained from the interview.

·  Research and discuss the impact of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators and The Joint Commission Patient Safety Goals in your clinical setting. Describe how these governing agencies influence delivery of direct patient care.

·  Research, discuss, and identify the Technology Informatics Guiding Education Reform (TIGER) utilized in your clinical setting. Be sure to get the perspective of your selected informatics professional during your interview.

·   

Please note that the title and reference pages should not be included in the total page count of your paper.

On a separate references page, cite all sources using APA format. Helpful APA guides and resources are available in the  University Online Library. Below are guides that are located in the library and can be accessed and downloaded via the University Online Citation Resources: APA Style page. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at APA Style.