Tag: Clinical-Nursing

Assignment 1: Assessing The Genitalia And Rectum

Patients are frequently uncomfortable discussing with health care professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

In this assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

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In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. Assignment 1: Assessing The Genitalia And Rectum

GENITALIA ASSESSMENT

Subjective:

CC: “I have bumps on my bottom that I want to have checked out.”

HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed. Assignment 1: Assessing The Genitalia And Rectum.

PMH: Asthma

Medications: Symbicort 160/4.5mcg

Allergies: NKDA

FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

Heart: RRR, no murmurs

Lungs: CTA, chest wall symmetrical

Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

Diagnostics: HSV specimen obtained

Assessment:

Chancre

PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses. Assignment 1: Assessing The Genitalia And Rectum

To prepare:

With regard to the SOAP note case study provided:

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

Consider what history would be necessary to collect from the patient in the case study.

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

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

To complete:

Refer to Chapter 5 of the Sullivan text. Analyze the SOAP note case study.  Using evidence based resources, answer the following questions and support your answers using current evidence from the literature.

Analyze the subjective portion of the note. List additional information that should be included in the documentation.

Analyze the objective portion of the note. List additional information that should be included in the documentation.

Is the assessment supported by the subjective and objective information? Why or Why not?

Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis?

Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Assignment 1: Assessing The Genitalia And Rectum. Explain your reasoning using at least 3 different references from current evidence based literature.

CALSS RESOURCES

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

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.

Chapter 16, “Breasts and Axillae” (pp. 350-369)

This chapter focuses on examining the breasts and axillae. The authors describe the examination procedures and the anatomy and physiology of breasts.

Chapter 18, “Female Genitalia” (pp. 416-465)

In this chapter, the authors explain how to conduct an examination of female genitalia. The chapter also describes the form and function of female genitalia Assignment 1: Assessing The Genitalia And Rectum.

Chapter 19, “Male Genitalia” (pp. 466-484)

The authors explain the biology of the penis, testicles, epididymides, scrotum, prostate gland, and seminal vesicles. Additionally, the chapter explains how to perform an exam of these areas.

Chapter 20, “Anus, Rectum, and Prostate” (pp. 485-500)

This chapter focuses on performing an exam of the anus, rectum, and prostate. The authors also explain the anatomy and physiology of the anus, rectum, and prostate.

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.

Chapter 5, “Amenorrhea” (pp. 47-60)

Amenorrhea, or the absence of menstruation, is the focus of this chapter. The authors include key questions to ask patients when taking histories and explain what to look for in the physical exam.

Chapter 6, “Breast Lumps and Nipple Discharge” (pp. 61-72)

This chapter focuses on the important topic of breast lumps and nipple discharge. Because breast cancer is the most common type of cancer in women, it is important to get an accurate diagnosis. Information in the chapter includes key questions to ask and what to look for in the physical exam Assignment 1: Assessing The Genitalia And Rectum.

Chapter 7, “Breast Pain” (pp. 73-80)

Determining the cause of breast pain can be difficult. This chapter examines how to determine the likely cause of the pain through diagnostic tests, physical examination, and careful analysis of a patient’s health history.

Chapter 27, “Penile Discharge” (pp. 318-324)

The focus of this chapter is on how to diagnose the causes of penile discharge. The authors include specific questions to ask when gathering a patient’s history to narrow down the likely diagnosis. They also give advice on performing a focused physical exam.

Chapter 36, “Vaginal Bleeding” (pp. 419-433)

In this chapter, the causes of vaginal bleeding are explored. The authors focus on symptoms outside the regular menstrual cycle. The authors discuss key questions to ask the patient, as well as specific physical examination procedures and laboratory studies that may be useful in reaching a diagnosis.

Chapter 37, “Vaginal Discharge and Itching” (pp. 434-445)

This chapter examines the process of identifying causes of vaginal discharge and itching. The authors include questions on the characteristics of the discharge, the possibility of the issues being the result of a sexually transmitted infection, and how often the discharge occurs. A chart highlights potential diagnoses based on patient history, physical findings, and diagnostic studies. Assignment 1: Assessing The Genitalia And Rectum.

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

Chapter 3, “Adult Preventative Care Visits” (“Gender Specific Screenings”; pp. 48–49)
Note:
Download the Physical Examination Objective Data Checklist to use as you complete the Head-to-Toe Physical Assessment Video assignment.

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

This Physical Examination Objective Data Checklist 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/

Cucci, E. Santoro, A., DiGesu, C., DiCerce, R., & Sallustio, G. (2015). Sclerosing adenosis of the breast: Report of two cases and review of the literature. Polish Journal of Radiology, 80, 122–127. doi:10.12659/PJR.892706. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356184/ 

Sabbagh, C., Mauvis, F., Vecten, A., Ainseba, N., Cosse, C., Diouf, M., & Regimbeau, J. M. (2014). What is the best position for analyzing the lower and middle rectum and sphincter function in a digital rectal examination? A randomized, controlled study in men. Digestive and Liver Disease, 46(12), 1082–1085. doi:10.1016/j.dld.2014.08.045

Retrieved from the Walden Library Databases. Assignment 1: Assessing The Genitalia And Rectum

Westhoff, C. L., Jones, H. E., & Guiahi, M. (2011). Do new guidelines and technology make the routine pelvic examination obsolete?
Journal of Women’s Health, 20
(1), 5–10.

Retrieved from the Walden Library databases.

This article describes the benefits of new technology and guidelines for pelvic exams. The authors also detail which guidelines and technology may become obsolete.

Centers for Disease Control and Prevention. (2012).
Sexually transmitted diseases (STDs)
. Retrieved from http://www.cdc.gov/std/#

This section of the CDC website provides a range of information on sexually transmitted diseases (STDs). The website includes reports on STDs, related projects and initiatives, treatment information, and program tools.

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 genitourinary radiology, as well as the cross-sectional female pelvis and the cross-sectional male pelvis in abdominal radiology.

Required Media

Online media for
Seidel’s Guide to Physical Examination

It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 16 and 18–20 that relate to special examinations, including breast, genital, prostate, and rectal. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/.

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014).
DeGowin’s diagnostic examination
(10th ed.). New York, NY: McGraw Hill Medical.

Chapter 8, “The Chest: Chest Wall, Pulmonary, and Cardiovascular Systems; The Breasts” (Section 2, “The Breasts,” pp. 434–444)

Section 2 of this chapter focuses on the anatomy and physiology of breasts. The section provides descriptions of breast examinations and common breast conditions. Assignment 1: Assessing The Genitalia And Rectum

Chapter 11, “The Female Genitalia and Reproductive System” (pp. 541–562)

In this chapter, the authors provide an overview of the female reproductive system. The authors also describe symptoms of disorders in the reproductive system.

Chapter 12, “The Male Genitalia and Reproductive System” (pp. 563–584)

The authors of this chapter detail the anatomy of the male reproductive system. Additionally, the authors describe how to conduct an exam of the male reproductive system.

Review of Chapter 9, “The Abdomen, Perineum, Anus, and Rectosigmoid” (pp. 445–527) Assignment 1: Assessing The Genitalia And Rectum

The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

Introduction

In the Prospectus, Proposal, and Direct Practice Improvement Project there are
10 key or strategic points
that need to be
clear, simple, correct, and aligned
to ensure the project is
doable, valuable, and credible
. These points, which provide a guide or vision for the project, are present in almost any research. They are defined within “The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project” (10 Strategic Points) document.

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The ten strategic points are developed in table format.

The 10 Strategic Points

The 10 strategic points emerge from researching literature on a topic that is based on, or aligned with, the defined need in the literature as well as the learner’s personal passion, future career purpose, and degree area. The 10 Strategic Points document
includes
the following 10 key or strategic points that define the project focus and approach: The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project.

Topic (10%)
– Provides a broad project topic area/title.

Literature Review (15%)
– Lists primary points for four sections in the Literature Review:

Background of the problem/gap and the need for the project based on citations from the literature.

Theoretical foundations (models and theories to be foundation for project).

Review of literature topics with key theme for each one.

Summary.

Problem Statement (10%)
– Describes the problem to address through the project based on defined needs or gaps in practice from the literature.

Sample and Location (10%)
– Identifies sample, needed sample size, and location.

Clinical/PICOT Questions (10%)
– Provides clinical/PICOT questions to collect data to address the problem statement. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project.

Variables (5%)
– Identifies and describes independent and dependent variables.

Methodology and Design

(10%)
– Describes the selected methodology and specific project design to address problem statement and clinical questions

Purpose Statement (10%)
– Provides one sentence statement of purpose including the problem statement, methodology, design, population sample, and location.

Data Collection (10%)
– Describes primary instruments to answer clinical questions.

Data Analysis

(10%)
– Describes the specific data analysis approaches to be used to address clinical/PICOT questions.

The Process for Defining the 10 Strategic Points

The order of the 10 strategic points listed above reflects the order in which the learner completes the work product. The first five strategic points focus primarily on defining the focus for the project based on a clearly defined need or gap from the literature as well as the learner’s passion, purpose, and specialty area focus. First, learners identify a broad topic area to investigate for their Direct Practice Improvement (DPI) Project based on a clearly defined need or gap from the literature or practice problem, and one in which they are interested based on personal passion, future career purpose, and degree being pursued. Second, learners complete a review of the literature to define the need or gap to be addressed, the theories and models that will provide a foundation for the project, related topics that are needed to demonstrate the learner’s expertise in the field, and to define the key strategic points behind the learner’s proposed research. Third, the learners develop a clear, simple, one-sentence problem statement that defines the problem or gap that will be addressed by the DPI project. Fourth, learners identify potential population samples for which they would have access in order to collect the data for the project, considering the fact the quantitative study sample sizes need to be much larger than those for qualitative studies. Fifth, learners develop the clinical/PICOT question(s) that will define the data needed to address the problem statement. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project.

Based on the first five strategic points above, learners next define the key aspects of the project methodology through the last five strategic points. The sixth point describes the independent and dependent variables. Seventh, learners determine if the project will be a qualitative, quantitative or mixed methodology. Due to the nature of the DPI project requirements, most projects will be utilizing a quantitative method because learners are not creating new research in a qualitative study. Qualitative projects often do not facilitate the intervention needed to demonstrate direct practice improvement. Please note that if you choose a qualitative project, you are still responsible for ensuring practice improvement is demonstrated through your work. Additionally, learners must be able to perform both qualitative and quantitative data analysis. A qualitative project with numbers or descriptive statistics does not mean it is mixed method study. Qualitative data can be displayed using tables, charts, graphs and descriptive statistics. Following are samples for a quantitative project and a qualitative project. A mixed method project, which includes quantitative and qualitative methods, takes much more time and many more resources to complete and
is not recommended
unless learners have a significant amount of extra time and resources to complete it. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project.

For the eighth strategic point, learners develop a purpose statement by integrating the problem statement, methodology, design, sample, and location. Ninth, learners identify the data they will need to collect to address the clinical questions or hypotheses and how they will collect the data (e.g., interviews, focus groups, observations, tested and validated instruments or surveys, databases, public media, etc.). Tenth and last, learners identify the appropriate data analysis, based on their project design, which will be used to answer the clinical questions and address the problem statement.

Criteria for Evaluating the 10 Strategic Points: Clear, Simple, Correct, and Aligned

When developing a project, it is important to define the 10 strategic points so they are
simple
,
clear
, and
correct
in order to ensure that anyone who reviews them will easily understand them. It is important to
align
all of the 10 strategic points to ensure it will be possible to conduct and complete the project. The problem statement must come out of the literature or practice problem. The clinical questions must collect the data needed to answer the problem statement. The methodology and design must be appropriate for the problem statement and PICOT questions. The data collection and data analysis must provide the information to answer the PICOT questions.

Developing the 10 Strategic Points document as a two- or three-page document can help ensure clarity, simplicity, correctness, and alignment of each of these 10 key or strategic points in the prospectus, proposal, and Direct Practice Improvement Project. Developing these 10 strategic points in this format also provides an easy-to-use use template to ensure the 10 strategic points will always be worded the same throughout the prospectus, proposal, and Direct Practice Improvement Project. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project.

Value of the 10 Strategic Points Document

The 10 Strategic Points document can be used for communicating and aligning key stakeholders for the Direct Practice Improvement Project. This document can be used to obtain agreement between the learner and the chair regarding the initial focus and approach for the project. The document can be used to review the proposed project with the people or organizations from whom learners need to gain permission to conduct their research, a critical step required before learners can develop their proposal. The document also proves useful for communicating the Direct Practice Improvement Project focus when attracting a Content Expert, as well as for reviewing the proposal with the Direct Practice Improvement Project committee and the AQR reviewers. Learners may choose to consult methodologists, statisticians, and editors in the process of developing the final manuscript.

Examples of the 10 Strategic Points Document

It is important that the 10 strategic points are clear, concise, doable, and aligned throughout the prospectus, proposal, and Direct Practice Improvement Project. Provided below is an example of a completed 10 Strategic Points document for a quantitative project. A blank 10 Strategic Points Table template is provided following the example for learners to use when developing their own 10 Strategic Point documents.

Example: 10 Strategic Points Document for a Quantitative Project

The 10 Strategic Points

Comments or Feedback

Broad Topic Area

1.     
Broad Topic Area:

Hint: What would I title my project?

Literature Review

2.     
Literature Review:

List primary points for four sections in the Literature Review: Background of the problem/gap; theoretical foundations (models and theories to be foundation for study); review of literature topics with key theme for each one; and summary.

a.     
Background of the Problem/Gap:

·         Rural ambulatory clinics have had to reorganize their management structures to enhance reimbursement.

·         Access to appropriate health services for rural Americans needs to be improved in areas where specialists are not available (Schoenberg, 2012).

·         Telehealth nursing services can be provided through rural health clinics to support specialty clinics (Schoenberg, 2012).

·         Approximately 200 telemedicine networks have been established nationwide. (American Telemedicine Association, 2017)

b.     
Theoretical Foundations (models and theories to be foundation for study):

·         The Greenhalgh’s Dissemination of Innovations model (Greenhalgh, Robert, Bate, Macfarlane, & Kyriakidau, 2005) can be used to implement rural telehealth services for rural Americans.

·         The D&M Information System Success model (DeLone &McLean, 2003) is a framework to conceptualize and operationalize information system success. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

·         Path constitution theory combines two contrasting perspectives on technology, path dependence, and path creation (Singh, Mathiassen, & Mishra, 2015).

c.      
Review of Literature Topics With Key Organizing Concepts or Topics for Each One

Rural Telehealth Services:

·         Rural telehealth can improve care in burn patients (McWilliams, Hendricks, Twigg, Wood, & Giles, 2016); smoking cessation (Carlson, Lounsberry, Maciejewski, Wright, Collacutt, & Taenzer, 2011), psychotherapy (Gonzales & Brossart, 2015);  cancer education (Doorenbos et al., 2011); diabetes (Holloway, Coon, Kersten, & Clemins, 2011).

Population Specific Telehealth Services:

·         Community based telehealth: Home-based telehealth can enhance older adults’ access to care and facilitate patient-provider collaboration which may in turn improve patient self-management (Hsieh, Tsai, Chic, & Lin, 2015).

·         Chronically ill: Disease management needs of chronically ill patients include prescription refills, medication and symptom management, lab results, and patient education (Vinson, McCallum, Thornlow, & Champagne, 2011).

·         Rural Native American telehealth:  Telehealth can improve health disparities in Native American communities (Kruse, Bouffard, Dougherty, & Parro, 2016).

·         Diabetes education and management:  Telehealth education improves glycemic control (Barker, Mallow, Theeke, & Schwertfeger, 2016).

·         Mental health emergencies can be managed effectively through telehealth services (Saurman et al., 2011).

Settings:

·         Rural health clinic/hospital (Carlson et al., 2011); Doorenbos et al., 2011; Gonzales & Brossart, 2015; Holloway et al., 2011). The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

·         Home-based (Demiris et al., 2103).

·         Community center (Demiris et al., 2103).

·         Library (Demiris et al., 2103).

·         Smart phone, computer-based (Forchuk et al., 2016).

Certifications:

·         National Committee for Quality Assurance (n.d). Disease Management Accreditation. Retrieved from http://www.ncqa.org/programs/accreditation/disease-management-dm

·         American Association of Critical Care Nurses (n.d.). CCRN-E: Certification for Tele-ICU Nurses. Retrieved from https://www.aacn.org/certification?tab=First-Time%20Certification

·         Acute stroke ready designation (Slivinski, Johes, Whitehead, & Hooper, 2017).

Network Systems
:

·         American Telemedicine Association: approximately 200 telemedicine networks have been established nationwide (Frederick, 2013).

·         Tablet PC Enabled Body Sensor System: real-time continuous collection of physiological parameters (Panicker, Kumar, 2016).

d.     
Summary

·         Gap/Problem: There is a need to implement evidence-based methods of improving health outcomes of rural residents through the use of telehealth.

·         Prior studies: Prior studies show that telehealth improves patient outcomes in diverse settings, including rural areas.

·         Quantitative application: Sources of data exist to collect numerical data on the rate of follow-up with primary care provider in rural areas.

·         Significance: Improving rate of follow-up with primary care provider will improve health outcomes of rural residents.

Problem Statement

3.     
Problem Statement:

Describe the variables/groups to study, in one sentence.

 

A well-written problem statement begins with the big picture of the issue (
macro)
and works to the small, narrower, and more specific problem (
micro
). It clearly communicates the significance, magnitude, and importance of the problem and transitions into the Purpose of the Project with a declarative statement such as: “It is not known if and to what degree/extent…” or “It is not known how/why and….”

Other examples are:

·         While the literature indicates ____________, it is not known in _________ (organization/community) if __________.

·         It is not known how or to what extent ________________.

While the literature indicates that telehealth is an important emerging technology for rural patient access, it is unknown if the implementation of telehealth impacts the rate of patient follow up for patients living in a rural area.

Clinical/

PICOT Questions

4.     
Clinical/PICOT Questions:

Provide PICOT question to guide the implementation and data collection of findings of the project:

(P)
Among adult patients in a rural care setting,
(I)
how does implementation of a telehealth program
(C)
compare to traditional commute-for-care (
O)
impact rate of follow-up with the primary care provider (
T)
over a period of four weeks.

Sample

5.     
Sample (and Location):

Identify sample, needed sample size, and location (study phenomena with small numbers and variables/groups with large numbers).

a.       Location: Arizona

b.      Population: Two neighboring rural towns equal distance from the nearest primary care provider.

c.       Sample: 40 participants include a power analysis if appropriate.

Define Variables

6.     
Define Variables:

a.      
Independent Variable:
Telehealth program.

b.     
Dependent Variable:
Follow-up rate with primary care provider. The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

Methodology  and Design

7.     
Methodology and Design:

Name the selected methodology and specific design to address the problem statement and clinical questions:

This project will use a quantitative methodology with a quasi-experimental design.

Purpose Statement

8.     
Purpose Statement:

Provide one sentence statement of purpose including the problem statement, sample, methodology, and design:

Creswell (2003) provided some sample templates for developing purpose statements aligned with the different project methods as follows:

The purpose of this
quantitative
___________ (correlational, descriptive, etc.) project is to ____________ (compare or see to what degree a relationship exists) between/among ______________________ (independent variable) to ___________________ (dependent variable) for ________________ (participants) at ___________________ (project site/geographical location). The ________ (independent variable) will be defined/measured as/by _______ (provide a general definition). The
                                 
 (dependent variable) will be defined/measured as/by ______ (provide a general definition).

 

 

Data Collection Approach

9.     
Data Collection Approach:

Describe primary instruments that will be used to answer clinical question.

Data Analysis Approach

10. 
Data Analysis Approach:

Descriptive statistics will describe the sample characteristics and variable results. An independent t-tests will test for difference between the two groups of 40 participants (telehealth and commute-for-care) follow-up with primary physician. A priori analysis will be used to justify the sample size.

The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

 

 

10 Strategic Points Table

(Use this table to complete the 10 Strategic Points document for your project.)

10 Strategic Points

Comments/Feedback

Broad Topic Area

Literature Review

Problem Statement

The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

Clinical/PICO Questions

Sample

Define Variables

Methodology  and Design

Purpose Statement

The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

 

 

Data Collection Approach

Data Analysis Approach

The 10 Strategic Points for the Prospectus, Proposal, and Direct Practice Improvement Project

Episodic/Focused SOAP Note Template Examples

Patient Information:

Initials  Age, Sex, Race

S.

CC
(chief complaint) a BRIEF statement identifying why the patient is here – in the patient’s own words – for instance “headache”, NOT “bad headache for 3 days”.

HPI
: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example: Episodic/Focused SOAP Note Template Examples.

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Location: head

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

Severity: 7/10 pain scale

Current Medications
: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.

Allergies:
include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).

PMHx
: include immunization status (note date of
last tetanus
for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed

Soc Hx
: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system. Episodic/Focused SOAP Note Template Examples.

Fam Hx
: illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

ROS
: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows:
General:

Head
:
EENT
: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL:  No weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat. Episodic/Focused SOAP Note Template Examples.

SKIN:  No rash or itching.

CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY:  No shortness of breath, cough or sputum.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY.

NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  No anemia, bleeding or bruising. Episodic/Focused SOAP Note Template Examples.

LYMPHATICS:  No enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  No history of depression or anxiety.

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  No history of asthma, hives, eczema or rhinitis.

O.

Physical exam
: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History.
Do not use “WNL” or “normal.” You must describe what you see.
Always document in head to toe format i.e. General: Head: EENT: etc.

Diagnostic results
: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines) Episodic/Focused SOAP Note Template Examples.

A
.

Differential Diagnoses
(list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence based guidelines.

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

References

You are required to include at least three evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 6
th
edition formatting.

 

 

Episodic/Focused SOAP Note Template – Episodic/Focused SOAP Note Template Examples 2

 

Patient Information:

L., 20, F, Caucasian

SUBJECTIVE.

CC:
“I have been having sore throat for three days, and I also have decreased appetite, headache, and pain with swallowing.”

HPI
: Ms. L is a 20-year-old female college student who presents with sore throat for three days, with additional decreased appetite, headache, and pain with swallowing. She recounts that similar “flu-like” symptoms recently affecting multiple students on campus. Ms. L also noted runny nose and a slight hoarseness in her voice but doesn’t sound congested. She took Tylenol and Chloraseptic lozenges, but did little for relief. Episodic/Focused SOAP Note Template Examples.

Location:
throat

Onset:
3 days ago

Character:
throat is sore

Associated signs and symptoms
: decreased appetite, headache, and pain with swallowing.

Timing
: constant

Exacerbating/ relieving factors
: light bothers eyes, Tylenol makes it tolerable but not completely better.

Severity:
8/10 pain scale

Problem-Specific Questions
:

Have you been coughing? Any drainage or phlegm? Is it productive, if so how much? What is the color of the phlegm?

Have you been running a fever or exhibiting chills?

Are you taking any medications for this? Are they helping?

Are you having any pain or pressure in your face, head, or sinuses? Have you recently had a head injury? Any nasal bleeding noted?

Do you smoke or have you been around anyone who smokes?

Do you experience gastroesophageal reflux or heartburn?

Does it hurt to swallow solids, liquids, or both?

Do you feel like something is stuck in your throat? Episodic/Focused SOAP Note Template Examples.

Do you cough or choke when swallowing?

Do you have any changes in your appetite? Did it start with the onset of your sore throat?

Any changes in your weight? Did you lose or gain weight?

What have you eaten in the last twenty-four hours?

Have you had any nausea or vomiting?

Current Medications
: Multivitamins 1 tablet daily; and Blisovi Fe 1/20 1 tab daily

Allergies:
Penicillin (Hives)

PMHx
: No pertinent medical history reported, it is unremarkable. No recent hospitalizations reported in the past. Immunizations are current. Last tetanus shot was taken June 2010. Last flu shot was taken September 2016. Denies any history of accidents/injury or falls.

Soc Hx
: Ms. L was born in Galveston, TX, and currently attends a community college at Houston Community College – Katy Campus. She attends classes Mon-Fri from 8am to 3pm. She works at daycare center on the weekends while in school, and during the week on Summer break. She is Single, and heterosexual. She is in a monogamous relationship with her boyfriend, and sexually active. She exercises 3x/week, and eats a diet consisting of meat/fish, vegetables, fruits, rice and beans. She drives a vehicle, and always put on her seatbelt. She is a social drinker, takes 1-2 glasses of wine every 2 weeks. Never smoked, and denies use of illicit/recreational drugs. Drinks green tea daily.

Fam Hx
:

Maternal Grandmother
: deceased at age 83 related to Stroke

Maternal Grandfather:
deceased at age 98, no health conditions noted

Paternal Grandmother:
deceased at age 38, post-partum hemorrhage

Paternal Grandfather:
deceased at age 102 related to uncontrolled HTN

Mother:
age 57, No health conditions reported Episodic/Focused SOAP Note Template Examples

Father:
age 63, has Arthritis, and HTN

Siblings:
She has 2 sisters age 18 and 16. Both are alive and well, no health conditions reported

Review of Systems
:

GENERAL:  The patient is awake, alert, oriented and appears generally well. See HPI.

HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclera. No decreased hearing. No hearing loss, sneezing, or congestion. Has complaints of runny nose, sore throat, headaches, and hoarse voice.

SKIN:  No rash or itching.

CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema.

RESPIRATORY:  Respirations are regular and unlabored. No shortness of breath, cough or sputum.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood. Complaints of decreased appetite

GENITOURINARY:  Denies burning in urination, never been pregnant. Menses are regular, last menstrual period, 05/28/2017.

NEUROLOGICAL:  No dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control. Complains of headache that started with the onset of sore throat.

MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness. Episodic/Focused SOAP Note Template Examples.

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No history of splenectomy. Swollen nodes in the neck

PSYCHIATRIC:  No history of depression or anxiety.

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  Allergic to PCN, gives her hives.

OBJECTIVE.

Physical exam
: The patient is awake, alert, oriented and appears generally well. The patient is in no distress. Vital signs revealed a Ht. 5’10”, Wt. 150 lbs; BMI= 21.5; pulse of 96, respirations of 18, temperature of 101.6 and O2 saturation on room air of 98%. HEENT: Pupils are equal, round and reactive to light. There is no sinus tenderness. Ears are clear. Throat is slightly red with some swelling and exudate. Neck is supple with anterior cervical lymphadenopathy. Note runny nose and hoarse voice. Lungs are clear. Heart has regular rate and rhythm without murmur or gallop. Back showed no CVA tenderness. Abdomen is soft and non-tender. No organomegaly. Extremities: No edema or tenderness. Skin/Hair/Nails: Normal color for ethnicity and turgor without rash.

Diagnostic results
: CBC and CMP ordered; throat swab was obtained and sent to the lab for rapid strep testing, rapid influenza diagnostic testing, and follow-up throat culture.

ASSESSMENT
.

Differential Diagnoses

Influenza
: Patient is exhibiting classic signs of sore throat, fever, headache, and nasal discharge (National Foundation for Infectious Diseases, 2016), with exposure to multiple infectious sources on her close-quartered college campus, this condition may be likely pending diagnostics.

Group A streptococcal pharyngitis
: I would consider this due to her sore throat, but would need to visualize her mouth and throat to observe for possible erythematous and exudative tonsils and uvula, as well as other symptoms common to this diagnosis (Vincent et al, 2004). Episodic/Focused SOAP Note Template Examples.

Diphtheria
: Common clinical manifestation includes low grade fever, sore throat, headache, malaise, and hoarseness (Centers for Disease Control and Prevention, 2016), very similar to my patient’s symptoms. However, this may be unlikely in United States as most people are vaccinated, though still prevalent in developing countries. In addition, Children under 5 and adults over 60 years old are particularly at risk for contracting the infection.

Epiglottitis
: Because of her sore throat and vocal changes, this should be ruled out as it can advance to emergent airway obstruction, however, my suspicions would tell me that this is not probable as these patients often present in respiratory distress and it is a potentially life-threatening illness. This condition is historically a condition more common in children, but it is becoming more frequent in adults. It requires prompt diagnosis and treatment in anyone, but especially in children, who are more vulnerable to breathing complications (Marcin, 2017).

Epstein-Barr virus (EBV) infectious mononucleosis
: Typically, these viruses spread most commonly through bodily fluids, especially saliva. Though classic signs of EBV is prolonged malaise, sore throat is a very prevalent sign, and the condition more common for those between ages 15-30 years, and close quarters being a common factor for transmission (Vincent et al, 2004), however, EBV should also be ruled out due to short time onset, and no enlarged spleen or liver noted.

PLAN.

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

References

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.

Centers for Disease Control and Prevention (2016). About Diphtheria. Retrieved from

https://www.cdc.gov/diphtheria/about/index.html Episodic/Focused SOAP Note Template Examples

 

Marcin, J. (2017). Epiglottis. Retrieved from

http://www.healthline.com/health/epiglottitis#overview1

 

National Foundation for Infectious Diseases (2016). Influenza (Flu). Retrieved from

http://www.nfid.org/idinfo/influenza

 

Vincent, M., et al (2004). Pharyngitis. Retrieved from

http://www.aafp.org/afp/2004/0315/p1465.html Episodic/Focused SOAP Note Template Examples

Use the “Translational Research Graphic Organizer Template” to compare three types of translational research with traditional (qualitative or quantitative) research. Make sure to include methodology, goals, and data collection in your organizer.

You are required to cite three to five sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

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Translational Research Graphic Organizer Template

 

 

Observations (Similarities/Differences)

Methodology

 

 

Translational Research Graphic Organizer

 

 

 

 

 

Goals

 

 

 

 

 

 

 

 

Data Collection

 

 

 

 

 

 

 

Translational Research Graphic Organizer

Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

Assessing the Genitalia and Rectum

Episodic/Focused SOAP Note Template

Patient Information:

JW       Age: 21         Sex: Female                 Race: Caucasian

S.

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CC
(chief complaint) “I have bumps on my bottom that I want to have checked out. ”

HPI
:  This 21-year-old Caucasian female presents to our clinic complaining of painless, rough bumps on her genital region.  The onset of these bumps was approximately one week ago.  JW reports being sexually active with more than one partner over the past year.  She also has a history of chlamydia 2 years ago with completed treatments.  She reports being sexually active since the age of 18 years of age.

Current Medications
:  Symbicort 160/4.5mcg PO twice daily

Allergies:
NKDA

PMHx
: Chlamydia, Asthma

Soc Hx
: Denies tobacco use; occasional ETOH, married, 3 children (1 girl, 2 boys)

Fam Hx
:  No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

ROS
:

Example of Complete ROS:

GENERAL:  Denies weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes:  Denies visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  Denies hearing loss, sneezing, congestion, runny nose or sore throat. Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

SKIN:  Reports bumps on around genital region, no vaginal discharge reported.

CARDIOVASCULAR:  Denies chest pain, chest pressure or chest discomfort. Denies palpitations or edema.

RESPIRATORY:  Denies shortness of breath, cough or sputum.

GASTROINTESTINAL:  Denies anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Denies urinary symptoms. LMP: 03/22/18. Last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal.

NEUROLOGICAL:  Denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. Denies change in bowel or bladder control.

MUSCULOSKELETAL:  Denies muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  Denies anemia, bleeding or bruising.

LYMPHATICS:  Denies enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  Denies history of depression or anxiety.

ENDOCRINOLOGIC:  Denies reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  history of asthma;  denies hives, eczema or rhinitis.

O.

VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

General:  
Awake, alert, and oriented x4 female.  She is well groomed and well-nourished.  Denies fever, chills, fatigue, nausea, and vomiting.

Cardiovascular:  +
S1, S2, heart rate and rhythm regular, no murmur, no peripheral edema observed.

Respiratory: 
CTA, chest wall symmetrical

Gastrointestinal:
Abdomen
 
soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

Genitourinary: 
Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

Diagnostic results
:  HSV results pending

A
.

Differential Diagnoses 

1)
Human Papilloma Virus (HPV)  
HPV infection commonly causes warts. Some  HPV infections may cause cervical cancers. There are more than 100 varieties of HPV (Hammer & McPhee, 2014).  Most HPV infections will not lead to cancer. However, some types of genital HPV may cause cervical cancer (Hammer & McPhee, 2014).  HPV may be responsible for cancers of the anus, penis, vagina, vulva, and oropharyngeal. Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

Signs and Symptoms

The body’s immune system combats  HPV before creating warts.  When warts appear, they vary in appearance depending on the type of HPV involved: genital warts, common warts, plantar warts, and flat warts (Hammer & McPhee, 2014).  Genital warts in women appear mostly on the vulva but may also appear near the anus, cervix, and vagina.

Risk Factors

An increased amount of sexual partners makes it more likely to contract HPV.  Genital warts are most common in adolescents and young adults (Hammer & McPhee, 2014).  Patients with a weakened immune system are at greater risk of HPV.  Exposed areas of skin that have been punctured or opened are at risk of developing common warts (Hammer & McPhee, 2014).

Diagnostic Tests

The following tests may be recommended if the genital warts are not visible.

Acetic acid solution test
consists of a vinegar solution applied to HPV-infected genital areas and turns these areas white (Hammer & McPhee, 2014).

Pap Smear 
consists of a clinician collecting a sample of cells from the cervix or vagina to send for laboratory analysis. A Pap test may be able to reveal abnormal cells that may lead to cancer (Hammer & McPhee, 2014).

DNA test
consists of analyzing cells from a patient’s cervix and is able to recognize DNA that is considered high-risk of HPV and linked to genital cancers (Hammer & McPhee, 2014).

 

2)
Genital Herpes:  
A  sexually transmitted infection (STI) caused by the herpes simplex virus (HSV) (Goljan, 2014).  The virus is primarily transmitted sexually.  The virus typically lies dormant and may emerge several times a year (Goljan, 2014).

Signs and Symptoms

Symptoms may begin between two to 12 days after exposure to HSV.  Symptoms if present may include:

Pain or itching in the genital region

Red bumps or white blisters

Ulcers that may ooze or bleed

Scabs (Goljan, 2014).

 

During the initial outbreak,  flu-like symptoms may present such as swollen lymph nodes in the groin, headache, muscle aches, and fever (Goljan, 2014). Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

Risk Factors

The risk of becoming infected with genital herpes may increase the patient:

Is Female.  The mode of transportation is much easier from men to women than it is women to men.

Multiple sexual partners (Goljan, 2014).

 

Diagnostic Tests

A clinician may diagnose genital herpes by the physical examination along with the results of some of the following lab results:

Viral culture of the sore

Polymerase chain reaction (PCR) test

HSV antibody test. This test may detect past infection of HSV (Goljan, 2014).

 

3) 
Bartholin’s cyst:  
The Bartholin’s glands are located on each side of the vaginal opening and secreted fluid that helps lubricate the vagina (McCance , Huether, Brashers, & Rote, 2014).  When the openings of the Bartholin’s glands become obstructed, fluid will back up into the gland.  This will result in a painless swelling called the Bartholin’s cyst (McCance et al., 2014).  The fluid within the cyst may become infected and collect pus which will develop into an abscess (McCance et al., 2014).

Signs and Symptoms

The cyst may present as a lump or mass near the vaginal opening.  The cyst may usually be painless, it can be tender.  When a cyst is infected the following symptoms may be present:

A tender, painful lump near the vaginal opening

Discomfort while walking or sitting

Pain during intercourse

Fever (McCance et al., 2014).

 

Diagnostic Tests

Diagnosing a Bartholin’s cyst may be possible by acquiring a thorough health history, performing a pelvic exam, obtaining a sample of secretions from the vagina to r/o STIs, and biopsy of the mass for women over 40 years of age (McCance et al., 2014). 
 

4)
Sebaceous cyst:   
Cysts are abnormalities in the body that contain noncancerous liquid material (McCance et al., 2014).  These cysts are mostly found on the face, neck, or torso.  Their growth is slow and is not life-threatening, but they may become uncomfortable if left untreated (McCance et al., 2014). Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

Signs and Symptoms

Small cysts are typically not painful.  Large cysts can range from uncomfortable to painful.  Large cysts on the face and neck cause pressure and pain.  The areas on the body where cysts are usually found include the scalp, face, neck, and back (McCance et al., 2014).

Diagnostic Tests

The clinician is able to diagnose a sebaceous cyst during the physical examination. If the cyst is seen as unusual, the clinician may order tests to rule out cancer.  The most common tests used for a sebaceous cyst include:  CT scans for a possible surgical route, ultrasounds for the internal structure of cyst, and biopsy (McCance et al., 2014).

5)
Syphilis:  
A bacterial infection primarily spread sexually.  It presents as a painless sore on the genitals, rectum or mouth (Hammer & McPhee, 2014).  Syphilis may spread via skin or mucous membrane contact with these sores  (Hammer & McPhee, 2014).  Post initial infection, syphilis can remain dormant for several decades before resurfacing.  Early treatment may rid the infection with antibiotics, however, when left untreated it can severely damage the heart, brain, and can be life-threatening, and maybe also passed from mother to unborn child (Hammer & McPhee, 2014).

Signs and Symptoms

Syphilis may present in different stages which may overlap at times.  The stages include:  primary syphilis, secondary syphilis, latent syphilis, tertiary syphilis, and congenital syphilis (Hammer & McPhee, 2014).

Primary syphilis:  
The first sign of syphilis is a small sore that appears at the spot where the bacteria entered the body.  This sore is also called a chancre.  The sore develops about three weeks after exposure, is usually painless and hidden within the vagina or rectum (Hammer & McPhee, 2014) .

Secondary syphilis:  
Within a few weeks of healing the patient may experience a rash that begins on the trunk and may eventually cover the entire body including the palms of the hands and soles of the feet (Hammer & McPhee, 2014).  The rash is usually not itchy and may be accompanied by wart-like sores in the mouth or genital area (Hammer & McPhee, 2014).

Latent syphilis
:  If left untreated the infection may be dormant for several years or never return.

Tertiary syphilis:  
This is considered the late stage of syphilis, the disease may damage the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints (Hammer & McPhee, 2014). Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

 

Risk Factors

Unprotected sex

Multiple sexual partners

Homosexual man engaging in sex with other men

Patient infected with HIV (Hammer & McPhee, 2014)

 

Diagnostics

Serum 
tests can confirm the presence of antibodies that the body produces to fight infection (McCance et al., 2014).  The antibodies to the bacteria that cause the infection remain in the body for years, therefore the test can be used to determine a current or past infection (McCance et al., 2014).

Cerebral spinal fluid.
If it’s suspected that the nervous system has been compromised by syphilis a lumbar puncture may be recommended.

 

References

Goljan, E. F. (2014).
Rapid review: Pathology
(4th ed.). Philadelphia, PA: Elsevier.

Hammer, G. D., & McPhee, S. J. (2014).
Pathophysiology of disease: An introduction to clinical medicine
(7th ed.). China: McGraw Hill.

McCance , K. L., Huether, S. E., Brashers, V. L., & Rote, N. S. (2014).
Pathophysiology: The biologic basis for disease in adults and children
(7th ed.). St. Louis, MS: Elsevier.

 

Assessing The Genitalia And Rectum

Patients are frequently uncomfortable discussing with health care professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam is vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.

In this assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

GENITALIA ASSESSMENT

Subjective:

CC: “I have bumps on my bottom that I want to have checked out.”

HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner over the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.

PMH: Asthma

Medications: Symbicort 160/4.5mcg

Allergies: NKDA

FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs

Heart: RRR, no murmurs

Lungs: CTA, chest wall symmetrical

Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact with a healed episiotomy scar present. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

Diagnostics: HSV specimen obtained

Assessment:

Chancre

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

To prepare:

With regard to the SOAP note case study provided:

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

Consider what history would be necessary to collect from the patient in the case study.

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

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

To complete:

Refer to Chapter 5 of the Sullivan text. Analyze the SOAP note case study.  Using evidence-based resources, answer the following questions and support your answers using current evidence from the literature.

Analyze the subjective portion of the note. List additional information that should be included in the documentation.

Analyze the objective portion of the note. List additional information that should be included in the documentation. Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

Is the assessment supported by the subjective and objective information? Why or Why not?

Would diagnostics be appropriate for this case and how would the results be used to make a diagnosis?

Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from the current evidence-based literature. Episodic/Focused SOAP Note Template – Assessing the Genitalia and Rectum

NURS 6501 – Advanced Pathophysiology Week 1 Quiz

A 12-year-old male is diagnosed with Klinefelter syndrome. His karyotype would reveal which of the following?

XXY

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The nurse is teaching staff about the most common cause of Down syndrome. What is the nurse describing?

Maternal nondisjunction

 

A nurse is discussing the movement of fluid across the arterial end of capillary membranes into the interstitial fluid surrounding the capillary. Which process of fluid movement is the nurse describing?

Hydrostatic pressure

 

What principle should the nurse remember when trying to distinguish aging from disease?

It is difficult to tell the difference because both processes are believed to result from cell injury.

 

What causes the rapid change in the resting membrane potential that initiates an action potential?

Sodium gates open, and sodium rushes into the cell, changing the membrane potential from negative to positive.

 

During childhood, the thymus decreases in size, and this is referred to as _____ atrophy.

Physiologic NURS 6501 – Advanced Pathophysiology Week 1 Quiz

 

Sodium and water accumulation in an injured cell are a direct result of:

Decreased ATP production

 

A 50-year-old male was recently diagnosed with Huntington disease. Transmission of this disease is associated with:

Delayed age of onset

 

 

What is the diagnosis of a 13-year-old female who has a karyotype that reveals an absent homologous X chromosome with only a single X chromosome? Her features include a short stature, widely spaced nipples, reduced carrying angle at the elbow, and sparse body hair.

Turner Syndrome

 

What is the role of cytokines in cell production?

Provide growth factor for tissue growth and development

 

A eukaryotic cell is undergoing DNA replication. In which region of the cell would most of the genetic information be contained?

Nucleolus

 

A patient has severe mental retardation caused by a deletion of part of chromosome 5. What genetic disorder will the nurse see documented in the chart?

Cri du chat syndrome NURS 6501 – Advanced Pathophysiology Week 1 Quiz

 

The student is reviewing functions of the cell. The student would be correct in identifying the primary function of the nerve cell as:

Communication

 

How are potassium and sodium transported across plasma membranes?

By adenosine triphosphate enzyme (ATPase)

 

After a geneticist talks to the patient about being a chromosomal mosaic, the patient as the nurse what that means. How should the nurse respond?  You may ____ genetic disease(s).

Have a mild form of the

 

A runner has depleted all the oxygen available for muscle energy. Which of the following will facilitate his continued muscle performance? NURS 6501 – Advanced Pathophysiology Week 1 Quiz

Anaerobic glycolysis

 

A patient who has diarrhea receives a hypertonic saline solution intravenously to replace the sodium and chloride lost in the stool. What effect will this fluid replacement have on cells?

Cells will shrink

 

A patient has a heart attack that leads to progressive cell injury that causes cell death with severe cell swelling and breakdown of organelles. What term would the nurse use to define this process?

Necrosis

 

A nurse reading the chart and sees the term oncotic pressure. The nurse recalls that oncotic pressure (colloid osmotic pressure) is determined by:

Plasma proteins

 

An aide asks the nurse why people who have neurofibromatosis will show varying degrees of the disease. Which genetic principle should the nurse explain to the aide?

Expressivity

 

A cell is isolated, and electrophysiology studies reveal that the resting membrane potential is -70 millivolts. The predominant intracellular ion is Na+, and the predominant extracellular ion is K+.  With voltage change, which of the following would result in an action potential?

Na+ rushing into the cell

 

A 13-year-old girl has a karyotype that reveals an absent homologous X chromosome with only a single X chromosome present. What medical diagnosis will the nurse observe in the chart?

Turner syndrome

 

A 15-year-old female is diagnosed with Prader-Willi syndrome. This condition is an example of:

Gene imprinting

 

A 55-year-old male with a 30-year history of smoking is examined for respiratory disturbance. Examination of his airway (bronchial) reveals that stratified squamous epithelial cells have replaced the normal columnar ciliated cells.  This type of cellular adaptation is called:

Metaplasia

 

A group of prison inmates developed tuberculosis following exposure to an infected inmate. On examination, tissues were soft and granular (like clumped cheese).  Which of the following is the most likely cause?

Caseous necrosis NURS 6501 – Advanced Pathophysiology Week 1 Quiz

Histrionic and Schizotypal Personality Disorders

Week 3: Personality Disorders

Discussion: Treatment of Personality Disorders – Histrionic Personality Disorder

Explain the diagnostic criteria for your assigned personality disorder.

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Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned personality disorder.

Describe clinical features from a client that led you to believe this client had this disorder. Align the clinical features with the DSM-5 criteria.

References

American Nurses Association. (2014).
 Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.)
. Washington, DC: Author.

· Standard 12 “Leadership” (pages 76-77)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). 
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer. Histrionic and Schizotypal Personality Disorders

· Chapter 4, “Theories of Personality and Psychopathology” (pp. 151–191)

· Chapter 22, “Personality Disorders” (pp. 742–762)

· Chapter 13, “Psychosomatic Medicine” (pp. 451–464)

Gabbard, G. O. (2014). 
Gabbard’s treatment of psychiatric disorders 
(5th ed.). Washington, DC: American Psychiatric Publications.

· Chapter 68, “Paranoid, Schizotypal, and Schizoid Personality Disorders”

· Chapter 69, “Antisocial Personality Disorder”

· Chapter 70, “Borderline Personality Disorder”

· Chapter 71, “Histrionic Personality Disorder”

· Chapter 72, “Narcissistic Personality Disorder”

· Chapter 73, “Cluster C Personality Disorders

Note:
 You will access this book from Walden Library databases.

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

· “Personality Disorders”

Note:
 You will access this book from Walden Library databases.

Perry, J. C., Presniak, M. D., & Olson, T. R. (2013). Defense mechanisms in schizotypal, borderline, antisocial, and narcissistic personality disorders. 
Psychiatry: Interpersonal & Biological Processes, 76
(1), 32–52. doi:10.1521/psyc.2013.76.1.32

Note:
 You will access this article from Walden Library databases.

Rees, C. S., & Pritchard, R. (2015). 
Brief cognitive therapy for avoidant personality disorder. Psychotherapy, 52
(1), 45–55. doi:10.1037/a0035158

Note:
 You will access this article from Walden Library databases.

Laureate Education. (2017a). 
A woman with personality disorder
 [Interactive media file]. Baltimore, MD: Author.

Kernberg, O. (n.d.). 
Psychoanalytic psychotherapy for personality disorders: An Interview with Otto Kernberg
, MD. [Video file]. Mill Valley, CA: Psychotherapy.net

Note:
 This video is approximately 94 minutes of length. You will access this article from Walden Library databases

 

Week 3: Personality Disorders

Discussion: Treatment of Personality Disorders – Schizotypal Personality Disorder

Explain the diagnostic criteria for your assigned personality disorder.

Explain the evidenced-based psychotherapy and psychopharmacologic treatment for your assigned personality disorder.

Describe clinical features from a client that led you to believe this client had this disorder. Align the clinical features with the DSM-5 criteria.

References

American Nurses Association. (2014).
 Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.)
. Washington, DC: Author.

· Standard 12 “Leadership” (pages 76-77)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). 
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
 (11th ed.). Philadelphia, PA: Wolters Kluwer.

· Chapter 4, “Theories of Personality and Psychopathology” (pp. 151–191)

· Chapter 22, “Personality Disorders” (pp. 742–762)

· Chapter 13, “Psychosomatic Medicine” (pp. 451–464)

Gabbard, G. O. (2014). 
Gabbard’s treatment of psychiatric disorders 
(5th ed.). Washington, DC: American Psychiatric Publications.

· Chapter 68, “Paranoid, Schizotypal, and Schizoid Personality Disorders”

· Chapter 69, “Antisocial Personality Disorder”

· Chapter 70, “Borderline Personality Disorder”

· Chapter 71, “Histrionic Personality Disorder”

· Chapter 72, “Narcissistic Personality Disorder”

· Chapter 73, “Cluster C Personality Disorders

Note:
 You will access this book from Walden Library databases.

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

· “Personality Disorders”

Note:
 You will access this book from Walden Library databases.

Perry, J. C., Presniak, M. D., & Olson, T. R. (2013). Defense mechanisms in schizotypal, borderline, antisocial, and narcissistic personality disorders. 
Psychiatry: Interpersonal & Biological Processes, 76
(1), 32–52. doi:10.1521/psyc.2013.76.1.32

Note:
You will access this article from Walden Library databases. Histrionic and Schizotypal Personality Disorders

Rees, C. S., & Pritchard, R. (2015). 
Brief cognitive therapy for avoidant personality disorder. Psychotherapy, 52
(1), 45–55. doi:10.1037/a0035158

Note:
 You will access this article from Walden Library databases.

Laureate Education. (2017a). 
A woman with personality disorder
 [Interactive media file]. Baltimore, MD: Author.

Kernberg, O. (n.d.). 
Psychoanalytic psychotherapy for personality disorders: An Interview with Otto Kernberg
, MD. [Video file]. Mill Valley, CA: Psychotherapy.net

Note:
This video is approximately 94 minutes of length. You will access this article from Walden Library databases Histrionic and Schizotypal Personality Disorders

Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

Week 7: Assignment 1: “Captain of the Ship” Project – Obsessive-Compulsive Disorders

In 4 pages, write a treatment plan for your client in which you do the following:

Overview of Obsessive-Compulsive Disorders

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Describe the HPI and clinical impression for the client.

Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)

Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.

Identify medical management needs, including primary care needs, specific to this client.

Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

Learning Resources

Required Readings

American Nurses Association. (2014).
 Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.)
. Washington, DC: Author.

· Standard 14 “Professional Practice Evaluation” (pages 80-81)

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). 
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
 (11th ed.). Philadelphia, PA: Wolters Kluwer.

· Chapter 10, “Obsessive-Compulsive and Related Disorders” (pp. 418–436)

Gabbard, G. O. (2014). 
Gabbard’s treatment of psychiatric disorders
(5th ed.). Washington, DC: American Psychiatric Publications. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

· Chapter 21, “Obsessive-Compulsive Disorder”

Note:
 You will access this textbook from the Walden Library databases.

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

· “Obsessive-Compulsive and Related Disorders”

Note:
 You will access this book from the Walden Library databases.

Stahl, S. M. (2014). 
Prescriber’s Guide: Stahl’s Essential Psychopharmacology
(5th ed.). New York, NY: Cambridge University Press. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

 

Note:
 All Stahl resources can be accessed through the Walden Library using the link below. This link will take you to a login page for the Walden Library. Once you log in to the library, the Stahl website will appear. http://ezp.waldenulibrary.org/login?url=http://stahlonline.cambridge.org/

 

To access information on specific medications, click on 
The Prescriber’s Guide, 5th Ed
. tab on the Stahl Online website and select the appropriate medication. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

 

Obsessive-compulsive disorder

citalopram clomipramine escitalopram fluoxetine fluvoxamine paroxetine sertraline venlafaxine vilazodone

Thompson-Hollands, J., Edson, A., Tompson, M. C., & Comer, J. S. (2014). Family involvement in the psychological treatment of obsessive-compulsive disorder: A meta-analysis. 
Journal of Family Psychology, 28
(3), 287–298. doi:10.1037/a0036709

 

Note:
 You will access this article from the Walden Library databases.

Required Media

Bruce, T. & Jongsma, A. (Producers). (n.d.) 
Evidence-based treatment planning for obsessive compulsive disorder
 [Video file]. Mill Valley, CA: Psychotherapy.net.

 

Note:
 The approximate length of this media piece is 64 minutes. You will access this video from the Walden Library databases.

Optional Resources

Himle, J. A., Chatters, L. M., Taylor, R. J., & Nguyen, A. (2013). The relationship between obsessive-compulsive disorder and religious faith: Clinical characteristics and implications for treatment. 
Spirituality in Clinical Practice, 1
(S), 53–70. doi:10.1037/2326-4500.1.S.53 Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

Wheaton, M. G., Rosenfield, D., Foa, E. B., & Simpson, H. B. (2015). Augmenting serotonin reuptake inhibitors in obsessive–compulsive disorder: 
What moderates improvement? Journal of Consulting and Clinical Psychology, 83
(5), 926–937. doi:10.1037/ccp0000025

Obsessive Compulsive Disorder (OCD) is represented by a diverse group of symptoms that include intrusive thoughts, rituals, preoccupations, and compulsions (Sadock, Sadock, & Ruiz, 2014).  These recurring obsessions or compulsions cause severe distress to the person.  An obsession is a recurrent and intrusive thought while a compulsion is a conscious, standardized, recurrent behavior.  The purpose of this paper is to explore management strategies of OCD in adult clients. As the PMHNP, I will discuss a case and recommend treatment modalities, medical management, follow-up plan and collaboration in the care of a client with OCD.

History of present illness (HPI) and Clinical Impression

HPI:  K. K. a 22 yo CF referred for a psychiatric evaluation by her PCP.  Karen reports a complaint of “I need help, I can’t keep a job because of these rituals I have.”  She reports that she cannot maintain a job because of her rituals of checking locks.  Karen has recurrent thoughts that she had left the door of her apartment and car unlocked.  She reports leaving work several times daily to check the locks on both her car and apartment.  Additionally, because she often had the thought that she had not locked the door to the car, it was difficult for her to leave the car or apartment until she had repeatedly checked that it was secured causing her to be late for work.  She has been fired several times for tardiness and poor attendance however checking the locks decreases her anxiety about security.  Karen denies any medical issues and is not currently taking any medications.  She also denies the use of any alcohol, tobacco or illicit drugs.  Reports a family history of depression in both maternal and paternal grandmothers.   Karen recognizes that she is needs help and is eager to begin treatment.

Assessment:  A healthy, well-groomed 22yo CF in no acute distress.  A, A&Ox4, pleasant and appropriately dressed.  Makes good eye contact however mood is depressed with a flat affect; recent and remoter memory are intact.  Karen’s thoughts are circumstantial and preoccupied with obsessions and compulsions.  Her insight and judgment are fair.  Denies SI/HI/AVH. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

Clinical Impression:  Based on the diagnostic criteria in APA (2013), a diagnosis of OCD is made.

Psychopharmacology

If the patient’s symptoms cause a significant impairment in function or distress, treatment is recommended (Fenske and Petersen, 2015).  Based on Karen’s report of losing several jobs because of tardiness and attendance, there is a significant impairment in social and home functionality.  Karen also reports that her rituals cause her significant distress.  The standard approach is to start treatment with an SSRI or clomipramine and then move to other pharmacological strategies if the SSRI is not effective (Sadock, Sadock, & Ruiz, 2014).  I will initiate Prozac 40mg oral daily as it is Food and Drug Administration (FDA) approved  for treatment of OCD (Stahl, 2014).  I will have the patient return to clinic in week to assess for tolerability and increase to the suggested 80mg oral daily.  Higher dosages have often been necessary for a beneficial effect (Stahl, 2014).  I prefer to initiate with an SSRI (Prozac) as opposed to tricyclic (Clomipramine) for the less troubling adverse effects associated with Clomipramine.  Karen will be informed that she might experience sleep disturbances, nausea, diarrhea, headache and anxiety which are all adverse effects of SSRIs.  The desired outcome of pharmacotherapy is to reduce the patient’s intrusive thoughts that cause the compulsions that interfere with her home and work life.  Well controlled studies have found that pharmacotherapy, behavior therapy, or combination of both is effective in significantly reducing the symptoms of patients with OCD  (Fenske and Petersen, 2015).

 

Psychotherapy

Some studies indicate that behavior therapy is as effective as pharmacotherapies in OCD and some indicate that the beneficial effects are longer lasting with behavior therapy (Sadock, Sadock, & Ruiz, 2014).  Many clinicians consider behavior therapy the treatment of choice for OCD and also because it can be conducted in both outpatient and inpatient settings.  With the prinicpal behavioral approaches being exposure and response prevention, patients must be committed to improvement as Karen is.  Behavior therapy will be initiated the same week as pharmacotherapy.  The goal of therapy is to change the client’s behavior to reduce dysfunction and to improve her quality of life.  A psychotherapist will be consulted to intiate and manage therapy sessions. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

Medical Management

I will consult with Karen’s PCP for updates and additional concerns.  Since she has been with her PCP for more than 5 years, he has good insight into her life.  We will discuss baseline labs such as CBC, CMP, TSH, hepatic panel.  Since with SSRIs, nausea, headache dry mouth and diarrhea are common side effects, monitoring the patient’s electrolytes is important.  I would also recommend an EKG for baseline and follow up after medication initiation as SSRIs can lengthen the OT interval in otherwise health people (Sadock, Sadock, & Ruiz, 2014).  Community resources such as the local chapter of the OCD Foundation will be provided to Karen for support services.

Follow -up Plan and Collaboration

Karen was instructed to follow up in 1 week to monitor tolerability and compliance of medicaiton and dose adjustment.  Subsequently, she will return every 4 weeks for medication management.  She is also instructed to begin behavior therapy the same week as medication are initiated and to follow up weekly for therapy sessions.  I will consult with the therapist weekly for updates and any concerns or questions.  I will reiterate and reinforce to both the PCP and therapist the importance of monitoring for suicidal ideations as the patient is taking an antidepressant and abuptly stopping will increase risk of suicide.  About one-third of patients with OCD have major depressive disorder, and suicide is a risk for all patients with OCD (Sadock, Sadock, & Ruiz, 2014).

Conclusion

A poor prognosis is indicated by Karen yielding to rather than resisting compulsion or the need for hospitalization.  A good prognosis for Karen is indicated by good home, social and occupational adjustment.  The importance of an interdisciplinary team including PCP, therapist and other ancillaries will benefit the client for a better quality of life. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

 

References

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

Fenske, N. & Petersen, K. (2015). Obsessive-Compulsive Disorder: Diagnosis and Management.
American Family Physician, 92
(10): 896-903. Retrieved from http://www.aafp.org.afp

/2015/1115/p896.html

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer

Stahl, S.M. (2014). Prescriber’s Guide: Stahl’s Essential Psychopharmacology (5th ed.). New York, NY: Cambridge University Press. Week 7: Assignment 1: “Captain of the Ship” Project Essay Example– Obsessive-Compulsive Disorders

Nurs 6660 Week 2: Working With Children and Adolescents versus Adults

Week 2: Working With Children and Adolescents versus Adults

Post your answers to the following:

Explain why a developmental assessment of children and adolescents is important.

Describe two assessment instruments and explain why they are used for children and adolescents but not adults.

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Describe two treatment options for children and adolescents that may not be used when treating adults.

Explain the role parents play in assessment and treatment. Nurs 6660 Week 2: Working With Children and Adolescents versus Adults

Required Readings

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). 
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry 
(11th ed.). Philadelphia, PA: Wolters Kluwer.

· Chapter 2, “Contributions of the Psychosocial Sciences” (pp. 93–130)

· Chapter 6, “Classification in Psychiatry” (pp. 290–299)

· Chapter 31, “Child Psychiatry” (pp. 1107–1152)

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

· “Neurodevelopmental Disorders”

· “Intellectual Disabilities”

· “Communication Disorders”

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). 
Rutter’s child and adolescent psychiatry
 (6th ed.). Hoboken, NJ: Wiley Blackwell.

· Chapter 2, “Diagnosis, Diagnostic Formulations, and Classification” (pp. 17–30) Nurs 6660 Week 2: Working With Children and Adolescents versus Adults

NURS 6660 Week 2 Discussion Assessment in Child and Adolescent Psychiatry

NURS 6660

Week 2 Main Posting

Why Development assessment of children and adolescent important

Developmental assessment is a part of comprehensive medical care and it is a process of mapping a child’s performance compared with children of a similar age from a similar population (CDC, 2018). It is important because it helps highlight normal development pattern and timings. Also, it helps identify areas of regression or areas with a specific impairment that requires being referred for specialist assessment (CDC, 2018).

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Assessment Instruments Used for Children and Adolescents

The two-assessment instruments that are used specifically for the children and adolescent are the Child and Adolescent Psychiatric Assessment (CAPA) and the Diagnostic Interview for Children and Adolescents (DICA). CAPA is an interviewer-based diagnostic interview with versions for use with children and their parents. The interview covers the age range from 9 to 17 years and it focused on symptoms occurring during the preceding 3-month period and is adapted for assessments in both clinical and epidemiological research (Jozefak, & Berg- Nielsen, 2016). DICA was once considered a structured interview, but now can be used in a semi-structured format. It displays good reliability and is designed for use with children 6 to 17 years. It usually takes between 1 to 2 hours to administer. The DICA is a useful measure for both research and clinical settings, and it provides a reliable tool for assessing psychiatric information in behavior disorders, anxiety disorders, depressive disorders, and substance abuse disorders (Sadock, Sadock & Ruiz, 2014). The CAPA and DICA instruments are used for children and adolescent and not adults because they are structured specifically for them and so they are simpler and more direct interview/questionnaire. NURS 6660 Week 2 Discussion Assessment in Child and Adolescent Psychiatry

Treatment options for children and adolescents

Two treatment options used for children and adolescent and not for adults are parenting training in behavior therapy and positive parenting program (Triple P). Parent training in behavior therapy or parent training is a treatment option, where parents learn new skills and or strengthen their existing skills to teach and manage their child’s behavior. It has shown to strengthen the relationship between the parents and their children and to decrease negative/problem behaviors in children and adolescent (CDC, 2017). The Triple P – Positive Parenting Program (Triple P) is a parent training program that is designed to prevent severe behavioral, and developmental problems in children. It helps to enhance the knowledge, skills, and confidence of parents. It gives parents simple and practical strategies to help them build strong, healthy relationships, confidently manage their children’s behavior and prevent problems developing (Aghebati, Gharraee, Hakim Shoshtari & Gohari, 2014). Triple P is used in many countries and has shown to work across cultures, socio-economic groups and in many kinds of family structures (Aghebati, Gharraee, Hakim Shoshtari & Gohari, 2014). NURS 6660 Week 2 Discussion Assessment in Child and Adolescent Psychiatry

Role Parents Assessment and Treatment

Parents play a significant role in their children’s assessment and treatment because they help in monitoring their health and development including facilitating their treatment attendance. They are often present in the assessment sessions and the observation of the child-parent interactions is an important aspect of the assessment. Parents also assist the professionals to make decisions and arrive at treatment plan (Haine-Schlagel, & Walsh, 2015).

Reference

Aghebati, A., Gharraee, B., Hakim Shoshtari, M., & Gohari, M. R. (2014). Triple P-Positive Parenting Program for Mothers of ADHD Children. Iranian Journal of Psychiatry and Behavioral Sciences, 8(1), 59–65.

Center for Disease Control and Prevention (CDC) (2017). Behavior Therapy, Including Training for Parents. Retrieved from: https://www.cdc.gov/ncbddd/adhd/treatment.html

Center for Disease Control and Prevention (CDC) (2018). Developmental Monitoring and Screening. Retrieved from: https://www.cdc.gov/ncbddd/childdevelopment/facts.html

Haine-Schlagel, R., & Walsh, N. E. (2015). A Review of Parent Participation Engagement in Child and Family Mental Health Treatment. Clinical Child and Family Psychology Review, 18(2), 133–150. http://doi.org/10.1007/s10567-015-0182-x

Jozefak, T., & Berg- Nielsen, T. S., (2016). Measuring characteristics of the Norwegian version of Child and Adolescent Psychiatric Assessment (CAPA) and Preschool Age Psychiatric Assessment (PAPA). Retrieved from: http://www.psyktestbarn.no/CMS/ptb.nsf/pages/capa-papa

Novick, J., Cawthorpe, D., & McLuckie. M., (2016). A measurable treatment plan: Using the Children’s Global Assessment and the Problem Severity scales as outcomes of clinical treatment. Retrieved from: http://www.sciedu.ca/journal/index.php/jha/article/viewFile/10407/6504

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA: Wolters Kluwer. NURS 6660 Week 2 Discussion Assessment in Child and Adolescent Psychiatry

Assessment in Child and Adolescent Psychiatry

Why are Development Assessments of Children and Adolescents Important

The assessment of children and adolescents in psychology is a very crucial component in the determination and diagnosing of maladaptive behaviors that can progress into more complicated disorders and challenges if not detected early. Early therapeutic treatment of children and adolescents is imperative for the proper achieval of developmental milestones.  Developmental assessment is so important because as a comprehensive medical care model it serves as a process map of children’s performance and can be used to compare children of similar ages and normal developmental patterns (CDC, 2018).  Additionally, notable areas of challenges and impairments can be addressed by a specialist when found.

Assessment Instruments Used for Children and Adolescents

Many diverse instruments are used in the assessment of children and adolescents and two of these assessment tools will be reviewed here.  One tool used in assessment is called the Child and Adolescent Psychiatric Assessment (CAPA) and another tool used is called the Diagnostic Interview for Children and Adolescents (DICA).  CAPA is a interview based instrument that is diverse in its variety of versions and used in the ages of 9-17. The CAPA looks at symptoms that have occurred in the preceding 3-month period and has established use in both the clinical arena and research (Jozefak, & Berg-Nielson, 2016).  DICA is another tool often used that was once a structured interview format that has been adapted to a semi-structure format with great accuracy in reliable measurements conducted over a 1-2 hour time period.  The DICA tool is used for children 6 to 17 years of age and assesses disorders in behavior, substance abuse, anxiety and depression (Sadock, Sadock & Ruiz, 2014).  Both of the tools reviewed are used specific to the population children and adolescents due to their simplistic nature.  These tools are not used in adults as they provide a direct/interview approach that is not required in this population to elicit details. The NHMRC has emphasized the need to use validated instruments in the developmental assessment of children and adolescents.  Two other validated tools that are often used in practice are the PSC-17; Pediatric Symptom Checklist and SCARED; Screen for Children and Anxiety-Related Emotional Disorders. NURS 6660 Week 2 Discussion Assessment in Child and Adolescent Psychiatry

Treatment options for children and adolescents

Treatment options in the care of children and adolescents is a vital component that must be considered as the PMHNP, prescribing the most suitable and therapeutic modality can be challenging.  Each child and adolescent must be treated individually and this consideration means that treatment options are not a one size fits all. Early intervention is essential and works to provide better outcomes for children and adolescents.  Treatment options include parental education/training and positive parenting program.  Parent training is a behavior therapy modality that works to educate parents on new skills and the enhancement of existing skills in management of their childrens behavior.  The Positive parenting program was designed to alleviate severe behavior, and developmental problems in children.  This process is completed by heightening skills and confidence of parents through the use of practical strategies.  This program has proven effectiveness worldwide and in many cultures, family backgrounds and socio-economic groups (Aghebati, Gharraee, Gohari, 2014).

The Role of Parents in Assessment and Treatment

The use of parental reports is recommended as a significant part of the assessment of children and adolescents. Parents help in monitoring the efficacy of treatment and work to help facilitate consistent attendance to treatment.  The ability to observe parent-child interactions is a very important component to be assessed and these observations work to help the PMHNP develop and modify treatment plans (Haine-Schlagel & Walsh, 2015).

 

References

Aghebati, A., Gharraee, B., Hakim, Shoshtari, M., & Gohari, M. R. (2014). Triple P- Positive Parenting Program for Mothers of ADHD children. Iranian Journal of Psychiatry and Behavioral Sciences, 8(1), 59-65

Centers for Disease Control and Prevention (CDC) (2018). Developmental Monitoring and Screening.  Retrieved from
https://www.cdc.gov/ncbddd/childdevelopment/facts.html

Haine-Schlagel, R., & Walsh, N. E. (2015). A Review of Parent Participation Engagement in Child and Family Mental Health Treatment. Clinical Child and Family Psychology Review 18(2), 133-150.

Jozefak, T., Berg-Nielson, T. S., (2016). Measuring characteristics of the Norwegian version of Child and Adolescent Psychiatric Assessment (CAPA) and Preschool Age Psychiatric Assessment (PAPA). Retrieved from http://www.psyktestbarn.co/CMS

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014).
Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry
(11th ed.). Philadelphia, PA: Wolters Kluwer. NURS 6660 Week 2 Discussion Assessment in Child and Adolescent Psychiatry