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Week 1 Discussion

Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.

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

76-year-old Black/African-American male with disabilities living in an urban setting

Adolescent Hispanic/Latino boy living in a middle-class suburb

55-year-old Asian female living in a high-density poverty housing complex

Pre-school aged white female living in a rural community

16-year-old white pregnant teenager living in an inner-city neighborhood.

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To prepare:

With the information presented in Chapter 1 in mind, consider the following:

How would your communication and interview techniques for building a health history differ with each patient?

How might you target your questions for building a health history based on the patient’s age, gender, ethnicity, or environment?

What risk assessment instruments would be appropriate to use with each patient?

What questions would you ask each patient to assess his or her health risks?

Select one patient from the list above on which to focus for this Discussion.

Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.

Select one of the risk assessment instruments presented in Chapter 1 or Chapter 26 of the course text, or another tool with which you are familiar, related to your selected patient.

Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history. NURS 6512 Complete Weekly Discussions latest

By Day 3

Post a description of the interview and communication techniques you would use with your selected patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected a different patient than you, using one or more of the following approaches:

Share additional interview and communication techniques that could be effective with your colleague’s selected patient.

Suggest additional health-related risks that might be considered.

Validate an idea with your own experience and additional research.

Week 2 Discussion: Diversity and Health Assessments

In May 2012, Alice Randall wrote an article for The New York Times on the cultural factors that encouraged black women to maintain a weight above what is considered healthy. Randall explained—from her observations and her personal experience as a black woman—that many African-American communities and cultures consider women who are overweight to be more beautiful and desirable than women at a healthier weight. As she put it, “Many black women are fat because we want to be” (Randall, 2012).

Randall’s statements sparked a great deal of controversy and debate; however, they emphasize an underlying reality in the health care field: different populations, cultures, and groups have diverse beliefs and practices that impact their health. Nurses and health care professionals should be aware of this reality and adapt their health assessment techniques and recommendations to accommodate diversity.

In this Discussion, you will consider different socioeconomic, spiritual, lifestyle, and other cultural factors that should be taken into considerations when building a health history for patients with diverse backgrounds.

Case 1

JC, an at-risk 86-year-old Asian male is physically and financially dependent on his daughter, a single mother who has little time or money for her father’s health needs. He has a hx of hypertension (HTN), gastroesophageal reflux disease (GERD), b12 deficiency, and chronic prostatitis. He currently takes Lisinopril 10mg QD, Prilosec 20mg QD, B12 injections monthly, and Cipro 100mg QD. He comes to you for an annual exam and states “I came for my annual physical exam, but do not want to be a burden to my daughter.”

Case 2

TJ, a 32-year-old pregnant lesbian, is being seen for an annual physical exam and has been having vaginal discharge. Her pregnancy has been without complication thus far. She has been receiving prenatal care from an obstetrician. She received sperm from a local sperm bank. She is currently taking prenatal vitamins and takes Tylenol over the counter for aches and pains on occasion. She a strong family history of diabetes. Gravida 1; Para 0; Abortions 0.

Case 3

MR, a 23-year-old Native American male comes in to see you because he has been having anxiety and wants something to help him. He has been smoking “pot” and says he drinks to help him too. He tells you he is afraid that he will not get into Heaven if he continues in this lifestyle. He is not taking any prescriptions medications and denies drug use. He has a positive family history of diabetes, hypertension, and alcoholism.

To prepare:

Reflect on your experiences as a nurse and on the information provided in this week’s Learning Resources on diversity issues in health assessments.

Select one of the three case studies. Reflect on the provided patient information.

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

Consider how you would build a health history for the patient. What questions would you ask, and how would you frame them to be sensitive to the patient’s background, lifestyle, and culture? Develop five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Think about the challenges associated with communicating with patients from a variety of specific populations. What strategies can you as a nurse employ to be sensitive to different cultural factors while gathering the pertinent information?

By Day 3

Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you selected. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.

Read a selection of your colleagues’ responses

By Day 6

Respond on or before Day 6 to at least two of your colleagues who selected a different patient than you, using one or more of the following approaches:

Suggest additional socioeconomic, spiritual, lifestyle, and other cultural factors related to the patient.

Critique your colleague’s targeted questions, and explain how the patient might interpret these questions. Explain whether any of the questions would apply to your patient, and why.

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Week 3 Discussion: Assessment Tools and Diagnostic Tests in Adults and Children

When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and assessment tools; however, different factors affect the validity and reliability of the results produced by these tests or tools. Nurses must be aware of these factors in order to select the most appropriate test or tool and to accurately interpret the results.

Not only do these diagnostic tests affect adults, body measurements can provide a general picture of whether a child is receiving adequate nutrition or is at risk for health issues. These data, however, are just one aspect to be considered. Lifestyle, family history, and culture-among other factors-are also relevant. That said, gathering and communicating this information can be a delicate process.

In this Discussion, you will consider the validity and reliability of different assessment tools and diagnostic tests. You will explore issues such as sensitivity, specificity, and positive and negative predictive values. You will also consider examples of children with various weight issues. You will explore how you could effectively gather information and encourage parents and caregivers to be proactive about their children’s health and weight.

To prepare:

Review this week’s learning resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. We will also review examples of pediatric patients and their families as it relates to BMI.

This week you will be assigned one of the following DB by your instructor.

Select one of the following assessment tools or diagnostic tests to explore for the purposes of this Discussion:

Mammogram

Prostate-specific antigen (PSA) test

Body-mass index (BMI) using waist circumference for adults

Select one of the examples on which to focus for this Discussion. What health issues and risks may be relevant to the child you selected?

Overweight 5-year-old boy with overweight parents

5-year-old girl of normal weight with obese parents

Severely underweight 12-year-old girl with underweight parents

Search the Walden Library and credible sources for resources explaining the tool or test you selected. What is its purpose, how is it conducted, and what information does it gather?

What does the literature discuss regarding the validity, reliability, and are there any issues with sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool?

Based on the risks you identified, consider what further information you would need to gain a full understanding of the child’s health. Think about how you could gather this information in a sensitive fashion.

Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

By Day 3

Post a description of how the assessment tool or diagnostic test you selected is used in health care. Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

Post an explanation of the health issues and risks that are relevant to the child you selected. Describe additional information you would need in order to further assess his or her weight-related health. Taking into account the parents’ and caregivers’ potential sensitivities, list at least three specific questions you would ask about the child to gather more information. Provide at least two strategies you could employ to encourage the parents or caregivers to be proactive about their child’s health and weight.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues who selected a different tool test, or child health example than you, using one or more of the following approaches:

Critique your colleague’s evaluation of the validity and reliability of the tool or test selected.

Suggest alternative or additional tools or tests that should be considered when gathering information about specific conditions or symptoms.

Consider how you could encourage parents or caregivers to be proactive toward the child’s health.

Suggest additional health risks or issues that could be relevant to the child.

Critique your colleagues’ questions, and suggest how the parents or caregivers might interpret these questions. Provide alternate or additional questions.

Suggest an additional strategy for gathering patient information or promoting proactivity

Week 5 Discussion: Assessing the Ears, Nose, and Throat

Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test.

In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the Episodic/Focused SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case. NURS 6512 Complete Weekly Discussions latest

Case 1: Nose Focused Exam

Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he’s taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.

Case 2: Focused Throat Exam

Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn’t take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily’s. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn’t sound congested. NURS 6512 Complete Weekly Discussions latest

Case 3: Focused Ear Exam

Martha brings her 11-year old grandson, James, to your clinic to have his right ear checked. He has complained to her about a mild earache for the past two days. His grandmother believes that he feels warm but did not verify this with a thermometer. James states that the pain was worse while he was falling asleep and that it was harder for him to hear. When you begin basic assessments, you notice that James has a prominent tan. When you ask him how he’s been spending his summer, James responds that he’s been spending a lot of time in the pool.

To prepare:

With regard to the case study you were assigned:

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

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

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

Identify at least 10 possible conditions that may be considered in a differential diagnosis for the patient.

Note: Before you submit your initial post, replace the subject line (“Week 5 Discussion”) with “Review of Case Study ___,” identifying the number of the case study you were assigned.

By Day 3

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

Read a selection of your colleagues’ responses. NURS 6512 Complete Weekly Discussions latest

By Day 6

Respond to at least two of your colleagues on two different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition and justify your reasoning.

Week 7 discussion

Discussion: Assessing the Heart, Lungs, and Peripheral Vascular System

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

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

In this Discussion, you will consider how a patient’s initial symptoms can result in very different diagnoses when further assessment is conducted.

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To prepare:

With regard to the case study you were assigned:

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

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

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

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

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 6”) with “Review of Case Study” identifying the number of the case study you were assigned.

By Day 3

Read a selection of your colleagues’ responses.

By Day 6

Week 8 Discussion: Assessing Muscoskeletal Pain

The body is constantly sending signals about its health. One of the most easily recognized signals is pain. Musculoskeletal conditions comprise one of the leading causes of severe long-term pain in patients. The musculoskeletal system is an elaborate system of interconnected levers that provide the body with support and mobility. Because of the interconnectedness of the musculoskeletal system, identifying the causes of pain can be challenging. Accurately interpreting the cause of musculoskeletal pain requires an assessment process informed by patient history and physical exams.

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

Case 1: Back Pain

A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

spine

Case 2: Ankle Pain

A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottowa ankle rules to determine if you need additional testing?

ankle

Case 3: Knee Pain

A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform? NURS 6512 Complete Weekly Discussions latest

knee

To prepare:

With regard to the case study you were assigned:

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 you were assigned.

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

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

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 8”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

By Day 3

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on 2 different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning. NURS 6512 Complete Weekly Discussions latest

Week 9 Discussion: Assessing Neurological Symptoms

Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates just how impactful brain disorders can be to a patient’s quality of living. Accurately assessing neurological symptoms is a complex process that involves the analysis of many factors.

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

Case 1: Headaches

A 20-year-old male complains of experiencing intermittent headaches. The headaches diffuse all over the head, but the greatest intensity and pressure occurs above the eyes and spreads through the nose, cheekbones, and jaw.

Case 2: Numbness and Pain

A 47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools.

Case 3: Drooping of Face

A 33-year-old female comes to your clinic alarmed about sudden “drooping” on the right side of the face that began this morning. She complains of excessive tearing and drooling on her right side as well. NURS 6512 Complete Weekly Discussions latest

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To prepare:

With regard to the case study you were assigned:

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 you were assigned.

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

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

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 9”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

By Day 3

Read a selection of your colleagues’ responses. NURS 6512 Complete Weekly Discussions latest

By Day 6

NURS 6512 Complete Weekly Discussions latest