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ABDOMINAL ASSESSMENT

Subjective:

  • CC: “My stomach hurts, I      have diarrhea and nothing seems to help.”
  • HPI: JR, 47 yo WM, complains      of having generalized abdominal pain that started 3 days ago. He has not      taken any medications because he did not know what to take. He states the      pain is a 5/10 today but has been as much as 9/10 when it first started.      He has been able to eat, with some nausea afterwards.
  • PMH: HTN,      Diabetes, hx of GI bleed 4 years ago
  • Medications: Lisinopril 10mg, Amlodipine 5      mg, Metformin 1000mg, Lantus 10 units qhs
  • Allergies: NKDA
  • FH: No hx of colon      cancer, Father hx DMT2, HTN,      Mother hx HTN, Hyperlipidemia, GERD
  • Social: Denies tobacco use;      occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

  • VS: Temp 99.8; BP 160/86; RR      16; P 92; HT 5’10”; WT 248lbs
  • Heart: RRR, no murmurs
  • Lungs: CTA, chest wall      symmetrical
  • Skin: Intact without      lesions, no urticaria
  • Abd: soft, hyperactive bowel      sounds, pos pain in the LLQ
  • Diagnostics: None

Assessment:

  • Left lower quadrant pain
  • Gastroenterit

With regard to the Episodic note case study provided:

  • Review this week’s Learning Resources, and consider the      insights they provide about the case study.
  • 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.

The Assignment

  1. Analyze the subjective portion      of the note. List additional information that should be included in the      documentation.
  2. Analyze the objective portion      of the note. List additional information that should be included in the      documentation.
  3. Is the assessment supported by      the subjective and objective information? Why or why not?
  4. What diagnostic tests would be      appropriate for this case, and how would the results be used to make a      diagnosis?
  5. 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.

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Explain academic integrity and how you are prepared to meet the academic integrity standards at this school.

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 How does a nurse know what (if any) knowledge in a research study is usable for clinical practice? What would a critical thinker look for in the evidence before deciding to change? What influence do credibility and clinical significance have on your decisions to integrate research-based evidence into your practice? 

two reference one paragraph response with incite citation 

one of your reference please use text book 

 Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Jones & Bartlett. 

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 APA style and less than 10 % similarity

Please answer the following Discussion Question. Please be certain to answer the four questions on this week DQ and to provide a well-developed and complete answer to receive credit. Also, please ensure to have read the assigned chapters for the current week. 

Case Study, Chapter 21, Health Care Reform: The Dismantling of the Affordable Care ActAs we entered 2018, millions of Americansstill relied onAffordable Care Act(ACA) subsidies, health premiums were soaring, and provider choice was more limited than ever.There was, however, momentum for reform. Health care was identified as the country’s leading priority for Democrats (54%) and the second highest priority for Republicans (42%) at the close of 2017. A group of registered nurses debate the issue of health care reform

.

1. The nurses debate whether the country feels that health care reform is really necessary. Discuss reasons why reform is needed and what that reform should address.

2. What were the 10 essential benefits guaranteed by insurance plans in the ACA Health Care Marketplace? 

3. What are the successes of the ACA?

4. What are the failures of the ACA?

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Purpose of Assignment:

These case studies are real-life scenarios that will help you explore the concepts of the immune system, diagnostic tests, and treatments.

Instructions:

Download MEA2203 Case Study Assignment Module 01 (Attached below) Click for more options

and read each of the patient scenarios. Then, use the lesson content from this module, your textbook, and perhaps additional research to answer the questions. Upload your completed document by following the instructions below. 

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The topic is Alzheimers so you need :

  • Introduce the topic/condition
  • Describe what it is
  • Explain why it is a problem related to health and nursing

Here are 3 recommend sites to you to get information on this topic 

https://www.uspreventiveservicestaskforce.org/uspstf/

https://www.cdc.gov/nchs/fastats/

https://health.gov/healthypeople

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The discussion assignment provides a forum for discussing relevant topics for this week on the basis of the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned and complete your participation for this assignment by Day 7. To support your work, use your course and text readings and also use resources from the South University Online Library.

As in all assignments, cite your sources in your work and provide references for the citations in APA format. Support your work, using your course lectures and textbook readings. Helpful APA guides and resources are available in the South University Online Library. Below are guides that are located in the library and can be accessed and downloaded via the South University Online Citation Resources: APA Style page. The American Psychological Association website also provides detailed guidance on formatting, citations, and references at APA Style.
• APA Citation Helper
• APA Citations Quick Sheet
• APA-Style Formatting Guidelines for a Written Essay
• Basic Essay Template

TASK

Post your initial response to one of the two topics below.

Topic 1 Health Problems

  • Which area, rural or urban, has the most health problems? Why?
  • Identify four common health problems found in that selected area.

Topic 2 Intervention Wheel

  • Choose two of the interventions, from the Intervention Wheel Chapter 9, that you feel are most important. Why did you select these two?
  • Discuss how they can be used with an aggregate.

Justify your responses with resources

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REPLY1

Being that Ms. Alma Faulkenberger is 85 years old, she has most likely had many interactions with healthcare staff that may have led to her this non-compliant, difficult way of thinking. “A participatory relationship between patient and physician appears to be the most important factor promoting medication adherence” and that “the more actively the patient is involved, the higher the level of adherence and the greater the chance that the patient engages in healthy diet and exercise behaviors” (Kleinsinger, 2010). Research has shown that open communication, quick responses and creating a trustworthy relationship will help the patient remain compliant with their plan of care.

I would start my interaction by introducing myself, apologizing and asking her how to pronounce her name. Then to develop a plan for Ms. Alma to be compliant with the procedure and post-treatment, it is important to assess her needs, and include her in the planning. Opening the floor with open ended questions and allowing her to voice her opinions and needs/wants is a method that enables her to feel included in the plan of care. I would use this time to discover any barriers in learning such as difficulty hearing, unable to read, living situations and needs at home. I would ask how she learns best, reading, written or demonstration. After assessing her and asking her questions, I would then use what I discovered to implement education. I would ask her to teach back what she has learned. It would be best if this teaching were done with a family member to help with coherence to the plan.

Kleinsinger F. (2010). Working with the noncompliant patient. The Permanente journal, 14(1), 5

REPLY2

To help Alma be compliant with the invasive pelvic procedure and post-treatment medication, the health care professional must develop a plan. The first step is providing therapeutic communication. Explaining the logic behind the plan, understanding the patient perceptions of the treatment and procedure, and talking about any problems with the post-treatment plan is important to have an effective plan (Falvo, 2011). Asking her about her family and other significant people can help aid in the education efforts as well. Being specific and providing printed handouts can help with the higher level of education needed for an extensive procedure and treatment. Being a positive influence on patient adherence is a great skill of health providers to have. Building a relationship should also be part of the health professionals plan to assist in Alma being successful in procedure and post-op treatment. 

Then, another step in the plan should be to meet the patients individual needs, if that patient wants to go biking again, we can work with her to ensure she can do that in 6 weeks after post-op for example and maybe collaborate with PT/OT to get here there. Same with finding out a medication regimen that works best for her every day life, if she has a book club at 10am every Wednesday, but you ask her to take it at 10am she may skip doses. The plan should be holistic and use communication and creating a relationship with the patient for it to be successful. Meeting the individuals needs with their strengths and being aware of weaknesses is also important. In patient education, the health professional should talk calmly, clearly, and slowly. Providing follow up questions and really taking the time to listen to Alma is very important. Using all of this into the plan of care, Alma’s pelvic procedure and post-treatment medication should be successful. 

Falvo, D. R. (2011). Effective Patient Education: A Guide to Increased Adherence. Retrieved from https://viewer.gcu.edu/RQBKXW

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Alma Faulkenberger is an 85-year-old female outpatient sitting in the waiting room awaiting an invasive pelvic procedure. The health care professional who will assist in her procedure enters the room and calls “Alma.” There is no reply so the professional retreats to the work area. Fifteen minutes later the professional returns and calls “Alma Frankenberg.” Still no reply, so he leaves again. Another 15 minutes pass and the professional approaches Alma and shouts in her ear, “Are you Alma Frankenberg?” She replies, “No I am not, and I am not deaf either, and when you get my name correct I will answer you.”

Using the topic 1 materials, develop a plan to help Alma be compliant with the procedure and post-treatment medication. Also, describe the approach you would take to patient education in this case.

250 WORDS CITATION AND REFERENMCES BY10/7

DQ2.        250 WORDS CITATION AND references BY 10/8

How would you use collaboration to assist in compliance with a patient as difficult as Alma?

 

REFERENCES:

Read chapters 1-3.

URL:http://gcumedia.com/digital-resources/jonesandbartlett/2010/effective-patient-education_-a-guide-to-increased-adherence_ebook_4e.php

Read “How to Facilitate Better Patient Compliance,” by Rothenberg, from Podiatry Today (2003).

URL:http://www.podiatrytoday.com/article/1612

Read “Should We Consider Non-Compliance a Medical Error?”  by Barber, from Quality & Safety in Health Care (2002).

URL:https://lopes.idm.oclc.org/login?url=http://search.proquest.com.lopes.idm.oclc.org/docview/206796490?accountid=7374

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Do you have the courage to ask for honest feedback? Do you have the courage to give honest feedback to a friend or colleague? How do you respond to negative feedback?

Instructions:

APA format (intext citations and references)

Plagiarism FREE

Follow the 3 x 3 rule: minimum three paragraphs per DQ, with a minimum of three sentences each paragraph.

·      All answers or discussions comments submitted must be in APA format according to Publication Manual American Psychological Association (APA) (6th ed.) 2009 ISBN: 978-1-4338-0561-5

·      Minimum of two references, not older than 2015.