Hello, I need to do my weekly discussion question for my nursing class. Here is the SOAP note and at the end there are 3 questions to answer. 

Name: X.X.                             Date:                                                   Age: 44

Gender: Female                       Marital Status: Married          Occupation: Bank Teller

Examiner: APRN-BC                     Time: 9:15 am

Subjective Data: 

HPI: Patient reports that after reading a recent article in Women’s Health magazine, she decided to do a self-breast exam.  This was the first time she had performed such an exam and is unsure of the results.  Patient reports that during the self-exam she felt a “marble-sized” mass in the upper, outer quadrant of her right breast.  Patient reports that the mass was movable and was not painful or tender to the touch.  Patient states that the self-breast exam occurred about ten days ago.  She is unaware of any changes in the mass. Also she reports some itching and burning sensation in vaginal area. Patient stated she is having regular monthly menstruation.

Objective Data: 

BP 128/82; T 98.1 F; P 64; R 25.  Patient is verbally responsive, demonstrates fluid coordination in large and small movements, and reports no pain or discomfort.  Patient is a non-smoker and an occasional drinker.  Patient states that she drinks approximately 3 alcoholic drinks per week with friends. Patient is slightly overweight with a BMI of 29.8.

PMH: Patient has no chronic illnesses.  Patient suffered from pneumonia for approximately four weeks in November 2007.

Family History: Patient is one of three children. Her siblings are both males.  Mother died in a car crash at the age of 69 and had no chronic conditions apart from mild arthritis.  Father is still alive and is undergoing treatment for lung cancer.

Sexual Health:  Married, but she believes her husband goes around and maybe have another sexual partner. She uses birth control pills to prevent pregnancy, but husband uses no condoms. She is afraid to confront husband regarding this issue. She is willing to talk to a therapist if it is need it.

Medications: use of contraceptives Altavera.

ROS: Patient has itching and burning sensation (vaginal area) showing some discomfort symptoms. Also patient present symptom is a marble-sized lump in right breast.

Allergies: NKA, immunizations current.

Physical Examination:

General: In no acute distress. Alert and oriented x 3. Appropriate and cooperative.

HEENT:  Head is normocephalic without lesions or masses. Pupils round and reactive to light accommodation. Extraocular movements intact.

Neck:  Supple.  Trachea is midline. No JVD, internal, Proper neck strength and movement.

Breast: symmetric, no lesion or discharge, palpation revels no masses or tenderness. Except for R breast lump.

Lungs:  Lung fields clear to auscultation bilaterally.  No acute respiratory distress, no accessory muscle use; No wheezing, rales or rhonchi.  Equal chest expansion bilaterally.

Cardiovascular:  Oral cavity lips moist and pink, no cyanosis.  Carotid pulses +2 palpable bilaterally, no JVD or bruit.  Upper extremities- capillary refills less than 2 seconds, no clubbing or cyanosis present.  Radial and brachial pulses +2 palpable bilaterally. Apical pulse palpable at the 5th and 6th intercostal spaces.  Apical rate and rhythm regular at 90 bpm. S1 and S2 are present without murmurs, rubs, or gallops.

Abdomen:  Flat, soft, no tender, non distended with positive bowel sounds x 4. No organs enlarged.

External Genitalia:  Redness, no lesions.

Internal Genitalia: showing redness and Gray-white color discharge with a fishy, foul rotten  odor. Vaginal walls erythematous and edematous. Cervix pink with no lesions. Specimens obtained

Bimanual: No tenderness to palpation, uterus and ovaries not enlarged.

Rectum: No masses or fissure. Stool brown test negative for occult blood.

Breast examination:  The lump the patient reports is indeed a marble-sized lump in the upper outer quadrant of the right breast.  The lump feels nodal, rather than smooth, has moderate density, and does not appear to give any discomfort to the patient when manipulated. Patient’s breast tissue is dense considering patient’s age.

Initial Post:

1-What further questions do you have for this patient at this visit? (ROS) 
(This questions will help you to narrow your differential diagnosis) 

2-What is your differential (ICD-10 Codes) diagnosis list for this visit? include at least 2 (Assessment)

3. What would be your plan for this patient ? (diagnostic work-up, Medications, Referrals, Conservative measures, Patient education, Follow-up plan, etc) 

 

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Organizations rely on financial statements to carry out important business decisions. The statements are typically compiled into a cohesive document, which allow managers to evaluate, based on various financial analysis methods. This process involves a comparison of ratio outcomes from the financial statements. Collectively, the ratios are used to execute financial analysis of business operations, to assess profitability and viability. This portion of the project requires you to apply financial analysis methods, choose the best method to evaluate financial outcomes for your case, and explain why this method should be used over other methods.

Submit a minimum 2-page report that:

• Defines and describes various financial analysis methods, such as vertical and horizontal analysis.
• Explains how and why each method would be used in an organization’s financial review process.
• Compares the similarities and differences among the methods.
• Using the financial statements for your case, examine how at least one of the methods can be used.
  • Support your position with the actual ratio outcome(s).
  • Explain WHY this method should be used over the others, based on case financial challenges

 

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specialization: Family Nurse Practitioner.

As a nurse practitioner, the major roles include the assessment of the needs of the patients. A nursing practitioner also orders and interprets test from laboratories, they do illness and disease diagnosis, medication prescription and formulate plans for treatment. There are a number of challenges that face the nurse in their field of practices. This paper will focus to discuss the hazards in the workspace of these practitioners. It will also seek to find a way of solving these challenge using innovative means.

The Problem of Interest

Hazard in The Nursing Field.

The nursing field of practice is one of the most dangerous places of working as one does work in a delicate environment where one is in the risks of being infected or even injuring oneself. Nurses are faced with a number of risks in daily job activities. Some of these hazards include injuries, flu germs, hand washing –related dermatitis and pathogens that are based in the blood among others.

According to the report produced by OSHA, about 5.6 million of 12.2 million workers are under the risk of being exposed to blood borne pathogens. This is a big number of health workers under the risk meaning that soon there will be a shortage of health nursing or health workers in general. Moreover, the rates of risks are higher in the health care industry than any other industries. This industry has registered around 35000 injuries covering different parts of the body. These range from the shoulders, hands, feet, and back. These statistics are according to the Bureau Labor Statistics (Gooch, 2015).

Apart from the acute injuries discussed, they also suffer harm exposed on their hands. From a recent study carried out in the University of Manchester, the health workers that follow protocols are 4.5 times exposed to skin damage risks. The report also reported up to 25 percent of cases of irritant contact dermatitis.

These individuals also get exposed to infectious diseases in their areas of practice. One of the most commonly contacted infection is Hepatitis B (HBV). This is infection can be contacted via blood contact, feces, saliva, and semen. This instrument of spreading the infection is in contact with the patient and also the needles (Gooch, 2015). Nursing practitioners also risk exposure to toxic substances in the clinical environment. Radiation is another risk that comes majorly from the ionizing radiation. Complications associated with radiation include skin cancer, leukemia, and cancer among others. One comes to contact with this radiation in the instances of performing x-ray scans. Another challenge that faces nursing practitioners is stress. This is experienced mostly among the nurses who work with the patients that are terminally or chronically ill (NCBI, 2016).

Research Strategy.

The focus of the research is on the articles that are based on nursing practices. These articles also further narrow down to the specific problems facing the nursing practitioners. The aim is to find a solution to the above-identified problem.

Innovative Solution.

It was crucial to put up ways to protect nursing practitioners. It is important to take extra measures when working in various situations. Capacity building of the nurses on the safety measures while working is very important. They should also be educated on using the protective gear which will reduce exposure to risks. For instance, the use of antiviral face mask inactivates the 99.99 percent of the flu viruses tested in the laboratory.

Literature review: Nursing problem.

Nursing problems dates as early as the period when the nursing profession started; these challenges range from the work based issues, personal issues to the working environment challenges that nurse’s face. Looking at various literature sources, the problems are comprehensively discussed and also potential solutions proposed to help address some of these challenges facing nurses in their profession according to the article “Problem facing nursing profession” by Iglehart, (1987). Nurses continue to fight with various struggles ranging from low wages to poor working condition that has not only jeopardized their safety but also endangered the safety of their patients too. This has greatly affected their output in their professions as they have to be extra careful when exercising their mandate to ensure that they remain safe. This has reduced their capabilities in treating and diagnosing their patients as a poor working environment makes them hesitant about what they can do at the prevailing working conditions.

The limitedness in the number of nurses in various healthcare remains to be one of the major problem facing nurses in their professions. According to the article by Peterson (2001), nurses tend to strain their efforts to serve the overwhelming number of patients in various health care facilities. Although there is a recommendation of the number of patients that can be served by one nurse, there remains a serious challenge on the effectiveness of the nurse’s, especially when their efforts are strained. When the workforce is strained, there is a tendency to compromise the quality of the service rendered by the nurses. This has remained to be a serious problem in the nursing profession. The problem has been there for quite some time, and although there has been some improvement in staffing in a various healthcare organization and the number of patients that can be served by one nurse.

For quite some time, the safety of the nurses while practicing their profession has been a major issue of concern. This is not a new challenge that is experienced today, the problem has been there, and despite the challenge being there for quite some time, and it remains to be a major challenge facing nurses. It is reported that the health of the nurses has been greatly attributed to the lack of proper working condition for the nurses as they practice their profession. With cases of hepatitis B being reported frequently in nurses working in poor working condition. In some cases, the contact of the nurse with highly infectious diseases has increased the risk of nurses contracting these diseases, therefore, affecting their output. With many incidences reported where nurses have contracted diseases while exercising their profession this is a major call for improvement in the working environment for the nurses to ensure that their health is nor endangered as they try to save lives.

Poor remuneration remains a serious challenge affecting nurses in their profession. In many incidences, the minimum wage for a nurse remains significantly low as compared to the demands in their work and also the risk of the exposure. According to Hayes et al. (2006), poor remuneration of nurses remains to be a significant problem affecting them in their profession; this has led to increased turnover whose implications have been negative when it comes to the provision of healthcare services in the healthcare organization. There call the necessary agencies to chip in and make the required regulations that can lay the guideline to be followed when it comes to remunerating nurses to solve this challenge.

References

Gooch, K. (2015, August 13). 5 of the biggest issues nurses face today. Becker’s Hospital Review. Retrieved from https://www.beckershospitalreview.com/human-capital-and-risk/5-of-the-biggest-issues-nurses-face-today.html

Gooch, K. (2015, July 15) 4 common nursing hazards demanding hospitals’ attention. Clinical Leadership & Infection Control. Retrieved from https://www.beckershospitalreview.com/quality/4-common-nursing-hazards-demanding-hospitals-attention.html

NCBI (2016). Nursing Health & Environment: Strengthening the Relationship to Improve the Public Health. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK232400/

Iglehart, J. K. (1987). Problems facing the nursing profession.

Peterson, C. A. (2001). Nursing shortage: Not a simple problem-no easy answers. Online Journal of Issues in Nursing, 6(1), 1-14.

Hayes, L. J., O’Brien-Pallas, L., Duffield, C., Shamian, J., Buchan, J., Hughes, F., … & Stone, P. W. (2006). Nurse turnover: a literature review. International journal of nursing studies, 43(2), 237-263.

 

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Report Issue

 This assignment builds on the Risk Management Program Analysis Part One assignment you completed in Topic 1 of this course.

Assume that the example risk management program you analyzed in Topic 1 was developed by and is now currently implemented by your health care employer/organization. Further assume that your supervisor has asked you to present a high-level summary brief of this new risk management program to a group of administrative personnel from a newly created community health organization in your state who has enlisted your organization’s assistance in developing their own risk management policies and procedures.

Compose a 1,250-1,500 word summary brief that expands upon the elements you addressed in the Risk Management Program Analysis Part One assignment. In addition, analyze the following:

1. Explain the Joint Commission’s role in the evaluation of an organization’s quality management processes.
2. Describe the roles that different levels of administrative personnel play in establishing or sustaining operational policies that are focused on employer-employee organizational risk management policies.
3. Explain the relationship of risk management programs and compliance with ethical standards.

In addition to your textbook, you are required to support your analysis with a minimum of three peer-reviewed references.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center

 

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2. In each of the following cases, the behavior illustrated seems to suggest that the people’s values differ significantly from our own.  Consider the possibility that, beneath appearances, the values are similar.  Develop a plausible explanation for the difference in behavior.

a. In one culture, the elderly and those with severe handicaps are put to death.  It would appear that this culture does not recognize human dignity as a value.

c. Members of a tribe living in a remote jungle area commonly shun the sick.  The moment members of the tribe become seriously ill, they cease to exist in the tribe’s view.  They must leave the village and care for themselves.  If they recover, however, they are restored to tribal membership.  Apparently, the tribe lacks compassion for the afflicted.

d. A group of young boys are gathered together.  Several men approach them, brandishing sticks and whips.  They beat the boys viciously. The other male members of the tribe sit by and watch, laughing and obviously enjoying the event.  It would seem that the men of this culture are sadistic, deriving pleasure from seeing others in pain.

PART B

Answer either inquiry 3 or 12.  If you choose to answer Inquiry 12 select only one of the experiences (a or c).
The inquiries are also found on pages 64 and 65 of the book.

3. When Hua, a Chinese woman, gave birth to a daughter rather than a son, her husband refused to look at the child.  Later he punished his wife for the “offense” by withholding money and hitting her without provocation.  When the child contracted pneumonia, he suggested she be left to die.  Eventually, he divorced his wife — the decree cited his disapproval of having a baby girl and specified that the wife would keep the child and he would get the apartment.

This story is not that uncommon in China,  where masculinity is defined as producing a son to maintain the family line.  This cultural value is so ancient and so strong that it is even reflected in the language  — the character for the word good is a combination of the sign for “woman” and the sign for “son”. Evaluate this cultural value.

12. When a Christian missionary is sent to preach the Gospel to members of a newly discovered tribe, she has the following experiences:

a. After arriving in their primitive jungle settlement and establishing a friendly relationship with them, she learns that they encourage extra-marital promiscuity.  She believes that this is morally wrong. She therefore explains to them that such promiscuity is immoral and an offense against God.  Is the missionary’s action ethical?

c. The missionary now makes an even more startling discovery.  Because tribe members  believe women are inferior to men and a tribe with a large number of women is an outrage to the god of good sense, they strictly control the female population.  Whenever the number of girl babies exceeds the percentage approved by the wise men of the tribe, they permit no more girls babies born that year to live.   More specifically, they take newborn babies out into the wilderness to die.  The missionary tries to persuade them that such behavior is wrong.  Is this action justifiable?  

 

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