create a SOAP note  with information below Create – objectives to understand assessment and treatment of COPD lp

create a SOAP note  with information below
Create – objectives to understand assessment and treatment of COPD
Add 3 APA style sources no older than 5 years
Chief Complaint Pt states gastric acid is getting into his lungs, making it hard to breathe and coughing with flems History of Present Illness 50-year-old male with a past medical history of GERD, COPD presented to ED with complaints of worsening cough and shortness of breath for the last 3 days. Patient reports he started feeling heart burn about 2 months ago and soon after developed a cough that worsened within the last 3 days. Associated with nasal congestion, sore throat, chest pain and yellow mucus that is hard to expectorate. He reported taking Tagamet for acid reflux. Reported allergy to PPIs. Denied history of asthma, sick contact or smoking. Patient stated he had GERD surgery about 20 years ago. Reported being a supervised and doing office work. Patient exercises 4 -5 times a week however he had to stop due to symptoms. Reported exposure to second hand smoke as a child. At time of evaluation patient was sitting on stretcher, alert and oriented. Speaks in short sentences. He is currently on room air, sat 92%. He denies fevers, HA, chest pain, abdominal pain, nausea, vomiting, diarrhea or dysuria. Patient is admitted to telemetry for further management of acute bronchitis. Plan of care was discussed with patient, he verbalized understanding.
VS on arrival to ED: BP 140/83, HR 68, RR 17, O2 sat 92% on room air. Patient afebrile. BMI 34.6.
Labs on admission: CBC remarkable for neutrophils of 70.1%. BMP remarkable for chloride of 109 and creatinine of 1.36. Troponin x1 negative. Lipid panel remarkable for HDL of 69. COVID-19 negative.
EKG shows sinus rhythm with sinus arrhythmia.
Chest x-ray: Hyperinflation no consolidation. Review of Systems Constitutional: No unexplained weight gain or loss, fevers, chills, fatigue
Eye: No recent visual problems
ENMT: No ear pain, nasal congestion, sore throat
Respiratory: + shortness of breath, +cough
Cardiovascular: N+ chest pain, no palpitations, leg edema
Gastrointestinal: No nausea, vomiting, diarrhea,+ heartburn
Genitourinary: No dysuria, hematuria
Hema/Lymph: Negative for bruising tendency, swollen lymph glands
Endocrine: Negative for excessive thirst or urination, heat or cold intolerance
Musculoskeletal: No back pain, joint pain, muscle pain
Integumentary: No rash, itching, abrasions
Neurologic: No history of fainting, memory loss,numbness
Psychiatric: No anxiety, depression
Allergic/Immun: No nasal allergies, itchy/red eyes, enlarged lymph nodes Physical Exam
Vitals & Measurements
T: 36.7 °C (Oral)
HR: 68 (Peripheral)
HR: 99 (Monitored)
RR: 20
BP: 132/98
SpO2: 96%
WT: 67 kg (Measured)
BMI: 26.17 General: Alert, well nourished, speaks in short sentences
Eye: Pupils equal, EOMI, normal conjunctiva, no scleral icterus
ENMT : Normocephalic, normal hearing, moist oral mucosa.
Neck: Supple, non-tender, trachea midline, no JVD
Respiratory : Normal respiratory effort, regular rate, bilateral wheezing to auscultation, O2 sat 92% on RA
Cardiovascular: Regular rate and rhythm, no murmur or pedal edema
Gastrointestinal: Soft, non-tender, non-distended, normal bowel sounds, no rebound or guarding.
Genitourinary: No costovertebral angle tenderness to palpation
Musculoskeletal: MAE, No digital clubbing or cyanosis. Negative Homans sign.
Skin: Skin is warm, no rashes or lesions.
Neurologic: AAOx3, MAE, Sensation to touch intact
Psychiatric: Good judgment and insight, appropriate mood and affect Assessment/Plan

1. Acute bronchitis COPD exacerbation. Patient presented to ED with complaints of worsening cough and shortness of breath for the last 3 days. Patient reports he started feeling heart burn about 2 months ago and soon after developed a cough that worsened within the last 3 days. Associated with nasal congestion, sore throat and yellow mucus that is hard to expectorate. He reported taking Tagamet for acid reflux. Reported allergy to PPIs. Denied history of asthma, sick contact or smoking. Patient stated he had GERD surgery about 20 years ago. Reported being a supervised and doing office work. Patient exercises 4 -5 times a week however he had to stop due to symptoms. Reported exposure to second hand smoke as a child.
-No leukocytosis, patient afebrile.
Chest x-ray: Hyperinflation no consolidation. COVID-19 negative.
plan: Started on Rocephin and Zithromax, respiratory treatments, systemic and inhaled steroids, supplemental oxygen as needed, follow RPP, check mycoplasma, strep pneumonia and Legionella
2. Acute renal injury (N17.9: Acute kidney failure, unspecified) creatinine of 1.36.
plan: IVF, avoid nephrotoxins, adjust medications per creatinine clearance, BMP in a.m.
3. Chest pain (R07.9: Chest pain, unspecified) Denies at this time. Likely atypical. Patient reports chest pain associated with coughing.
Troponin x1 negative. Lipid panel remarkable for HDL of 69.
EKG shows sinus rhythm with sinus arrhythmia.
Chest x-ray: Hyperinflation no consolidation.
Plan: Telemetry, trend troponin, cardiology consult, check A1c, follow echocardiogram
4. GERD (gastroesophageal reflux disease) (K21.9: Gastro-esophageal reflux disease without esophagitis) History of GERD surgery. Reports heart burn. Takes Tagamet.
Plan: Started on Pepcid and sucralfate, GI consulted
VTE prophylaxis: Lovenox
GI prophylaxis: Pepcid
Case and plan of care discussed with admitting physician.
Medical Necessity Needs cardiology and GI evaluation, IVF, IV antibiotics, systemic and inhaled steroids. Pending troponins and echocardiogram. Problem List/Past Medical History Ongoing GERD (gastroesophageal reflux disease) Procedure/Surgical History
· GERD
· Knee
Home Medications Home Medications (3) Active
albuterol 90 mcg/inh inhalation aerosol 1 puffs, PRN, Inhale, Every 6 hrs
Carafate 1 g oral tablet 1 g = 1 tabs, Oral, BID
metoclopramide 5 mg/5 mL oral syrup 5 mg = 5 mL, Oral, BID Allergies Prevacid Social
Inpatient
albuterol 2.5 mg/0.5 mL (0.5%) inhalation solution, 2.5 mg= 0.5 mL, Nebulized Inhalation, Every 2 hrs, PRN
Antivert, 25 mg= 1 tab(s), Oral, Every 6 hrs, PRN
Artificial Tears, 2 drops, Eye-Both, Every 2 hrs, PRN
Ayr Saline 0.65% nasal solution, 1 sprays, Nasal, 6 times per day, PRN
bisacodyl, 10 mg= 1 supp, Rectal, Daily, PRN
budesonide 0.5 mg/2 mL inhalation suspension, 0.5 mg= 2 mL, Inhale, BID
Carafate, 1 g= 1 tab(s), Oral, QID
cefTRIAXone
famotidine, 20 mg= 2 mL, IV Push, BID
guaiFENesin-dextromethorphan 100 mg-10 mg/5 mL oral liquid, 5 mL, Oral, Every 4 hrs, PRN
ipratropium-albuterol 0.5 mg-2.5 mg/3 mL inhalation solution, 3 mL, Nebulized Inhalation, Every 6 hr
labetalol, 10 mg= 2 mL, IV Push, Every 4 hr, PRN
Lovenox, 40 mg= 0.4 mL, SubCutaneous, Daily
LR 1,000 mL, 1000 mL, IV Continuous
melatonin, 5 mg, Oral, Daily at bedtime, PRN
methylPREDNISolone sodium succinate, 40 mg, IV Push, Every 8 hrs
metoclopramide, 5 mg= 5 mL, Oral, BID before meals
Metoprolol Tartrate, 2.5 mg= 2.5 mL, IV Push, Once, PRN
ondansetron, 4 mg= 2 mL, IV Push, Every 4 hrs, PRN
simethicone, 80 mg= 1 tab(s), Oral, QID, PRN
Tessalon Perles, 100 mg= 1 cap(s), Oral, TID, PRN
Tylenol, 650 mg= 2 tab(s), Oral, Every 6 hrs, PRN
Zithromax IV, 500 mg= 1 tab(s), Oral, Every 24 hr
History
Alcohol
Current user, Occasional Use
Substance Use
Never
Tobacco
Tobacco Use: Never (less than 100 in lifetime). Exposure to Secondhand Smoke: Yes. Family History Arthritis: Mother. MI: Father. Stroke: Father.
Lab Results (Most Recent 36 hrs) Hemoglobin: 15.6 g/dL (09/13/23 08:25:00)
Hematocrit: 45.7 % (09/13/23 08:25:00)
WBC: 10.56 K/uL (09/13/23 08:25:00)
Platelet Count: 237 K/uL (09/13/23 08:25:00)
Sodium on Blood: 141 mmol/L (09/13/23 08:25:00)
Potassium on Blood: 3.6 mmol/L (09/13/23 08:25:00)
Chloride on Blood: 109 mmol/L High (09/13/23 08:25:00)
CO2 on Blood: 26 mmol/L (09/13/23 08:25:00)
Anion Gap: 6 mmol/L (09/13/23 08:25:00)
Glucose on Blood: 96 mg/dL (09/13/23 08:25:00)
Creatinine on Blood: 1.36 mg/dL High (09/13/23 08:25:00)
BUN on Blood: 11 mg/dL (09/13/23 08:25:00)
Calcium (Total): 9.1 mg/dL (09/13/23 08:25:00)
TSH: 1.67 uIU/mL (09/13/23 08:25:00)
Hemoglobin A1C (Glycosylated): 5.5 % (09/13/23 08:25:00)
Cholesterol Level: 186 mg/dL (09/13/23 08:25:00)
Triglycerides: 92 mg/dL (09/13/23 08:25:00)
HDL Cholesterol: 61 mg/dL High (09/13/23 08:25:00)
Cholesterol/HDL Ratio: 3 ratio (09/13/23 08:25:00)
LDL: 107 mg/dL (09/13/23 08:25:00) Diagnostics Results (Last 48 hrs) Chest Single View XR
09/13/23 09:03:00
IMPRESSION:
Hyperinflation no consolidation.
– 039321 – 9/13/2023 9:08
AM

Compare and contrast differences and similarities among the disciplines in terms of central concerns, values, methodologies, and relationships to public life.

Essay
Your first research essay should be a fully completed work of 5 pages (
Body Paragraphs, NOT including Title or Reference Page, or any graphics). Your topic may be related to the development of any idea that has already been expressed as part of the course; your thesis should be a synthesis of carefully documented research and critical analysis of this topic. The essay should incorporate the general parts of an academic essay—an introduction and thesis, a body of specific evidence/support/analysis, and a conclusion that emphasizes the answers to questions you may have asked within your research.

Your writing should address the Core Learning Outcomes of the course and the Instructor Specific Learning Outcomes, as specified on the syllabus. I have included them here for your convenience:
1. Analyze the disciplinary content in its own context and in relationship to the issues, questions, and positions of other disciplines.
2. Compare and contrast differences and similarities among the disciplines in terms of central concerns, values, methodologies, and relationships to public life.
3. Synthesize diverse perspectives to achieve an interdisciplinary understanding.
4. Analyze the relationships among academic knowledge, professional work, and the responsibilities of local and global citizenship.
5. Interpret and critique the possible “real world” connections or behaviors associated with the viewing or playing of media violence.
Instructor Learning Outcomes
1. Identify, discuss, and critique the representations of serial killers as heroes, celebrities, and icons in modern media forms. Explain the characteristics of the media forms, genres, and methods for each subject.
2. Describe and analyze the popular culture forms that encourage audience identification or participation through violence or vicarious experience.
3. Evaluate multiple perspectives, modes of inquiry and expression, and processes for decision-making in the disciplines.
Specifics
Your essay should conform to the MLA format for citations within the text and in your works cited. Therefore, your writing should be double-spaced, with one-inch margins, in a 10-12-pitch font. The grading of this essay will be based upon the objective skills we have focused upon in our course lectures and discussions—incorporating your research sources seamlessly within your own writing, building upon your skills as a “close-reading” expert, and analysis of your topic, and answering the larger questions about “why” we are studying serial killers as heroes (as well as, “why” your topic is popular? important? significant? worthy of study? definitive of its audience?)
Resources
You should carefully construct your essay by looking at the examples we have studied within our course—the popular culture essays that have been part of your reading assignments, our in-class examples, and the writing process that has been investigated in our class assignments (Reader Response Essays, Discussion Postings, etc.).

This is an enhanced, clearer version of the instructions from the Week 8 Module. Clarifications from me are in brackets/blue and important points are bolded. You should start planning this essay NOW to avoid stress and frustration. Working in “small bites” is always the best way to approach large projects.

Assignment

Paper: Your Final Research Essay should be a
fully completed work of 5 pages [
body only – NOT including Title Page, Sources, graphics/charts or other elements]. Your topic may be
related to the development of any idea that has already been expressed as part of the course [you can write about
anything –
your choice – as long as it’s
related to the class materials and topics. Think about what interested you particularly and if you have questions, send the idea to me and I’ll be happy to review it].

Ideas were provided for the
Midterm that would work here (though you
cannot
rehash your Midterm). You can choose from any of the materials/subjects from Weeks 1-7 for this essay, not only the first three weeks. Craft these example prompts in a way you want with the subjects you want and you will have a topic. You can, of course, develop your own topic and approach.

Example questions/topics from Midterm instructions:

· You may
compare and contrast the way
literary analysis would analyze 
Darkly Dreaming Dexter [or any novel]
differently than
a film analysis would be of the TV series [or movie].  How does Dexter’s “heroic” vigilantism bleed into the real world?

· You may
compare or contrast the film analysis of Alfred Hitchcock’s 
Psycho with the
medical or psychological diagnosis of Norman Bates.  Is it possible to learn from the film’s fiction to allow us to see a “real world” perspective on serial killers?

· How would a
criminal justice perspective on Hannibal Lecter differ from a
social psychological profile?  How does our academic knowledge change our viewing of the film? 

Other options could be analyzing how the movies/ TV series or novels were reviewed, analysis of characters or other elements, the connection between the fictional characters and real-life criminals (who were often the basis for the fictional characters), WHY the market for anything “serial killer related” is so huge or anything else you want to explore. Do not forget to start with a
Research Question about your topic, the
answer to which (through research) will be your
Thesis Statement.

Your
Thesis Statement should be a
synthesis of carefully documented research and critical analysis of this topic. Note that the Thesis Statement is an assertive
statement and
never
a question. The essay should
incorporate the general parts of an academic essay—an Introduction and Thesis, a body of specific evidence/support/analysis, and a conclusion that emphasizes the answers to questions you may have asked within your research.

Your writing should address the
Core Learning Outcomes of the course as specified on the syllabus.

I have included the Outcomes here for your convenience [include/demonstrate as many as you can]:
1.
Analyze the disciplinary content
in its own context and in relationship to the issues, questions, and positions of other disciplines.

2.
Compare and
contrast differences and similarities among the disciplines in terms of central concerns, values, methodologies, and relationships to public life.

3.
Synthesize diverse perspectives to achieve an interdisciplinary understanding.

4.
Analyze the relationships among
academic knowledge, professional work, and the responsibilities of local and global citizenship.

5.
Interpret and critique the possible
“real world” connections or behaviors associated with the viewing or playing of media violence.

Instructor Learning Outcomes:

1.
Identify, discuss and critique the representations of serial killers as heroes, celebrities, and icons in modern media forms. Explain the characteristics of the media forms, genres, and methods for each subject.

2.
Describe and analyze the popular culture forms that encourage audience identification or participation through violence or vicarious experience.

3.
Evaluate multiple perspectives, modes of inquiry and expression, and processes for decision-making in the disciplines.

Specifics

Your essay should conform to the
MLA format [I’ll also accept APA – just make sure you don’t mix the styles] for
citations within the text and in your
Works Cited [or Reference]
Page. Therefore, your writing should be double-spaced, with one-inch margins, in a 10-12-pitch font. The grading of this essay will be based upon the objective skills we have focused on in our course lectures and discussions—incorporating your research sources seamlessly within your own writing, building upon your skills as a “close-reading” expert and analysis of your topic, and answering the larger questions about “why” we are studying serial killers as heroes (as well as, “why” your topic is popular? important? significant? worthy of study? definitive of its audience?)

Resources

You should carefully construct your essay by looking at the
examples we have studied within our course—
the popular culture essays that have been part of your reading assignments, our in-class examples, and the writing process that has been investigated in our class assignments (Midterm Essay, Discussion Postings, etc). [You can include any of the sources I’ve posted in
Discussion or
Doc Sharing or any other
credible sources you find on your own]. Below are links to information on the two styles:

MLA

APA

Policy and Advocacy for Improving Population Health, Comparing APRN Regulations: Full Practice Authority vs. Collaborative Models in New York and Florida

**minimum of three (2) scholarly references are required for each reply cited within the body of the reply & at the end**

Nerline Mildort

Comparing APRN Regulations: Full Practice Authority vs. Collaborative Models in New York and Florida

In New York Advanced Practice Registered Nurses (APRNs), including nurse practitioners (NPs), operate under specific regulations that grant them a degree of autonomy in their practice. On the other hand, in Florida, the regulatory framework for APRNs is different, requiring them to maintain a Collaborative Practice Agreement (CPA) with a physician (Kleinpell et al., 2023). This comparison highlights the distinctions between the two states’ regulations and their potential impact on nursing practice.

New York Regulations

In New York, APRNs, including NPs, have Full Practice Authority (FPA). This means they can practice independently within the full scope of their education and training without needing a CPA with a physician (Kleinpell et al., 2023). They are authorized to diagnose, treat, and prescribe medications, including controlled substances, without mandatory physician oversight.
For example, an NP working in a family practice clinic in New York can conduct patient assessments, order, and interpret diagnostic tests, make treatment decisions, and prescribe medications without supervision from a collaborating physician.

Florida Regulations

In contrast, Florida has a more restrictive regulatory approach for APRNs, including NPs. APRNs in Florida must have a CPA with a physician, which introduces an element of collaboration into their practice (Neff et al., 2018). While NPs in Florida can diagnose and treat patients, certain aspects of their practice, particularly prescribing medications, are influenced by the terms of the CPA.
For instance, an NP in Florida may need to consult with their collaborating physician for certain prescription decisions, and the physician may be required to co-sign these prescriptions. This collaborative model ensures physician involvement in NP practice and adds an extra layer of oversight.

Application to APRNs with Full Scope Practice

The regulations in New York, granting Full Practice Authority to APRNs allow them to operate autonomously, offering timely and comprehensive care to patients (Wheeler et al., 2022). This autonomy can be particularly beneficial in underserved areas where physicians may be scarce, improving access to care and potentially reducing healthcare disparities. In contrast, Florida’s regulatory framework, which requires CPAs with physicians, may create administrative hurdles and slow the delivery of care (Wheeler et al., 2022). However, this model can also facilitate collaborative decision-making and ensure an additional layer of clinical oversight.
For example, in a rural clinic in New York, an NP may see patients and prescribe medications independently, whereas, in a similar clinic in Florida, the NP might need to consult with their collaborating physician for certain prescription decisions, adding an extra layer of clinical judgment and expertise.
In conclusion, the regulatory differences between Florida and New York for APRNs, particularly NPs, highlight the varying levels of autonomy and collaboration in their practice. These regulations reflect the states’ approaches to balancing access to care with patient safety, and they have direct implications for how APRNs provide healthcare services within their respective jurisdictions.
 
References

Florida: Information and Resources for Florida NPs. American Association of Nurse Practitioners. (n.d.-a). https://www.aanp.org/advocacy/florida

Kleinpell, R., Myers, C. R., & Schorn, M. N. (2023). Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19. 
Journal of Nursing Regulation, 
14(1), 13–20. https://doi.org/10.1016/s2155-8256(23)00064-9

Neff, D. F., Yoon, S. H., Steiner, R. L., Bejleri, I., Bumbach, M. D., Everhart, D., & Harman, J. S. (2018). The impact of nurse practitioner regulations on population access to care. 
Nursing Outlook, 
66(4), 379–385. https://doi.org/10.1016/j.outlook.2018.03.001

 
New York: Information and Resources for New York NPs. American Association of Nurse Practitioners. (n.d.). https://www.aanp.org/advocacy/new-york

Wheeler, K. J., Miller, M., Pulcini, J., Gray, D., Ladd, E., & Rayens, M. K. (2022). Advanced Practice Nursing Roles, Regulation, Education, and Practice: A Global Study. 
Annals of Global Health, 
88(1). https://doi.org/10.5334/aogh.3698

Describe the key functions in the body of the biomolecules you studied in this virtual lab AND include key structural details. a. Carbohydrates b. Proteins

CHEM120OX, Week 7 OL Lab

Virtual Lab Week 7: Introduction to Food Macromolecules

Learning Objectives

· Understand the types of macromolecules found in food
· Understand the structure of carbohydrates, proteins, and lipids
· Detect macromolecules in food samples

Introduction

Macromolecules are very large molecules created by the polymerization of small units called monomers. Most of the macromolecules are present in everyday life, for instance in food.

Learn about biological macromolecules

There are several types of biological macromolecules: carbohydrates, proteins, lipids and nucleic acids. All macromolecules, except lipids, are polymers. A polymer is a long molecule composed of chains of monomers. Monomers are small molecules that serve as building blocks of polymers. In addition, there are also oligomers in nature. Oligomers are molecular complexes composed of a few monomer units, instead of the theoretical unlimited number of monomers. Dimers and trimers are oligomers composed of two and three monomers, respectively, such as lactose in milk for instance. However, in biochemistry, an oligomer usually refers to a macromolecular complex formed by non-covalent bonding of a few macromolecules, such as nucleic acids or proteins. An example is the oligomers found in many neurodegenerative diseases, such as the alpha-synuclein aggregations in Parkinson’s disease.

Help your friend with your macromolecule knowledge

In the Introduction to Food Macromolecules simulation, you will help your friend get a healthy diet and investigate the types of macromolecules found in food. By performing a series of biochemistry tests, you will know the contents of various food items.
Can you use your macromolecule knowledge to convince your friend to change her diet to a healthier one?

Study the transcription and translation processes

Begin by learning about the transcription process of DNA to RNA. Discover the translation process where an RNA sequence is read by a ribosome inside a cell and the corresponding to amino acids are made. With these two processes any protein can be made. How do the amino acids form different proteins?

Synthesis of proteins from amino acids

Find out how amino acids are assembled to make proteins. A 3D animation describes how triplets of codons in the RNA sequence are translated into amino acids. Observe how these amino acids are joined together by peptide bonds to create a polypeptide chain: this is the primary structure of a protein. Then watch as the primary structure is folded into secondary, tertiary and quaternary structures. Discover the two main types of secondary structure and see an example of how the tertiary structure of a protein can be modified post-translation.

Part 1: Complete Labster Lab: Introduction to Food Macromolecules

Purpose: Describe in complete sentences and in your own words, the purpose of this experiment.

Observations: Record three observations from the simulation.

Answer the questions below

1. Describe the key functions in the body of the biomolecules you studied in this virtual lab AND include key structural details.
a. Carbohydrates
b. Proteins
c. Lipids
2. Choose a food in your house. What are some of the biomolecules you expect to be in this food and why?

Part 2: Complete Labster Lab: Introduction to Protein Synthesis

3. In your own words, describe the process of gene expression beginning from the nucleus to the formation of the polypeptide sequence.
4. Complete the table below (2 points):

Nucleic acid

Amine Bases Present

Location(s) in cell

DNA

RNA

5. Assume that RNA Polymerase will read the parental strand of DNA given here and write the mRNA sequence that would result: – TATGCTTCCGTA –
Reflection: Consider what you learned from the two simulations. Reflect on three to four key concepts that you learned in this lab exercise. How could the lessons have learned in this virtual lab related to a real world situation in the community/world or your future career? Be specific in your answer (this should require 5-10 sentences).

Grading Rubric: 

Activity 

Deliverable 

Points 

Part I

Complete Week 7 Virtual Lab: Introduction to Macromolecules Simulation

10

Part II  

Complete the Introduction to Protein Synthesis simulation

10

Part III

Complete lab report and answer questions 
· Purpose (1 point) 
· Observation (3 points)  
· Questions (6 points) 
· Reflection (5 points)

15

Total  

Complete all lab activities  

35

1

Nursing lab assignment: differential diagnosis for skin conditions

SkinComprehensiveSOAPNoteTemplate.docx

Week 4

Skin Comprehensive SOAP Note Template

Patient Initials: _______ Age: _______ Gender: _______

SUBJECTIVE DATA:

Chief Complaint (CC):

History of Present Illness (HPI):

Medications:

Allergies:

Past Medical History (PMH):

Past Surgical History (PSH):

Sexual/Reproductive History:

Personal/Social History:

Health Maintenance:

Immunization History:

Significant Family History:

Review of Systems:

General:

HEENT:

Respiratory:

Cardiovascular/Peripheral Vascular:

Gastrointestinal:

Genitourinary:

Musculoskeletal:

Neurological:

Psychiatric:

Skin/hair/nails:

OBJECTIVE DATA:

Physical Exam:

Vital signs:

General:

HEENT:

Neck:

Chest/Lungs:.

Heart/Peripheral Vascular:

Abdomen:

Genital/Rectal:

Musculoskeletal:

Neurological:

Skin:

Diagnostic results:

ASSESSMENT:

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

© 2021 Walden University Page 2 of 3

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Edmg541wk3 | Law homework help

Mass-Casualty Incident Management: Clinical Issues
In Week 3 we examine logistical, organizational, and communication issues in the clinical management of Mass
Casualty Incidents.

When we think of clinical issues, we must start at the event site and work our way to recovery. To do this, we will have
a network of paths that will work independently and interdependently to recover patients, scene, community, and
disaster responders.

From a scene perspective, we now have fire, EMS, and police, as well as the potential for nurses and doctors to all
converge upon the scene and operate to rescue, treat, and transport mass casualty victims. As noted in content 2, this
organization will occur under the ICS system, but because we can have physicians, nurses, and other medical
professionals working in the field, the protocols and medical actions may contraindicate the normal ICS structure and
pre-arranged protocols utilized by police, fire, and EMS. This coordination will become important as decisions made at
the scene will have downstream effects on hospitals, police investigations, and community recovery efforts.

Currently there are various thoughts on where the centralization of command should reside in a mass casualty event.
This is further complicated by the use of unified command needed for active shooter/active violence events. The best
practice involves the use of an emergency operations center to allow coordination of the various centralized command
structures that will exist at the scene, in the hospitals, and in community government. Attendance at the FEMA G191
EOC/ICS interface course can help to understand the coordination needed to keep all parts of a mass casualty
coordinated.

Patient Flow issues are related to surmounting a large patient influx and the communication process necessary to
determine resource allocation and forecast patient volumes. The knowledge of patient flow patterns is critical to
disaster planning. Recent funding challenges due to no elective surgeries have places some hospitals in a position that
creates subpar staffing daily.

In Mass Casualty Incidents, the creation of the Discharge Unit should be on the same level of importance as the
delineation of the Command Center. Without the Discharge Unit the patients will languish and the hospital will
compromise the ability to provide further care for incoming patients. In a disaster, no patient should leave the hospital
without passing through Discharge unit.

Without a properly planned physical plant design for the emergency department, the performance of a successful
disaster mitigation strategy is challenged. Failure to take the special requirements for Mass Casualty Incidents into
account will present unanticipated problem when a Mass Casualty Incident occurs. The key in disaster management
architectural planning is whiter the proposed design will allow for appropriate patient flow.

The new information management systems enhance patient management and allow hospitals and other health care
and emergency services provides to communicate with hospital core Health Information System. It also enable the
implementation of the National Network for Real-time Syndromic and Bioterrorist Surveillance Systems.

Victim lists are essential tools for hospital response. Victim lists are required, not only to identify victims that have
come into the hospital but also to identify casualties brought to multiple other sites during a disaster. Lists are often
electronic in nature and require the systems to function at the time of a disaster. Plan accordingly.

Systems Deliverable 3 draws on course content from weeks Nursing Assignment Help

Systems
Deliverable 3 draws on course content from weeks 1-5. Begin your slide deck, incorporating feedback from the instructor on your project idea and adding the following:

A system statement as the title of your slide deck
Summary of the Public Health Challenge and Issue brief, including a description of a system and the area of concern you want to address (the “wicked problem”)
At least 1 characteristic of a wicked problem that illustrates how your system is a wicked problem. Provide an example of why your system meets this characteristic in your geographic area of focus.
A description of system boundaries and a rich picture of the system
A list of 4-6 key community partners. Conduct a CATWOE analysis for each community partner and a root definition.
A causal loop diagram (CLD) that visually represents the system you are focusing on, and at least one system archetype that represents your wicked problem.
A case for transformation that will guide your system co-design approach (parts II and III) Identify an example for each of the system leverage point (e.g., system infrastructure, information flows, organizing principles, and mindsets) without including specific solutions or interventions.

System Statement is: The System to Reduce African-American Maternal Mortality Rates in Harris County, TX

You are a medical professor in charge of creating college assignments and answers for medical college students. You design and conduct lectures, evaluate student performance and provide feedback through examinations and assignments. Answer each question separately. Include and Introduction. Provide an answer to this content

Systems
Deliverable 3 draws on course content from weeks 1-5. Begin your slide deck, incorporating feedback from the instructor on your project idea and adding the following:

Real due | Nursing homework help

Name: Linda McCarthy
Age: 86 years
Provider: K. Townsend MD
Codestatus: DNI
BMI: 24.1
Allergies: penicillin, atorvastatin, red dye, latex
Admitweight: 145 lbs (65.8kg)

Linda McCartchy had a rough night. She was pretty restless and only slept two hours.
This morning she was having an issue with her hearing aids not working. They kept
whistling. I went to change the batteries, but she was out of them. Her family will be
bringing them in later today.

Nursing Assessments and notes

11/1
0700

Neuro/Cognitive: Alert and oriented to person and place. She intermittently
confused and called staff by the names of her children. Speech raspy. 4/5
strength in all extremities.
Cardiovascular: S1 and S2 heart sound present. Heart rate regular and even.
No edema was noted. Pedal pulses +2, radial pulses +3. Capillary refill less
than 3 seconds.

Respiratory: Even, regular, unlabored. Lung sounds wheezing through all
lung fields. Chronic dry cough. Wears 2 L via nasal cannula chronically.

Gastrointestinal: BS present x 4 quadrants. Abdomen soft, non-distended,
non-tender. Last bowel movement 2 days ago.

Genitourinary: Occasional stress incontinence.

Integumentary: Scattered bruising. Various stages of healing.

Sensory: Hard of hearing. Wears hearing aids and glasses.

11/1
0730

ADLs: Independent with utensil holders
Activity: Ambulated 100 feet with a roller walker

11/1
0830

Nursing Note: Client resting quietly in bed. Looking out the window, not
responding to staff prompts for verbal interaction. Moves all extremities
appropriately. Morning medications were administered without difficulty. Able
to state name but unsure of her birthday. Up in the hall with physical therapy.
Shuffling gait with use of a rolling walker.

11/1
1100

Nursing Note: RN called to bedside. The client stated that the staff took her
favorite earrings. Earrings were found in the client’s tissue box at the bedside.

11/1
2015

Nursing Note: Client evening hygiene offered. The client begins yelling, “No!
No! No!” as staff offer to assist with teeth brushing and denture care. Attempts
were made to deescalate the client and place her hearing aids so that she
could hear the conversation. The client begins attempting to hit and bite staff.
Client sitting in bed. Staff leave room to reduce stimulation.

11/1
2015

Neuro/Cognitive: Alert, oriented to self only. She believes it is 1965 and that
there are strangers in her house. Client calling out for her mother. Extremely
hard of hearing with hearing aids in place.

11/2
0700

Nursing Note: The client is awake in bed, staring around her room, rubbing
her eyes, and frequently yawning. Noted to have redness and purulent
drainage from right eye. Provider notified; prescriptions received.

11/2
0900

Nursing Note: Appetite poor, ate 5 small bites only, Drank a cup of juice.
Weight down. Will encourage protein supplement drinks between meals.

Date Intake Source & Amount

11/1 0700 Oral 240 mL

11/1
0900

Client Information:
Medical History: Presbyopia, bilateral cataracts, Alzheimer’s dementia,
hearing loss, hypertension, hyperlipidemia, osteoarthritis, ambulatory
dysfunction, chronic obstructive pulmonary disease

Medications:
? Rivastigmine 6 mg by mouth twice daily
? Lisinopril 20 mg by mouth daily
? Ezetimibe 10 mg by mouth daily
? Simvastatin 40 mg by mouth daily
? Docusate sodium 100 mg by mouth daily
? Polyethylene glycol 17 g by mouth daily – diluted in 8 oz of beverage
? Duloxetine 60 mg by mouth daily
? Artificial tears 1-2 drops into eyes PRN for dry eyes
? Oxygen 2L/NC PRN for difficulty breathing

11/2 0730 Prescriptions:
? Ciprofloxacin ocular ointment 0.5-inch right eye three times

daily

What are the differences between the ads from other countries and the United States? What are the similarities between the ads from other countries and the United States?

BeautyStandards.docx

Beauty Standards

So often, it is easy to think that everyone else sees the world in the same way that we do. It is often a surprise when we discover the differences.

Resources

Internet search engine such as google, yahoo, etc.

The Prompt

For your initial prompt on this discussion board, please use the internet to research current advertisements from other countries around the world, and compare these ads to those we see in the United States.  You will need to respond to the following three questions, at a minimum.
What are the differences between the ads from other countries and the United States?
What are the similarities between the ads from other countries and the United States?
How are beauty standards portrayed in advertising different when comparing other countries to the United States?
Please reference your ads at the end of your post.

Discussion Forum Grading Criteria

The Discussion Forum (DF) represents your class participation.  Your performance will be evaluated on the quality of your initial input and then on your responses to other students input.  It is highly suggested that students post their responses early in the week in order to allow students to have someone to respond to. Failure to post your initial response to the question by
 Friday will result in -10 points per day for each day after. 
For instance if you make you main post on Sunday, and respond to two classmates with all of the requirements met, the highest grade that you can earn is a 70 for that particular discussion board.

Quality primary input–
Your initial post will count as 80%.  Primary input should be  thorough and direct and posted no later than Friday. Quality primary input should be complete, thoughtful, and well-developed responses that are substantive and may contain specific text references.  Students should refrain from personal opinions unless it is based upon objective facts. It must be detailed; at least two paragraphs (5-7 sentences each). If there is more than one part to a question, you must answer all parts of the question.

Identify an example—from your own experience—either of a workplace that was characterized by drama or negativity, or a singular incident involving drama or negativity that was poorly handled by management.

CREATING A DRAMA-FREE WORKPLACE
The ways in which managers deal with—or fail to deal with—drama and negativity in the workplace have far-reaching effects on the overall organizational culture. The average professional spends a significant portion of their lives in the workplace, so it would be sensible to ensure that it is as enjoyable an experience as possible. Although many people “put up with” toxic work environments, they also frequently leave those environments to be treated better. For those who stay, it can be expected that they would be less committed and connected to their job. Instead of thinking of ways to innovate or cut costs, they might spend their mental energy imagining what they will be doing on their next vacation. Leaders who strive to create a drama-free workplace do their part to avoid that outcome.
In this Discussion, you will recall an instance of workplace drama or negativity you’ve observed or experienced. You will then analyze the manager’s role in the experience and develop specific, behavioral suggestions for ways that same manager could have responded to foster a more positive overall environment.

To prepare for this Discussion:
Review the resources from this week focusing on creating a drama-free workplace.
Identify an example—from your own experience—either of a workplace that was characterized by drama or negativity, or a singular incident involving drama or negativity that was poorly handled by management.
Also consider the role of the manager in the situation. 

Post an analysis of the role of a manager in influencing workplace culture and formulate some recommended managerial action steps for addressing drama and negativity and improving the workplace culture. Specifically:

Describe, in detail, the situation involving workplace drama and/or negativity.
Interpret the manager’s role in either fueling or permitting the drama or negativity.
Explain how the manager might have behaved differently and propose some recommendations for the manager to foster a more positive, drama-free work environment going forward.  

You are a medical professor in charge of creating college assignments and answers for medical college students. You design and conduct lectures, evaluate student performance and provide feedback through examinations and assignments. Answer each question separately. Include and Introduction. Provide an answer to this content

CREATING A DRAMA-FREE WORKPLACE
The ways in which managers deal with—or fail to deal with—drama and negativity in the workplace have far-reaching effects on the overall organizational culture. The average professional spends a significant portion of their lives in the workplace, so it would be sensible to ensure that it is as enjoyable an experience as possible. Although many people “put up with” toxic work environments, they also frequently leave those environments to be treated better. For those who stay, it can be expected that they would be less committed and connected to their job. Instead of thinking of ways to innovate or cut costs, they might spend their mental energy imagining what they will be doing on their next vacation. Leaders who strive to create a drama-free workplace do their part to avoid that outcome.
In this Discussion, you will recall an instance of workplace drama or negativity you’ve observed or experienced. You will then analyze the manager’s role in the experience and develop specific, behavioral suggestions for ways that same manager could have responded to foster a more positive overall environment.

To prepare for this Discussion:
Review the resources from this week focusing on creating a drama-free workplace.
Identify an example—from your own experience—either of a workplace that was characterized by drama or negativity, or a singular incident involving drama or negativity that was poorly handled by management.
Also consider the role of the manager in the situation. 

Post an analysis of the role of a manager in influencing workplace culture and formulate some recommended managerial action steps for addressing drama and negativity and improving the workplace culture. Specifically:

Describe, in detail, the situation involving workplace drama and/or negativity.
Interpret the manager’s role in either fueling or permitting the drama or negativity.
Explain how the manager might have behaved differently and propose some recommendations for the manager to foster a more positive, drama-free work environment going forward.  

. Do not write who you are in the answer.