This assignment will demonstrate your ability to provide age-appropriate anticipatory guidance while recognizing the need to refer patients that are outside of the scope of practice of the family nurse practitioner. This will be demonstrated by completing a SOAP note based on the virtual reality patient that you evaluated in Unit 6 platform. 

THE PLAN AND ASSESSMENT AT THE END OF SOAP NOTE MUST HAVE REREFENCES, AT LEAST THREE NOTHING LESS THAN THAT PLEASE. APA FORMAT.

HERE IS THE INFORMATION ABOUT THE UNIT 6 VIRTUAL PATIENT:

Mr. Anthony Quinn, 58 y/o male, has come to the clinic today with concerns of increased confusion.

Vital Signs

BP 150/78 

Pulse 80

Temp 37.1 °C 

Past medical History: Hypertension

• Medications: Atenolol 50 mg, Tylenol 

Has family: wife and three kids

• Alcohol: a beer or two occasionally on weekends

Tobacco: Does not use.

• Psych: No feelings of depression or unhappiness. 

Neuro Assessment: He is alert and oriented x4. Knows where he is, full name and date of birth, knows who the president is.

Urinary Assessment: “I’m not sure. Sometimes not much urine comes out, but other times it’s a normal amount.” I don’t pee as much as I used too”. 

Surgical history: Vasectomy 22 years ago.

Previous Hospitalizations: None.

Allergies: no known allergies.

Family medical History: High blood pressure from my mom and diabetes from my dad runs in my family.

LABS Ordered: Albumin, 24 hour urine, basic metabolic panel, BUN/CR, CBC, CMP, renal profile, UA.

Referral to nephrologist.

Follow up with primary care physician.

Top differential diagnosis: Dementia

Lead Diagnosis: Acute Kidney Injury.

Write-ups

The SOAP note serves several purposes:

It is an important reference document that provides concise      information about a patient’s history and exam findings at the time of      patient visit.

It outlines a plan for addressing the issues which prompted the      office visit. This information should be presented in a logical fashion      that prominently features all of the data that’s immediately relevant to      the patient’s condition.

It is a means of communicating information to all providers who are      involved in the care of a particular patient.

It allows the NP student an opportunity to demonstrate their ability      to accumulate historical and examination-based information, make use of      their medical knowledge, and derive a logical plan of care.

The core aspects of the SOAP note are described in detail below.

For ease of learning, a SOAP Note Template has been provided. For this assignment, proper citation and referencing is required because this is an academic paper.

S: Subjective information. Everything the patient tells you. This includes several areas including the chief complaint (CC), the history of present illness (HPI), medical history, surgical history, family history, social history, medications, allergies, and other information gathered from the patient. A commonly used mnemonic to explore the core elements of the history of present illness (HPI) is OLDCARTS, which includes: Onset, Location, Duration, Characteristics, Aggravating factors, Relieving factors, Treatments, and Severity.

O: Objective is what you see, hear, feel, or smell. Your physical exam, includes vital signs.

A: Assessment/Your differentials

P: Plan of care including health promotion and disease prevention for the patient related to their age and gender.

Is there a difference between “common practice” and “best practice”?

When you first went to work for your current organization, experienced colleagues may have shared with you details about processes and procedures. Perhaps you even attended an orientation session to brief you on these matters. As a “rookie,” you likely kept the nature of your questions to those with answers that would best help you perform your new role.

Over time and with experience, perhaps you recognized aspects of these processes and procedures that you wanted to question further. This is the realm of clinical inquiry.

Clinical inquiry is the practice of asking questions about clinical practice. To continuously improve patient care, all nurses should consistently use clinical inquiry to question why they are doing something the way they are doing it. Do they know why it is done this way, or is it just because we have always done it this way? Is it a common practice or a best practice?

In this Assignment, you will identify clinical areas of interest and inquiry and practice searching for research in support of maintaining or changing these practices. You will also analyze this research to compare research methodologies employed.

To Prepare:

Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry. Keep in mind that the clinical issue you identify for your research will stay the same for the entire course. 

Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least four different databases in the Walden Library to identify at least four relevant peer-reviewed articles related to your clinical issue of interest. You should not be using systematic reviews for this assignment, select original research articles.

Review the results of your peer-reviewed research and reflect on the process of using an unfiltered database to search for peer-reviewed research.

Reflect on the types of research methodologies contained in the four relevant peer-reviewed articles you selected.

• Part 1: Identifying Research Methodologies
• After reading each of the four peer-reviewed articles you selected, use the Matrix Worksheet template to analyze the methodologies applied in each of the four peer-reviewed articles. Your analysis should include the following:
• The full citation of each peer-reviewed article in APA format.
• A brief (1-paragraph) statement explaining why you chose this peer-reviewed article and/or how it relates to your clinical issue of interest, including a brief explanation of the ethics of research related to your clinical issue of interest.

A brief (1-2 paragraph) QUESTION of the aims of the research of each peer-reviewed article.

A brief (1-2 paragraph) QUESTION of the research methodology used. Be sure to identify if the methodology used was qualitative, quantitative, or a mixed-methods approach. Be specific.

A brief (1- to 2-paragraph) QUESTION of the strengths of each of the research methodologies used, including reliability and validity of how the methodology was applied in each of the peer-reviewed articles you selected

Write down everything you eat and drink for one day. Include breakfast, lunch, dinner, and snacks. You do not need to write down water as it has no calories. If you drink alcohol, you need to add the amount as alcohol does have calories. 

You will need to create a free account when you are ready to analyze your food intake. 

Click on the Cronometer Link to enter your 1-day food intake. 

CronometerLinks to an external site.

To create your account, click the green “Sign up for Free” tab. Enter your email (you may use your college email if you don’t want to use your personal email). Create and confirm a password and write it down. Enter the information for “Your Body Type.” Then, click the box for “I agree to the cronometer.com Terms of Service.

You may then begin adding your food by clicking the “ADD FOOD” tab. Type a food into the search box and find the closest choice from the list. Continue adding until all the food you consumed for the day has been added. You must add a minimum of 1500 calories for this assignment!

You will need to save and submit the analysis as part of this assignment. (20 Points) You can save your Cronometer analysis by clicking “Print” then instead of printing, choose “Save as PDF”.

If you need help, click on the help tab and refer to the user’s manual. You are also welcome to join me during my office hours!

Once you have finished adding all of your foods, scroll through the Nutrient Target Summaries.

By default, Cronometer set each nutrient to the recommended values as set by the DRI nutrition standards. The basic idea for these targets is to get at least 100% of the minimum value each day to have good nutrition. For nutrients that have a maximum, it is recommended to not exceed the maximum value.

Bars colored in yellow mean you have not yet reached your minimum target
Bars colored in green mean you have met the minimum target and not yet exceeded your maximum target.
Bars colored in red mean you have exceeded your maximum target.

You can mouse over a bar to see the top contributors from your diary on that day to meet this specific target.

Answer the following questions and submit them along with your saved Cronometer food analysis.

How many calories did you consume? (4 Points) You must enter a minimum of 1500 calories for this assignment.

What percentage of Carbohydrates, Lipids (fats), and Proteins did you consume? 

Referring back to the foods you consumed the day of the analysis, what are two changes you can make to improve your nutritional intake? Please talk specifically about your foods. For example, if you are consuming too much fat, discuss the specific foods you ate that are high in fat and give me alternative foods to decrease your fat intake. 

Write down everything you eat and drink for one day. Include breakfast, lunch, dinner, and snacks. You do not need to write down water as it has no calories. If you drink alcohol, you need to add the amount as alcohol does have calories. 

You will need to create a free account when you are ready to analyze your food intake. 

Click on the Cronometer Link to enter your 1-day food intake. 

CronometerLinks to an external site.

To create your account, click the green “Sign up for Free” tab. Enter your email (you may use your college email if you don’t want to use your personal email). Create and confirm a password and write it down. Enter the information for “Your Body Type.” Then, click the box for “I agree to the cronometer.com Terms of Service.

You may then begin adding your food by clicking the “ADD FOOD” tab. Type a food into the search box and find the closest choice from the list. Continue adding until all the food you consumed for the day has been added. You must add a minimum of 1500 calories for this assignment!

You will need to save and submit the analysis as part of this assignment. (20 Points) You can save your Cronometer analysis by clicking “Print” then instead of printing, choose “Save as PDF”.

If you need help, click on the help tab and refer to the user’s manual. You are also welcome to join me during my office hours!

Once you have finished adding all of your foods, scroll through the Nutrient Target Summaries.

By default, Cronometer set each nutrient to the recommended values as set by the DRI nutrition standards. The basic idea for these targets is to get at least 100% of the minimum value each day to have good nutrition. For nutrients that have a maximum, it is recommended to not exceed the maximum value.

Bars colored in yellow mean you have not yet reached your minimum target
Bars colored in green mean you have met the minimum target and not yet exceeded your maximum target.
Bars colored in red mean you have exceeded your maximum target.

You can mouse over a bar to see the top contributors from your diary on that day to meet this specific target.

Answer the following questions and submit them along with your saved Cronometer food analysis.

How many calories did you consume? 

What percentage of Carbohydrates, Lipids (fats), and Proteins did you consume?

Referring back to the foods you consumed the day of the analysis, what are two changes you can make to improve your nutritional intake? Please talk specifically about your foods. For example, if you are consuming too much fat, discuss the specific foods you ate that are high in fat and give me alternative foods to decrease your fat intake.