Tag: Clinical-Nursing

NURS 6630 – The woman who liked a late-night TV

Case 1: Volume 2, Case #16: The woman who liked a late-night TV

The patient is a 70-year-old woman who exhibits symptoms of depression due to loneliness. Her son and aide assist in her care. She is hard of hearing and has other cardiological problems. She also has a family history of depression. Her ailment worsened because she was unable to sleep and consequently has s restless leg syndrome. NURS 6630 – The woman who liked a late-night TV.

The three questions I will ask the patient in my office are as follows;

1. Do you feel sleepy or do you have sleep attacks during the day and describe your usual night sleep (Hours of sleep, quality of sleep, etc.)? Lack of sleep results in more health problems and worsens depression.

2. Have any members in your family been depressed? Genetic loading in depression, anxiety or schizophrenia. Get medication effectiveness of family similar to patient’s disorder.

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3. Have you ever suffered from depression, anxiety or similar problems? Pt exhibited symptoms of depression-crying, sadness etc. Patient’s mother has history of depression. NURS 6630 – The woman who liked a late-night TV.

Patient’s son and the home health aide are the persons assisting with his care. So, I will direct my questions to his mother as well as her home health aide about depression history, sleeping pattern, the activity of daily living and patient’s compliance with the medication regimen.

physical exams and diagnostic tests

Actigraphy is a device that measures and records movement. It is worn on the wrist and can be used as a rough measure of the sleep-wake cycle. It is useful for assessing insomnia, circadian rhythm disorders, movement disorders and an assortment of rare events (Sadock, 2015).

Polysomnography is the continuous attended, comprehensive recording of the biophysiological changes that occur during sleep. It is recorded at night and lasts between 6 and 8 hours. Brainwave activity, eye movements, submental electromyography activity, nasal-oral airway flow, respiratory effort, oxyhemoglobin saturation, heart rhythm, and leg movement during sleep are measured (Sadock, 2015). NURS 6630 – The woman who liked a late-night TV.

Three differential diagnoses

1. Major Depressive Disorder (MDD)

A major depressive disorder is a depressed mood that persists for least two weeks duration or longer. Signs and symptoms of major depression include poor appetite, insomnia or hypersomnia, low energy or fatigue, low self-esteem, lack of concentration or difficulty making decisions, and feelings of hopelessness, significant weight loss or weight gain and recurring thought of death or suicide (Sadock, 2015) NURS 6630 – The woman who liked a late-night TV. The predisposing factors to this illness include responses to a significant loss such as grief, a financial ruin from natural disaster, or severe medical illness or disability and other factors such as environmental (stressful life events), genetic and physiological or other psychosocial factors. All currently available antidepressants may take 3 to 4 weeks to exert significant therapeutic effects, although they may begin to show their effects earlier. Examples of antidepressant medications include SSRIs, TCAs, and MAOIs.

2. Insomnia

Sleep is regulated by basic mechanisms, and when these systems go awry, sleep disorders occur. Sleep disorders are both dangerous and difficult to treat. Obstruction Sleep Apnea (OSA) Insomnia is defined as difficulty initiating sleep. DSM-5 defines insomnia disorder as dissatisfaction with sleep quantity or quality with one or more of the following symptoms: difficulty in maintaining sleep with frequent awakenings and early morning inability to return to sleep. Primary insomnia is a condition resulting from too much arousal both at night and day time and may progress to a first major depressive episode (Stahl, 2013). Pharmacologic treatment includes Benzodiazepines, zolpidem, eszopiclone, zaleplon, and Trazodone.

3. Restless Leg Syndrome (RLS)

RLS also known as Ekbom syndrome is an uncomfortable, subjective sensation of the limbs. Usually, the legs, sometimes described as a “creepy crawly” feeling, and the irresistible urge to move the legs when at rest or while trying to fall asleep. Patients often report the sensation or any walking on the skin and crawling feelings in their legs. It worsens at night and moving the legs or walking helps to alleviate the discomfort. RLS is associated with fibromyalgia, rheumatoid arthritis, diabetes, thyroid diseases and COPD. Treatment for RLS includes levodopa, benzodiazepine, opiates, and antiepileptic (Gabapentin) drugs. NURS 6630 – The woman who liked a late-night TV Non- pharmacological treatment is massage, hot baths, hot/cold compress to affected areas, moderate exercises and alcohol avoidance at bedtime (Sadock, 2015).

Insomnia is the major diagnosis for this Patient because it is an ongoing issue.

Two pharmacologic agents for the patient’s sleep/wake therapy

The patient is on Citalopram for depression. Insomnia, fatigue and multiple painful physical complaints are side effects the medication. Citalopram increases in serotonin concentrations at serotonin receptors in parts of the brain and body other than those that cause therapeutic actions. For example, the unwanted actions of serotonin in sleep centers cause insomnia in the patient. These symptoms cause the disorder not to go into remission. Hypnotics medications will enhance remission rates for both patients with major depression and generalized anxiety disorder with insomnia. For example, Eszopiclone added to SSRI will lead to higher remission rate among the clients. Slow wave sleeping enhancing agents can also be administered to augment SSRIs/ SNRIs. These include gabapentin and Trazadone (Stahl, 2013). NURS 6630 – The woman who liked a late-night TV.

1.Eszopiclone

Eszopiclone is a class of non-benzodiazepine hypnotic; alpha 1 isoform selective agonist of GABA-A/benzodiazepine receptors. Eszopiclone is an effective treatment for Primary insomnia, Chronic insomnia, Transient insomnia, Insomnia secondary to psychiatric or medical conditions and Residual insomnia following treatment with antidepressants. Inhibitory actions in sleep centers may provide sedative-hypnotic effects. NURS 6630 – The woman who liked a late-night TV While Eszopiclone is a hypnotic agent with a chemical structure unrelated to benzodiazepines, barbiturates, or other drugs with known hypnotic properties, it interacts with the gamma-aminobutyric acid-benzodiazepine (GABA-BZ) receptor complex. Eszopiclone binds selectively to the brain alpha subunit of the GABA A omega-1 receptor. Side effects include unpleasant taste, Sedation, Dizziness, Dose-dependent amnesia, Nervousness, Dry mouth, headache. Dosages include 2-3mg at bedtime (Drugbank.ca, 2018).

2. Trazodone

Trazodone binds at the 5-HT2 receptor; it acts as a serotonin agonist at high doses and a serotonin antagonist at low doses. Like fluoxetine, trazodone’s antidepressant activity likely results from blockage of serotonin reuptake by inhibiting serotonin reuptake pump at the presynaptic neuronal membrane. If used for long time periods, postsynaptic neuronal receptor binding sites may also be affected. The sedative effect of trazodone is likely the result of alpha-adrenergic blocking action and modest histamine blockade at the H1 receptor. It weakly blocks presynaptic alpha2-adrenergic receptors and strongly inhibits postsynaptic alpha1 receptors. Trazodone does not affect the reuptake of norepinephrine or dopamine within the CNS (Drugbank.ca, 2018).

Dosing for Depression as a monotherapy: initial 150 mg/day in divided doses; can increase every 3–4 days by 50 mg/day as needed; maximum 400 mg/day (outpatient) or 600 mg/day (inpatient), split into two daily doses. Initial 25–50 mg at bedtime; increase as tolerated, usually to 50–100 mg/day, but some patients may require up to full antidepressant dose range. NURS 6630 – The woman who liked a late-night TV Augmentation of other antidepressants in the treatment of depression: dose as recommended for insomnia (Stahl, 2013). Side effects include Nausea, vomiting, edema, blurred vision, constipation, dry mouth, Dizziness, sedation, fatigue, headache, incoordination, tremor, Hypotension, syncope, Occasional sinus bradycardia (long-term), Rare side effects are rash, and priapism NURS 6630 – The woman who liked a late-night TV.

Check points

The patient responded positively to faxes received from therapies. Now that she had her cochlear implant inserted, she can hear people thus ending some of her frustrations. NURS 6630 – The woman who liked a late-night TV She needs to get involved in different activities with people her age. In addition to her medication, the patient will benefit more from non-pharmacological interventions such as psychosocial therapies, social skills training, family-oriented therapies, case management, group therapy, and cognitive behavioral therapy (Sadock, 2015).

Lessons learned

From psychopharmacology point of view, I will not prescribe anti-stimulant to patient. She will be on hypnotics, and I will augment with another SSRIs/SNRIs and gabapentin for neuropathic pain. NURS 6630 – The woman who liked a late-night TV As prescribed medications become effective, she will sleep well at night and the leg pain or spasm will melt away.

Reference

Drugbank, ca (2018). Hypnotics medications. Retrieved July 10th, 2018 from https://www.drugbank.ca/drugs/DB00402

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (Eleventh edition.). Philadelphia: Wolters Kluwer. NURS 6630 – The woman who liked a late-night TV.

Stahl, S. M. (2013).  NURS 6630 – The woman who liked a late-night TVStahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press *Preface, pp. ix–x.

Pharmacotherapy for Hepatobiliary Disorders case study sample essay

Review of Case Study:

Patient HL comes into the clinic with the following symptoms of nausea, vomiting, and diarrhea and has a history of drug abuse and possible Hepatitis C. HL is currently on the following prescription drugs:

Synthroid 100 mcg daily for hypothyroidism

Nifedipine 30 mg daily for hypertension

Prednisone 10 mg daily for immune suppressant

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History of Present Illness

Patient presents with symptoms of diarrhea, nausea and vomiting. From his current medications list, patient HL.As stated above, he’s taking  Synthroid 100 mg daily for the treatment of hypothyroidism, Nifedipine 30mg daily for  high blood pressure or any form of angina, and prednisone 10mg daily for anti-inflammation or immune suppressant for multiple diseases.( Drugs.com, 2015).Patient also has a history of drug abuse as well as possible Hepatitis C Pharmacotherapy for Hepatobiliary Disorders case study sample essay.

Primary Diagnosis

Although a comprehensive history and physical examination, diagnostic workup is needed to come up with a primary diagnostic, based on the presenting symptoms; I
will give a primary diagnosis of acute gastroenteritis.
With gastroenteritis, your stomach and intestines are irritated and inflamed. The cause is typically a viral or bacterial irritation/inflammation of the stomach and intestines caused by food contaminated with bacteria, viruses, parasites, or toxins Pharmacotherapy for Hepatobiliary Disorders case study sample essay. Symptoms may include cramping, nausea, vomiting, or diarrhea. The illness usually spreads easily from contact with a sick person or eating or drinking contaminated food or beverages also will spread the illness. The symptoms usually appear days after contamination and last one to three days. (WebMD, 2015). Since this patient is presenting nausea, vomiting and diarrhea and no fever, I will conclude with acute bacterial gastroenteritis. (WebMD, 2015).

Differential Diagnosis.

 
Based on the patient’s history of drug abuse which could be IV drug use and presenting symptoms, I will come up with a differential diagnosis of acute hepatitis C flare up.
Hepatitis C is a serious liver infection caused by the hepatitis C virus that usually result from infected person-to-person contact of blood and bodily fluids, sexual intercourse or sharing of needles associated with illicit drug/substance use which could  be acute or chronic., vague abdominal pain, and sometimes diarrhea. Diarrhea develops during acute hepatitis C. Although this initial phase of infection generally causes no symptoms at all, approximately 20 to 30 percent of people notice symptoms about 1 to 3 months after contracting the virus (Centers for Disease Control and Prevention, 2016). Pharmacotherapy for Hepatobiliary Disorders case study sample essay.

 
Drug Therapy and Treatment Plan

The primary goal of therapy is reducing the symptoms and the prevention of complications (Arcangelo & Peterson, 2017). Beacause the patient is presenting with nausea and vomiting,and diarrhea, I will start with intravenous fluid hydration either with 0.9% normal saline to hydrate fluid lost from vomiting and diarrhea and also prevent further dehydration (Arcangelo & Peterson, 2017). CBC with differential will be obtained to find out what type of bacterial and a with CMP( Complete Metabolic Panel) to find out which electrolte needs to be replaced.If the results comes back and the potasium is low, I will change the fluid from 0.9 NS and add potassium to the IV fuid.I will also order Phenergan and zofran to be given IVP as needed for nausea and vomiting every 6 hours. Imodium is a first line drug to treat diarrhea, and it can be purchased over-the-counter (Arcangelo & Peterson, 2017). Pharmacotherapy for Hepatobiliary Disorders case study sample essay. Once the nausea subsides I will then encourage  the patient to drink clear liquids and broth to help replace fluids and electrolytes lost.

Since the patient is also having diarrhea, I will order for a stool specimen to find out if the patient is having CDIFF or if the gastroenteritis is viral or bacterial.If the results indicates viral, I will continue with IV fluid and encourage bowel rest by placing the patient on NPO(No food by mouth) for a day or two and depending ion the severity, I can start the patient on flagyl which is an anti infective agent.On the other hand, if it is a bacterial infection, I will continue with IV fluid and an antibiotic like a broad spectrum antibiotic like Ciprofloxacin.In addition, I will do a complete tyroid panel test to adjust patient’s synthroid, do a liver and hepatitis test to start patient on treatment for hepatitis C, I will find out why patient is on prednisone, the duration and see if it needs to be tapered. Pharmacotherapy for Hepatobiliary Disorders case study sample essay.

 

References

Arcangelo, V. P., & Peterson, A.M. (Eds.). (2017).
Pharmacotherapeutics for advanced practice: A practical approach
(3
rd
ed.). Ambler, PA: Lippincott Williams & Wilkins.

Drugs.com. (2012). Retrieved from http://www.drugs.com/

Huether, S. E., & McCance, K. L. (2017).
Understanding pathophysiology
(6
th
ed.). St. Louis, MO: Mosby.

WebMD (2015). Gastroenteritis. Retrieved from

http://symptoms.webmd.com/default.htm#conditionView Pharmacotherapy for Hepatobiliary Disorders case study sample essay

NURS 6630 Weekly Discussion Essay Assignment Papers Week 1 discussion

Discussion: Foundational Neuroscience

As a psychiatric mental health nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat clients, you must not only understand the pathophysiology of psychiatric disorders, but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. NURS 6630 Weekly Discussion Essay Assignment Papers Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues.

Learning Objectives

Students will:

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Analyze the agonist-to-antagonist spectrum of action of psychopharmacologic agents

Compare the actions of g couple proteins to ion gated channels

Analyze the role of epigenetics in pharmacologic action

Analyze the impact of foundational neuroscience on the prescription of medications

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press *Preface, pp. ix–x

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 1, “Chemical Neurotransmission” NURS 6630 Weekly Discussion Essay Assignment Papers.

Chapter 2, “Transporters, Receptors, and Enzymes as Targets of Psychopharmacologic Drug Action”

Chapter 3, “Ion Channels as Targets of Psychopharmacologic Drug Action”

Document: Midterm Exam Study Guide (PDF)

Document: Final Exam Study Guide (PDF)

Required Media

Laureate Education (Producer). (2016i). Introduction to psychopharmacology [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 3 minutes.

Accessible player

Optional Resources

Laureate Education (Producer). (2009). Pathopharmacology: Disorders of the nervous system: Exploring the human brain [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 15 minutes.

Dr. Myslinski reviews the structure and function of the human brain. Using human brains, he examines and illustrates the development of the brain and areas impacted by disorders associated with the brain. NURS 6630 Weekly Discussion Essay Assignment Papers.

Accessible player

Laureate Education (Producer). (2012). Introduction to advanced pharmacology [Video file]. Baltimore, MD: Author.

Note: The approximate length of this media piece is 8 minutes.

In this media presentation, Dr. Terry Buttaro, associate professor of practice at Simmons School of Nursing and Health Sciences, discusses the importance of pharmacology for the advanced practice nurse.

Accessible player

To prepare for this Discussion:

Review this week’s Learning Resources.

Reflect on concepts of foundational neuroscience.

Week 3 discussion

Discussion: The Impact of Ethnicity on Antidepressant Therapy

Major depressive disorder is one of the most prevalent disorders you will see in clinical practice. Treatment for this disorder, however, can vary greatly depending on client factors, such as ethnicity and culture. As a psychiatric mental health professional, you must understand the influence of these factors to select appropriate psychopharmacologic interventions. For this NURS 6630 Weekly Discussion Essay Assignment Papers Discussion, consider how you might assess and treat the individuals in the case studies based on the provided client factors, including ethnicity and culture.

Learning Objectives

Students will:

Assess client factors and history to develop personalized plans of antidepressant therapy for adult and geriatric clients

Analyze factors that influence pharmacokinetic and pharmacodynamic processes in adult and geriatric clients requiring antidepressant therapy

Analyze the impact of ethnicity on antidepressant therapy

Evaluate efficacy of treatment plans

Apply knowledge of providing care to adult and geriatric clients presenting for antidepressant therapy

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. NURS 6630 Weekly Discussion Essay Assignment Papers.

Note: To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 7, “Antidepressants”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

Note: To access the following medications, click on the The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication.

Review the following medications:

amitriptyline

bupropion

citalopram

clomipramine

desipramine

desvenlafaxine

doxepin

duloxetine

escitalopram

fluoxetine

fluvoxamine

imipramine

ketamine

mirtazapine

nortriptyline

paroxetine

selegiline

sertraline

trazodone

venlafaxine

vilazodone

vortioxetine

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: Retrieved from Walden Library databases.

Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 1: Study design. Journal of Psychosocial Nursing and Mental Health Services, 46(9), 21–24. doi:10.3928/02793695-20080901-06

Note: Retrieved from Walden Library databases.

Howland, R. H. (2008a). Sequenced treatment alternatives to relieve depression (STAR*D). Part 2: Study outcomes. Journal of Psychosocial Nursing and Mental Health Services, 46(19), 21–24. doi:10.3928/02793695-20081001-05

Note: Retrieved from Walden Library databases.

Yasuda, S.U., Zhang, L. & Huang, S.-M. (2008). The role of ethnicity in variability in response to drugs: Focus on clinical pharmacology studies. Clinical Pharmacology & Therapeutics, 84(3), 417–423. Retrieved from https://web.archive.org/web/20170809004704/https://www.fda.gov/downloads/Drugs/ScienceResearch/…/UCM085502.pdf

To prepare for this Discussion:

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number. NURS 6630 Weekly Discussion Essay Assignment Papers.

Case 1: Volume 1, Case #1: The man whose antidepressants stopped working

Case 2: Volume 1, Case #7: The case of physician do not heal thyself

Case 3: Volume 1, Case #29: The depressed man who thought he was out of options

Review this week’s Learning Resources and reflect on the insights they provide.

Go to the Stahl Online website and examine the case study you were assigned.

Take the pretest for the case study.

Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).

Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

Review the posttest for the case study. NURS 6630 Weekly Discussion Essay Assignment Papers.

Week 7 discussion

Discussion: Sleep/Wake Disorders

It is not uncommon to experience a night or two of disrupted sleep when there is something major going on in your life. However, sleep/wake disorders are much more than an occasional night of disrupted sleep. A recent report from the Centers for Disease Control and Prevention estimated that between 50 and 70 million American have problems with sleep/wake disorders (CDC, 2015). NURS 6630 Weekly Discussion Essay Assignment Papers Although the vast majority of Americans will visit their primary care provider for treatment of these disorders, many providers will refer patients for further evaluation. For this Discussion, you consider how you might assess and treat the individuals based on the provided client factors.

Learning Objectives

Students will:

Assess client factors and history to develop personalized therapy plans for clients with sleep/wake disorders

Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for sleep/wake disorders

Evaluate efficacy of treatment plans for clients presenting for sleep/wake therapy NURS 6630 Weekly Discussion Essay Assignment Papers.

Apply knowledge of providing care to adult and geriatric clients presenting for sleep/wake disorders

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 11, “Disorders of Sleep and Wakefulness and Their Treatment”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication. NURS 6630 Weekly Discussion Essay Assignment Papers.

Review the following medications:

For insomnia

alprazolam

amitriptyline

amoxapine

clomipramine

clonazepam

desipramine

diazepam

doxepin

flunitrazepam

flurazepam

hydroxyzine

imipramine

lorazepam

nortriptyline

ramelteon

temazepam

trazodone

triazolam

trimipramine

zaleplon

zolpidem

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: Retrieved from Walden Library databases.

Davidson, J. (2016). Pharmacotherapy of post-traumatic stress disorder: Going beyond the guidelines. British Journal of Psychiatry, 2(6), e16-e18. doi:10.1192/bjpo.bp.116.003707. Retrieved from http://bjpo.rcpsych.org/content/2/6/e16

To prepare for this Discussion:

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.

Case 1: Volume 2, Case #16: The woman who liked late-night TV

Case 2: Volume 2, Case #11: The figment of a man who looked upon the lady

Case 3: Volume 1, Case #5: The sleepy woman with anxiety

Review this week’s Learning Resources and reflect on the insights they provide.

Go to the Stahl Online website and examine the case study you were assigned.

Take the pretest for the case study. NURS 6630 Weekly Discussion Essay Assignment Papers

Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.). NURS 6630 Weekly Discussion Essay Assignment Papers.

Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

Review the posttest for the case study.

Week 9 discussion

Discussion: Presentations of ADHD

Although ADHD is often associated with children, this disorder is diagnosed in clients across the lifespan. While many individuals are properly diagnosed and treated during childhood, some individuals who have ADHD only present with subsyndromal evidence of the disorder. These individuals are often undiagnosed until they reach adulthood and struggle to cope with competing demands of running a household, caring for children, and maintaining employment. For this NURS 6630 Weekly Discussion Essay Assignment Papers Discussion, you consider how you might assess and treat individuals presenting with ADHD.

Learning Objectives

Students will:

Assess client factors and history to develop personalized therapy plans for clients with ADHD

Analyze factors that influence pharmacokinetic and pharmacodynamic processes in clients requiring therapy for ADHD

Evaluate efficacy of treatment plans

Apply knowledge of providing care to adult and geriatric clients presenting for antidepressant therapy

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Note: All Stahl resources can be accessed through the Walden Library using this link. This link will take you to a log-in page for the Walden Library. Once you log into the library, the Stahl website will appear. NURS 6630 Weekly Discussion Essay Assignment Papers.

Clancy, C.M., Change, S., Slutsky, J., & Fox, S. (2011). Attention deficit hyperactivity disorder: Effectiveness of treatment in at-risk preschoolers; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatment. Table B. KQ2: Long-term(>1 year) effectiveness of interventions for ADHD in people 6 years and older.

Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY: Cambridge University Press. NURS 6630 Weekly Discussion Essay Assignment Papers.

To access the following chapters, click on the Essential Psychopharmacology, 4th ed tab on the Stahl Online website and select the appropriate chapter. Be sure to read all sections on the left navigation bar for each chapter.

Chapter 12, “Attention Deficit Hyperactivity Disorder and Its Treatment”

Stahl, S. M., & Mignon, L. (2012). Stahl’s illustrated attention deficit hyperactivity disorder. New York, NY: Cambridge University Press.

To access the following chapter, click on the Illustrated Guides tab and then the ADHD tab.

Chapter 4, “ADHD Treatments”

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

To access information on the following medications, click on The Prescriber’s Guide, 5th ed tab on the Stahl Online website and select the appropriate medication. NURS 6630 Weekly Discussion Essay Assignment Papers.

Review the following medications:

For ADHD

armodafinil

amphetamine (d)

amphetamine (d,l)

atomoxetine

bupropion

chlorpromazine

clonidine

guanfacine

haloperidol

lisdexamfetamine

methylphenidate (d)

methylphenidate (d,l)

modafinil

reboxetine

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Note: Retrieved from Walden Library databases.

Optional Resources

Hodgkins, P., Shaw, M., McCarthy, S., & Sallee, F. R. (2012). The pharmacology and clinical outcomes of amphetamines to treat ADHD: Does composition matter? CNS Drugs, 26(3), 245–268. doi:10.2165/11599630-000000000-00000

Psychiatric Times. (2016). A 5-question quiz on ADHD. Retrieved from http://www.psychiatrictimes.com/adhd/5-question-quiz-adhd?GUID=AA46068B-C6FF-4020-8933-087041A0B140&rememberme=1&ts=22072016

To prepare for this Discussion:

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following case studies to review for this Discussion. To access the following case studies, click on the Case Studies tab on the Stahl Online website and select the appropriate volume and case number.

Case 1: Volume 1, Case #13: The 8-year-old girl who was naughty NURS 6630 Weekly Discussion Essay Assignment Papers

Case 2: Volume 1, Case #14: The scatter-brained mother whose daughter has ADHD, like mother, like daughter

Case 3: Volume 2, Case #21: Hindsight is always 20/20, or attention deficit hyperactivity disorder

Review this week’s Learning Resources and reflect on the insights they provide.

Go to the Stahl Online website and examine the case study you were assigned.

Take the pretest for the case study.

Review the patient intake documentation, psychiatric history, patient file, medication history, etc. As you progress through each section, formulate a list of questions that you might ask the patient if he or she were in your office.

Based on the patient’s case history, consider other people in his or her life that you would need to speak to or get feedback from (i.e., family members, teachers, nursing home aides, etc.).

Consider whether any additional physical exams or diagnostic testing may be necessary for the patient.

Develop a differential diagnoses for the patient. Refer to the DSM-5 in this week’s Learning Resources for guidance.

Review the patient’s past and current medications. Refer to Stahl’s Prescriber’s Guide and consider medications you might select for this patient.

Review the posttest for the case study.

Week 10 discussion

Discussion: Influencing Social Change

Individuals with psychiatric mental health disorders are frequently stigmatized not only by society as a whole, but also by their friends, family, and sometimes healthcare providers. In your role, however, you have the opportunity to become a social change agent for these individuals. For this Discussion, consider how you might make a positive impact for your clients and advocate for social change within your own community. NURS 6630 Weekly Discussion Essay Assignment Papers.

Learning Objectives

Students will:

Apply strategies to become a social change agent for psychiatric mental health

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Angermeyer, M. C., Matschinger, H., & Schomerus, G. (2013). Attitudes towards psychiatric treatment and people with mental illness: Changes over two decades. The British Journal of Psychiatry, 203(2), 146–151. Retrieved from http://bjp.rcpsych.org/content/203/2/146.full

Bui, Q. (2012). Antidepressants for agitation and psychosis in patients with dementia. American Family Physician, 85(1), 20–22. Retrieved from http://www.aafp.org/journals/afp.html NURS 6630 Weekly Discussion Essay Assignment Papers.

Note: Retrieved from from the Walden Library databases.

Dingfelder, S. F. (2009). Stigma: Alive and well. American Psychological Association, 40(6), 56. Retrieved from http://www.apa.org/monitor/2009/06/stigma.aspx

Jenkins, J. H. (2012). The anthropology of psychopharmacology: Commentary on contributions to the analysis of pharmaceutical self and imaginary. Culture, Medicine and Psychiatry, 36(1), 78–79. doi:10.1007/s11013-012-9248-0

Note: Retrieved from from the Walden Library databases.

Price, L. H. (2010). Violence in America: Is psychopharmacology the answer? Brown University Psychopharmacology Update, 21(5), 5. Retrieved from http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1556-7532

Note: Retrieved from from the Walden Library databases.

Optional Resources

Bennett, T. (2015). Changing the way society understands mental health. National Alliance on Mental Illness. Retrieved from http://www.nami.org/Blogs/NAMI-Blog/April-2015/Changing-The-Way-Society-Understands-Mental-Health

Mechanic, D. (2007). Mental health services then and now. Health Affairs, 26(6), 1548–1550. Retrieved from https://web.archive.org/web/20170605094514/http://content.healthaffairs.org/content/26/6/1548.full

Rothman, D. J. (1994). Shiny, happy people: The problem with “cosmetic psychopharmacology.” New Republic, 210(7), 34–38.

To prepare for this Discussion:

Reflect on how you might influence social change for psychiatric mental health. NURS 6630 Weekly Discussion Essay Assignment Papers.

Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper

Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe treatment that targets the cause rather than the symptom. Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Discussion, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.

ORDER A CUSTOM-WRITTEN PAPER NOW

Consider the following case study:

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:

Synthroid 100 mcg daily

Nifedipine 30 mg daily

Prednisone 10 mg daily

To prepare:

·        Review this week’s media presentation on pharmacology for the gastrointestinal system.

·        Review the provided case study. Reflect on the patient’s symptoms, medical history, and drugs currently prescribed. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.

·        Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors such as pregnancy, drugs, or a psychological disorder.

·        Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

Post 1 page page APA format  

 
an explanation of your diagnosis for the patient including your rationale for the diagnosis.

Then, describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.
(Note this is a pharmacology class make sure medicine is appropriate and will work with pt’s current med list)

 

Readings

·        Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). 
Pharmacotherapeutics for advanced practice: A practical approach
 (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.

o   Chapter 28, “Nausea and Vomiting” (pp. 392–409)

This chapter focuses on the etiology of nausea and vomiting, as well as body systems that impact or trigger nausea and vomiting. It also covers various drugs used to treat nausea and vomiting including the process of selecting, administering, and managing drug therapy for patients.

o   Chapter 29, “Gastroesophageal Reflux Disease and Peptic Ulcer Disease” (pp. 410–423)

This chapter begins with an overview of risk factors, symptoms, and clinical stages of gastroesophageal reflux disease (GERD). It then examines drugs used to treat GERD and peptic ulcer disease (PUD), including proper dosages, possible adverse reactions, contraindications, and special considerations. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.

o   Chapter 30, “Constipation, Diarrhea, and Irritable Bowel Syndrome” (pp. 424–453)

This chapter begins by exploring disorders associated with constipation and diarrhea, as well as drugs used in treatment. It also covers the pathophysiology of irritable bowel syndrome and related drug therapies.

o   Chapter 31, “Inflammatory Bowel Disease” (pp. 454–471)

This chapter examines the causes, pathophysiology, and diagnostic criteria of inflammatory bowel disease (IBD), Crohn’s disease, and ulcerative colitis. It also identifies drugs used to treat IBD, including proper dosage, adverse reactions, and special considerations.

·        Starr, S., & Raines, D. (2011). Cirrhosis: Diagnosis, management, and prevention. 
American Family Physician
, 
84
(12), 1353–1359.

Retrieved from the Walden Library databases.

This article examines the clinical presentation, pathophysiology, diagnosis, management, and prevention of cirrhosis. It also provides methods for managing complications of cirrhosis.

·        Drugs.com. (2012). Retrieved from 
http://www.drugs.com/

This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.

Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe treatment that targets the cause rather than the symptom. Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper. In this Discussion, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.

Consider the following case study:

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:

Synthroid 100 mcg daily

Nifedipine 30 mg daily

Prednisone 10 mg daily

To prepare:

•Review this week’s media presentation on pharmacology for the gastrointestinal system.

•Review the provided case study. Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.

•Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors such as pregnancy, drugs, or a psychological disorder. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.

•Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

Post on or before Day 3 an explanation of your diagnosis for the patient including your rationale for the diagnosis. Then, describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

RESOURCES:

Required Resources

To access required library resources,  click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Readings

•Arcangelo, V. P., & Peterson, A. M. (Eds.). (2013). Pharmacotherapeutics for advanced practice: A practical approach (3rd ed.). Ambler, PA: Lippincott Williams & Wilkins.

?Chapter 28, “Nausea and Vomiting” (pp. 392–409)

This chapter focuses on the etiology of nausea and vomiting, as well as body systems that impact or trigger nausea and vomiting. It also covers various drugs used to treat nausea and vomiting including the process of selecting, administering, and managing drug therapy for patients.

?Chapter 29, “Gastroesophageal Reflux Disease and Peptic Ulcer Disease” (pp. 410–423)

This chapter begins with an overview of risk factors, symptoms, and clinical stages of gastroesophageal reflux disease (GERD). It then examines drugs used to treat GERD and peptic ulcer disease (PUD), including proper dosages, possible adverse reactions, contraindications, and special considerations Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.

?Chapter 30, “Constipation, Diarrhea, and Irritable Bowel Syndrome” (pp. 424–453)

This chapter begins by exploring disorders associated with constipation and diarrhea, as well as drugs used in treatment. It also covers the pathophysiology of irritable bowel syndrome and related drug therapies.

? Chapter 31, “Inflammatory Bowel Disease” (pp. 454–471)

This chapter examines the causes, pathophysiology, and diagnostic criteria of inflammatory bowel disease (IBD), Crohn’s disease, and ulcerative colitis. It also identifies drugs used to treat IBD, including proper dosage, adverse reactions, and special considerations.

•Starr, S., & Raines, D. (2011). Cirrhosis: Diagnosis, management, and prevention. American Family Physician, 84(12), 1353–1359.

Retrieved from the Walden Library databases Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.

This article examines the clinical presentation, pathophysiology, diagnosis, management, and prevention of cirrhosis. It also provides methods for managing complications of cirrhosis.

•Drugs.com. (2012). Retrieved from https://www.drugs.com/

This website presents a comprehensive review of prescription and over-the-counter drugs including information on common uses and potential side effects. It also provides updates relating to new drugs on the market, support from health professionals, and a drug-drug interactions checker.

Media

•Laureate Education, Inc. (Executive Producer). (2012). Pharmacology for the gastrointestinal system. Baltimore, MD: Author. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.

This media presentation outlines drug treatment options for disorders of the gastrointestinal system.

Note: The approximate length of this media piece is 2 minutes.

Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe treatment that targets the cause rather than the symptom. Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Discussion, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.

Consider the following case study:

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:

· Synthroid 100 mcg daily

· Nifedipine 30 mg daily

· Prednisone 10 mg daily

To prepare:

· Review this week’s media presentation on pharmacology for the gastrointestinal system.

· Review the provided case study. Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.

· Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors such as pregnancy, drugs, or a psychological disorder.

· Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.

With these thoughts in mind:

Post
 an explanation of your diagnosis for the patient including your rationale for the diagnosis. Then, describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed

Discussion:
Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders

Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe treatment that targets the cause rather than the symptom. Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Discussion, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.

Consider the following case study:

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:

Synthroid 100 mcg daily

Nifedipine 30 mg daily

Prednisone 10 mg daily

To prepare:

Review this week’s media presentation on pharmacology for the gastrointestinal system.

Review the provided case study. Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.

Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors such as pregnancy, drugs, or a psychological disorder. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.

Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

With these thoughts in mind:

By Day 3

Post
 an explanation of your diagnosis for the patient including your rationale for the diagnosis. Then, describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

 

Points to follow when writing a paper:

Please all bullets points, bold, red and highlighted area must be attended to.

A clear purpose statement (The purposeof this paper is to…) is required in the introduction of all writings.

Please review all rubrics.

Check APA format/setting.

Please personalized where necessary.

Refrain from direct quote

Class Rules

Avoid public facing sites like university web pages or foundation pages (such as the American Cancer Society or the Alzheimer’s Association) and medical sites designed for consumption by the general public (such as Mayo Clinic or WebMD).

 

you are required to cite scholarly resources including peer-review journals and current practice guidelines
.

May use https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html

Writer must be familiar with nursing pharmacology. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.

Rules for writing (FYI)

Whether writing a discussion posting or a paper, keep a few things in mind—

1) I am looking for an explanation at the cellular or molecular level (whenever possible).

 2) I am not looking for pathophysiological explanations that we would give to patients (e.g. “your heart just isn’t pumping the right way). While this explanation is acceptable for patient teaching, it will not cut it in a course titled “advanced pathophysiology.” To be very specific- I am looking for you to tell me the precise aberrancies (or theorized aberrancies) which inexorably lead to disease states. Thanks. Pharmacotherapy for Gastrointestinal and Hepatobiliary Disorders Essay Assignment paper.

COH 315: Principles of Epidemiology – Final Part 1

Calculations and Interpretations: Answer the following questions in the space provided. Show all of your work.

1. Evidence of an increased risk of lung cancer associated with cigarette smoking was sought by Doll and Hill. In one study, 649 lung cancer cases were matched by age, and gender to 649 controls; 647 of the cases and 622 of the control had a history of smoking cigarettes. COH 315: Principles of Epidemiology.

a. Name the type of study.

b. Create the appropriate 2X2 table for the study. (2 points)

Lung Cancer Controls

Smokers 647 622

Nonsmokers 2 27

Total 649 649

c. Calculate the appropriate measure of association for the study. (4 points)

d. Interpret the results. (2 points)

2. In another study, the smoking habits of 34,445 male physicians were obtained by mailed questionnaires. Deaths among these physicians over the subsequent years were identified though contact with the office of the Registrar General. The death rates from lung cancer of these physicians classified by smoking habits were :

Standardized Death Rates per 1000 Persons Aged 35 or More per Year

Nonsmokers 0.07

ORDER A PLAGIARISM-FREE PAPER HERE

Cigarette Smokers 0.96

a. Name the type of study. (2 points)

b. Calculate the Relative Risk for smokers as compared to nonsmokers. (6 points)

c. Interpret the results (2 points) COH 315: Principles of Epidemiology

Annual Death Rates per 100,000 Persons

Exposure Category Lung Cancer Coronary Heart Disease

Heavy Smokers 166 599

Nonsmokers 7 422

a. Calculate the relative risk from Lung Cancer Mortality for Heavy Smokers compared to non smokers. ( 4 points)

b. Calculate the attributable risk of Lung Cancer from smoking. (4 points)

c. Interpret the results. (2 points)

d. Calculate the percent attributable risk of Coronary Heart Disease due to smoking (4 points)

e. Interpret the results. (2 points)

3. Convert the following incidence rates to attributable risk using the additive model: (5 points)

Incidence Rates Relative Risks

Factor A Factor A

_ + _ +

Factor B – 3.0 9.0

_____________________________________ __________________________________

+ 15.0 21.00

4. Calculate the concordance rate for the following data: (5 points)

Twin 1

Has Leukemia Does Not Have Leukemia

Twin 2 Has Leukemia 14 1

Does Not Have Leukemia 26 36

COH 315: Principles of Epidemiology

Discussion: Digestive Disorders

Many patient symptoms can be tied to multiple disorders, which may lead to misdiagnoses. For instance, consider two digestive disorders of the gastrointestinal tract—inflammatory bowel disease and irritable bowel syndrome. These two disorders are commonly confused because they present similar symptoms. As an advanced practice nurse, you must know the differences to properly diagnose and treat the disorders. Discussion: Digestive Disorders. How does the pathophysiology of inflammatory bowel disease compare to the pathophysiology of irritable bowel syndrome? How do treatments for the two disorders compare?

ORDER A PLAGIARISM-FREE PAPER HERE

To Prepare

· Review Chapter 36 in the Huether and McCance text and Chapter 13 in the McPhee and Hammer text.

· Identify the pathophysiological mechanisms of inflammatory bowel disease and irritable bowel syndrome. Think about similarities and differences between the disorders.

· Consider common treatments for inflammatory bowel disease and irritable bowel syndrome. Reflect on whether treatments for one disorder would work for the other disorder.

· Select one of the following patient factors: genetics, gender, ethnicity, age, or behavior. Reflect on how the factor you selected might impact the pathophysiology of and treatments for each disorder.

write

· An explanation of the pathophysiological mechanisms of inflammatory bowel disorder and irritable bowel syndrome, including similarities and differences. (
I am looking for an explanation at the cellular or molecular level (whenever possible) Discussion: Digestive Disorders.

· Then describe common treatments, addressing whether treatments for one disorder would work for the other disorder.

· Finally, explain how the patient factor you selected might impact the pathophysiology of and treatments for each disorder.

Points to follow when writing a paper Discussion: Digestive Disorders:

· Please all bullets points, bold, red and highlighted area must be attended to.

· A clear purpose statement (The purpose of this paper is to…) is required in the introduction of all writings.

· Please review all rubrics.

· Check APA format/setting.

· Your final paragraph should be a summary of the key points of your paper.

· Please personalized where necessary.

Refrain from direct quote

Class Rules

Avoid public facing sites like university web pages or foundation pages (such as the American Cancer Society or the Alzheimer’s Association) and medical sites designed for consumption by the general public (such as Mayo Clinic or WebMD).

you are required to cite scholarly resources including peer-review journals and current practice guidelines
.

May use https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html

Writer must be familiar with nursing pharmacology Discussion: Digestive Disorders.

Rules for writing (FYI)

Whether writing a discussion posting or a paper, keep a few things in mind—

1) I am looking for an explanation at the cellular or molecular level (whenever possible).

2) I am not looking for pathophysiological explanations that we would give to patients (e.g. “your heart just isn’t pumping the right way). While this explanation is acceptable for patient teaching, it will not cut it in a course titled “advanced pathophysiology.” To be very specific- I am looking for you to tell me the precise aberrancies (or theorized aberrancies) which inexorably lead to disease states Discussion: Digestive Disorders. Thanks.

Urinary Tract Infections Essay Example

Urinary Tract Infections

Urinary tract infections (UTIs) are caused by bacteria—most often 
Escherichia coli
. However, certain viruses, fungi, and parasites can also lead to infection. The infection can affect the lower and upper urinary tract, including the urethra, prostate (in males), bladder, ureter, and kidney. Due to the progression of the disease and human anatomy, symptoms present differently among the sexes as well as among age groups. It is important to understand how these factors, as well as others, impact the pathophysiology of UTIs. Advanced practice nurses must have this foundation in order to properly diagnose patients.

ORDER A PLAGIARISM-FREE PAPER HERE

To Prepare

· Review Chapter 30 in the Huether and McCance text. Identify the pathophysiology of lower and upper urinary tract infections. Consider the similarities and differences between the two types of infections.

· Select two of the following patient factors: genetics, gender, ethnicity, age, or behavior Urinary Tract Infections Essay Example. Reflect on how the factors you selected might impact the pathophysiology of the infections, as well as the diagnosis of and treatment for the infections.

Write

· a description of the pathophysiology of lower and upper urinary tract infections, including their similarities and differences. (
I am looking for an explanation at the cellular or molecular level (whenever possible).

· Then explain how the factors you selected might impact the pathophysiology of the infections, as well as the diagnosis of and treatment for the infections.

Points to follow when writing a paper:

· 
Please all bullets points, bold, red and highlighted area must be attended to.

· A clear purpose statement (The purpose of this paper is to…) is required in the introduction of all writings.

· Please review all rubrics.

· Check APA format/setting.

· Your final paragraph should be a summary of the key points of your Urinary Tract Infections Essay Example paper.

· Please personalized where necessary.

Refrain from direct quote

you are required to cite scholarly resources including peer-review journals and current practice guidelines
.

May use https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html

Rules for writing (FYI)

Whether writing a discussion posting or a paper, keep a few things in mind—

1) I am looking for an explanation at the cellular or molecular level (whenever possible).

2) I am not looking for pathophysiological explanations that we would give to patients (e.g. “your heart just isn’t pumping the right way). While this explanation is acceptable for patient teaching, it will not cut it in a course titled “advanced pathophysiology.” To be very specific- I am looking for you to tell me the precise aberrancies (or theorized aberrancies) which inexorably lead to disease states Urinary Tract Infections Essay Example. Thanks.

Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System

Assessing the Heart, Lungs, and Peripheral Vascular System

Take a moment to observe your breathing. Notice the sensation of your chest expanding as air flows into your lungs. Feel your chest contract as you exhale. How might this experience be different for someone with chronic lung disease or someone experiencing an asthma attack?

In order to adequately assess the chest region of a patient, nurses need to be aware of a patient’s history, potential abnormal findings, and what physical exams and diagnostic tests should be conducted to determine the causes and severity of abnormalities.

ORDER A PLAGIARISM-FREE PAPER HERE

In this Discussion, you will consider how a patient’s initial symptoms can result in very different diagnoses when further assessment is conducted. Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System.

Note:
 By 
Day 1
 of this week, your Instructor will have assigned you to one of the video case studies in this week’s Learning Resources titled 
Advanced health assessment and diagnostic reasoning
. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance. 
Remember that not all comprehensive SOAP data are included in every patient case.

To prepare:

With regard to the case study you were assigned:

·        Review this week’s Learning Resources and consider the insights they provide.

·        Consider what history would be necessary to collect from the patient.

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

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

Note:
 Before you submit your initial post, replace the subject line (“Discussion – Week 6”) with “Review of Case Study” identifying the number of the case study you were assigned. Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System.

Post a 1 page APA
SOAP Note format

1.      a description of the health history you would need to collect from the patient in the case study you were assigned (
See attached case study below
)

2.      Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis.

3.      List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

Readings

·        Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). 
Seidel’s guide to physical examination
 (8th ed.). St. Louis, MO: Elsevier Mosby.

o   Chapter 13, “Chest and Lungs” (pp. 260-293)

This chapter explains the physical exam process for the chest and lungs. The authors also include descriptions of common abnormalities in the chest and lungs.

o   Chapter 14, “Heart” (pp. 294-331)

The authors of this chapter explain the structure and function of the heart. The text also describes the steps used to conduct an exam of the heart.

o   Chapter 15, “Blood Vessels” (pp. 332-349)

This chapter describes how to properly conduct a physical examination of the blood vessels. The chapter also supplies descriptions of common heart disorders.

·        Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). 
Advanced health assessment and clinical diagnosis in primary care 
(5th ed.). St. Louis, MO: Elsevier Mosby.

o   Chapter 8, “Chest Pain” (pp. 81–96)

This chapter focuses on diagnosing the cause of chest pain and highlights the importance of first determining whether the patient is in a life-threatening condition. It includes questions that can help pinpoint the type and severity of pain and then describes how to perform a physical examination. Finally, the authors outline potential laboratory and diagnostic studies.

o   Chapter 11, “Cough” (pp. 118-147)

A cough is a very common symptom in patients and usually indicates a minor health problem. This chapter focuses on how to determine the cause of the cough through asking questions and performing a physical exam.

o   Chapter 14, “Dyspnea” (pp. 159–173)

The focus of this chapter is dyspnea, or shortness of breath. The chapter includes strategies for determining the cause of the problem through evaluation of the patient’s history, through physical examination, and through additional laboratory and diagnostic tests.

o   Chapter 26, “Palpitations” (pp. 310-317)

This chapter describes the different causes of heart palpitations and details how the specific cause in a patient can be determined.

o   Chapter 33, “Syncope” (pp. 390-397)

This chapter focuses on syncope, or loss of consciousness. The authors describe the difficulty of ascertaining the cause, because the patient is usually seen after the loss of consciousness has happened. The chapter includes information on potential causes and the symptoms of each. Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System.

·        Sullivan , D. D. (2012). 
Guide to clinical documentation
 (2nd ed.). Philadelphia, PA: F. A. Davis.

o   Chapter 6, “Outpatient Charting and Communications” (pp. 119–141)

Note:
 Download these Adult Examination Checklists and Physical Exam Summaries to use during your practice cardiac and respiratory examination.

·        Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). 
Physical exam summary: Blood vessels
. In 
Mosby’s guide to physical examination 
(7th ed.). St. Louis, MO: Elsevier Mosby.

This Blood Vessels Physical Exam Summary was published as a companion to 
Seidel’s guide to physical examination
 (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

·        Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). 
Adult examination checklist: Guide for cardiovascular assessment
. In 
Mosby’s guide to physical examination
(7th ed.). St. Louis, MO: Elsevier Mosby.

This Adult Examination Checklist: Guide for Cardiovascular Assessment was published as a companion to 
Seidel’s guide to physical examination
 (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

·        Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). 
Adult examination checklist: Guide for chest and lung assessment
. In 
Mosby’s guide to physical examination 
(7th ed.). St. Louis, MO: Elsevier Mosby.

This Adult Examination Checklist: Guide for Chest and Lung Assessment was published as a companion to 
Seidel’s guide to physical examination
 (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/ Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System.

·        Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). 
Physical exam summary: Chest and lungs
. In 
Mosby’s guide to physical examination 
(7th ed.). St. Louis, MO: Elsevier Mosby.

This Chest and Lungs Physical Exam Summary was published as a companion to 
Seidel’s guide to physical examination
 (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

·        Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). 
Physical exam summary: Heart.
 In 
Mosby’s guide to physical examination 
(7th ed.). St. Louis, MO: Elsevier Mosby.

This Heart Physical Exam Summary was published as a companion to 
Seidel’s guide to physical examination
 (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

·        McCabe, C., & Wiggins, J. (2010a). Differential diagnosis of respiratory disease part 1. 
Practice Nurse
,
40
(1), 35–41.

Retrieved from the Walden Library databases.

This article describes the warning signs of impending deterioration of the respiratory system. The authors also explain the features of common respiratory conditions.

·        McCabe, C., & Wiggins, J. (2010b). Differential diagnosis of respiratory diseases part 2. 
Practice Nurse
, 
40
(2), 33–41.

Retrieved from the Walden Library databases. Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System.

The authors of this article specify how to identify the major causes of acute breathlessness. Additionally, they explain how to interpret a variety of findings from respiratory investigations.

·        SkillStat Learning, Inc. (2014). 
The 6 second ECG
. Retrieved from 
http://www.skillstat.com/tools/ecg-simulator#/-home

This interactive website allows you to explore common cardiac rhythms. It also offers the Six Second ECG game so you can practice identifying rhythms.

·        University of Virginia. (n.d.). 
Introduction to radiology: An online interactive tutorial
. Retrieved from
http://www.med-ed.virginia.edu/courses/rad/index.html

This website provides an introduction to radiology and imaging. For this week, focus on cardiac radiography and chest radiology.

Media

·        Laureate Education. (Producer). (2012). 
Advanced health assessment and diagnostic reasoning
. Baltimore, MD: Author. Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System.

 

Exam Results

Exam Results: Scenario 2

Vital signs:

Temperature: 97.9 oral

Respiratory rate: 32, labored

Heart rate: 112, tachycardic

BP right arm: 148/88

Oxygen saturation: 90% on room air

Weight: 210 lbs, stable

Skin: Cool, diaphoretic

Thorax and lungs: Thorax symmetrical; diminished breath sounds right middle and lower lobes; no rales, rhonchi, or wheezes; breath sounds vesicular with no adventitious sounds left lung

Cardiovascular: Heart rate is irregular with good S1, S2; no S3 or S4; no murmur

Abdomen: Protuberant with normoactive bowel sounds auscultated x4 quadrants Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System

Peripheral vascular: Right calf with 2+ edema, erythema; warmth and tenderness on palpation noted; left lower extremity without edema or erythema; 2+ dorsalis pedis pulses bilaterally

Neurologic: Anxious; awake, alert, and oriented to person, place, and time Nurs 6512 Health Assessment Discussion Wk 6 – Assessing the Heart, Lungs, and Peripheral Vascular System.

Disorders of the Veins and Arteries Essay Assignment Paper – NURS 6501: Advanced Pathophysiology

Disorders of the Veins and Arteries

Part of the roles of a nurse practitioner is to diagnose and treat illnesses that creates imbalances in the body. Blood clots and altered circulation are factors that can affect the venous system. The biological and physical manifestation of the arteries and veins will be expounded. will be expounded. Arterial thrombosis and venous thrombosis will be discussed at length and their dissimilarities will be outlined. Two mind maps will be attached to this assignment at the end of this paper per the instructor on CVI and DVT.

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Deep Venous Thrombosis (DVT)

According to Douketis (2017), DVT occurs when there is a formation of clot in the deep vein of the body’s extremity and it is dislodges from the wall of the blood vessel. The triad of Virchow is made up of factors that are responsible for DVT. These three factors are responsible or advances DVT and they are hypercoagulability, endothelial injury and abnormal blood flow (Laureate Education, 2012). According to Heuther and McCance (2017), DVT can develop from trauma, pregnancy or spinal injury. Disorders of the Veins and Arteries Essay Assignment Paper – NURS 6501: Advanced Pathophysiology. DVTs are known to develop near the venous valve and also from the buildup of clotting materials in the blood such as thrombin, fibrin and platelets (Douketis, 2017). Homan’s sign can be a sign of DVT and this is when there is pain behind the knee when there is a forced dorsiflexion. To prevent DVT after surgery ambulation (early) is encouraged; anticoagulants are used and compression devices are applied on patients legs to keep blood flowing (Heuther & McCance, 2017). According to  Heuther and McCance (2017), diagnostic instrument like Doppler ultrasonography and lab test such as d-Dimer are used to detect and confirm DVTs after the clinician suspects one.

Chronic Venous Insufficiency (CVT)

The main cause of CVT is the disruption in the competence of superficial venous system but can also develop due to the incompetence of the valves, and sometimes both case can lead to CVI (Weiss, & Izaguirre-Anaribe, 2017). The absence of valves (Congenital) could lead to CVI. The risk for developing CVI is high for an individual who regularly stands for long period of time, wears tight clotting or crosses their legs constantly (Heuther & McCance, 2017). An individual with CVI will present symptoms such as swelling of leg, pain that worsens with standing and improves when leg is raised, varicose veins and restless legs (Weiss, & Izaguirre-Anaribe, 2017). Duplex sonography and d-dimer are used to diagnose and confirm CVI after physical examination.

Dissimilarities between Arterial Thrombosis and Venous Thrombosis

In the case of arterial thrombosis the obstruction of blood flow leads to the side effects and arterial thrombosis can affect various areas of the body while venous thrombosis occurs in the lower extremity. When there is restriction in the flow of blood from the coronary artery to the muscles of the heart it will result to a heart attack and this is linked to arterial thrombosis (NHS Choices, 2017). According to Weinberg (2017) crossed embolism which is known as paradoxical embolism occurs when a clot carried by the venous circulation crosses over or travels to the arterial side and vice-versa. Disorders of the Veins and Arteries Essay Assignment Paper – NURS 6501: Advanced Pathophysiology.

The Role of Gender in DVT and CVI

Research has not proven any direct link to DVT and gender but the use of oral contraceptives and hormone replacement therapy in women is known to cause hypercoagulability which is part of the triad (Huether & McCance, 2017). CVI occurs in women more than men and varicose is the main culprit of CVI in women and women tend to put on tight clothings also (Huether & McCance, 2017).

Summary

The pathophysiology of DVT and CVI has been discussed in the paper and the characteristics of venous and arterial thrombosis. The role of gender in CVI and DVT with regards to females being more susceptible to CVI than males was explained. Diagnosis and treatment of DVT and CVI were also presented in this paper. The next step will be to attach the mind maps of both DVT and CVI.

DVT and CVI Mind Maps

References

 

Arterial thrombosis – NHS Choices
. (2017).  Retrieved 26 March 2017, from

http://www.nhs.uk/conditions/arterial-thrombosis/Pages/Introduction.aspx

Douketis, MD, J. (2017).
Deep Venous Thrombosis (DVT) – Cardiovascular Disorders – MSD

Manual Professional Edition
.
MSD Manual Professional Edition
. Retrieved 26 March

2017, from
http://www.merckmanuals.com/professional/cardiovascular-

disorders/peripheral-venous-disorders/deep-venous-thrombosis-dvt#v941044

Huether, S. E., & McCance, K. L. (2017). 
Understanding Pathophysiology, 6e (Huether,

 
understanding Pathophysiology)
 (6th ed.). Philadelphia, PA, United States: Elsevier Disorders of the Veins and Arteries Essay Assignment Paper – NURS 6501: Advanced Pathophysiology

 

Health Sciences.

 

Laureate Education, Inc. (Executive Producer). (2012a). 
Alterations of cardiovascular functions

 

PPT lecture
. Baltimore, MD: Author.

 

Weinberg, I. (2017).
Arterial and Venous Thrombosis | Angiologist
.
Angiologist.com
. Retrieved

 

25 March 2017, from
http://www.angiologist.com/thrombosis-section/arterial-and-

 

venous-thrombosis/ Disorders of the Veins and Arteries Essay Assignment Paper – NURS 6501: Advanced Pathophysiology

Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions

Question 1

1 out of 1 points

Underestimation of blood pressure will occur if the blood pressure cuff’s width covers:

Question 2

1 out of 1 points

Mrs. Hartzell is a 34-year-old patient who has presented for nutritional counseling because she is a vegetarian. Deficiency of which of the following is a concern in the vegetarian diet? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions

Question 3

1 out of 1 points

The most superior part of the stomach is the:

Question 4

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1 out of 1 points

When recording physical findings, which data are recorded first for all systems?

Question 5

1 out of 1 points

Mr. Kevin Marks is a new health care provider. What is the best method to develop cultural competence?

Question 6

1 out of 1 points

To perform the Rinne test, place the tuning fork on the:

Question 7

1 out of 1 points

When are open-ended questions generally most useful?

Question 8

0 out of 1 points

The review of systems is a component of the:

Question 9

1 out of 1 points

Fluorescing lesions are best distinguished using a(n):

Question 10

1 out of 1 points

Pigmented, raised, warty lesions over the face and trunk should be assessed by an experienced practitioner who can distinguish: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.

Question 11

1 out of 1 points

Mr. Franklin is speaking with you, the health care provider, about his respiratory problem. Mr. Franklin says, “I’ve had this cough for 3 days, and it’s getting worse.” You reply, “Tell me more about your cough.” Mr. Franklin states, “I wish I could tell you more. That’s why I’m here. You tell me what’s wrong!” Which caregiver response would be most appropriate for enhancing communication? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.

Question 12

1 out of 1 points

The term denoting the caregiver’s need to do no harm to the patient is:

Question 13

0 out of 1 points

Recommended carbohydrate content of total dietary intake (% total calories) is ____%.

Question 14

1 out of 1 points

Mr. Abdul is a 40-year-old Middle Eastern man who presents to the office for a first visit with the complaint of new abdominal pain. You are concerned about violating a cultural prohibition when you prepare to do his rectal examination. The best tactic would be to:

Question 15

1 out of 1 points

Your patient is complaining of acute, intense sharp epigastric pain that radiates to the back and left scapula with nausea and vomiting. Based on this history, your prioritized physical examination should be to: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.

Question 16

1 out of 1 points

When examining the skull of a 4-month-old baby, you should normally find:

Question 17

1 out of 1 points

Ms. G. is being seen for her routine physical examination. She is a college graduate and president of a research firm. Although her exact salary is unknown, she has adequate health insurance. Most of the above information is part of Ms. G.’s _____ history.

Question 18

1 out of 1 points

During an interview, tears appear in the patient’s eyes and his voice becomes shaky. Initially, you should:

Question 19

1 out of 1 points

Before performing an abdominal examination, the examiner should:

Question 20

1 out of 1 points

The adult recommended dietary fat intake should be _____ g/day.

Question 21

1 out of 1 points

Nuchal rigidity is most commonly associated with:

Question 22

1 out of 1 points

A serous membrane that lines the abdominal cavity and forms a protective cover for many abdominal structures is the:

Question 23

1 out of 1 points

A flat, nonpalpable lesion is described as a macule if the diameter is:

Question 24

1 out of 1 points

Bulging of an amber tympanic membrane without mobility is most often associated with:

Question 25

1 out of 1 points

The position on a clock, topographic notations, and anatomic landmarks:

Question 26

1 out of 1 points

When assessing abdominal pain in a college-age woman, one must include:

Question 27

1 out of 1 points

The infant should be placed in which position to have his or her height or length measured? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.

Question 28

1 out of 1 points

A fixed image of any group that rejects its potential for originality or individuality is known as a(n):

Question 29

1 out of 1 points

Sweat glands, hair, and nails are all formed from:

Question 30

1 out of 1 points

Mr. Walters, a 32-year-old patient, tells you that his ears are “stopped up.” An objective assessment of this complaint is achieved by using the:

Question 31

1 out of 1 points

Ms. Davis is a 27-year-old patient with a BMI of 33. Based on her BMI, your diagnosis would be:

Question 32

1 out of 1 points

Tracheal tug suggests the presence of a(n):

Question 33

1 out of 1 points

Mr. Black is a 44-year-old patient who presents to the clinic with complaints of neck pain that he thinks is from his job involving computer data entry. As the examiner, you are checking the range of motion in his neck and note the greatest degree of cervical mobility is at: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.

Question 34

1 out of 1 points

The most common form of birth trauma of the scalp is:

Question 35

1 out of 1 points

Which question would be considered a leading question?

Question 36

1 out of 1 points

A brief statement of the reason the patient is seeking health care is called the:

Question 37

1 out of 1 points

Your patient is complaining of acute, intense sharp epigastric pain that radiates to the back and left scapula with nausea and vomiting. Based on this history, your prioritized physical examination should be to:

Question 38

1 out of 1 points

A tool used to screen adolescents for alcoholism is the:

Question 39

1 out of 1 points

Expected hair distribution changes in older adults include:

Question 40

1 out of 1 points

Mr. Johnson presents with a freely movable cystic mass in the midline of the high neck region at the base of the tongue. This is most likely a: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.

Question 41

1 out of 1 points

When hearing is evaluated, which cranial nerve is being tested?

Question 42

1 out of 1 points

Mrs. Grace is a 58-year-old patient who has a diagnosis of pernicious anemia. Which B vitamin is deficient in patients with pernicious anemia?

Question 43

1 out of 1 points

Mr. Marks is a 66-year-old patient who presents for a physical examination to the clinic. Which question has the most potential for exploring a patient’s cultural beliefs related to a health problem?

Question 44

1 out of 1 points

You are examining a pregnant patient and have noted a vascular lesion. When you blanche over the vascular lesion, the site blanches and refills evenly from the center outward. The nurse documents this lesion as a:

Question 45

1 out of 1 points

A blood pressure cuff bladder should be long enough to:

Question 46

1 out of 1 points

A college student comes to the student health center complaining of difficulty in concentrating during class and while studying. The diet that would contribute to this problem is one that consumes mostly:

Question 47

1 out of 1 points

After thorough inspection of the abdomen, the next assessment step is:

Question 48

1 out of 1 points

Mr. Mathews is a 47-year-old patient who presents for a routine physical examination. On examination, you have noted a bruit heard over the thyroid. This is suggestive of:

Question 49

1 out of 1 points

During percussion, a dull tone is expected to be heard over:

Question 50

1 out of 1 points

Which of the following occurs when firm pressure is used to apply the stethoscope’s bell end-piece to the skin?

Question 51

1 out of 1 points

When communicating with older children and teenagers, you should be sensitive to their:

Question 52

1 out of 1 points

To approximate vocal frequencies, which tuning fork should be used to assess hearing?

Question 53

1 out of 1 points

You are palpating a patient’s thyroid and find that its broadest dimension measures 4 cm. The right lobe is 25% larger than the left. These data would indicate:

Question 54

1 out of 1 points

When you are questioning a patient regarding alcohol intake, she tells you that she is only a social drinker. Which initial response is appropriate?

Question 55

1 out of 1 points

Expected normal percussion tones include:

Question 56

1 out of 1 points

Subjective and symptomatic data are:

Question 57

1 out of 1 points

You are collecting a history from an 11-year-old girl. Her mother is sitting next to her in the examination room. When collecting history from older children or adolescents, they should be: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.

Question 58

1 out of 1 points

Which technique is most likely to result in the patient’s understanding of questions?

Question 59

1 out of 1 points

Mr. and Mrs. Johnson have presented to the office with their infant son with complaints of ear drainage. When examining an infant’s middle ear, the nurse should use one hand to stabilize the otoscope against the head while using the other hand to:

Question 60

1 out of 1 points

Unusual white areas on the skin may be due to:

Question 61

1 out of 1 points

George Michaels, a 22-year-old patient, tells the nurse that he is here today to “check his allergies.” He has been having “green nasal discharge” for the last 72 hours. How would the nurse document his reason for seeking care? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.

Question 62

0 out of 1 points

To correctly document absent bowel sounds, one must listen continuously for:

Question 63

1 out of 1 points

Which of the following formats would be used for visits that address problems not yet identified in the problem-oriented medical record (POMR)?

Question 64

1 out of 1 points

Which type of speculum should be used to examine a patient’s tympanic membrane?

Question 65

1 out of 1 points

Ms. Jones is a 31-year-old female patient who presents for a routine physical examination. Which examination technique will be used first?

Question 66

1 out of 1 points

In counseling a client regarding nutrition education, you explain that linoleic acid, a major fatty acid, is thought to be essential for:

Question 67

1 out of 1 points

Mr. D. complains of a headache. During the history, he mentions his use of alcohol and illicit drugs. This information would most likely belong in the:

Question 68

0 out of 1 points

Peritonitis produces bowel sounds that are:

Question 69

1 out of 1 points

The recommended minimum daily protein requirement for the normal adult is ______.

Question 70

1 out of 1 points

As part of your health promotion education for a new patient, you explain that the risk factors for skin cancer include:

Question 71

1 out of 1 points

Which is the best way to position a patient’s neck for palpation of the thyroid? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.

Question 72

1 out of 1 points

When taking a history, you should:

Question 73

1 out of 1 points

Ms. Otten is a 45-year-old patient who presents with a complaint of weight gain. Which medication is frequently associated with weight gain?

Question 74

1 out of 1 points

Which of the following is an expected change in the assessment of the thyroid during pregnancy?

Question 75

1 out of 1 points

Brittle nails are typical findings in:

Question 76

1 out of 1 points

Regardless of the origin, discharge is described by noting:

Question 77

1 out of 1 points

Nasal symptoms that imply an allergic response include:

Question 78

1 out of 1 points

Mrs. Britton brings her 16-year-old son in with a complaint that he is not developing correctly into adolescence. Which structures disproportionately enlarge in the male during adolescence?

Question 79

1 out of 1 points

Mr. Mills is a 55-year-old patient who presents to the office for an initial visit for health promotion. A survey of mobility and activities of daily living (ADLs) is part of a(an):

Question 80

1 out of 1 points

Tangential lighting is best used for inspecting skin:

Question 81

1 out of 1 points

A 5-year-old child presents with nasal congestion and a headache. To assess for sinus tenderness you should palpate over the:

Question 82

1 out of 1 points

Tuning forks with a frequency of 500 to 1000 Hz are most commonly used to measure:

Question 83

1 out of 1 points

Which statement is true regarding the relationship of physical characteristics and culture?

Question 84

1 out of 1 points

A guideline for history taking is for caregivers to:

Question 85

1 out of 1 points

A 17-year-old girl presents to the clinic for a sports physical. Physical examination findings reveal bradycardia, multiple erosions of tooth enamel, and scars on her knuckles. She appears healthy otherwise. You should ask her if she: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.

Question 86

1 out of 1 points

During an interview, you have the impression that a patient may be considering suicide. Which action is essential?

Question 87

1 out of 1 points

Mrs. Leonard brings her newborn infant into the pediatrician’s office for a first well-baby visit. As the health care provider, you teach her that newborns are more vulnerable to hypothermia due to:

Question 88

1 out of 1 points

Your patient returns for a blood pressure check 2 weeks after a visit during which you performed a complete history and physical. This visit would be documented by creating a(n):

Question 89

1 out of 1 points

You are planning to palpate the abdomen of your patient. Which part of the examiner’s hand is best for palpating vibration?

Question 90

1 out of 1 points

In examining the neck of a 34-year-old female patient, you note that the uppermost ridge of the tracheal cartilage is at the: Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.

Question 91

1 out of 1 points

You are using an ophthalmoscope to examine a patient’s inner eye. You rotate the lens selector clockwise, then counterclockwise to compensate for:

Question 92

1 out of 1 points

Your patient presents with symptoms that lead you to suspect acute appendicitis. Which assessment finding is least likely to be associated with this condition early in its course?

Question 93

1 out of 1 points

Under normal circumstances, how much water is lost daily by the body?

Question 94

0 out of 1 points

Tympanic thermometers measure body temperature when a probe is placed:

Question 95

1 out of 1 points

Which cranial nerves innervate the face?

Question 96

1 out of 1 points

Which of the following is an “ABCD” characteristic of malignant melanoma?

Question 97

1 out of 1 points

Mrs. Tuber is a 36-year-old patient who comes into the health center with complaints that her fingernails are not growing. Which structure is the site of new nail growth?

Question 98

1 out of 1 points

Which of the following is the most accurate reflection of an individual’s food intake?

Question 99

1 out of 1 points

A 51-year-old woman calls with complaints of weight loss and constipation. She reports enlarged hemorrhoids and rectal bleeding. You advise her to:

Question 100

1 out of 1 points

White, rounded, or oval ulcerations surrounded by a red halo and found on the oral mucosa are:

Question 101

0 out of 0 points

When completing this exam, did you comply with Walden University’s Code of Conduct including the expectations for academic integrity? Study Guide – NURS 6512 Advanced Health Assessment Midterm Exam Questions.