Category: Nursing

  • [Solved] NUR 504 Discussion #1

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    Executive Solution Overview

    – ## NUR504DIscussion1.docx **## NUR504DIscussion1.docx** For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. | | | | — | — | | | **Case 1** | | **Chief Complaint**<br>**(CC)** | “I came for my annual physical exam, but d…

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    Assignment Prompt & Instructions

    – ## NUR504DIscussion1.docx

    **## NUR504DIscussion1.docx**

    For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases.

    | | |
    | — | — |
    | | **Case 1** |
    | **Chief Complaint**<br>**(CC)** | “I came for my annual physical exam, but do not want to be a burden to my daughter.” |
    | **History of Present Illness (HPI)** | At-risk 86-year-old Asian male – who is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. |
    | **PMH** | Hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency and chronic prostatitis |
    | **PSH** | S/P cholecystectomy |
    | **Drug Hx** | Current Meds: Lisinopril 10mg daily, Prilosec 20mg daily, B12 injections monthly, and Cipro 100mg daily. |
    | **Allergies** | |
    | **Family Hx** | |
    | **General** | + weight loss of 25 lbs over the past year; no recent fatigue, fever, or chills. |
    | **Head, Eyes, Ears, Nose & Throat (HEENT)** | No changes in vision or hearing, no difficulty chewing or swallowing. |
    | **Neck** | No pain or injury |
    | **Respiratory** | |
    | **CV** | |
    | **GI** | |
    | **GU** | no urinary hesitancy or change in urine stream |
    | **Integument** | multiple bruises on his upper arms and back. |
    | **MS/Neuro** | + falls x 2 within the last 6 months; no syncopal episodes or dizziness |
    | **PE** | B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8 |
    | **General** | |
    | **HEENT** | Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous. |
    | **Lungs** | CTA AP&L |
    | **Card** | S1S2 without rub or gallop |
    | **Abd** | benign, normoactive bowel sounds x 4 |
    | **GU** | |
    | **Ext** | no cyanosis, clubbing or edema |
    | **Integument** | multiple bruises in different stages of healing – on his upper arms and back. |
    | **MS** | |
    | **Neuro** | No obvious deformities, CN grossly intact II-XII |

    **Answer the following questions:**

    1.
    **Discuss the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.**

    2.
    **Utilizing the five assessment domains, which ones would you utilize on your patients in conducting a comprehensive nutritional assessment.**

    3.
    **Discuss the functional anatomy and physiology of a psychiatric mental health patient. Which key concepts must a nurse know in order to assess specific functions?**

    **Submission Instructions:**

    · Your initial post must be at least 500 words, formatted, and cited in current APA style with support from at least two academic sources.

    · Quotes “……” cannot be used at a higher learning level for your assignments, so sentences need to be paraphrased and referenced.

    · Acceptable references include scholarly journal articles or primary legal sources (statutes, court opinions), journal articles, and books published in the last five years-no websites to be referenced without prior approval.

    **## NUR504DIscussion1.docx**

    For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases.

    | | |
    | — | — |
    | | **Case 1** |
    | **Chief Complaint**<br>**(CC)** | “I came for my annual physical exam, but do not want to be a burden to my daughter.” |
    | **History of Present Illness (HPI)** | At-risk 86-year-old Asian male – who is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. |
    | **PMH** | Hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency and chronic prostatitis |
    | **PSH** | S/P cholecystectomy |
    | **Drug Hx** | Current Meds: Lisinopril 10mg daily, Prilosec 20mg daily, B12 injections monthly, and Cipro 100mg daily. |
    | **Allergies** | |
    | **Family Hx** | |
    | **General** | + weight loss of 25 lbs over the past year; no recent fatigue, fever, or chills. |
    | **Head, Eyes, Ears, Nose & Throat (HEENT)** | No changes in vision or hearing, no difficulty chewing or swallowing. |
    | **Neck** | No pain or injury |
    | **Respiratory** | |
    | **CV** | |
    | **GI** | |
    | **GU** | no urinary hesitancy or change in urine stream |
    | **Integument** | multiple bruises on his upper arms and back. |
    | **MS/Neuro** | + falls x 2 within the last 6 months; no syncopal episodes or dizziness |
    | **PE** | B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8 |
    | **General** | |
    | **HEENT** | Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous. |
    | **Lungs** | CTA AP&L |
    | **Card** | S1S2 without rub or gallop |
    | **Abd** | benign, normoactive bowel sounds x 4 |
    | **GU** | |
    | **Ext** | no cyanosis, clubbing or edema |
    | **Integument** | multiple bruises in different stages of healing – on his upper arms and back. |
    | **MS** | |
    | **Neuro** | No obvious deformities, CN grossly intact II-XII |

    **Answer the following questions:**

    1.
    **Discuss the specific socioeconomic, spiritual, lifestyle, and other cultural factors related to the health of the patient you selected.**

    2.
    **Utilizing the five assessment domains, which ones would you utilize on your patients in conducting a comprehensive nutritional assessment.**

    3.
    **Discuss the functional anatomy and physiology of a psychiatric mental health patient. Which key concepts must a nurse know in order to assess specific functions?**

    **Submission Instructions:**

    · Your initial post must be at least 500 words, formatted, and cited in current APA style with support from at least two academic sources.

    · Quotes “……” cannot be used at a higher learning level for your assignments, so sentences need to be paraphrased and referenced.

    · Acceptable references include scholarly journal articles or primary legal sources (statutes, court opinions), journal articles, and books published in the last five years-no websites to be referenced without prior approval.

  • [Solved] Nursing Assignment

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    – ## PsychosocialAssignment.docx – ## Chapter31OlderAdults1.pptx – Chapter33ForensicNursing12.pptx – Chapter32SeriousMentalIllness1.pptx – Chapter30DyingDeathandGrieving1.pptx **## PsychosocialAssignment.docx** Directions: Find something that interests you from each of the four chapters (use PowerPo…

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    Assignment Prompt & Instructions

    – ## PsychosocialAssignment.docx

    – ## Chapter31OlderAdults1.pptx

    – Chapter33ForensicNursing12.pptx
    – Chapter32SeriousMentalIllness1.pptx
    – Chapter30DyingDeathandGrieving1.pptx

    **## PsychosocialAssignment.docx**

    Directions:

    Find something that interests you from each of the four chapters (use PowerPoints or textbook). Post a brief share from each chapter that will add to your classmates' understanding, insight, or future nursing practice. Your post should look approximately like this:

    Chapter 30: Here is an experience I've had with [insert topic here]. Followed by a few supporting sentences that illustrate your experience.

    Chapter 31: I was curious about [insert topic here]. I found this short video on YouTube that talks about [very brief summary]. Insert hyperlink here.

    Chapter 32: This is something in my community that I would (or have) recommended as a resource. They do X, Y, Z. Insert hyperlink here.

    Chapter 33: I researched this [insert job description]. Here's what I found about the required education, job opportunities, and potential wages.

    *The examples above are NOT prescriptive and can be used in any order if you choose these prompts. These are just some formats that I think might be interesting. Please choose whatever catches your interest and write up a little something about it for the sake of discussion. You will write one post (4 points) with a few sentences of information about each of the four chapters.

    **## Chapter31OlderAdults1.pptx**

    Chapter 31

    Older Adults

    1

    Objectives

    3

    Identify statistics related to aging in the United States.

    01

    Describe mental health disorders that may occur in older adults.

    02

    Discuss the importance of pain assessment and tools used to assess pain in older adults.

    03

    Explain the negative impact of ageism that is evident in discriminatory labels, public policy, and research.

    04

    Case Study

    Mr. Nixon is being admitted to a short-term care facility because his wife, who had been his only caretaker, has recently died. His son, who lives about 250 miles away, has been staying with him for the past 4 weeks, but has to go home now to go back to work.

    Mr. Nixon has COPD and has trouble getting around because he gets short of breath. He is still grieving, of course, but his son shares that he feels his dad has been depressed over his health “off and on” as well.
    You will be doing an intake assessment with Mr. Nixon.

    4

    Statistics on Aging

    5

    Life expectancy and number of older adults growing

    Common classifications for older adults:

    Young-old: 65 to 74 years

    Middle-old: 75 to 84 years

    Old-old: 85 to 100 years

    Centenarians: 100 to 104 years

    Mental Health and Aging

    6

    Late-life Mental Illness

    Major Depressive Disorder

    Suicide

    Anxiety disorders

    Delirium—secondary to general medical condition

    Neurocognitive disorders

    Alcohol use disorder

    Pain

    Pain

    [This Photo](https://www.aliem.com/2018/06/trigger-point-injection-musculoskeletal-pain/) by Unknown author is licensed under
    [CC BY-NC-ND](https://creativecommons.org/licenses/by-nc-nd/3.0/).

    Nonpharmacological treatments for pain include physical therapy, vagal nerve stimulation, exercise, hydrotherapy, heat and cold packs, chiropractic, and transcutaneous electrical nerve stimulation (TENS).

    Yoga, biofeedback, hypnosis, acupuncture, massage, Reiki, guided imagery, reflexology, and therapeutic touch are integrative therapies for managing pain.

    Herbal remedies include cayenne, capsaicin, ginger extract, echinacea, kava, and willow bark.

    7

    Barriers to accurate pain assessment

    Assessment tools

    Wong-Baker FACES Pain Rating Scale

    Pain Assessment in Advanced Dementia (PAINAD) scale

    Pain management

    Pharmacotherapy

    Non-opioids

    Opioids

    Nonpharmacological pain treatments

    Healthcare Concerns
    of Older Adults

    Financial burden

    Medicare Part D for help with medications

    Caregiver burden

    Ageism

    Language

    Public policy

    Research

    [This Photo](http://jobsanger.blogspot.com/2011/06/right-wing-attacks-medicare-in-tv-ads.html) by Unknown author is licensed under
    [CC BY-NC-ND](https://creativecommons.org/licenses/by-nc-nd/3.0/).

    8

    Discussion Topic

    Ageism sometimes affects the care of older adult patients. The best way to help prevent this is to do a self-assessment and discuss your feelings and attitudes with others:

    What kinds of feelings, assumptions, or hesitations do you have when you think about working with an older adult?

    9

    Healthcare Decision-Making

    Advance Directives and Portable Medical Orders

    Advance Directives and Portable Medical Orders

    Guardianship

    Court-ordered relationship in which the selected guardian acts on behalf of another individual (the ward)

    The ward must be proven to lack capacity to manage personal and/or financial affairs

    [This Photo](https://betterhealthwhileaging.net/end-of-life-planning-easy-advance-directives-through-prepare/) by Unknown author is licensed under
    [CC BY-NC-ND](https://creativecommons.org/licenses/by-nc-nd/3.0/).

    10

    Objectives

    11

    Explain the importance of a comprehensive assessment in older adults.

    1

    Recognize the significance of healthcare costs for older adults.

    2

    Compare the facts and myths about aging.

    3

    Analyze how ageism may affect attitudes and willingness to care for older adults.

    4

    Apply the nursing process to the care of older adults.

    5

    Objectives

    12

    Identify at least four priority nursing diagnoses in the care of older adults.

    1

    Discuss basic nursing interventions in the care of older adults.

    2

    Identify psychological therapies used in the treatment of older adults.

    3

    Identify treatment settings for the care of older adults.

    4

    Application of the Nursing Process

    Assessment

    Private interview space

    Adequate lighting & low-level noise

    Establish rapport & convey warmth

    Physical Assessment

    Medication reconciliation

    Polypharmacy & prescribing cascades

    Mental Status exam

    Older adult drivers

    Older adult abuse

    [This Photo](https://wtcs.pressbooks.pub/nursingfundamentals/chapter/4-3-assessment/) by Unknown author is licensed under
    [CC BY](https://creativecommons.org/licenses/by/3.0/).

    Assessing the use of multiple medications for the same condition (polypharmacy) includes prescription, over-the-counter drugs, and herbal agents. Adverse drug reactions or negative responses to drugs are common among the older adult.

    Prescribing cascades happen when drug-induced symptoms are treated with another drug. The provider may assess the side effect of the first drug as part of the original medical problem or a new one.

    13

    Case Study
    Discussion Question

    You are preparing to interview Mr. Nixon. What are some techniques the nurse could use to help the patient feel more comfortable?

    Conducting the interview in a private area

    Introducing oneself and asking the patient what he or she would like to be called (use of the first name is rarely appropriate unless one is invited to do so)

    Establishing rapport and putting the patient at ease by sitting or standing at the same level as the patient

    Ensuring that lighting is adequate and noise level is low, in recognition of the fact that hearing and vision may be impaired

    Using touch (with permission) to convey warmth, while at the same time respecting the patient's comfort level with personal touch

    Summarizing the interaction, inviting feedback and questions, and thanking the patient for giving his or her time and information

    14

    Quick Quiz

    Mr. Nixon, who has difficulty walking because of shortness of breath secondary to COPD says, “Every day is a struggle when you get old. No one cares about old people.” Select the best response.

    “Rest periods are important. Don’t try to overexert yourself.”

    “It sounds like you’re having a difficult time. Tell me about it.”

    “Let’s not focus on the negative. Tell me something good.”

    “You are still able to get around, and your mind is alert.”

    ANS: B

    15

    Nursing Diagnosis

    The International Classification for Nursing Practice (ICNP) (International Council of Nurses)

    Provides useful nursing diagnoses for older adults

    Acute/chronic pain, impaired low nutrition intake, impaired fluid intake, constipation, and impaired sleep

    Safety needs

    Higher level needs

    Caregiver stress/impaired family process

    Outcomes Identification

    Shared decision making; realistic goals

    [This Photo](http://researchoutreach.org/articles/patient-compliance-modern-medicine/) by Unknown author is licensed under
    [CC BY](https://creativecommons.org/licenses/by/3.0/).

    Some essential safety diagnoses include risk for injury, risk for falls, impaired ability to manage medication regime, victim of older adult abuse, and confusion.

    Higher level needs fall under Maslow’s categories of love and belonging needs, and esteem. Specific (ICNP) nursing diagnoses address those higher-level needs such as loneliness, hopelessness, impaired role performance, chronic low self-esteem, and disturbed personal identity.

    16

    Implementation

    Psychotherapeutic Methods

    Empathetic, active listening to encourage ventilation of feelings & reestablish emotional equilibrium

    Provide health education & alternatives

    Assist in problem solving

    Group counseling to help build relationships and reduce isolation

    Pharmacotherapy skills & psychotherapy

    Treatment Modalities

    Psychological Therapies

    [This Photo](http://hackingchristianity.net/2018/08/who-will-have-power-of-attorney-to-care-for-an-ailing-umc.html) by Unknown author is licensed under
    [CC BY-SA](https://creativecommons.org/licenses/by-sa/3.0/).

    Reminiscence is a cognitive stimulation activity that engages individuals in socialization and rapport building. Assisting to evoke pleasant feelings or memories is an effective method to improve mood, particularly in those with memory impairment.

    17

    Case Study

    Mr. Nixon’s son drives back down the next weekend so they can meet to talk about his options for a more permanent living situation. As part of this process, the son has made an appointment for the two of them to meet with the nurse, who can help them explore their options.

    His son asks, “So what kinds of choices does Dad have at this point?”

    18

    Treatment Settings for Older Adults

    [This Photo](https://blog.ssmgrp.com/blog/what-is-caregiver-role-strain-like-and-how-do-you-defeat-it) by Unknown author is licensed under
    [CC BY-SA](https://creativecommons.org/licenses/by-sa/3.0/).

    19

    Hospital-Based Care

    Partial hospitalization versus Inpatient

    Home-Based Services

    Day care programs

    Home healthcare

    Community support services

    Respite care

    Residential Care

    Assisted living

    Skilled nursing facilities

    Case Study

    Mr. Nixon’s son heads for home again and says, “I’ll be back again next weekend, Dad. Keep thinking about what sounds good to you. You can call me any time.”
    Mr. Nixon feels a little better about his future, but says, “It’s just a lot to think about. The nurse suggests that Mr. Nixon might benefit from group sessions with others who are trying to make similar plans. This may not only aid in decision making but help him to feel less alone in this big next step.

    20

    Quick Quiz

    A community mental health nurse plans an educational program for the staff of a home health agency specializing in care of the elderly. A topic of high priority should be

    identifying clinical depression in older adults.

    identifying nutritional deficiencies in the elderly.

    providing cost-effective foot care for the elderly.

    psychosocial stimulation for those who live alone.

    ANS: A

    21

    Case Study &
    Quick Quiz

    Mr. Nixon needs help with his prescription ordering. Which component of Medicare assists seniors to pay for prescription drugs?

    Part A

    Part B

    Part C

    Part D

    ANS: D

    22

    Quick Quiz

    A family member of a patient with advanced dementia says to the nurse, “I will sign the consent for my mother’s surgery.” What is the nurse’s best response?

    “This should be a family decision. When will your siblings arrive?”

    “Can you please show me the Court order designating you as guardian?”

    “Thank you. Please use a black ballpoint pen to sign.”

    “The patient is able to sign her own consent.”

    ANS: B

    A guardianship is a court-ordered relationship in which one party, the guardian, acts on behalf of an individual, the ward. Many people with mental illness, mental retardation, traumatic brain injuries, and organic brain disorders, such as dementia, have guardians. It is important that health care workers identify patients who have guardians and communicate with the guardians when health care decisions are being made.

    23

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    **Chapter33ForensicNursing12.pptx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/chapter33forensicnursing12-pptx)

    **Chapter32SeriousMentalIllness1.pptx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/chapter32seriousmentalillness1-pptx-10337669)

    **Chapter30DyingDeathandGrieving1.pptx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/chapter30dyingdeathandgrieving1-pptx-10337673)

    **Chapter30DyingDeathandGrieving1.pptx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/chapter30dyingdeathandgrieving1-pptx-10337673)

    **## PsychosocialAssignment.docx**

    Directions:

    Find something that interests you from each of the four chapters (use PowerPoints or textbook). Post a brief share from each chapter that will add to your classmates' understanding, insight, or future nursing practice. Your post should look approximately like this:

    Chapter 30: Here is an experience I've had with [insert topic here]. Followed by a few supporting sentences that illustrate your experience.

    Chapter 31: I was curious about [insert topic here]. I found this short video on YouTube that talks about [very brief summary]. Insert hyperlink here.

    Chapter 32: This is something in my community that I would (or have) recommended as a resource. They do X, Y, Z. Insert hyperlink here.

    Chapter 33: I researched this [insert job description]. Here's what I found about the required education, job opportunities, and potential wages.

    *The examples above are NOT prescriptive and can be used in any order if you choose these prompts. These are just some formats that I think might be interesting. Please choose whatever catches your interest and write up a little something about it for the sake of discussion. You will write one post (4 points) with a few sentences of information about each of the four chapters.

    **## Chapter31OlderAdults1.pptx**

    Chapter 31

    Older Adults

    1

    Objectives

    3

    Identify statistics related to aging in the United States.

    01

    Describe mental health disorders that may occur in older adults.

    02

    Discuss the importance of pain assessment and tools used to assess pain in older adults.

    03

    Explain the negative impact of ageism that is evident in discriminatory labels, public policy, and research.

    04

    Case Study

    Mr. Nixon is being admitted to a short-term care facility because his wife, who had been his only caretaker, has recently died. His son, who lives about 250 miles away, has been staying with him for the past 4 weeks, but has to go home now to go back to work.

    Mr. Nixon has COPD and has trouble getting around because he gets short of breath. He is still grieving, of course, but his son shares that he feels his dad has been depressed over his health “off and on” as well.
    You will be doing an intake assessment with Mr. Nixon.

    4

    Statistics on Aging

    5

    Life expectancy and number of older adults growing

    Common classifications for older adults:

    Young-old: 65 to 74 years

    Middle-old: 75 to 84 years

    Old-old: 85 to 100 years

    Centenarians: 100 to 104 years

    Mental Health and Aging

    6

    Late-life Mental Illness

    Major Depressive Disorder

    Suicide

    Anxiety disorders

    Delirium—secondary to general medical condition

    Neurocognitive disorders

    Alcohol use disorder

    Pain

    Pain

    [This Photo](https://www.aliem.com/2018/06/trigger-point-injection-musculoskeletal-pain/) by Unknown author is licensed under
    [CC BY-NC-ND](https://creativecommons.org/licenses/by-nc-nd/3.0/).

    Nonpharmacological treatments for pain include physical therapy, vagal nerve stimulation, exercise, hydrotherapy, heat and cold packs, chiropractic, and transcutaneous electrical nerve stimulation (TENS).

    Yoga, biofeedback, hypnosis, acupuncture, massage, Reiki, guided imagery, reflexology, and therapeutic touch are integrative therapies for managing pain.

    Herbal remedies include cayenne, capsaicin, ginger extract, echinacea, kava, and willow bark.

    7

    Barriers to accurate pain assessment

    Assessment tools

    Wong-Baker FACES Pain Rating Scale

    Pain Assessment in Advanced Dementia (PAINAD) scale

    Pain management

    Pharmacotherapy

    Non-opioids

    Opioids

    Nonpharmacological pain treatments

    Healthcare Concerns
    of Older Adults

    Financial burden

    Medicare Part D for help with medications

    Caregiver burden

    Ageism

    Language

    Public policy

    Research

    [This Photo](http://jobsanger.blogspot.com/2011/06/right-wing-attacks-medicare-in-tv-ads.html) by Unknown author is licensed under
    [CC BY-NC-ND](https://creativecommons.org/licenses/by-nc-nd/3.0/).

    8

    Discussion Topic

    Ageism sometimes affects the care of older adult patients. The best way to help prevent this is to do a self-assessment and discuss your feelings and attitudes with others:

    What kinds of feelings, assumptions, or hesitations do you have when you think about working with an older adult?

    9

    Healthcare Decision-Making

    Advance Directives and Portable Medical Orders

    Advance Directives and Portable Medical Orders

    Guardianship

    Court-ordered relationship in which the selected guardian acts on behalf of another individual (the ward)

    The ward must be proven to lack capacity to manage personal and/or financial affairs

    [This Photo](https://betterhealthwhileaging.net/end-of-life-planning-easy-advance-directives-through-prepare/) by Unknown author is licensed under
    [CC BY-NC-ND](https://creativecommons.org/licenses/by-nc-nd/3.0/).

    10

    Objectives

    11

    Explain the importance of a comprehensive assessment in older adults.

    1

    Recognize the significance of healthcare costs for older adults.

    2

    Compare the facts and myths about aging.

    3

    Analyze how ageism may affect attitudes and willingness to care for older adults.

    4

    Apply the nursing process to the care of older adults.

    5

    Objectives

    12

    Identify at least four priority nursing diagnoses in the care of older adults.

    1

    Discuss basic nursing interventions in the care of older adults.

    2

    Identify psychological therapies used in the treatment of older adults.

    3

    Identify treatment settings for the care of older adults.

    4

    Application of the Nursing Process

    Assessment

    Private interview space

    Adequate lighting & low-level noise

    Establish rapport & convey warmth

    Physical Assessment

    Medication reconciliation

    Polypharmacy & prescribing cascades

    Mental Status exam

    Older adult drivers

    Older adult abuse

    [This Photo](https://wtcs.pressbooks.pub/nursingfundamentals/chapter/4-3-assessment/) by Unknown author is licensed under
    [CC BY](https://creativecommons.org/licenses/by/3.0/).

    Assessing the use of multiple medications for the same condition (polypharmacy) includes prescription, over-the-counter drugs, and herbal agents. Adverse drug reactions or negative responses to drugs are common among the older adult.

    Prescribing cascades happen when drug-induced symptoms are treated with another drug. The provider may assess the side effect of the first drug as part of the original medical problem or a new one.

    13

    Case Study
    Discussion Question

    You are preparing to interview Mr. Nixon. What are some techniques the nurse could use to help the patient feel more comfortable?

    Conducting the interview in a private area

    Introducing oneself and asking the patient what he or she would like to be called (use of the first name is rarely appropriate unless one is invited to do so)

    Establishing rapport and putting the patient at ease by sitting or standing at the same level as the patient

    Ensuring that lighting is adequate and noise level is low, in recognition of the fact that hearing and vision may be impaired

    Using touch (with permission) to convey warmth, while at the same time respecting the patient's comfort level with personal touch

    Summarizing the interaction, inviting feedback and questions, and thanking the patient for giving his or her time and information

    14

    Quick Quiz

    Mr. Nixon, who has difficulty walking because of shortness of breath secondary to COPD says, “Every day is a struggle when you get old. No one cares about old people.” Select the best response.

    “Rest periods are important. Don’t try to overexert yourself.”

    “It sounds like you’re having a difficult time. Tell me about it.”

    “Let’s not focus on the negative. Tell me something good.”

    “You are still able to get around, and your mind is alert.”

    ANS: B

    15

    Nursing Diagnosis

    The International Classification for Nursing Practice (ICNP) (International Council of Nurses)

    Provides useful nursing diagnoses for older adults

    Acute/chronic pain, impaired low nutrition intake, impaired fluid intake, constipation, and impaired sleep

    Safety needs

    Higher level needs

    Caregiver stress/impaired family process

    Outcomes Identification

    Shared decision making; realistic goals

    [This Photo](http://researchoutreach.org/articles/patient-compliance-modern-medicine/) by Unknown author is licensed under
    [CC BY](https://creativecommons.org/licenses/by/3.0/).

    Some essential safety diagnoses include risk for injury, risk for falls, impaired ability to manage medication regime, victim of older adult abuse, and confusion.

    Higher level needs fall under Maslow’s categories of love and belonging needs, and esteem. Specific (ICNP) nursing diagnoses address those higher-level needs such as loneliness, hopelessness, impaired role performance, chronic low self-esteem, and disturbed personal identity.

    16

    Implementation

    Psychotherapeutic Methods

    Empathetic, active listening to encourage ventilation of feelings & reestablish emotional equilibrium

    Provide health education & alternatives

    Assist in problem solving

    Group counseling to help build relationships and reduce isolation

    Pharmacotherapy skills & psychotherapy

    Treatment Modalities

    Psychological Therapies

    [This Photo](http://hackingchristianity.net/2018/08/who-will-have-power-of-attorney-to-care-for-an-ailing-umc.html) by Unknown author is licensed under
    [CC BY-SA](https://creativecommons.org/licenses/by-sa/3.0/).

    Reminiscence is a cognitive stimulation activity that engages individuals in socialization and rapport building. Assisting to evoke pleasant feelings or memories is an effective method to improve mood, particularly in those with memory impairment.

    17

    Case Study

    Mr. Nixon’s son drives back down the next weekend so they can meet to talk about his options for a more permanent living situation. As part of this process, the son has made an appointment for the two of them to meet with the nurse, who can help them explore their options.

    His son asks, “So what kinds of choices does Dad have at this point?”

    18

    Treatment Settings for Older Adults

    [This Photo](https://blog.ssmgrp.com/blog/what-is-caregiver-role-strain-like-and-how-do-you-defeat-it) by Unknown author is licensed under
    [CC BY-SA](https://creativecommons.org/licenses/by-sa/3.0/).

    19

    Hospital-Based Care

    Partial hospitalization versus Inpatient

    Home-Based Services

    Day care programs

    Home healthcare

    Community support services

    Respite care

    Residential Care

    Assisted living

    Skilled nursing facilities

    Case Study

    Mr. Nixon’s son heads for home again and says, “I’ll be back again next weekend, Dad. Keep thinking about what sounds good to you. You can call me any time.”
    Mr. Nixon feels a little better about his future, but says, “It’s just a lot to think about. The nurse suggests that Mr. Nixon might benefit from group sessions with others who are trying to make similar plans. This may not only aid in decision making but help him to feel less alone in this big next step.

    20

    Quick Quiz

    A community mental health nurse plans an educational program for the staff of a home health agency specializing in care of the elderly. A topic of high priority should be

    identifying clinical depression in older adults.

    identifying nutritional deficiencies in the elderly.

    providing cost-effective foot care for the elderly.

    psychosocial stimulation for those who live alone.

    ANS: A

    21

    Case Study &
    Quick Quiz

    Mr. Nixon needs help with his prescription ordering. Which component of Medicare assists seniors to pay for prescription drugs?

    Part A

    Part B

    Part C

    Part D

    ANS: D

    22

    Quick Quiz

    A family member of a patient with advanced dementia says to the nurse, “I will sign the consent for my mother’s surgery.” What is the nurse’s best response?

    “This should be a family decision. When will your siblings arrive?”

    “Can you please show me the Court order designating you as guardian?”

    “Thank you. Please use a black ballpoint pen to sign.”

    “The patient is able to sign her own consent.”

    ANS: B

    A guardianship is a court-ordered relationship in which one party, the guardian, acts on behalf of an individual, the ward. Many people with mental illness, mental retardation, traumatic brain injuries, and organic brain disorders, such as dementia, have guardians. It is important that health care workers identify patients who have guardians and communicate with the guardians when health care decisions are being made.

    23

    ## image2.jpg

    ## image3.png

    ## image4.jpeg

    ## image5.jpeg

    ## image6.jpeg

    ## image7.jpeg

    ## image8.jpeg

    ## image9.jpeg

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    ## image1.jpg

    **Chapter33ForensicNursing12.pptx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/chapter33forensicnursing12-pptx)

    **Chapter32SeriousMentalIllness1.pptx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/chapter32seriousmentalillness1-pptx-10337669)

    **Chapter30DyingDeathandGrieving1.pptx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/chapter30dyingdeathandgrieving1-pptx-10337673)

    **## PsychosocialAssignment.docx**

    Directions:

    Find something that interests you from each of the four chapters (use PowerPoints or textbook). Post a brief share from each chapter that will add to your classmates' understanding, insight, or future nursing practice. Your post should look approximately like this:

    Chapter 30: Here is an experience I've had with [insert topic here]. Followed by a few supporting sentences that illustrate your experience.

    Chapter 31: I was curious about [insert topic here]. I found this short video on YouTube that talks about [very brief summary]. Insert hyperlink here.

    Chapter 32: This is something in my community that I would (or have) recommended as a resource. They do X, Y, Z. Insert hyperlink here.

    Chapter 33: I researched this [insert job description]. Here's what I found about the required education, job opportunities, and potential wages.

    *The examples above are NOT prescriptive and can be used in any order if you choose these prompts. These are just some formats that I think might be interesting. Please choose whatever catches your interest and write up a little something about it for the sake of discussion. You will write one post (4 points) with a few sentences of information about each of the four chapters.

    **## Chapter31OlderAdults1.pptx**

    Chapter 31

    Older Adults

    1

    Objectives

    3

    Identify statistics related to aging in the United States.

    01

    Describe mental health disorders that may occur in older adults.

    02

    Discuss the importance of pain assessment and tools used to assess pain in older adults.

    03

    Explain the negative impact of ageism that is evident in discriminatory labels, public policy, and research.

    04

    Case Study

    Mr. Nixon is being admitted to a short-term care facility because his wife, who had been his only caretaker, has recently died. His son, who lives about 250 miles away, has been staying with him for the past 4 weeks, but has to go home now to go back to work.

    Mr. Nixon has COPD and has trouble getting around because he gets short of breath. He is still grieving, of course, but his son shares that he feels his dad has been depressed over his health “off and on” as well.
    You will be doing an intake assessment with Mr. Nixon.

    4

    Statistics on Aging

    5

    Life expectancy and number of older adults growing

    Common classifications for older adults:

    Young-old: 65 to 74 years

    Middle-old: 75 to 84 years

    Old-old: 85 to 100 years

    Centenarians: 100 to 104 years

    Mental Health and Aging

    6

    Late-life Mental Illness

    Major Depressive Disorder

    Suicide

    Anxiety disorders

    Delirium—secondary to general medical condition

    Neurocognitive disorders

    Alcohol use disorder

    Pain

    Pain

    [This Photo](https://www.aliem.com/2018/06/trigger-point-injection-musculoskeletal-pain/) by Unknown author is licensed under
    [CC BY-NC-ND](https://creativecommons.org/licenses/by-nc-nd/3.0/).

    Nonpharmacological treatments for pain include physical therapy, vagal nerve stimulation, exercise, hydrotherapy, heat and cold packs, chiropractic, and transcutaneous electrical nerve stimulation (TENS).

    Yoga, biofeedback, hypnosis, acupuncture, massage, Reiki, guided imagery, reflexology, and therapeutic touch are integrative therapies for managing pain.

    Herbal remedies include cayenne, capsaicin, ginger extract, echinacea, kava, and willow bark.

    7

    Barriers to accurate pain assessment

    Assessment tools

    Wong-Baker FACES Pain Rating Scale

    Pain Assessment in Advanced Dementia (PAINAD) scale

    Pain management

    Pharmacotherapy

    Non-opioids

    Opioids

    Nonpharmacological pain treatments

    Healthcare Concerns
    of Older Adults

    Financial burden

    Medicare Part D for help with medications

    Caregiver burden

    Ageism

    Language

    Public policy

    Research

    [This Photo](http://jobsanger.blogspot.com/2011/06/right-wing-attacks-medicare-in-tv-ads.html) by Unknown author is licensed under
    [CC BY-NC-ND](https://creativecommons.org/licenses/by-nc-nd/3.0/).

    8

    Discussion Topic

    Ageism sometimes affects the care of older adult patients. The best way to help prevent this is to do a self-assessment and discuss your feelings and attitudes with others:

    What kinds of feelings, assumptions, or hesitations do you have when you think about working with an older adult?

    9

    Healthcare Decision-Making

    Advance Directives and Portable Medical Orders

    Advance Directives and Portable Medical Orders

    Guardianship

    Court-ordered relationship in which the selected guardian acts on behalf of another individual (the ward)

    The ward must be proven to lack capacity to manage personal and/or financial affairs

    [This Photo](https://betterhealthwhileaging.net/end-of-life-planning-easy-advance-directives-through-prepare/) by Unknown author is licensed under
    [CC BY-NC-ND](https://creativecommons.org/licenses/by-nc-nd/3.0/).

    10

    Objectives

    11

    Explain the importance of a comprehensive assessment in older adults.

    1

    Recognize the significance of healthcare costs for older adults.

    2

    Compare the facts and myths about aging.

    3

    Analyze how ageism may affect attitudes and willingness to care for older adults.

    4

    Apply the nursing process to the care of older adults.

    5

    Objectives

    12

    Identify at least four priority nursing diagnoses in the care of older adults.

    1

    Discuss basic nursing interventions in the care of older adults.

    2

    Identify psychological therapies used in the treatment of older adults.

    3

    Identify treatment settings for the care of older adults.

    4

    Application of the Nursing Process

    Assessment

    Private interview space

    Adequate lighting & low-level noise

    Establish rapport & convey warmth

    Physical Assessment

    Medication reconciliation

    Polypharmacy & prescribing cascades

    Mental Status exam

    Older adult drivers

    Older adult abuse

    [This Photo](https://wtcs.pressbooks.pub/nursingfundamentals/chapter/4-3-assessment/) by Unknown author is licensed under
    [CC BY](https://creativecommons.org/licenses/by/3.0/).

    Assessing the use of multiple medications for the same condition (polypharmacy) includes prescription, over-the-counter drugs, and herbal agents. Adverse drug reactions or negative responses to drugs are common among the older adult.

    Prescribing cascades happen when drug-induced symptoms are treated with another drug. The provider may assess the side effect of the first drug as part of the original medical problem or a new one.

    13

    Case Study
    Discussion Question

    You are preparing to interview Mr. Nixon. What are some techniques the nurse could use to help the patient feel more comfortable?

    Conducting the interview in a private area

    Introducing oneself and asking the patient what he or she would like to be called (use of the first name is rarely appropriate unless one is invited to do so)

    Establishing rapport and putting the patient at ease by sitting or standing at the same level as the patient

    Ensuring that lighting is adequate and noise level is low, in recognition of the fact that hearing and vision may be impaired

    Using touch (with permission) to convey warmth, while at the same time respecting the patient's comfort level with personal touch

    Summarizing the interaction, inviting feedback and questions, and thanking the patient for giving his or her time and information

    14

    Quick Quiz

    Mr. Nixon, who has difficulty walking because of shortness of breath secondary to COPD says, “Every day is a struggle when you get old. No one cares about old people.” Select the best response.

    “Rest periods are important. Don’t try to overexert yourself.”

    “It sounds like you’re having a difficult time. Tell me about it.”

    “Let’s not focus on the negative. Tell me something good.”

    “You are still able to get around, and your mind is alert.”

    ANS: B

    15

    Nursing Diagnosis

    The International Classification for Nursing Practice (ICNP) (International Council of Nurses)

    Provides useful nursing diagnoses for older adults

    Acute/chronic pain, impaired low nutrition intake, impaired fluid intake, constipation, and impaired sleep

    Safety needs

    Higher level needs

    Caregiver stress/impaired family process

    Outcomes Identification

    Shared decision making; realistic goals

    [This Photo](http://researchoutreach.org/articles/patient-compliance-modern-medicine/) by Unknown author is licensed under
    [CC BY](https://creativecommons.org/licenses/by/3.0/).

    Some essential safety diagnoses include risk for injury, risk for falls, impaired ability to manage medication regime, victim of older adult abuse, and confusion.

    Higher level needs fall under Maslow’s categories of love and belonging needs, and esteem. Specific (ICNP) nursing diagnoses address those higher-level needs such as loneliness, hopelessness, impaired role performance, chronic low self-esteem, and disturbed personal identity.

    16

    Implementation

    Psychotherapeutic Methods

    Empathetic, active listening to encourage ventilation of feelings & reestablish emotional equilibrium

    Provide health education & alternatives

    Assist in problem solving

    Group counseling to help build relationships and reduce isolation

    Pharmacotherapy skills & psychotherapy

    Treatment Modalities

    Psychological Therapies

    [This Photo](http://hackingchristianity.net/2018/08/who-will-have-power-of-attorney-to-care-for-an-ailing-umc.html) by Unknown author is licensed under
    [CC BY-SA](https://creativecommons.org/licenses/by-sa/3.0/).

    Reminiscence is a cognitive stimulation activity that engages individuals in socialization and rapport building. Assisting to evoke pleasant feelings or memories is an effective method to improve mood, particularly in those with memory impairment.

    17

    Case Study

    Mr. Nixon’s son drives back down the next weekend so they can meet to talk about his options for a more permanent living situation. As part of this process, the son has made an appointment for the two of them to meet with the nurse, who can help them explore their options.

    His son asks, “So what kinds of choices does Dad have at this point?”

    18

    Treatment Settings for Older Adults

    [This Photo](https://blog.ssmgrp.com/blog/what-is-caregiver-role-strain-like-and-how-do-you-defeat-it) by Unknown author is licensed under
    [CC BY-SA](https://creativecommons.org/licenses/by-sa/3.0/).

    19

    Hospital-Based Care

    Partial hospitalization versus Inpatient

    Home-Based Services

    Day care programs

    Home healthcare

    Community support services

    Respite care

    Residential Care

    Assisted living

    Skilled nursing facilities

    Case Study

    Mr. Nixon’s son heads for home again and says, “I’ll be back again next weekend, Dad. Keep thinking about what sounds good to you. You can call me any time.”
    Mr. Nixon feels a little better about his future, but says, “It’s just a lot to think about. The nurse suggests that Mr. Nixon might benefit from group sessions with others who are trying to make similar plans. This may not only aid in decision making but help him to feel less alone in this big next step.

    20

    Quick Quiz

    A community mental health nurse plans an educational program for the staff of a home health agency specializing in care of the elderly. A topic of high priority should be

    identifying clinical depression in older adults.

    identifying nutritional deficiencies in the elderly.

    providing cost-effective foot care for the elderly.

    psychosocial stimulation for those who live alone.

    ANS: A

    21

    Case Study &
    Quick Quiz

    Mr. Nixon needs help with his prescription ordering. Which component of Medicare assists seniors to pay for prescription drugs?

    Part A

    Part B

    Part C

    Part D

    ANS: D

    22

    Quick Quiz

    A family member of a patient with advanced dementia says to the nurse, “I will sign the consent for my mother’s surgery.” What is the nurse’s best response?

    “This should be a family decision. When will your siblings arrive?”

    “Can you please show me the Court order designating you as guardian?”

    “Thank you. Please use a black ballpoint pen to sign.”

    “The patient is able to sign her own consent.”

    ANS: B

    A guardianship is a court-ordered relationship in which one party, the guardian, acts on behalf of an individual, the ward. Many people with mental illness, mental retardation, traumatic brain injuries, and organic brain disorders, such as dementia, have guardians. It is important that health care workers identify patients who have guardians and communicate with the guardians when health care decisions are being made.

    23

    ## image2.jpg

    ## image3.png

    ## image4.jpeg

    ## image5.jpeg

    ## image6.jpeg

    ## image7.jpeg

    ## image8.jpeg

    ## image9.jpeg

    ## image10.jpeg

    ## image1.jpg

    **Chapter33ForensicNursing12.pptx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/chapter33forensicnursing12-pptx)

    **Chapter32SeriousMentalIllness1.pptx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/chapter32seriousmentalillness1-pptx-10337669)

    **Chapter30DyingDeathandGrieving1.pptx**

    This file is too large to display. [View in new window](https://www.sweetstudy.com/files/chapter30dyingdeathandgrieving1-pptx-10337673)

    – 1
    – 2
    – 3
    – 4
    – 5

  • [Solved] Create a discussion following the isntructions mbellow. NO AI use, no plagiarism. Scholarly references nio oldr than 5 years old

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    Discuss types of information that descriptive statistics can provide to the DNP student when he/she is examining literature; provide examples of descriptive statistics that are presented in the literature and those that you can collect when conducting your Capstone project. Please include at least 5…

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    Assignment Prompt & Instructions

    Discuss types of information that descriptive statistics can provide to the DNP student when he/she is examining literature; provide examples of descriptive statistics that are presented in the literature and those that you can collect when conducting your Capstone project.
    Please include at least 500 words in your initial thread.
    **Participation Requirements**
    The student must answer the graded discussion with a substantive reply to the graded discussion question(s)/topic(s) posted by the course instructor by Wednesday, 11:59 p.m. Eastern Time of each week. Two scholarly sources references are required unless stated otherwise by your professor.
    Remember that a new discussion rubric was approved by the professors, committee members, and a majority of the students. Please review the rubric before posting to ensure a maximum of points.
    Here are the categories of the new discussion rubric:
    **Initial Post** relevance to the topic of discussion, applicability, and insight. (20%)
    **Quality of Written Communication** Appropriateness of audience and words choice is specific, purposeful, dynamic, and varied. Grammar, spelling, punctuation. (20%)
    **Inclusion of DNP essentials explored in the discussion as well as the role-specific competencies as applicable.**(10%)
    **Rigor, currency,  and relevance of the scholarly references.** (Use articles that are below 5 years). (20%)
    **Peer & Professor Responses.** The number of responses, quality of response posts. (20%)
    **Timeliness of the initial post and the answers to the peers. (10%)**

  • [Solved] CJP OB 2

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    Please complete with a mixture of the information given and online resources: Patient Name: Maria R. Age: 23 Gravida/Para (G/P): G1P1 (primigravida) Hospitalized for: Spontaneous vaginal delivery at 39 weeks History/Conditions: Anemia in pregnancy (Hgb 9.5 g/dL on admission) Prolonged second stage o…

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    Assignment Prompt & Instructions

    Please complete with a mixture of the information given and online resources:
    Patient Name: Maria R.
    Age: 23
    Gravida/Para (G/P): G1P1 (primigravida)
    Hospitalized for: Spontaneous vaginal delivery at 39 weeks
    History/Conditions:
    Anemia in pregnancy (Hgb 9.5 g/dL on admission)
    Prolonged second stage of labor (3.5 hours)
    Mild gestational hypertension diagnosed at 36 weeks (BP averaging 140/90)
    No significant past medical history
    Delivery Details:
    Delivered a healthy baby boy, 7 lb 9 oz, at 8:20 AM.
    Third stage of labor lasted 20 minutes.
    Moderate vaginal tear requiring suturing.
    Blood loss estimated at 800 mL (higher than normal).
    Postpartum Nursing Unit Findings:
    Fundus boggy, deviated to the right.
    Heavy vaginal bleeding with large clots noted on pad checks.
    Patient reports feeling dizzy, weak, and lightheaded upon sitting up.
    Vital signs:
    BP 90/58 mmHg
    HR 118 bpm
    Temp 99.2°F
    Lochia: Heavy, bright red
    Hgb post-delivery: 7.8 g/dL (down from 9.5 g/dL)
    Interventions:
    Fundal massage performed — uterus responded but remained soft after brief improvement.
    Straight catheterization performed — drained 450 mL urine (bladder distention contributing to atony).
    Administered IV oxytocin per protocol.
    Blood type and cross-match sent.
    1 unit packed RBCs ordered.
    Emotional support provided; patient tearful and anxious, reporting fear about her bleeding.
    Additional Anticipated/Postpartum Unit Findings:
    Fatigue and pallor (due to anemia and blood loss)
    Difficulty initiating breastfeeding due to exhaustion
    Anxiety about newborn care and physical recovery
    Close monitoring for postpartum depression risk factors
    Possible delayed ambulation related to dizziness and weakness
    Hematoma assessment at the perineal repair site
    \
    NURS316L-AClinicalJudgementPlan.docx](https://www.sweetstudy.com/files/nurs316l-aclinicaljudgementplan-docx-10337705 "NURS316L-AClinicalJudgementPlan.docx")

  • [Solved] Create a disucssion of at least 500 words using the following guidelines, scholarly references no oldr than 5 years, no AI use and NO plagiarism

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    Find one qualitative and one quantitative research article. Compare the difference and similarities between both articles (in terms of research methods). ### **Participation Requirements** The student must answer the graded discussion with a substantive reply to the graded discussion question(s)/top…

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    Assignment Prompt & Instructions

    Find one qualitative and one quantitative research article.  Compare the difference and similarities between both articles (in terms of research methods).
    ### **Participation Requirements**
    The student must answer the graded discussion with a substantive reply to the graded discussion question(s)/topic(s) posted by the course instructor by wednesday 11:59 p.m. Eastern Time. Two scholarly sources references are required unless stated otherwise by your professor.
    Please review the rubric before posting to ensure a maximum of points.
    Here are the categories of the new discussion rubric:
    **Initial Post** relevance to the topic of discussion, applicability, and insight. (20%)
    **Quality of Written Communication** Appropriateness of audience and words choice is specific, purposeful, dynamic, and varied. Grammar, spelling, punctuation. (20%)
    **Inclusion of DNP essentials explored in the discussion as well as the role-specific competencies as applicable.**(10%)
    **Rigor, currency,  and relevance of the scholarly references.** (Use articles that are below 5 years). (20%)
    **Peer & Professor Responses.** The number of responses, quality of response posts. (20%)
    **Timeliness of the initial post and the answers to the peers. (10%)**
    \
    DNPEssentials.pdf](https://www.sweetstudy.com/files/dnpessentials-pdf-10337711 "DNPEssentials.pdf")

  • [Solved] NUR 504

    ✓ Verified Academic Solution Available

    Executive Solution Overview

    – ## NUR504Case2.pdf – ## NUR504Ass1.pdf – ## NUR504Dis1.pdf **## NUR504Case2.pdf** Case 2 Chief Complaint. (CC). I am here for my annual physical exam and have been having vaginal discharge.” History of Present Illness (HPI) 32-year-old pregnant lesbian – her pregnancy has been without complication…

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    Assignment Prompt & Instructions

    – ## NUR504Case2.pdf

    – ## NUR504Ass1.pdf

    – ## NUR504Dis1.pdf

    **## NUR504Case2.pdf**

    Case 2
    Chief Complaint. (CC).
    I am here for my

    annual physical exam

    and have been having

    vaginal discharge.”

    History of Present Illness (HPI)
    32-year-old pregnant

    lesbian – her

    pregnancy has been

    without complication

    thus far. She has

    been receiving

    prenatal care from an

    obstetrician. She

    received sperm from

    a local sperm bank.

    PMH- None

    PSH- None

    Drug Hx
    Current Meds:

    prenatal vitamins and

    takes Tylenol over the

    counter for aches and

    pains on occasion

    Allergies-None

    Family Hx
    She has a strong

    family history of

    diabetes. Gravida 1;

    Para 0; Abortions 0.

    Review of Systems (ROS)

    General
    No fatigue, fever, or

    chills.

    Head, Eyes, Ears, Nose & Throat (HEENT)-None

    Neck
    No fatigue, fever, or

    chills.

    Respiratory-None

    CV- None

    GI-None

    GU- None

    Integument
    multiple piercings,

    and tattoos. Old

    scars related to

    “cutting”

    MS/Neurono
    syncopal episodes

    or dizziness, no

    change in memory or

    thinking patterns; no

    twitches or abnormal

    movements.

    Objective Data
    PE
    B/P 128/76; Pulse 83;

    RR 16; Temp 99.0; Ht

    5,6; wt 128; BMI

    20.98

    General-None

    HEENT
    Atraumatic,

    normocephalic,

    PERRLA, EOMI,

    conjunctiva and

    sclera clear; nares

    patent, nasopharynx

    clear, good dentition.

    Piercing in her right

    nostril and lower lip.

    Lungs
    CTA AP&L

    Card
    S1S2 without rub or

    gallop

    Abd
    benign, normoactive

    bowel sounds x 4

    GU
    external genitalia

    intact, no lesions or

    masses. White

    copious discharge

    with an amine odor;

    no cervical motion

    tenderness; adnexa

    intact.

    Ext
    no cyanosis, clubbing

    or edema

    Integument
    intact without lesions

    masses or rashes.

    MS-None

    Neuro
    No obvious deficits

    and CN grossly intact

    II-XII

    **## NUR504Ass1.pdf**

    Comprehensive Mental Health Examination

    For this assignment, list the parts of a comprehensive mental status examination (MSE)
    for mental health patients. Give examples of each and describe the significance to the
    advanced practice nurse.

    Submission Instructions

    • The paper is to be clear and concise and students will lose points for improper
    grammar, punctuation, and misspelling.

    • The paper should be formatted per current APA and 2-4 pages in length,
    excluding the title, abstract, and references page.

    • Incorporate a minimum of 5 current (published within the last five years)
    scholarly journal articles or primary legal sources (statutes, court opinions) within
    your work.

    • This assignment will be assessed through Turnitin.

    Mental Exam Rubric

    Mental Exam Rubric

    Criteria Ratings
    Poi
    nts

    Identificati
    on of Main
    Issues/
    Problems

    Distinguished

    Identify and demonstrate a sophisticated understanding of the issues/

    problems.

    20 pts

    Excellent

    Identifies and demonstrate an accomplished understanding of most of

    issues/problems.

    18 pts

    Fair

    Identifies and demonstrate an an acceptable understanding of most of

    issues/problems.

    16 pts

    Poor

    Identifies and demonstrate an unacceptable understanding of most of

    issues/problems.

    8 pts

    /20
    pts

    Analysis
    and
    Evaluation
    of Issues/
    Probelms

    Distinguished

    Presents an insightful, thorough analysis and evaluation of issues/problems.

    20 pts

    Excellent

    Presents a thorough analysis and evaluation of most of the issues/problems.

    18 pts

    Fair

    Presents a superficial or incomplete analysis and evaluation of issues/

    problems.

    16 pts

    Poor

    Presents unacceptable analysis and evaluation of issues/problems.

    8 pts

    /20
    pts

    Demonstr
    ates a
    Conceptu
    al
    Understan
    ding

    Distinguished

    Provides a thorough, competent and interpretive responses to all issues/

    problems, and shows a high level of conceptual understanding.

    20 pts

    Excellent

    Provides a competent and interpretive responses to all issues/problems, and

    shows a moderate level of conceptual understanding.

    18 pts

    Fair

    Provides a competent responses to all issues/problems, but lacks

    interpretation and a moderate level of conceptual understanding.

    16 pts

    Poor

    Provides an unacceptable response to all issues/problems, and lacks

    interpretation and a moderate level of conceptual understanding.

    8 pts

    /20
    pts

    Use of
    Citations
    to Course
    Readings
    and
    Additional
    Research/
    Literature

    Distinguished

    Effectively uses the literature and other resources to inform their work.

    Exceptional use of citations and extended referencing.

    20 pts

    Excellent

    Effectively uses the literature and other resources to inform their work.

    Moderate use of citations and extended referencing.

    18 pts

    Fair

    Ineffectively uses the literature and other resources to inform their work.

    Moderate use of citations and extended referencing.

    16 pts

    Poor

    Ineffectively uses the literature and other resources to inform their work. An

    unacceptable use of citations and extended referencing.

    8 pts

    /20
    pts

    Writing
    Mechanic
    s and APA
    Formattin
    g
    Guidelines

    Full Marks

    Demonstrate a high level of clarity, precision, and attention to detail. APA

    style is correct and writing is free of grammar and spelling errors.

    20 pts

    Excellent

    Demonstrate a high level of clarity. APA style and writing mechanics need

    more precision and attention to detail.

    18 pts

    Fair

    Demonstrate a moderate level of clarity. APA style and writing mechanics

    need more precision and attention to detail.

    16 pts

    Poor

    Demonstrates issues in writing and communicating clearly. APA style and

    writing mechanics need serious attention.

    8 pts

    /20
    pts

    **## NUR504Dis1.pdf**

    Cultural, Spiritual, Nutritional,
    & Mental Health Disorders

    For this Discussion, you will take on the role of a clinician who is
    building a health history for one of the following cases. Your
    instructor will assign you your case number. Case 2

    Case 1 Case 2 Case 3
    Subjective Data

    Chief
    Compla
    int
    (CC)

    “I came for my annual
    physical exam, but do
    not want to be a
    burden to my
    daughter.”

    “I am here for my
    annual physical exam
    and have been having
    vaginal discharge.”

    “Annual physical
    exam”

    History
    of
    Present
    Illness
    (HPI)

    At-risk 86-year-old
    Asian male – who is
    physically and
    financially dependent
    on his daughter, a
    single mother who has
    little time or money for
    her father’s health
    needs.

    32-year-old pregnant
    lesbian – her
    pregnancy has been
    without complication
    thus far. She has
    been receiving
    prenatal care from an
    obstetrician. She
    received sperm from
    a local sperm bank.

    23-year-old Native
    American male
    comes in to see you
    because he has been
    having anxiety and
    wants something to
    help him. He has
    been smoking “pot”
    and says he drinks to
    help him too. He tells
    you he is afraid that
    he will not get into
    Heaven if he
    continues in this
    lifestyle.

    PMH

    Hypertension (HTN),
    gastroesophageal
    reflux disease (GERD),
    b12 deficiency and
    chronic prostatitis

    PSH S/P cholecystectomy

    Drug Hx

    Current Meds:
    Lisinopril 10mg daily,
    Prilosec 20mg daily,
    B12 injections
    monthly, and Cipro
    100mg daily.

    Current Meds:
    prenatal vitamins and
    takes Tylenol over the
    counter for aches and
    pains on occasion

    Current Meds: denied

    Allergie
    s

    No allergies to food
    or medications.

    Family
    Hx

    She has a strong
    family history of
    diabetes. Gravida 1;
    Para 0; Abortions 0.

    He has a family
    history of diabetes,
    hypertension, and
    alcoholism.

    Review of Systems (ROS)

    General

    + weight loss of 25 lbs
    over the past year; no
    recent fatigue, fever,
    or chills.

    No fatigue, fever, or
    chills.

    No recent weight
    gains of losses,
    fatigue, fever, or
    chills.

    Head,
    Eyes,
    Ears,
    Nose &
    Throat
    (HEENT
    )

    No changes in vision
    or hearing, no
    difficulty chewing or
    swallowing.

    Neck No pain or injury No pain or injury
    Respira
    tory

    CV no chest discomfort
    or palpitations

    GI

    GU
    no urinary hesitancy
    or change in urine
    stream

    Integum
    ent

    multiple bruises on his
    upper arms and back.

    multiple piercings,
    and tattoos. Old
    scars related to
    “cutting”

    history of eczema –
    not active

    MS/
    Neuro

    + falls x 2 within the
    last 6 months; no
    syncopal episodes or
    dizziness

    no syncopal episodes
    or dizziness, no
    change in memory or
    thinking patterns; no
    twitches or abnormal
    movements.

    no syncopal episodes
    or dizziness, no
    change in memory or
    thinking patterns; no
    twitches or abnormal
    movements

    Objective Data

    PE
    B/P 188/96; Pulse 89;
    RR 16; Temp 99.0; Ht
    5,6; wt 110; BMI 17.8

    B/P 128/76; Pulse 83;
    RR 16; Temp 99.0; Ht
    5,6; wt 128; BMI
    20.98

    B/P 158/90; Pulse 88;
    RR 18; Temp 99.2; Ht
    5,7; wt 208; BMI 32.6

    General

    23-year-old male
    appears well
    developed and well-
    nourished. He is
    anxious – pacing in
    the room and
    fidgeting, but in no
    acute distress.

    HEENT

    Atraumatic,
    normocephalic,
    PERRLA, EOMI, arcus
    senilus bilaterally,
    conjunctiva and sclera
    clear, nares patent,
    nasopharynx clear,
    edentulous.

    Atraumatic,
    normocephalic,
    PERRLA, EOMI,
    conjunctiva and
    sclera clear; nares
    patent, nasopharynx
    clear, good dentition.
    Piercing in her right
    nostril and lower lip.

    Atraumatic,
    normocephalic,
    PERRLA, EOMI,
    sclera with mild
    icterus, nares patent,
    nasopharynx clear,
    poor dentition –
    multiple carries.

    Lungs CTA AP&L CTA AP&L CTA AP&L

    Once you received your case number, answer the following
    questions: Case 2

    1. Discuss the specific socioeconomic, spiritual, lifestyle,
    and other cultural factors related to the health of the
    patient you selected.

    2. Utilizing the five assessment domains, which ones
    would you utilize on your patients in conducting a
    comprehensive nutritional assessment.

    Card S1S2 without rub or
    gallop

    S1S2 without rub or
    gallop

    S1S2, +II/VI
    holosystolic murmur;
    without rub or gallop

    Abd benign, normoactive
    bowel sounds x 4

    benign, normoactive
    bowel sounds x 4

    benign, normoactive
    bowel sounds x 4;
    Hepatomegaly 2cm
    below the costal
    margin.

    GU

    external genitalia
    intact, no lesions or
    masses. White
    copious discharge
    with an amine odor;
    no cervical motion
    tenderness; adnexa
    intact.

    Ext no cyanosis, clubbing
    or edema

    no cyanosis, clubbing
    or edema

    no cyanosis, clubbing
    or edema

    Integum
    ent

    multiple bruises in
    different stages of
    healing – on his upper
    arms and back.

    intact without lesions
    masses or rashes.

    intact without lesions
    masses or rashes.

    MS

    Neuro
    No obvious
    deformities, CN
    grossly intact II-XII

    No obvious deficits
    and CN grossly intact
    II-XII

    No obvious deficits
    and CN grossly intact
    II-XII

    3. Discuss the functional anatomy and physiology of a
    psychiatric mental health patient. Which key concepts
    must a nurse know in order to assess specific
    functions?

    Submission Instructions:

    • Your instructor will assign you your case number and you
    will post on the case number you have been assigned.

    • You will reply to the other two case studies (One of each).

    • Your initial post should be at least 500 words, formatted and

    cited in current APA style with support from at least 2
    academic sources. Your initial post is worth 8 points.

    • You should respond to at least two of your peers by
    extending, refuting/correcting, or adding additional nuance
    to their posts. Your reply posts are worth 2 points (1 point
    per response.)

    • All replies must be constructive and use literature where
    possible.

    **## NUR504Dis1.pdf**

    Cultural, Spiritual, Nutritional,
    & Mental Health Disorders

    For this Discussion, you will take on the role of a clinician who is
    building a health history for one of the following cases. Your
    instructor will assign you your case number. Case 2

    Case 1 Case 2 Case 3
    Subjective Data

    Chief
    Compla
    int
    (CC)

    “I came for my annual
    physical exam, but do
    not want to be a
    burden to my
    daughter.”

    “I am here for my
    annual physical exam
    and have been having
    vaginal discharge.”

    “Annual physical
    exam”

    History
    of
    Present
    Illness
    (HPI)

    At-risk 86-year-old
    Asian male – who is
    physically and
    financially dependent
    on his daughter, a
    single mother who has
    little time or money for
    her father’s health
    needs.

    32-year-old pregnant
    lesbian – her
    pregnancy has been
    without complication
    thus far. She has
    been receiving
    prenatal care from an
    obstetrician. She
    received sperm from
    a local sperm bank.

    23-year-old Native
    American male
    comes in to see you
    because he has been
    having anxiety and
    wants something to
    help him. He has
    been smoking “pot”
    and says he drinks to
    help him too. He tells
    you he is afraid that
    he will not get into
    Heaven if he
    continues in this
    lifestyle.

    PMH

    Hypertension (HTN),
    gastroesophageal
    reflux disease (GERD),
    b12 deficiency and
    chronic prostatitis

    PSH S/P cholecystectomy

    Drug Hx

    Current Meds:
    Lisinopril 10mg daily,
    Prilosec 20mg daily,
    B12 injections
    monthly, and Cipro
    100mg daily.

    Current Meds:
    prenatal vitamins and
    takes Tylenol over the
    counter for aches and
    pains on occasion

    Current Meds: denied

    Allergie
    s

    No allergies to food
    or medications.

    Family
    Hx

    She has a strong
    family history of
    diabetes. Gravida 1;
    Para 0; Abortions 0.

    He has a family
    history of diabetes,
    hypertension, and
    alcoholism.

    Review of Systems (ROS)

    General

    + weight loss of 25 lbs
    over the past year; no
    recent fatigue, fever,
    or chills.

    No fatigue, fever, or
    chills.

    No recent weight
    gains of losses,
    fatigue, fever, or
    chills.

    Head,
    Eyes,
    Ears,
    Nose &
    Throat
    (HEENT
    )

    No changes in vision
    or hearing, no
    difficulty chewing or
    swallowing.

    Neck No pain or injury No pain or injury
    Respira
    tory

    CV no chest discomfort
    or palpitations

    GI

    GU
    no urinary hesitancy
    or change in urine
    stream

    Integum
    ent

    multiple bruises on his
    upper arms and back.

    multiple piercings,
    and tattoos. Old
    scars related to
    “cutting”

    history of eczema –
    not active

    MS/
    Neuro

    + falls x 2 within the
    last 6 months; no
    syncopal episodes or
    dizziness

    no syncopal episodes
    or dizziness, no
    change in memory or
    thinking patterns; no
    twitches or abnormal
    movements.

    no syncopal episodes
    or dizziness, no
    change in memory or
    thinking patterns; no
    twitches or abnormal
    movements

    Objective Data

    PE
    B/P 188/96; Pulse 89;
    RR 16; Temp 99.0; Ht
    5,6; wt 110; BMI 17.8

    B/P 128/76; Pulse 83;
    RR 16; Temp 99.0; Ht
    5,6; wt 128; BMI
    20.98

    B/P 158/90; Pulse 88;
    RR 18; Temp 99.2; Ht
    5,7; wt 208; BMI 32.6

    General

    23-year-old male
    appears well
    developed and well-
    nourished. He is
    anxious – pacing in
    the room and
    fidgeting, but in no
    acute distress.

    HEENT

    Atraumatic,
    normocephalic,
    PERRLA, EOMI, arcus
    senilus bilaterally,
    conjunctiva and sclera
    clear, nares patent,
    nasopharynx clear,
    edentulous.

    Atraumatic,
    normocephalic,
    PERRLA, EOMI,
    conjunctiva and
    sclera clear; nares
    patent, nasopharynx
    clear, good dentition.
    Piercing in her right
    nostril and lower lip.

    Atraumatic,
    normocephalic,
    PERRLA, EOMI,
    sclera with mild
    icterus, nares patent,
    nasopharynx clear,
    poor dentition –
    multiple carries.

    Lungs CTA AP&L CTA AP&L CTA AP&L

    Once you received your case number, answer the following
    questions: Case 2

    1. Discuss the specific socioeconomic, spiritual, lifestyle,
    and other cultural factors related to the health of the
    patient you selected.

    2. Utilizing the five assessment domains, which ones
    would you utilize on your patients in conducting a
    comprehensive nutritional assessment.

    Card S1S2 without rub or
    gallop

    S1S2 without rub or
    gallop

    S1S2, +II/VI
    holosystolic murmur;
    without rub or gallop

    Abd benign, normoactive
    bowel sounds x 4

    benign, normoactive
    bowel sounds x 4

    benign, normoactive
    bowel sounds x 4;
    Hepatomegaly 2cm
    below the costal
    margin.

    GU

    external genitalia
    intact, no lesions or
    masses. White
    copious discharge
    with an amine odor;
    no cervical motion
    tenderness; adnexa
    intact.

    Ext no cyanosis, clubbing
    or edema

    no cyanosis, clubbing
    or edema

    no cyanosis, clubbing
    or edema

    Integum
    ent

    multiple bruises in
    different stages of
    healing – on his upper
    arms and back.

    intact without lesions
    masses or rashes.

    intact without lesions
    masses or rashes.

    MS

    Neuro
    No obvious
    deformities, CN
    grossly intact II-XII

    No obvious deficits
    and CN grossly intact
    II-XII

    No obvious deficits
    and CN grossly intact
    II-XII

    3. Discuss the functional anatomy and physiology of a
    psychiatric mental health patient. Which key concepts
    must a nurse know in order to assess specific
    functions?

    Submission Instructions:

    • Your instructor will assign you your case number and you
    will post on the case number you have been assigned.

    • You will reply to the other two case studies (One of each).

    • Your initial post should be at least 500 words, formatted and

    cited in current APA style with support from at least 2
    academic sources. Your initial post is worth 8 points.

    • You should respond to at least two of your peers by
    extending, refuting/correcting, or adding additional nuance
    to their posts. Your reply posts are worth 2 points (1 point
    per response.)

    • All replies must be constructive and use literature where
    possible.

    **## NUR504Case2.pdf**

    Case 2
    Chief Complaint. (CC).
    I am here for my

    annual physical exam

    and have been having

    vaginal discharge.”

    History of Present Illness (HPI)
    32-year-old pregnant

    lesbian – her

    pregnancy has been

    without complication

    thus far. She has

    been receiving

    prenatal care from an

    obstetrician. She

    received sperm from

    a local sperm bank.

    PMH- None

    PSH- None

    Drug Hx
    Current Meds:

    prenatal vitamins and

    takes Tylenol over the

    counter for aches and

    pains on occasion

    Allergies-None

    Family Hx
    She has a strong

    family history of

    diabetes. Gravida 1;

    Para 0; Abortions 0.

    Review of Systems (ROS)

    General
    No fatigue, fever, or

    chills.

    Head, Eyes, Ears, Nose & Throat (HEENT)-None

    Neck
    No fatigue, fever, or

    chills.

    Respiratory-None

    CV- None

    GI-None

    GU- None

    Integument
    multiple piercings,

    and tattoos. Old

    scars related to

    “cutting”

    MS/Neurono
    syncopal episodes

    or dizziness, no

    change in memory or

    thinking patterns; no

    twitches or abnormal

    movements.

    Objective Data
    PE
    B/P 128/76; Pulse 83;

    RR 16; Temp 99.0; Ht

    5,6; wt 128; BMI

    20.98

    General-None

    HEENT
    Atraumatic,

    normocephalic,

    PERRLA, EOMI,

    conjunctiva and

    sclera clear; nares

    patent, nasopharynx

    clear, good dentition.

    Piercing in her right

    nostril and lower lip.

    Lungs
    CTA AP&L

    Card
    S1S2 without rub or

    gallop

    Abd
    benign, normoactive

    bowel sounds x 4

    GU
    external genitalia

    intact, no lesions or

    masses. White

    copious discharge

    with an amine odor;

    no cervical motion

    tenderness; adnexa

    intact.

    Ext
    no cyanosis, clubbing

    or edema

    Integument
    intact without lesions

    masses or rashes.

    MS-None

    Neuro
    No obvious deficits

    and CN grossly intact

    II-XII

    **## NUR504Ass1.pdf**

    Comprehensive Mental Health Examination

    For this assignment, list the parts of a comprehensive mental status examination (MSE)
    for mental health patients. Give examples of each and describe the significance to the
    advanced practice nurse.

    Submission Instructions

    • The paper is to be clear and concise and students will lose points for improper
    grammar, punctuation, and misspelling.

    • The paper should be formatted per current APA and 2-4 pages in length,
    excluding the title, abstract, and references page.

    • Incorporate a minimum of 5 current (published within the last five years)
    scholarly journal articles or primary legal sources (statutes, court opinions) within
    your work.

    • This assignment will be assessed through Turnitin.

    Mental Exam Rubric

    Mental Exam Rubric

    Criteria Ratings
    Poi
    nts

    Identificati
    on of Main
    Issues/
    Problems

    Distinguished

    Identify and demonstrate a sophisticated understanding of the issues/

    problems.

    20 pts

    Excellent

    Identifies and demonstrate an accomplished understanding of most of

    issues/problems.

    18 pts

    Fair

    Identifies and demonstrate an an acceptable understanding of most of

    issues/problems.

    16 pts

    Poor

    Identifies and demonstrate an unacceptable understanding of most of

    issues/problems.

    8 pts

    /20
    pts

    Analysis
    and
    Evaluation
    of Issues/
    Probelms

    Distinguished

    Presents an insightful, thorough analysis and evaluation of issues/problems.

    20 pts

    Excellent

    Presents a thorough analysis and evaluation of most of the issues/problems.

    18 pts

    Fair

    Presents a superficial or incomplete analysis and evaluation of issues/

    problems.

    16 pts

    Poor

    Presents unacceptable analysis and evaluation of issues/problems.

    8 pts

    /20
    pts

    Demonstr
    ates a
    Conceptu
    al
    Understan
    ding

    Distinguished

    Provides a thorough, competent and interpretive responses to all issues/

    problems, and shows a high level of conceptual understanding.

    20 pts

    Excellent

    Provides a competent and interpretive responses to all issues/problems, and

    shows a moderate level of conceptual understanding.

    18 pts

    Fair

    Provides a competent responses to all issues/problems, but lacks

    interpretation and a moderate level of conceptual understanding.

    16 pts

    Poor

    Provides an unacceptable response to all issues/problems, and lacks

    interpretation and a moderate level of conceptual understanding.

    8 pts

    /20
    pts

    Use of
    Citations
    to Course
    Readings
    and
    Additional
    Research/
    Literature

    Distinguished

    Effectively uses the literature and other resources to inform their work.

    Exceptional use of citations and extended referencing.

    20 pts

    Excellent

    Effectively uses the literature and other resources to inform their work.

    Moderate use of citations and extended referencing.

    18 pts

    Fair

    Ineffectively uses the literature and other resources to inform their work.

    Moderate use of citations and extended referencing.

    16 pts

    Poor

    Ineffectively uses the literature and other resources to inform their work. An

    unacceptable use of citations and extended referencing.

    8 pts

    /20
    pts

    Writing
    Mechanic
    s and APA
    Formattin
    g
    Guidelines

    Full Marks

    Demonstrate a high level of clarity, precision, and attention to detail. APA

    style is correct and writing is free of grammar and spelling errors.

    20 pts

    Excellent

    Demonstrate a high level of clarity. APA style and writing mechanics need

    more precision and attention to detail.

    18 pts

    Fair

    Demonstrate a moderate level of clarity. APA style and writing mechanics

    need more precision and attention to detail.

    16 pts

    Poor

    Demonstrates issues in writing and communicating clearly. APA style and

    writing mechanics need serious attention.

    8 pts

    /20
    pts

    **## NUR504Dis1.pdf**

    Cultural, Spiritual, Nutritional,
    & Mental Health Disorders

    For this Discussion, you will take on the role of a clinician who is
    building a health history for one of the following cases. Your
    instructor will assign you your case number. Case 2

    Case 1 Case 2 Case 3
    Subjective Data

    Chief
    Compla
    int
    (CC)

    “I came for my annual
    physical exam, but do
    not want to be a
    burden to my
    daughter.”

    “I am here for my
    annual physical exam
    and have been having
    vaginal discharge.”

    “Annual physical
    exam”

    History
    of
    Present
    Illness
    (HPI)

    At-risk 86-year-old
    Asian male – who is
    physically and
    financially dependent
    on his daughter, a
    single mother who has
    little time or money for
    her father’s health
    needs.

    32-year-old pregnant
    lesbian – her
    pregnancy has been
    without complication
    thus far. She has
    been receiving
    prenatal care from an
    obstetrician. She
    received sperm from
    a local sperm bank.

    23-year-old Native
    American male
    comes in to see you
    because he has been
    having anxiety and
    wants something to
    help him. He has
    been smoking “pot”
    and says he drinks to
    help him too. He tells
    you he is afraid that
    he will not get into
    Heaven if he
    continues in this
    lifestyle.

    PMH

    Hypertension (HTN),
    gastroesophageal
    reflux disease (GERD),
    b12 deficiency and
    chronic prostatitis

    PSH S/P cholecystectomy

    Drug Hx

    Current Meds:
    Lisinopril 10mg daily,
    Prilosec 20mg daily,
    B12 injections
    monthly, and Cipro
    100mg daily.

    Current Meds:
    prenatal vitamins and
    takes Tylenol over the
    counter for aches and
    pains on occasion

    Current Meds: denied

    Allergie
    s

    No allergies to food
    or medications.

    Family
    Hx

    She has a strong
    family history of
    diabetes. Gravida 1;
    Para 0; Abortions 0.

    He has a family
    history of diabetes,
    hypertension, and
    alcoholism.

    Review of Systems (ROS)

    General

    + weight loss of 25 lbs
    over the past year; no
    recent fatigue, fever,
    or chills.

    No fatigue, fever, or
    chills.

    No recent weight
    gains of losses,
    fatigue, fever, or
    chills.

    Head,
    Eyes,
    Ears,
    Nose &
    Throat
    (HEENT
    )

    No changes in vision
    or hearing, no
    difficulty chewing or
    swallowing.

    Neck No pain or injury No pain or injury
    Respira
    tory

    CV no chest discomfort
    or palpitations

    GI

    GU
    no urinary hesitancy
    or change in urine
    stream

    Integum
    ent

    multiple bruises on his
    upper arms and back.

    multiple piercings,
    and tattoos. Old
    scars related to
    “cutting”

    history of eczema –
    not active

    MS/
    Neuro

    + falls x 2 within the
    last 6 months; no
    syncopal episodes or
    dizziness

    no syncopal episodes
    or dizziness, no
    change in memory or
    thinking patterns; no
    twitches or abnormal
    movements.

    no syncopal episodes
    or dizziness, no
    change in memory or
    thinking patterns; no
    twitches or abnormal
    movements

    Objective Data

    PE
    B/P 188/96; Pulse 89;
    RR 16; Temp 99.0; Ht
    5,6; wt 110; BMI 17.8

    B/P 128/76; Pulse 83;
    RR 16; Temp 99.0; Ht
    5,6; wt 128; BMI
    20.98

    B/P 158/90; Pulse 88;
    RR 18; Temp 99.2; Ht
    5,7; wt 208; BMI 32.6

    General

    23-year-old male
    appears well
    developed and well-
    nourished. He is
    anxious – pacing in
    the room and
    fidgeting, but in no
    acute distress.

    HEENT

    Atraumatic,
    normocephalic,
    PERRLA, EOMI, arcus
    senilus bilaterally,
    conjunctiva and sclera
    clear, nares patent,
    nasopharynx clear,
    edentulous.

    Atraumatic,
    normocephalic,
    PERRLA, EOMI,
    conjunctiva and
    sclera clear; nares
    patent, nasopharynx
    clear, good dentition.
    Piercing in her right
    nostril and lower lip.

    Atraumatic,
    normocephalic,
    PERRLA, EOMI,
    sclera with mild
    icterus, nares patent,
    nasopharynx clear,
    poor dentition –
    multiple carries.

    Lungs CTA AP&L CTA AP&L CTA AP&L

    Once you received your case number, answer the following
    questions: Case 2

    1. Discuss the specific socioeconomic, spiritual, lifestyle,
    and other cultural factors related to the health of the
    patient you selected.

    2. Utilizing the five assessment domains, which ones
    would you utilize on your patients in conducting a
    comprehensive nutritional assessment.

    Card S1S2 without rub or
    gallop

    S1S2 without rub or
    gallop

    S1S2, +II/VI
    holosystolic murmur;
    without rub or gallop

    Abd benign, normoactive
    bowel sounds x 4

    benign, normoactive
    bowel sounds x 4

    benign, normoactive
    bowel sounds x 4;
    Hepatomegaly 2cm
    below the costal
    margin.

    GU

    external genitalia
    intact, no lesions or
    masses. White
    copious discharge
    with an amine odor;
    no cervical motion
    tenderness; adnexa
    intact.

    Ext no cyanosis, clubbing
    or edema

    no cyanosis, clubbing
    or edema

    no cyanosis, clubbing
    or edema

    Integum
    ent

    multiple bruises in
    different stages of
    healing – on his upper
    arms and back.

    intact without lesions
    masses or rashes.

    intact without lesions
    masses or rashes.

    MS

    Neuro
    No obvious
    deformities, CN
    grossly intact II-XII

    No obvious deficits
    and CN grossly intact
    II-XII

    No obvious deficits
    and CN grossly intact
    II-XII

    3. Discuss the functional anatomy and physiology of a
    psychiatric mental health patient. Which key concepts
    must a nurse know in order to assess specific
    functions?

    Submission Instructions:

    • Your instructor will assign you your case number and you
    will post on the case number you have been assigned.

    • You will reply to the other two case studies (One of each).

    • Your initial post should be at least 500 words, formatted and

    cited in current APA style with support from at least 2
    academic sources. Your initial post is worth 8 points.

    • You should respond to at least two of your peers by
    extending, refuting/correcting, or adding additional nuance
    to their posts. Your reply posts are worth 2 points (1 point
    per response.)

    • All replies must be constructive and use literature where
    possible.

    **## NUR504Case2.pdf**

    Case 2
    Chief Complaint. (CC).
    I am here for my

    annual physical exam

    and have been having

    vaginal discharge.”

    History of Present Illness (HPI)
    32-year-old pregnant

    lesbian – her

    pregnancy has been

    without complication

    thus far. She has

    been receiving

    prenatal care from an

    obstetrician. She

    received sperm from

    a local sperm bank.

    PMH- None

    PSH- None

    Drug Hx
    Current Meds:

    prenatal vitamins and

    takes Tylenol over the

    counter for aches and

    pains on occasion

    Allergies-None

    Family Hx
    She has a strong

    family history of

    diabetes. Gravida 1;

    Para 0; Abortions 0.

    Review of Systems (ROS)

    General
    No fatigue, fever, or

    chills.

    Head, Eyes, Ears, Nose & Throat (HEENT)-None

    Neck
    No fatigue, fever, or

    chills.

    Respiratory-None

    CV- None

    GI-None

    GU- None

    Integument
    multiple piercings,

    and tattoos. Old

    scars related to

    “cutting”

    MS/Neurono
    syncopal episodes

    or dizziness, no

    change in memory or

    thinking patterns; no

    twitches or abnormal

    movements.

    Objective Data
    PE
    B/P 128/76; Pulse 83;

    RR 16; Temp 99.0; Ht

    5,6; wt 128; BMI

    20.98

    General-None

    HEENT
    Atraumatic,

    normocephalic,

    PERRLA, EOMI,

    conjunctiva and

    sclera clear; nares

    patent, nasopharynx

    clear, good dentition.

    Piercing in her right

    nostril and lower lip.

    Lungs
    CTA AP&L

    Card
    S1S2 without rub or

    gallop

    Abd
    benign, normoactive

    bowel sounds x 4

    GU
    external genitalia

    intact, no lesions or

    masses. White

    copious discharge

    with an amine odor;

    no cervical motion

    tenderness; adnexa

    intact.

    Ext
    no cyanosis, clubbing

    or edema

    Integument
    intact without lesions

    masses or rashes.

    MS-None

    Neuro
    No obvious deficits

    and CN grossly intact

    II-XII

    **## NUR504Ass1.pdf**

    Comprehensive Mental Health Examination

    For this assignment, list the parts of a comprehensive mental status examination (MSE)
    for mental health patients. Give examples of each and describe the significance to the
    advanced practice nurse.

    Submission Instructions

    • The paper is to be clear and concise and students will lose points for improper
    grammar, punctuation, and misspelling.

    • The paper should be formatted per current APA and 2-4 pages in length,
    excluding the title, abstract, and references page.

    • Incorporate a minimum of 5 current (published within the last five years)
    scholarly journal articles or primary legal sources (statutes, court opinions) within
    your work.

    • This assignment will be assessed through Turnitin.

    Mental Exam Rubric

    Mental Exam Rubric

    Criteria Ratings
    Poi
    nts

    Identificati
    on of Main
    Issues/
    Problems

    Distinguished

    Identify and demonstrate a sophisticated understanding of the issues/

    problems.

    20 pts

    Excellent

    Identifies and demonstrate an accomplished understanding of most of

    issues/problems.

    18 pts

    Fair

    Identifies and demonstrate an an acceptable understanding of most of

    issues/problems.

    16 pts

    Poor

    Identifies and demonstrate an unacceptable understanding of most of

    issues/problems.

    8 pts

    /20
    pts

    Analysis
    and
    Evaluation
    of Issues/
    Probelms

    Distinguished

    Presents an insightful, thorough analysis and evaluation of issues/problems.

    20 pts

    Excellent

    Presents a thorough analysis and evaluation of most of the issues/problems.

    18 pts

    Fair

    Presents a superficial or incomplete analysis and evaluation of issues/

    problems.

    16 pts

    Poor

    Presents unacceptable analysis and evaluation of issues/problems.

    8 pts

    /20
    pts

    Demonstr
    ates a
    Conceptu
    al
    Understan
    ding

    Distinguished

    Provides a thorough, competent and interpretive responses to all issues/

    problems, and shows a high level of conceptual understanding.

    20 pts

    Excellent

    Provides a competent and interpretive responses to all issues/problems, and

    shows a moderate level of conceptual understanding.

    18 pts

    Fair

    Provides a competent responses to all issues/problems, but lacks

    interpretation and a moderate level of conceptual understanding.

    16 pts

    Poor

    Provides an unacceptable response to all issues/problems, and lacks

    interpretation and a moderate level of conceptual understanding.

    8 pts

    /20
    pts

    Use of
    Citations
    to Course
    Readings
    and
    Additional
    Research/
    Literature

    Distinguished

    Effectively uses the literature and other resources to inform their work.

    Exceptional use of citations and extended referencing.

    20 pts

    Excellent

    Effectively uses the literature and other resources to inform their work.

    Moderate use of citations and extended referencing.

    18 pts

    Fair

    Ineffectively uses the literature and other resources to inform their work.

    Moderate use of citations and extended referencing.

    16 pts

    Poor

    Ineffectively uses the literature and other resources to inform their work. An

    unacceptable use of citations and extended referencing.

    8 pts

    /20
    pts

    Writing
    Mechanic
    s and APA
    Formattin
    g
    Guidelines

    Full Marks

    Demonstrate a high level of clarity, precision, and attention to detail. APA

    style is correct and writing is free of grammar and spelling errors.

    20 pts

    Excellent

    Demonstrate a high level of clarity. APA style and writing mechanics need

    more precision and attention to detail.

    18 pts

    Fair

    Demonstrate a moderate level of clarity. APA style and writing mechanics

    need more precision and attention to detail.

    16 pts

    Poor

    Demonstrates issues in writing and communicating clearly. APA style and

    writing mechanics need serious attention.

    8 pts

    /20
    pts

    **## NUR504Dis1.pdf**

    Cultural, Spiritual, Nutritional,
    & Mental Health Disorders

    For this Discussion, you will take on the role of a clinician who is
    building a health history for one of the following cases. Your
    instructor will assign you your case number. Case 2

    Case 1 Case 2 Case 3
    Subjective Data

    Chief
    Compla
    int
    (CC)

    “I came for my annual
    physical exam, but do
    not want to be a
    burden to my
    daughter.”

    “I am here for my
    annual physical exam
    and have been having
    vaginal discharge.”

    “Annual physical
    exam”

    History
    of
    Present
    Illness
    (HPI)

    At-risk 86-year-old
    Asian male – who is
    physically and
    financially dependent
    on his daughter, a
    single mother who has
    little time or money for
    her father’s health
    needs.

    32-year-old pregnant
    lesbian – her
    pregnancy has been
    without complication
    thus far. She has
    been receiving
    prenatal care from an
    obstetrician. She
    received sperm from
    a local sperm bank.

    23-year-old Native
    American male
    comes in to see you
    because he has been
    having anxiety and
    wants something to
    help him. He has
    been smoking “pot”
    and says he drinks to
    help him too. He tells
    you he is afraid that
    he will not get into
    Heaven if he
    continues in this
    lifestyle.

    PMH

    Hypertension (HTN),
    gastroesophageal
    reflux disease (GERD),
    b12 deficiency and
    chronic prostatitis

    PSH S/P cholecystectomy

    Drug Hx

    Current Meds:
    Lisinopril 10mg daily,
    Prilosec 20mg daily,
    B12 injections
    monthly, and Cipro
    100mg daily.

    Current Meds:
    prenatal vitamins and
    takes Tylenol over the
    counter for aches and
    pains on occasion

    Current Meds: denied

    Allergie
    s

    No allergies to food
    or medications.

    Family
    Hx

    She has a strong
    family history of
    diabetes. Gravida 1;
    Para 0; Abortions 0.

    He has a family
    history of diabetes,
    hypertension, and
    alcoholism.

    Review of Systems (ROS)

    General

    + weight loss of 25 lbs
    over the past year; no
    recent fatigue, fever,
    or chills.

    No fatigue, fever, or
    chills.

    No recent weight
    gains of losses,
    fatigue, fever, or
    chills.

    Head,
    Eyes,
    Ears,
    Nose &
    Throat
    (HEENT
    )

    No changes in vision
    or hearing, no
    difficulty chewing or
    swallowing.

    Neck No pain or injury No pain or injury
    Respira
    tory

    CV no chest discomfort
    or palpitations

    GI

    GU
    no urinary hesitancy
    or change in urine
    stream

    Integum
    ent

    multiple bruises on his
    upper arms and back.

    multiple piercings,
    and tattoos. Old
    scars related to
    “cutting”

    history of eczema –
    not active

    MS/
    Neuro

    + falls x 2 within the
    last 6 months; no
    syncopal episodes or
    dizziness

    no syncopal episodes
    or dizziness, no
    change in memory or
    thinking patterns; no
    twitches or abnormal
    movements.

    no syncopal episodes
    or dizziness, no
    change in memory or
    thinking patterns; no
    twitches or abnormal
    movements

    Objective Data

    PE
    B/P 188/96; Pulse 89;
    RR 16; Temp 99.0; Ht
    5,6; wt 110; BMI 17.8

    B/P 128/76; Pulse 83;
    RR 16; Temp 99.0; Ht
    5,6; wt 128; BMI
    20.98

    B/P 158/90; Pulse 88;
    RR 18; Temp 99.2; Ht
    5,7; wt 208; BMI 32.6

    General

    23-year-old male
    appears well
    developed and well-
    nourished. He is
    anxious – pacing in
    the room and
    fidgeting, but in no
    acute distress.

    HEENT

    Atraumatic,
    normocephalic,
    PERRLA, EOMI, arcus
    senilus bilaterally,
    conjunctiva and sclera
    clear, nares patent,
    nasopharynx clear,
    edentulous.

    Atraumatic,
    normocephalic,
    PERRLA, EOMI,
    conjunctiva and
    sclera clear; nares
    patent, nasopharynx
    clear, good dentition.
    Piercing in her right
    nostril and lower lip.

    Atraumatic,
    normocephalic,
    PERRLA, EOMI,
    sclera with mild
    icterus, nares patent,
    nasopharynx clear,
    poor dentition –
    multiple carries.

    Lungs CTA AP&L CTA AP&L CTA AP&L

    Once you received your case number, answer the following
    questions: Case 2

    1. Discuss the specific socioeconomic, spiritual, lifestyle,
    and other cultural factors related to the health of the
    patient you selected.

    2. Utilizing the five assessment domains, which ones
    would you utilize on your patients in conducting a
    comprehensive nutritional assessment.

    Card S1S2 without rub or
    gallop

    S1S2 without rub or
    gallop

    S1S2, +II/VI
    holosystolic murmur;
    without rub or gallop

    Abd benign, normoactive
    bowel sounds x 4

    benign, normoactive
    bowel sounds x 4

    benign, normoactive
    bowel sounds x 4;
    Hepatomegaly 2cm
    below the costal
    margin.

    GU

    external genitalia
    intact, no lesions or
    masses. White
    copious discharge
    with an amine odor;
    no cervical motion
    tenderness; adnexa
    intact.

    Ext no cyanosis, clubbing
    or edema

    no cyanosis, clubbing
    or edema

    no cyanosis, clubbing
    or edema

    Integum
    ent

    multiple bruises in
    different stages of
    healing – on his upper
    arms and back.

    intact without lesions
    masses or rashes.

    intact without lesions
    masses or rashes.

    MS

    Neuro
    No obvious
    deformities, CN
    grossly intact II-XII

    No obvious deficits
    and CN grossly intact
    II-XII

    No obvious deficits
    and CN grossly intact
    II-XII

    3. Discuss the functional anatomy and physiology of a
    psychiatric mental health patient. Which key concepts
    must a nurse know in order to assess specific
    functions?

    Submission Instructions:

    • Your instructor will assign you your case number and you
    will post on the case number you have been assigned.

    • You will reply to the other two case studies (One of each).

    • Your initial post should be at least 500 words, formatted and

    cited in current APA style with support from at least 2
    academic sources. Your initial post is worth 8 points.

    • You should respond to at least two of your peers by
    extending, refuting/correcting, or adding additional nuance
    to their posts. Your reply posts are worth 2 points (1 point
    per response.)

    • All replies must be constructive and use literature where
    possible.

    – 1
    – 2
    – 3

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