case study

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QUESTION

CategoryItemValueClient InformationSitePrivate PracticeAgeAdult (18- 64 years)GenderMaleVisit InformationStudent Level of FunctionSupervision – Level 2Category of CareDirect Patient CarePractice ManagementType of visitConsultationDiagnosis1 Personality DisorderStudent Notes

36 years old male who is in Miami on vacation from New York and has been off his medication, today patient became very paranoid and delusional. Patient presents accompanied by his girlfriend Treatment: -Increase Aripripazole to 10 mg daily for mood dysregulation. -Start Clonazepam 0.5 mg twice daily. -Start Temazepam 30 mg at bedtime. 

Psychiatric notes are a way to reflect on your practicum experiences and connect them to the didactic learning you gain from your NRNP courses. Focused SOAP notes, such as the ones required in this practicum course, are often used in clinical settings to document patient care.

For this Assignment, you will document information about a patient that you examined during the last three weeks, using the Focused SOAP Note Template provided. You will then use this note to develop and record a case presentation for this patient.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

TO PREPARE

Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.

Select a patient of any age (either a child or an adult) that you examined during the last 3 weeks.

Create a Focused SOAP Note on this patient using the template provided in the Learning Resources. There is also a completed Focused SOAP Note Exemplar provided to serve as a guide to assignment expectations.
Please Note:

All SOAP notes must be signed, by your Preceptor. Note: Electronic signatures are not accepted.

When you submit your note, you should include the complete focused SOAP note as a Word document and PDF/images of the completed assignment signed by your Preceptor.

You must submit your SOAP note using Turnitin. Note: If both files are not received by the due date, faculty will deduct points per the Walden Grading Policy.

Then, based on your SOAP note of this patient, develop a video case study presentation. Take time to practice your presentation before you record.

Include at least five scholarly resources to support your assessment, diagnosis, and treatment planning.

Ensure that you have the appropriate lighting and equipment to record the presentation.

THE ASSIGNMENT

Record yourself presenting the complex case for your clinical patient.

Do not sit and read your written evaluation! The video portion of the assignment is a simulation to demonstrate your ability to succinctly and effectively present a complex case to a colleague for a case consultation. The written portion of this assignment is a simulation for you to demonstrate to the faculty your ability to document the complex case as you would in an electronic medical record. The written portion of the assignment will be used as a guide for faculty to review your video to determine if you are omitting pertinent information or including non-essential information during your case staffing consultation video. 

In your presentation:

Dress professionally and present yourself in a professional manner.

Display your photo ID at the start of the video when you introduce yourself.

Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).

Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management.

Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.

Be succinct in your presentation, and do not exceed 8 minutes. Specifically address the following for the patient, using your SOAP note as a guide:

Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

Objective: What observations did you make during the psychiatric assessment? 

Assessment: Discuss their mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis and why? Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and supported by the patient’s symptoms.

Plan: In your video, describe your treatment plan using clinical practice guidelines supported by evidence-based practice. Include a discussion on your chosen FDA-approved psychopharmacologic agents and include alternative treatments available and supported by valid research. All treatment choices must have a discussion of your rationale for the choice supported by valid research. What were your follow-up plan and parameters? What referrals would you make or recommend as a result of this treatment session? 

In your written plan include all the above as well as include one social determinant of health according to the HealthyPeople 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health. As a future advanced provider, what are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking.

Reflection notes: What would you do differently with this patient if you could conduct the session again? If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow up, discuss what your next intervention would be.

SEARCHING DATABASES

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QUESTION

When you decide to purchase a new car, you first decide what is important to you. If mileage and dependability are the important factors, you will search for data focused more on these factors and less on color options and sound systems.

The same holds true when searching for research evidence to guide your clinical inquiry and professional decisions. Developing a formula for an answerable, researchable question that addresses your need will make the search process much more effective. One such formula is the PICO(T) format.

In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format, so you can search the electronic databases more effectively and efficiently. You will share this PICO(T) question and examine strategies you might use to increase the rigor and effectiveness of a database search on your PICO(T) question.

Post a brief QUESTION of your clinical issue of interest. This clinical issue will remain the same for the entire course and will be the basis for the development of your PICOT question. Describe your search results in terms of the number of articles returned on original research and how this changed as you added search terms using your Boolean operators. Finally, explain strategies you might make to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples.

To Prepare:

Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.

Review the materials offering guidance on using databases, performing keyword searches, and developing PICO(T) questions provided in the Resources.

Based on the clinical issue of interest and using keywords related to the clinical issue of interest, search at least two 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 Resources for guidance and develop a PICO(T) question of interest to you for further study. It is suggested that an Intervention-type PICOT question be developed as these seem to work best for this course. 

  • *Library tip: 
  • Walden Library recommends starting your search broadly with one concept or search word and adding more elements one at a time. Depending on your topic, the evidence will not necessarily address all the aspects of your PICO(T) question in one article. Select the most important concepts to search and find the best evidence available, even if that means assembling evidence from multiple articles.
  • Nursing Research PageLinks to an external site. databases and resources specifically for Nursing
  • Evidence-Based Practice guide: Evidence TypesLinks to an external site.

Nursing and Health research videosLinks to an external site., including a 15-minute introduction

Get HelpLinks to an external site. page, including Ask a LibrarianLinks to an external site. service

Quick Answers:

How do I find an article that reports on research that uses a specific methodology?Links to an external site.

How do I find original or primary research that analyzes empirical data?Links to an external site.

What is the Find at Walden button?Links to an external site.

Message from the teacher
In this Discussion, you will transform a clinical inquiry into a searchable question in PICO(T) format. This will assist in searching the electronic databases more effectively and efficiently. You will share this PICO(T) question with the class and examine strategies to increase the rigor and effectiveness of a database search on your PICO(T) question. To sum it all up:
By Day 3 of Week 4, post a brief QUESTION of your clinical issue of interest (remember this will stay the same for the entire course). Describe the search results regarding the number of articles returned on the original research and how this changed as you added search terms using the Boolean operators (again, see my announcement with links titled Library Resources for further info on the Boolean operators). Explain any strategies you might apply to increase the rigor and effectiveness of a database search on your PICO(T) question. Be specific and provide examples. An Intervention-type PICOT question should be developed as these seem to work best for this course.
Review ‘How to prepare for this discussion’ for the library tips, quick answer section, and learning resources.
Don’t forget to Respond to at least two of your colleagues (or myself), on two different days and provide further suggestions on how their database search might be improved. This should be done by Day 6, Week 4.
******My example of PICOT(T) research question********
In hospitalized patients with post-operative pain, does intravenous morphine, compared to oral acetaminophen, provide greater pain relief within the first 24 hours after surgery?
P- Population/problem: hospitalized patients with post-operative pain
I- Intervention: intravenous morphine
C- Comparison: compared to oral acetaminophen.
O- Outcome: provide greater pain relief.
T- Time: within the first 24 hours after surgery

Discussion 11

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QUESTION

Write based on this discussion below, and answer two people discussions 

1. Based on the theory of attachment, what behaviors would a nurse attempt to stimulate when working with parent to promote health attachment?

Tamara Hernandez Rodriguez – Saturday, March 16, 2024, 10:16 PM

Number of replies: 3

Promoting Attachment Bonds Through Routine and Attachment-Supportive Practices

Consistency in routines and traditions, such as bedtime rituals, meal schedules, and playtime routines, plays a vital role in providing children with a sense of stability and predictability, ultimately bolstering attachment connections. Nurses are well-positioned to support parents in implementing and maintaining these routines, thereby fostering stability and emotional well-being in children.

Establishing regular schedules and rituals offers children a structured environment that they can rely on, creating a sense of security and stability. Bedtime rituals, for instance, provide children with a predictable transition to sleep, helping them feel secure and calm. Similarly, meal schedules and playtime routines contribute to a sense of order and familiarity in the child’s daily life, enhancing their overall emotional stability.

Nurses can play a crucial role in aiding parents to develop and adhere to these routines. By providing guidance and support, nurses empower parents to create a nurturing environment that promotes attachment and emotional security. Through education and encouragement, nurses can help parents understand the importance of consistency in routines and its positive impact on their child’s development.

Furthermore, teaching parents about attachment-supportive techniques can further reinforce the significance of physical closeness and emotional responsiveness in nurturing secure attachment bonds. Practices such as babywearing, safe co-sleeping practices, and responsive feeding emphasize the importance of close physical proximity and emotional availability in fostering healthy attachment relationships.

Babywearing allows infants to remain close to their caregivers, promoting bonding and attachment through physical proximity. Safe co-sleeping practices, when done in accordance with safety guidelines, can enhance the parent-infant bond by facilitating nighttime closeness and responsiveness to the child’s needs. Additionally, responsive feeding practices, where caregivers attentively respond to the infant’s cues and signals during feeding, promote a sense of security and trust in the caregiver-infant relationship.

By educating parents about these attachment-supportive techniques, nurses empower them to cultivate strong attachment bonds with their children from an early age. Through understanding and implementing these practices, parents can enhance their responsiveness to their child’s emotional and physical needs, thereby promoting secure attachment relationships.

In conclusion, implementing regular schedules and traditions, along with teaching attachment-supportive techniques, are essential strategies for promoting attachment bonds between parents and children. Nurses’ support in establishing and maintaining these practices can significantly secure attachment relationships that endure throughout life. Through education, guidance, and encouragement.

References:

Ali, E., Letourneau, N., & Benzies, K. (2021). Parent-Child Attachment: A Principle-Based Concept Analysis. SAGE open nursing, 7, 23779608211009000. https://doi.org/10.1177/23779608211009000

Widström, A. M., Brimdyr, K., Svensson, K., Cadwell, K., & Nissen, E. (2019). Skin-to-skin contact the first hour after birth, underlying implications and clinical practice. Acta paediatrica (Oslo, Norway : 1992), 108(7), 1192–1204. https://doi.org/10.1111/apa.14754theory of attachment and nursing role to enhance health attachment

by Hilda Mahmoudi – Saturday, March 9, 2024, 10:33 PM
Number of replies: 3
Attachment theory, as proposed by John Bowlby, emphasizes the significance of an affectionate, mutually satisfying relationship between a child and a caregiver for the child’s emotional and psychological development. Bowlby identified attachment behaviors, such as crying, smiling, sucking, clinging, and crawling, as ways infants seek closeness and security with their caregivers. He highlighted the importance of responsive and sensitive caregiving in fostering a child’s expectation of support and availability from others. Furthermore, Bowlby argued that a well-loved infant would protest separation from parents but would later develop more self-reliance, emphasizing the caregiver’s emotional and physical availability as a crucial aspect of attachment.
Additionally, the concept of maternal-infant bonding, popularized by Rubin and later expanded upon by Klaus and Kennell, contributed to significant changes in hospital care practices for postpartum women. While initial theories suggested a “sensitive period” immediately after birth for optimal bonding, controversy arose regarding the necessity of immediate close physical contact between parents and newborns. Subsequent revisions acknowledged that early separation did not necessarily prevent the formation of a close bond. However, inconsistencies in the use of the concept of bonding persist, often conflating it with attachment behaviors.
In nursing practice, understanding both attachment theory and the concept of maternal-infant bonding is crucial for promoting secure parent-child attachment (PCA) and improving long-term child health outcomes. Nurses play a vital role in supporting parents, especially those at increased risk for developing insecure attachments, due to factors such as poverty, intimate partner violence, stress, parental mental health problems, and substance use. By promoting responsive caregiving, recognizing infant cues, facilitating physical contact and affection, and encouraging consistent routines and rituals, nurses can help foster secure attachment between parents and infants. Clarifying the distinction between attachment and bonding in nursing practice will enhance interventions aimed at improving bonding and attachment, ultimately benefiting maternal and child outcomes.
References:
Bicking Kinsey, C., & Hupcey, J. E. (2013). State of the science of maternal-infant bonding: a principle-based concept analysis. Midwifery, 29(12), 1314–1320. https://doi.org/10.1016/j.midw.2012.12.019
Ali, E., Letourneau, N., & Benzies, K. (2021). Parent-Child Attachment: A Principle-Based Concept Analysis. SAGE open nursing, 7, 23779608211009000. https://doi.org/10.1177/23779608211009000
Naki? Radoš, S., Hairston, I., & Handelzalts, J. E. (2024). The concept analysis of parent-infant bonding during pregnancy and infancy: a systematic review and meta-synthesis. Journal of reproductive and infant psychology, 42(2), 142–165. https://doi.org/10.1080/02646838.2022.2162487

Improvement Plan In-Service Presentatio

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QUESTION

The final deliverable for this assessment will be a PowerPoint presentation with detailed presenter’s notes representing the material you would deliver at an in-service session to raise awareness of your chosen safety improvement initiative focusing on a specific patient safety issue and to explain the need for such an initiative. Additionally, you must educate the audience as to their role and importance to the success of the initiative. This includes providing examples and practice opportunities to test out new ideas or practices related to the safety improvement initiative.

Be sure that your presentation addresses the following, which corresponds to the grading criteria in the scoring guide. Please study the scoring guide carefully so you understand what is needed for a distinguished score.

Describe the purpose and goals of an in-service session focusing on a specific patient safety issue.

Explain the need for and process to improve safety outcomes related to a specific patient safety issue.

  • Explain to the audience their role and importance of making the improvement plan successful.
  • Create resources or activities to encourage skill development and process understanding related to a safety improvement initiative.
  • Communicate with nurses in a respectful and informative way that clearly presents expectations and solicits feedback on communication strategies for future improvement.
  • There are various ways to structure an in-service session; below is just one example:
  • Part 1: Agenda and Outcomes.

Explain to your audience what they are going to learn or do, and what they are expected to take away.

Part 2: Safety Improvement Plan.

  • Give an overview of the current problem focusing on a specific patient safety issue, the proposed plan, and what the improvement plan is trying to address.

Explain why it is important for the organization to address the current situation.

Part 3: Audience’s Role and Importance.

  • Discuss how the staff audience will be expected to help implement and drive the improvement plan.
  • Explain why they are critical to the success of the improvement plan focusing on a specific patient safety issue.

Describe how their work could benefit from embracing their role in the plan.

Part 4: New Process and Skills Practice.

  • Explain new processes or skills.
  • Develop an activity that allows the staff audience to practice and ask questions about these new processes and skills.
  • In the notes section of your PowerPoint, brainstorm potential responses to likely questions or concerns.

Part 5: Soliciting Feedback.

Describe how you would solicit feedback from the audience on the improvement plan and the in-service.

Guidelines for Effective PowerPoint Presentations [PPTX].

Presentation length: There is no required length; use just enough slides to address all the necessary elements. Remember to use short, concise bullet points on the slides and expand on your points in the presenter’s notes. If you use 2 or 3 slides to address each of the parts in the above example, your presentation would be at least 10 slides and no more than 15 slides (not including the title, conclusion, or references slides).

  • Speaker notes: Speaker notes (located under each slide) should reflect what you would actually say if you were delivering the presentation to an audience. This presentation does NOT require audio or a transcript. Another presenter would be able to use the presentation by following the speaker’s notes.
  • APA format: Use APA formatting for in-text citations. Include an APA-formatted reference slide at the end of your presentation.
  • Number of references: Cite a minimum of 3 sources of scholarly or professional evidence to support your assertions. Resources should be no more than 5 years old.
  • As a practicing professional, you are likely to present educational in-services or training to staff pertaining to quality improvement (QI) measures of safety improvement interventions. Such in-services and training sessions should be presented in a creative and innovative manner to hold the audience’s attention and promote knowledge acquisition and skill application that changes practice for the better. The teaching sessions may include a presentation, audience participation via simulation or other interactive strategy, audiovisual media, and participant learning evaluation.

The use of in-services and/or training sessions has positive implications for nursing practice by increasing staff confidence when providing care to specific patient populations. It also allows for a safe and nonthreatening environment where staff nurses can practice their skills prior to a real patient event. Participation in learning sessions fosters a team approach, collaboration, patient safety, and greater patient satisfaction rates in the health care environment (Patel & Wright, 2018).

As you prepare to complete the assessment, consider the impact of in-service training on patient outcomes as well as practice outcomes for staff nurses. Be sure to support your thoughts on the effectiveness of educating and training staff to increase the quality of care provided to patients by examining the literature and established best practices.

  • You are encouraged to explore the AONE Nurse Executive Competencies Review activity before you develop the Improvement Plan In-Service Presentation. This activity will help you review your understanding of the AONE Nurse Executive Competencies—especially those related to competencies relevant to developing an effective training session and presentation. This is for your own practice and self-assessment, and demonstrates your engagement in the course.

NURS 682 WCU Expanding APRN Scope for Improved Care Discussion

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Question

NURS 682 Responses

Yenisleidy Gonzalez Leon Response 1

APRN Scope of Practice

APRN practice is based on evidence-based guidelines in the process of evidence-based practice (EBP). APRNs access these guidelines, assess their applicability to their practice situation and case, and use them to inform their qualitative and quantitative decisions. By using evidence-based guidelines, APRNs translate evidence into practice, facilitating EBP. Physicians and APRNs are held to the same evidence-based standards. This is mainly because their scope of practice intersects and; hence, they practice in the same setting. Despite requiring supervision from physicians depending on the state of practice, APRNs provide services that are similar to those offered by physicians (Van Wicklin, 2021). They are, therefore, expected to uphold the same evidence-based standards.

The scope of practice for APRNs depends on the state where they are licensed and practice. In some states, they have full independence and autonomy. However, in many states, APRNs need physician oversight to some extent including patient assessment, prescriptions, diagnosing, and treating patients. This may be restricted or reduced oversight levels. A collaborative practice agreement between an APRN and a physician is a written agreement on joint practice and complementary work in the healthcare sector. It is a legal document defining roles and responsibilities, providing oversight by the physician, and defining the procedures and approaches to ensure that oversight under the existing law (Buppert, 2023). APRNs in reduced and restricted autonomy states need to enter a collaborative practice agreement with a physician to operate in those states.

APRNs are expected to pay physicians for their collaboration in practice. This compensation is based on the roles and responsibilities that the physician handles on behalf of the APRN as dictated by law and defined by the collaborative practice agreement (Buppert, 2023). The APRN will incorporate consultation and collaboration in several ways. For instance, the APRN may call the physician for consultation before prescribing certain medications or require the physician to be present when treating specific issues.

References

Buppert, C. (2023). Nurse Practitioner’s Business Practice and Legal Guide. Jones & Bartlett Learning.

Van Wicklin, S. A. (2021). Determining scope of practice. Plastic and Aesthetic Nursing, 41(1), 40-42. https://doi.org/10.1097/PSN.0000000000000354

Maria Bates Response 2

Evidence-based guidelines are put in place so that they can be used to provide safe, efficient, and quality care to patients. APRNs are part of the healthcare team who must be knowledgeable and competent to be able to care for others using evidence-based practices (Clarke, et al, 2021). APRNs are busy clinicians but it is their responsibility to stay up to date with the evolving guidelines that are changing. There are various ways that APRNs can stay up to date such as subscribing to receive updates on evidenced-based topics and connecting with other professionals. Knowing how to filter out information can be beneficial to APRNs to be able to grasp the most important information.

Evidence-based research can be a topic of conflict. This can be due to trials with limited populations and not enough information for some clinicians. An obstacle can be that not everyone is on board with making changes. There could be different opinions on how things are being done and this can affect making changes. That is why it is important for APRNs to participate in studies and provide feedback, questions that they would want answered, and information to researchers to gain information that applies to their patient population. “APRNs play a vital role in implementing new interventions or guidelines and they should be active participants in constructing and testing implementation models and delivery systems” (Blair, 2018, p. 258). APRNs can implement evidence-based practices on an individual level and with patient consent called micro-level solutions. APRNs can implement evidence-based practices in organizations at a greater scale by being part of the clinical decision-making process called meso-level solutions. They would work in collaboration with other professionals to integrate evidence-based practices at a greater level. APRNs can influence policy making by providing their knowledge, skills, and evidence-based practices that benefit their patients and advocate for them called macro-level solutions.

APRNs, depending on the state that they live in, can be independent with full authority to prescribe medications. APRNs and physicians are healthcare providers who work collaboratively and APRNs are not required to pay physicians to practice. APRNs have the autonomy to use evidence-based practices when and if the facility or organization and physician they work for permits it. Some facilities, organizations, and physicians might not want to implement evidence-based practices due to costs. It might cost them more money to use a certain drug even if it is more effective. APRNs and physicians can work collaboratively to implement evidence-based practices. APRNs can bring new ideas and suggestions to physician or organizations but ultimately decisions might need to be made as a team.

Blair, K. A. (2018). Advanced Practice Nursing Roles (6th ed.). Springer Publishing LLC. https://online.vitalsource.com/books/9780826161536Links to an external site.

Clarke, V., Lehane, E., Mulcahy, H., & Cotter, P. (2021). Nurse Practitioners’ Implementation of Evidence-Based Practice Into Routine Care: A Scoping Review. Worldviews on evidence-based nursing, 18(3), 180–189. https://doi.org/10.1111/wvn.12510Links to an external site.

practicum part 1

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QUESTION

Psychiatric notes are a way to reflect on your practicum experiences and connect them to the didactic learning you gain from your NRNP courses. Focused SOAP notes, such as the ones required in this practicum course, are often used in clinical settings to document patient care.

For this Assignment, you will document information about a patient that you examined during the last three weeks, using the Focused SOAP Note Template provided. You will then use this note to develop and record a case presentation for this patient.

  • Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.
  • Select a patient of any age (either a child or an adult) that you examined during the last 3 weeks.
  • Create a Focused SOAP Note on this patient using the template provided in the Learning Resources. There is also a completed Focused SOAP Note Exemplar provided to serve as a guide to assignment expectations.
    Please Note:
    • All SOAP notes must be signed, by your Preceptor. Note: Electronic signatures are not accepted.
    • When you submit your note, you should include the complete focused SOAP note as a Word document and PDF/images of the completed assignment signed by your Preceptor.
    • You must submit your SOAP note using Turnitin. Note: If both files are not received by the due date, faculty will deduct points per the Walden Grading Policy.
  • Then, based on your SOAP note of this patient, develop a video case study presentation. Take time to practice your presentation before you record.
  • Include at least five scholarly resources to support your assessment, diagnosis, and treatment planning.
  • Ensure that you have the appropriate lighting and equipment to record the presentation.

THE ASSIGNMENT

Record yourself presenting the complex case for your clinical patient.

Do not sit and read your written evaluation! The video portion of the assignment is a simulation to demonstrate your ability to succinctly and effectively present a complex case to a colleague for a case consultation. The written portion of this assignment is a simulation for you to demonstrate to the faculty your ability to document the complex case as you would in an electronic medical record. The written portion of the assignment will be used as a guide for faculty to review your video to determine if you are omitting pertinent information or including non-essential information during your case staffing consultation video.

In your presentation:

  • Dress professionally and present yourself in a professional manner.
  • Display your photo ID at the start of the video when you introduce yourself.
  • Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).
  • Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management.
  • Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.
  • Be succinct in your presentation, and do not exceed 8 minutes. Specifically address the following for the patient, using your SOAP note as a guide:
    • Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
    • Objective: What observations did you make during the psychiatric assessment?
    • Assessment: Discuss their mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis and why? Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and supported by the patient’s symptoms.
    • Plan: In your video, describe your treatment plan using clinical practice guidelines supported by evidence-based practice. Include a discussion on your chosen FDA-approved psychopharmacologic agents and include alternative treatments available and supported by valid research. All treatment choices must have a discussion of your rationale for the choice supported by valid research. What were your follow-up plan and parameters? What referrals would you make or recommend as a result of this treatment session?
    • In your written plan include all the above as well as include one social determinant of health according to the HealthyPeople 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health. As a future advanced provider, what are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking.
    • Reflection notes: What would you do differently with this patient if you could conduct the session again? If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow up, discuss what your next intervention would be.

ASSESSING THE GENITALIA AND RECTUM

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Question

ASSIGNMENT

LAB ASSIGNMENT: ASSESSING THE GENITALIA AND RECTUM

In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

RESOURCES

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 17, “Breasts and Axillae”
This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.

  • Chapter 19, “Female Genitalia”
    In this chapter, the authors explain how to conduct an examination of female genitalia. The chapter also describes the form and function of female genitalia.

Chapter 20, “Male Genitalia”
The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, the chapter explains how to perform an exam of these areas.

Chapter 21, “Anus, Rectum, and Prostate”
This chapter focuses on performing an exam of the anus, rectum, and prostate. The authors also explain the anatomy and physiology of the anus, rectum, and prostate.

  • Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
    Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

  • Chapter 3, “SOAP Notes” (Previously read in Week 8)

Centers for Disease Control and Prevention. (2021, April 13). Sexually transmitted disease surveillance, 2019Links to an external site..Links to an external site. https://www.cdc.gov/std/#
This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projects and initiatives, treatment information, and program tools.

  •        TO PREPARE    

Review the Episodic note case study 

  • Based on the Episodic note case study:

Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.

Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.

  • Consider what history would be necessary to collect from the patient in the case study.

Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

  • Episodic note case study: Genitalia Assessment listed below.

Genitourinary Assessment

CC: Increased frequency and pain with urination

  • HPI:

T.S. is a 32-year-old woman who reports that for the past two days, she has dysuria, frequency, and urgency. Has not tried anything to help with the discomfort. Has had this symptom years ago. She is sexually active and has a new partner for the past 3 months.

  • Medical History:

None

Surgical History:

Tonsillectomy in 2001

Appendectomy in 2020

Review of Systems:

General: Denies weight change, positive for sleeping difficulty because e the flank pain. Feels warm.

  • Abdominal: Denies nausea and vomiting. No appetite
  • Objective 

VSS T = 37.3°C, P = 102/min, RR = 16/min, and BP = 116/74 mm Hg.

  • Pelvic Exam:
  • mild tenderness to palpation in the suprapubic area
  • bimanual pelvic examination reveals a normal-sized uterus and adnexae
  • no adnexal tenderness.
  • No vaginal discharge is noted.

The cervix appears normal.

Diagnostics: Urinalysis, STI testing, Papsmear

Assessment:

UTI

STI

PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

                 THE LAB ASSIGNMENT    

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

Analyze the subjective portion of the note. List additional information that should be included in the documentation.

Analyze the objective portion of the note. List additional information that should be included in the documentation.

Is the assessment supported by the subjective and objective information? Why or why not?

Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?

Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.

Assignment1_Rubric

Criteria

With regard to the SOAP note case study provided and using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature:   Analyze the subjective portion of the note. List additional information that should be included in the documentation.

Ans.

The response clearly, accurately, and thoroughly analyzes the subjective portion of the SOAP note and lists detailed additional information to be included in the documentation.

Aquifer Knee Pain

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Question

Essay Elements:

  • One to three pages of scholarly writing in paragraph format, not counting the title page or reference page
  • Brief introduction of the case
  • Identification of the main diagnosis with supporting rationale
  • Identification of at least two additional differential diagnoses with brief rationale for why these were ruled out
  • Diagnostic plan with supporting rationale or references
  • A specific treatment plan supported by recent clinical guidelines
  • Please refer to the rubric for point value and requirements. In general, these elements must be covered as per the rubric.

Patient Name: Gerta Roman

Ms. Roman is a 74-year-old female who presents with worsening of her chronic right knee pain over the last two weeks. There is no history of trauma, no constitutional symptoms, and no morning stiffness. Physical exam reveals mildly decreased range of motion of the right knee with crepitus and a small effusion and warmth but no erythema and no skin lesions are present.

The ideal summary statement concisely highlights the most pertinent features without omitting any significant points. The summary statement above includes:

  1. Epidemiology and risk factors: 74-year-old female with chronic right knee pain
  2. Key clinical findings about the present illness using qualifying adjectives and descriptive language:
  • No history of trauma
  • No constitutional symptoms
  • No morning stiffness
  • Decreased range of motion
  • Crepitus
  • Small effusion
  • No erythema
  • No skin lesions
  • Past medical history:
    • History of GERD
    • Remote history of alcohol use disorder
    • Past surgical history:
    • Tonsillectomy as a child and no other surgeries
    • Medications:
    • Multivitamin
    • Extra-strength Tylenol
    • Tums as needed for heartburn
    • No herbal supplements.
    • Review of systems: Normal, except for the right knee pain, occasional left knee pain, intermittent back pain, and occasional heartburn. She reports no fevers, weakness, numbness, or tingling.Family history: Her mother has type 2 diabetes and osteoarthritis, and her dad has “skin problems.”Social history: Doesn’t drink alcohol or smoke. She is a retired teacher and lives alone in a two-story home in a rural community. Her hobbies include gardening and playing with her granddaughter, Lucy, who lives nearby.Since Ms. Roman hasn’t had a drink in years, you decide to skip screening her for alcohol disorders.
  • Vital signs:
    • Temperature is 37.1 °C (98.8 °F)
    • Pulse is 64 beats/minute
    • Respiratory rate is 18 breaths/minute
    • Blood pressure is 130/80 mmHg
    • No conjunctivitis or apparent skin lesions.The patient favors putting weight on her left knee a little, but she does not have much trouble climbing onto the table.No erythema, edema, bruising, or atrophy of the quadriceps on either leg. Some tenderness to palpation along both the medial and lateral joint lines on the right leg.Range of motion is 120 degrees in her right leg. Some crepitus with motion in the right patella. Small effusion appreciated from milking the right suprapatellar pouch. Right knee joint is slightly warm compared to the left. No fullness in the popliteal fossa.Negative Lachman and McMurray tests. No pain or laxity with varus or valgus stress. Negative anterior and posterior drawer tests.Hip exam is unremarkable, with no tenderness and a normal range of motion.Ankle exam is unremarkable, with no tenderness and normal range of motion.
  • In Ms. Roman’s case, a knee sprain (C), osteoarthritis (E) and rheumatoid arthritis (G) are the most likely causes of her subacute to chronic knee pain. Knee sprains are very common. Though they are typically associated with a history of trauma, the trauma may be minor enough that a patient may not recall it. Osteoarthritis is the most likely cause of her pain. Rheumatoid arthritis is slightly less common than OA but still can cause pain with a mild effusion (as she has). Her mention of wrist pain could also indicate that she has more joints involved, which would be consistent with RA.Suspected infectious process causing knee pain
  • If concerned about septic arthritis or an acute inflammatory arthropathy, check a complete blood count (CBC) with differential and erythrocyte sedimentation rate (ESR) or C-reactive protein, though these tests are nonspecific.Perform an arthrocentesis and send the fluid for cell count with differential, glucose and protein, bacterial culture and sensitivity, and polarized light microscopy for crystals. An arthrocentesis can also help differentiate between simple effusion and hemarthrosis or occult osteochondral fracture. A delay in diagnosis of septic arthritis can lead to serious joint damage, so an arthrocentesis must be performed immediately if this diagnosis is under consideration.
    • A simple joint effusion produces clear, straw-colored transudative fluid. This can happen with osteoarthritis and degenerative meniscal injuries.
    • Hemarthrosis is typically caused by a tear of the anterior cruciate ligament or a fracture. A bloody knee aspirate can be associated with a knee sprain (i.e., ACL, PCL) or acute meniscal tear. An osteochondral fracture causes hemarthrosis with fat globules.
    • Suspected rheumatoid arthritis causing knee painIf considering RA, check rheumatoid factor (RF) on blood work. While not very sensitive, this test has a high likelihood ratio for a positive test with a positive predictive value of 95%. Hand x-rays may also identify erosions and soft tissue swelling, which, if found, indicate a high likelihood of RA.Trauma causing knee painTo evaluate knee pain following trauma, apply the Ottawa Knee Rules to decide whether or not to order an x-ray.

discussion on nursing informatics and other profession

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QUESTION

Nursing informaticians, technology specialists, clinical nurses, nurse managers, educators, and other professionals within healthcare interact indirectly on any given day when accessing and inputting data into patient medical records. Nurses in patient interaction areas serve as the face. They are examples of the caring theory providing assistance utilizing tools such as the workflows that nurse informaticians, project managers, and technical specialists develop behind the scenes to create (McGonigle & Mastrian, 2022). Though sparse, direct interaction between each healthcare group typically occurs during new program rollouts, the target group interview sessions, and a call to a technical specialist to fix a glitch; minimal direct interaction occurs despite each department’s shared goal of improving healthcare outcomes, experiences, and workflows. Much like the floor nurse vs. emergency room or ICU nurse wars, the situation between each healthcare genre stands to achieve exponential leap and bounds with quality collaboration, respect, and recognition that each genre is a specialty and is necessary for the progression of patient care.

Example of Observation:

A recurring experience with technology specialists in the clinic area is during the rolling out of new software, updates, or adaptations of clinical applications. The medical center underwent a recent rollout of the Patient Dashboard. The Patient Dashboard consists of large television Monitors hung on the walls of waiting rooms that list the patient’s name, designated module number, and estimated wait time. The rollout of this system created a huge culture shock, seemingly going against a professional healthcare culture that holds patient health information (PHI) covering every aspect of the patient. In the past, information, including the patient’s name, was treated with extreme secrecy, and healthcare providers signed contracts and employment agreements upholding proper handling of PHI under the Health Insurance Portability and Accountability Act (HIPAA). In the rollout of the patient dashboard, management now says publicly posting a patient’s name is no longer a PHI violation and is the thing to do to help improve patient satisfaction scores. 

Technology Specialists were assigned to each medical suite to assist in training and troubleshooting the system during patient care hours. The Dashboard system, a virtual patient waiting room, was designed as a one-size-fits-all program for all departments, regardless of workflows, which typically vary for specialty clinics. The Dashboard operates as a separate program that is designed to run simultaneously with other programs, allowing the health care provider to toggle between the Dashboard to operate the system, placing the virtual patient in the cue, adjusting projected wait times, assigning the patient a virtual room or nursing station, placing the patient in virtual observation or discharge home, all in real-time on the computer and matching it up with actual patient handling. One barrier found was that the clinic’s currently programmed flowsheet locked the nurse in. They could not toggle between programs in real-time, as accessing the Dashboard once in the immunotherapy program would mean exiting the treatment forum, losing everything necessary to carry out the appointment, and then starting over once the patient was there instead of being prepared for the patient. This action delayed appointment times and increased the risk of missing pertinent steps, leading to mistakes when jumping in and out of the program.

One strategy to improve interaction among healthcare genres is to promote consideration and respect for each team member; adopting reflection as part of the workflows may enhance interactions (McGonigle & Mastrian, 2022). 

Promoting reflection by all stakeholders allows for intuitiveness and collaboration (McGonigle & Mastrian, 2022). In the observation above the rolling out of the patient dashboard, there are several moments for self-reflection from all healthcare providers involved. Reflection by the clinical nurse may reduce the stress associated with unexpected workflow changes and a realization that the new system is likely to place patients at ease when they are seen within time frame expectations. Reflection may also assist with the realization that the nurse informatician’s role is to aid the healthcare system by translating data into workable solutions that improve how care is delivered (Walden University, LLC. 2018). Self-reflection by the informatician and technologist may allow for additional exploration of the individual clinic programming needs and collaboration for workarounds with the technology specialist and clinical nurse, making a smoother transition. 

Future interactions of informatics as a specialty and emerging technologies continue to propel healthcare and how it is provided by the informatician’s answer to the call during COVID-19. Informaticians were instrumental in not only adapting and quickly aiding the transformation of healthcare delivery to maintain a safe connection to loved ones in the hospital, extending the reach of doctor visits through telehealth, adapting clinical networks to alert and track COVID exposures through electronic medical records and personal cell phone apps (Garcia-Dia, 2021). Informaticians also returned to the bedside along with their colleagues, reigniting comradery and promoting each other grace to perform and carry out optimal care on all levels (Garcia-Dia, 2021).

responseee

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Question

Hello class, so this week was a successful one as I felt accomplished in being able to comfort a worried mom. The baby came in with a fever as well as a strong cough, she was worried the baby was very sick and had to be sent to the hospital. She was a first-time mom, so she wasn’t sure what was going to happen, and it was her first time her baby was experiencing a fever. So, all of it led to her head having huge paranoia. Thankfully me and my preceptor were there as we both were moms as well and told her her baby was in the best hands and we were going to make sure the baby left the office with a well-rounded plan for her to get better in no time. The mom seemed to be less worried and when the baby was examined and she needed was some antibiotics and to be kept on Tylenol PRN, and baby would be fine in no time. The mother was very thankful and appreciative of us, so it made me feel very fulfilled, she came in the office very scared and left with hope and peace that her baby was going to be fine.

2.) Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.

So patient S.M came in with her mother because, there seemed to be a rash on the superficial layers of the skin of the patient. The mother says they were like honey-colored crusts. She states her daughter has also been having weakness, some diarrhea, and a mild fever. When the patient was examined, on her face around the nose and under the mouth there were some papules as well as pustules present. There were also some that were broken and looked like honey-colored crusts as the mother described it. There was also some lymphadenopathy on the patient’s neck, basically meaning there was a bacterium the patient was fighting. Some of the tests that needed to be done was a gram stain/culture to test what type of bacteria is positive to best treat it. Some of the differential diagnosis involves, herpes, varicella as well as scabies. Herpes simplex 1 because; this leaves blisters, and they break and cause painful open sores in the mouth region. Varicella, this can cause a itchy blister like rash in the mouth as well as other parts in the body like impetigo. Scabies is another one because, it causes a intense itching and pimple like skin rash on the skin. The plan of care for the patient involves topical antibiotics since its superficial and localized. If there is no response to the antibiotics within a week of starting them then there needs to be a culture taken to see what else is necessary to treat it. There also needs to be education mostly of the parent on hygienic measures that needs to be taken to avoid passing of bacterium. Child should also not go into daycare until they have been treated for 24 hours. The antibiotic would consist of mupirocin 2% ointment. It needs to be applied to the lesions at least 3 times a day for 3-5 days (Schaefer TJ, 2023).

3.) Mention the health promotion intervention for this patient.

Some of the health promotion strategies for this patient would include, to make sure to cover the lesions and make sure to apply topical antibiotics as ordered for best affect. Mother needs to help the child to practice good body, face and hand hygiene. The towels, linens, as well as clothing of the contagious person need to not be used by anyone else in the house.

4.) What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?

What I learned from this week clinical experience is knowing how to treat impetigo. Knowing what to tell the parents on how to help the patient not contaminate other members of the household as well as what topical antibiotic is useful. Since this patients’ lesions were not spread out all over the body she just needs topical ointment if its spread through the body the patient needs oral antibiotic which in this case is amoxicillin/clavulanate 90 mg per kg per day, and it would be divided twice daily for 10 days (Schaefer TJ, 2023).

5.) Support your plan of care with the current peer-reviewed research guideline.

On the scholarly article Interventions for impetigo, it was stated; topical antibiotics (mupirocin, retapamulin, fusidic acid) were found to be more effective than the placebo and preferable to oral antibiotics for limited impetigo. Topical antibiotics were also superior to disinfection methods (Dellavalle R, 2021).