The physical examination should include components that are relevant to the patient’s complaint and with the patient’s history in mind. Thyroid palpation and an abdominal assessment are appropriate for all individuals with complaints of painful menstruation. A pelvic examination and bimanual exam are appropriate tests for sexually active individuals (Osavande & Mehulic, 2014). Adolescents that are not sexually active with histories consistent with primary dysmenorrhea do not need to have a pelvic examination (Osavande & Mehulic, 2014). Laboratory tests may be used pending the relevance determined by the provider. Laboratory tests may include: pregnancy test, CBC, thyroid function tests, vaginal and endocervical swabs, erythrocyte sedimentation rate, and urinalysis (Osayande & Mehulic, 2014). Additional tests may be ordered as necessary.

Diagnosis and Differentials

Without more information, the initial diagnosis in this case would be unspecified dysmenorrhea (ICD-10: N94.6). Further information and evaluations may be needed to rule out secondary causes of dysmenorrhea, if clinical findings are suspicious for secondary dysmenorrhea. Differential diagnoses may be: primary dysmenorrhea, endometriosis, pelvic inflammatory disease, fibroids, or uterine cancer (Hackley & Kriebs, 2017).

Therapies

Pharmacological therapies for primary dysmenorrhea include NSAIDs or oral contraceptives (Osavande & Mehulic, 2014). Strong evidence supports the use of NSAIDs as the first line treatment for primary dysmenorrhea (Osavande & Mehulic, 2014). The choice of NSAID should be made on an individual basis, though over-the-counter ibuprofen, Aleve, or Midol are popular and effective choices (Osavande & Mehulic, 2014). The decision to use oral contraceptives should be made by the patient after thorough education and risks are explained to the patient.

The most effective non-pharmacological therapy used to treat primary dysmenorrhea is the topical application of heat (Osavande & Mehulic, 2014). Some dietary supplements, such as omega 3 fatty acids and B vitamins, have shown mixed effectiveness for controlling menstrual pain (Osavande & Mehulic, 2014). Lifestyle modifications can also assist in decreasing painful menstruation. Some evidence suggests low fat or vegetarian diets can decrease intensity and duration of menstrual cramps (Alsaleem, 2018). Obesity and smoking are other factors that can be modified to improve menstrual cramps, through weight loss and smoking cessation, respectfully (Hackley & Kriebs, 2017). Stress reduction techniques may also improve symptoms in stressed individuals (Osavande & Mehulic, 2014).

Follow-Up

If symptoms of primary dysmenorrhea improve with the pharmacological adjustments and non-pharmacological interventions, Osavande and Mehulic (2014) recommend continuing treatment and reassessing every six months. If symptoms are not relieved, the patient should return to the clinic for further evaluation after menstruation.  

References

Alsaleem M. A. (2018). Dysmenorrhea, associated symptoms, and management among students at King Khalid University, Saudi Arabia: An exploratory study. Journal of Family Medicine and Primary Care, 7(4), 769-774. https://dx.doi.org/10.4103%2Fjfmpc.jfmpc_113_18

Hackley, B. & Kriebs, J. (2017). Primary care of women. Burlington, MA: Jones & Bartlett Learning.

Osayande, A. & Mehulic, S. (2014). Diagnosis and initial management of dysmenorrhea. American Family Physician, 89(5), 341-346. Retrieved from https://www.aafp.org/afp/2014/0301/p341.html

 

1) **********minimum  4 full pages ( not words)**************************** (cover or reference page not included) 

2)¨**********APA norms  (All paragraphs must be narrative and cited in the text- each paragraphs- bulleted responses are not accepted- do not write in the first person.)

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

4) Minimum 4 references not older than 5 years ( 2 references per part)

5) Each answer must be identified according to the question number.

– Check the list of questions. Your answer should start objectively answering the question

Question:

1)…………

2)…………

3)…………

Answer:

1)…………

2)…………

3)…………

You should not make an introduction or conclusions. Do not make topics definitions if not requested.

____________________________________________________________

250 words:

1) explain the Christian perspective of the nature of spirituality and ethics in contrast to the perspective of postmodern relativism within health care.

250 words:

1) explain what scientism is and describe two of the main arguments against it

Complete the total of the 4 pages:

Answer each of the questions (narrative form) of the worldview according to your own personal perspective and worldview:

What is ultimate reality?

What is the nature of the universe?

What is a human being?

What is knowledge?

What is your basis of ethics?

What is the purpose of your existence?

Please See Attachment with The Required Reading Resources

Mukherjee, T., Al Rahahleh, N., Lane, W., & Dunn, J. (2016). The capital budgeting process of healthcare organizations: A review of surveys. Journal of Healthcare Management, 61(1), 58-77. Available in the Trident Online Library.

Nowicki, M. (2018). Introduction to the Financial Management of Healthcare Organizations (Vol. Seventh edition). Chicago, Illinois: Health Administration Press. Part 4, pages 295-351. Available in the Trident Online Library.

Healthcare budgets are often classified by their managerial approach and their design characteristics. This Module’s Case will examine your understanding of the central types of healthcare budgets, and how they are used in the current setting. Production units, as specifically measured units of work volume in a given department or setting of service provision, will also be examined.

Homework Case Assignment

Using the information in the required readings, as well as some additional research in peer-reviewed sources, complete your Case assignment by answering the following:

1. Summarize both the benefits and the drawbacks of top-down vs. bottom-up budgeting. Which works best in your current or future setting?
2. Concisely describe the eight design characteristics of budgeting. Which do you feel would be most effective in running a for-profit hospital, and why?
3. Choose any department in the healthcare setting, and explain how their production units would be effectively measured. How do these production units tie into the larger budgeting process?

Assignment Expectations

1. Conduct additional research to gather sufficient information to support your analysis.
2. Provide a response of 3-5 pages, not including title page and references
3. As we have multiple required items to be addressed herein, please use subheadings to show where you’re responding to each required item and to ensure that none are omitted.
4. Support your paper with peer-reviewed articles and reliable sources. Use at least three references, and a minimum of two of these from peer-reviewed sources. For additional information on how to recognize peer-reviewed journals, see http://www.angelo.edu/services/library/handouts/peerrev.php and for evaluating internet sources:
   https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content
5. You may use the following source to assist in your formatting your assignment: https://owl.english.purdue.edu/owl/resource/560/01/. Paraphrase all source information into your own words carefully, and use in-text citations.

Elder abuse /end of life planning

Word totals for each post should be in the 100-200 words range.  Whether you agree or disagree explain why with supporting evidence and concepts from the readings or a related experience.  Include a reference, link, or citation when appropriate. APA 6th edition format for references as well as in-text citations is expected.

Please pay attention to case study

zero plagiarism

five references

• Provide the case number in the subject line of the Discussion.
• List three questions you might ask the patient if he or she were in your office. Provide a rationale for why you might ask these questions.
• Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation. Include specific questions you might ask these people and why.
• Explain what physical exams and diagnostic tests would be appropriate for the patient and how the results would be used.
• List three differential diagnoses for the patient. Identify the one that you think is most likely and explain why.
• List two pharmacologic agents and their dosing that would be appropriate for the patient’s sleep/wake therapy based on pharmacokinetics and pharmacodynamics. From a mechanism of action perspective, provide a rationale for why you might choose one agent over the other.
• If your assigned case includes “check points” (i.e., follow-up data at week 4, 8, 12, etc.), indicate any therapeutic changes that you might make based on the data provided.
• Explain “lessons learned” from this case study, including how you might apply this case to your own practice when providing care to patients with similar clinical presentations.