In this assignment, you will analyze a SOAP 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.

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WEEK 5 ASSIGNMENT

In this assignment, you will analyze a SOAP 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.

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, hyperctive bowel sounds, pos pain in the LLQ

· Diagnostics: None

ASSESSMENT:

· Left lower quadrant pain

· Gastroenteritis

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

To prepare:

With regard to the SOAP 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.

To complete:

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 3 different references from current evidence based literature.

 
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A SOAP Note Case Study

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In this assignment, you will analyze a SOAP 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.

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, hyperctive bowel sounds, pos pain in the LLQ

· Diagnostics: None

ASSESSMENT:

· Left lower quadrant pain

· Gastroenteritis

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

To prepare:

With regard to the SOAP 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.

To complete:

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?

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 3 different references from current evidence based literature 

 
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PICOT Statement Paper

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Review the Topic Materials and the work completed in NRS-433V to formulate a PICOT statement for your capstone project.

A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process.

Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project.

In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome.

Make sure to address the following on the PICOT statement:

  1. Evidence-Based Solution
  2. Nursing Intervention
  3. Patient Care
  4. Health Care Agency
  5. Nursing Practice

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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The purpose is to write a review of the literature on to answer your PICOT question using original research evidence. Discuss how this health problem is applicable in both the United States and a non-USA country, and appraise four original research studies on this topic.

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This paper will have an 8-page narrative (8 pages maximum – 5 point deduction for over page limit) plus a title page, abstract page, and reference list. 

You must use a minimum of four original research articles for your paper.

The purpose is to write a review of the literature on to answer your PICOT question using original research evidence. Discuss how this health problem is applicable in both the United States and a non-USA country, and appraise four original research studies on this topic.

This is a scholarly paper, written as if it was a “Review of the Literature” article published in a nursing journal. Select articles published within the past five years (2014 to present).
Do not use a non-peer review journal. Do not use a literature review article or systematic review article or clinical protocols as one of your articles. At least TWO of the four original research report articles MUST BE authored by nurses and published in a peer-reviewed nursing journal.  At least ONE of the two nursing research studies must address nursing practice in a non-USA country.

  • Page 1: Title page Create a title for your paper. Refer to your APA Manual.
  • Page 2: Abstract The abstract should open with a sentence that will serve as an introduction to and purpose of the paper. Then describe what is in each part of the paper. An abstract is usually a brief outline of the contents of the paper that typically does not exceed 250 words. At the end of the abstract place the phrase Key Words, and denote 3-4 keywords that would describe your paper (as for publication and indexing in CINAHL or PubMed).
  • Pages 3-11: Narrative
    • Heading: Significance and Background: Start the paper with a short paragraph that introduces the health problem in your PICOT question. (Approximately ½-page).
    • Heading: Purpose: Clearly define the global health problem, and discuss why it is important for nursing (why you are discussing this topic).  Discuss what is known about this problem in the United States and in a non-USA country.  For example, if the focus is adult hypertension, discuss guidelines for defining hypertension in the US and in a non-USA country.  (Approximately 1 page).
    • Heading: Methods: Discuss the methods used to select the following research studies.
      Next use the subheading:
      • Sub-headings: Study #1: Nursing research Study in the USA (Approximately 1½ pages)
      • Sub-headings: Study #2: Nursing Research Study Non-USA (Approximately 1½ pages)
      • Sub-headings: Study #3: Nursing Research Study USA or Non-USA (Approximately 1½ pages)
      • Sub-headings: Study #4: Nursing Research Study USA or Non-USA (Approximately 1½ pages)
    • Heading: Conclusion.  Summarize the key points from your discussion. How would you translate (use) the new evidence found from your appraisals to change practice or answer your PICOT question? (Approximately 1 page).
 
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To write a critical appraisal that demonstrates comprehension of the research study conducted

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Research Critique Guidelines

To write a critical appraisal that demonstrates comprehension of the research study conducted, address each component below for qualitative study in the Topic 2 assignment and the quantitative study in the Topic 3 assignment.

Successful completion of this assignment requires that you provide a rationale, include examples, or reference content from the study in your responses.

Qualitative Study

Background of Study:

· Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.

· How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.

· Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.

· List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.

· Were the purpose and research questions related to the problem?

Method of Study:

· Were qualitative methods appropriate to answer the research questions?

· Did the author identify a specific perspective from which the study was developed? If so, what was it?

· Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include?

· Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study.

· Did the author evaluate or indicate the weaknesses of the available studies?

· Did the literature review include adequate information to build a logical argument?

· When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings?

Results of Study

· What were the study findings?

· What are the implications to nursing?

· Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing?

Ethical Considerations

· Was the study approved by an Institutional Review Board?

· Was patient privacy protected?

· Were there ethical considerations regarding the treatment or lack of?

Conclusion

· Emphasize the importance and congruity of the thesis statement.

· Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.

· Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.

· Integrate a summary of the knowledge learned.

Quantitative Study

Background of Study:

· Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.

· How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.

· Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.

· List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.

· Were the purpose and research questions related to the problem?

Methods of Study

· Identify the benefits and risks of participation addressed by the authors. Were there benefits or risks the authors do not identify?

· Was informed consent obtained from the subjects or participants?

· Did it seem that the subjects participated voluntarily in the study?

· Was institutional review board approval obtained from the agency in which the study was conducted?

· Are the major variables (independent and dependent variables) identified and defined? What were these variables?

· How were data collected in this study?

· What rationale did the author provide for using this data collection method?

· Identify the time period for data collection of the study.

· Describe the sequence of data collection events for a participant.

· Describe the data management and analysis methods used in the study.

· Did the author discuss how the rigor of the process was assured? For example, does the author describe maintaining a paper trail of critical decisions that were made during the analysis of the data? Was statistical software used to ensure accuracy of the analysis?

· What measures were used to minimize the effects of researcher bias (their experiences and perspectives)? For example, did two researchers independently analyze the data and compare their analyses?

Results of Study

· What is the researcher’s interpretation of findings?

· Are the findings valid or an accurate reflection of reality? Do you have confidence in the findings?

· What limitations of the study were identified by researchers?

· Was there a coherent logic to the presentation of findings?

· What implications do the findings have for nursing practice? For example, can the findings of the study be applied to general nursing practice, to a specific population, or to a specific area of nursing?

· What suggestions are made for further studies?

Ethical Considerations

· Was the study approved by an Institutional Review Board?

· Was patient privacy protected?

· Were there ethical considerations regarding the treatment or lack of?

Conclusion

· Emphasize the importance and congruity of the thesis statement.

· Provide a logical wrap-up to bring the appraisal to completion and to leave a lasting impression and take-away points useful in nursing practice.

· Incorporate a critical appraisal and a brief analysis of the utility and applicability of the findings to nursing practice.

· Integrate a summary of the knowledge learned.

Reference

Burns, N., & Grove, S. (2011). Understanding nursing research (5th ed.). St. Louis, MO: Elsevier.

© 2016. Grand Canyon University. All Rights Reserved.

4

 
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The facility should consider the financial aspect of its business

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1-The facility should consider the financial aspect of its business. This means there is a need to have funds available to help in making the project a reality. It is imperative to have an adequate amount of money that will be considered useful to assist the project to achieve its existing objectives. Quality entails improving the overall delivery of medical care by having a high level of cleanliness within the context of the healthcare environment (McFarland et al., 2017). The clinical aspect is ensuring that nurses maintain cleanliness within the context of the medical care environment. The proposal will have a direct impact on finances by stating the amount of money required for the project. It will also have a quality implication by giving the specific aspects that the organization needs to consider. The clinical element should be implemented from the context of nursing because it is the role of these individuals to ensure that medical care delivery to patients is appropriated.

Reference

McFarland, D. C., Shen, M. J., Parker, P., Meyerson, S., & Holcombe, R. F. (2017). Does hospital size affect patient satisfaction? Quality management in health care, 26(4), 205-209.

2-After discussion with my mentor, one financial aspect to be considered for developing this evidence-based practice project is an analysis of cost to determine if the EBP project will produce adequate value. For my specific evidence-based practice proposal it will cost the organization no money to implement musical therapy to decreases agitation, anxiety, and aggression in dementia patient residing in the memory support unit directly impacting this EBP project making the value of the proposal go up. The implementation of the EBP project could ultimately reduce costs associated with the negative side effects associated with psychotropic medication use including increased fall risk and emergent transfer to the ER which can also be linked to a clinical aspect as well. One quality aspect to this EBP project is increasing positive patient outcome by decreasing negative behaviors exhibited by dementia patient, ultimately increasing their quality of life. This quality aspect directly impacts the organization by meeting CMS goals to reduce psychotropic medication use in dementia patients to increase quality of life.

3-EBP is a problem-solving approach which incorporates the careful use of up to date, quality data in decisions regarding the care of patients (Vaidya et al., 2017). Speaking with my mentor, the financial aspect of the project would be hours spent trying to get nurses and nurse aides educated on the proposed guidelines for the care of dementia patient. Staff will also need training on updated tools that will be implemented at the end of the study. The facility will need to spend more to hire therapies to incorporate therapy in the daily schedule of the residents. Also, they will need additional staffs during sundowning period either paying for extra hours or hiring staffs that can cover that window.

Frequent falls with injuries tell a lot about the quality of services provided. The quality of a nursing facility depends on the quality of care that the patient receives. To prevent frequent falls and numerous injuries, EBP implemented needs to involve every step to provide the best care needed for the resident.

Clinically, staff acceptance of the project needs to be taken into consideration. Patient injury is something that a conscious nurse will not want it to happen on her shift. Proper education and providing staffs with proven research data will help them staff involve in the process. As lifelong learners, staff nurses continually encounter new knowledge of relevance to their patients. The conscientious nurse remains alert to clinical problems and encourages investigation into ways to improve patient outcomes (Di Lenoardi, 2014).

All the aspects brought together will make a good impact on the project. With the research and data given to the nurses, implementation, and then follow up of results will show this is a great solution to help alleviate the many falls and injuries. If this facility shows that the guidelines are helping there, then they can teach other colleagues at the corporate level that this helps and also will cut costs by preventing readmissions.

References

Di Lenoardi, B. C. (2014). Bringing evidence-based practice to life. Retrieved from https://lms.rn.com/getpdf.php/2145.pdf

Vaidya, N., Thota, A. B., Proia, K. K., Jamieson, S., Mercer, S. L., Elder, R. W., … & Zaza, S. (2017). Practice-Based Evidence in Community Guide Systematic Reviews. American journal of public health, 107(3), 413-420.

 
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Change Implementation And Management Plan

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To Prepare:

  • Review the Resources and identify one change that you believe is called for in your organization/workplace.
    • This may be a change necessary to effectively address one or more of the issues you addressed in the Workplace Environment Assessment you submitted in Module 4. It may also be a change in response to something not addressed in your previous efforts. It may be beneficial to discuss your ideas with your organizational leadership and/or colleagues to help identify and vet these ideas.
  • Reflect on how you might implement this change and how you might communicate this change to organizational leadership.

The Assignment (5-6-minute PowerPoint presentation):

Change Implementation and Management Plan

Create a narrated PowerPoint presentation of 5 or 6 slides that presents a comprehensive plan to implement the change you propose.

Your presentation should be 5–6 minutes in length 

Your Change Implementation and Management Plan should include the following:

  • An executive summary of the issues that are currently affecting your organization/workplace (This can include the work you completed in your Workplace Environment Assessment previously submitted, if relevant.)
  • A description of the change being proposed
  • Justifications for the change, including why addressing it will have a positive impact on your organization/workplace
  • Details about the type and scope of the proposed change
  • Identification of the stakeholders impacted by the change
  • Identification of a change management team (by title/role)
  • A plan for communicating the change you propose
  • A description of risk mitigation plans you would recommend to address the risks anticipated by the change you propose
 
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Imagine you are the office manager at a small doctor’s office. As the office manager, you are in charge of educating all new employees.

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Imagine you are the office manager at a small doctor’s office. As the office manager, you are in charge of educating all new employees.

Write a 700- to 1,050-word reference guide describing electronic data interchange (EDI).

Your reference guide should:

  • Define EDI.
  • Explain how using EDI facilitates electronic transactions.
  • Explain how HIPAA has changed how health care information is transmitted in EDI.
  • Describe the relationship between Electronic Health Records, reimbursement, HIPAA, and EDI transactions.

Cite a minimum of two outside sources according to APA guidelines. For additional information on how to properly cite your sources, access the Reference and Citation Generator in the Center for Writing Excellence.

Format your assignment according to APA guidelines.

 
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Moral Status

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that answers the following questions:

  1. What is the Christian view of the nature of human persons, and which theory of moral status is it compatible with? How is this related to the intrinsic human value and dignity?
  2. Which theory or theories are being used by Jessica, Marco, Maria, and Dr. Wilson to determine the moral status of the fetus? What from the case study specifically leads you to believe that they hold the theory you selected?
  3. How does the theory determine or influence each of their recommendations for action?
  4. What theory do you agree with? Why? How would that theory determine or influence the recommendation for action?

Remember to support your responses with the topic study materials.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

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. Refer to the LopesWrite Technical Support articles for assistance.

 
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Transcultural Perspectives in Mental Health

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Read chapter 10 of the class textbook and review the attached PowerPoint presentation.  Once done, develop and post an analysis of the following cases;

1. Stephane, a 15-year-old Haitian refugee who is living at a center for children of refugees has a severe cough and fever. She is curled up in a corner of the community room wrapped in a towel. She looks like she has been crying.

  1. How can the nurse ensure culturally competent care?

List three priorities for the nurse regarding the cultural values, beliefs, and possible practices that Stephane may have.

2. Jacob is an 87-year-old with bipolar I disorder. He came to the United States from Poland in 1937. He was institutionalized for 2 years in a large mental health facility; currently, he lives in a community mental health center (transitional housing).

a. Identify three questions that would be important to ask Jacob on your first encounter.

b. What is the main health issue for Jacob?

What structures are needed in a community to ensure that Jacob will get the care he needs?

As stated in the syllabus present your assignment in an APA format word document, Arial 12 font attached to the forum in the discussion tab of the blackboard titled “Week 10 discussion questions” for grading and in Turnitin to verify originality.   If you don’t post your assignment in any of the required forums you will not get the points.  A minimum of 2 evidence-based references besides the class textbook must be used.  You must post two replies to any of your peers sustained with the proper references and make sure the references are properly quoted in your assignment. A minimum of 800 words is required.  Please make sure to follow the instructions as given. need turnitin prove

 
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