Category: Clinical Nursing & Patient Care

[Solved] HEALTHCARE

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Can someone help me with this?

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November 6, 2026
[Solved] Lorem, Ipsum

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November 6, 2026
[Solved] WEEK1 RESPONSES

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RESPONDING TO CLASSMATES **files (1)** – ## WEEK1RESPONSES.docx **## WEEK1RESPONSES.docx** Matthre f According to Boland psychopatholoy is the product of interacting biological, psychological, and sociocultural forces instead of just one single cause (Boland et al., 2022). When we discuss biological…

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RESPONDING TO CLASSMATES

**files (1)**

– ## WEEK1RESPONSES.docx

**## WEEK1RESPONSES.docx**

Matthre f

According to Boland psychopatholoy is the product of interacting biological, psychological, and sociocultural forces instead of just one single cause (Boland et al., 2022).

When we discuss biological factors, we often think of families with illnesses, but according to the literature, genes are not all defining if infact someone will get sick. It only increases the chances of their development. We have to consider chemicals like serotonin that also have an effect. Chemical imbalances, along with moods and sleep can also be important to consider. It has been proven that long periods of stress can change the mind. Tests have shown problems with memory, attention, and the ability to plan (Jackson & Milberg, 2018).

Psychological factors involve thinking and acting, and all too often anxiety is focused on. People with anxiety can sometimes hyperfocus on what scares them, which causes the fear to become stronger. Events that affect a 10-year-old may transpire differently than the same event for an 85-year-old Babushka. Interestingly, children with strong support, which causes resilience, tend to "bounce back" more quickly.

When talking about social and cultural factors, we think of poverty, violence, unjust treatment, and hard childhood experiences. It's been shown that having good friends and social support systems in place can help. Keep in mind that the culture of a person can be presented in ways differently than your own. This also affects how feelings are displayed. What may seem like an issue in our culture may be considered totally normal in another (Cheung & Mak, 2018).

As this is brought inside the scope of a Nurse Practitioner, we need to consider that most problems are multifacited, and with that comes the responsibility to be knowledgeable and sensitive towards each patient differently. Meds might not be the answer for an unsafe home. Each person is a tapestry of character that must be individualized to fully understand and properly treat.

**References**

Boland, R., Verduin, M. L., & Ruiz, P. (2022).
_Kaplan & Sadock's synopsis of psychiatry_ (12th ed.). Wolters Kluwer.

Butcher, J. N., & Kendall, P. C. (2018). Introduction to childhood and adolescent psychopathology. In J. N. Butcher & P. C. Kendall (Eds.),
_APA handbook of psychopathology: Vol. 2. Child and adolescent psychopathology_ (pp. 3–14). American Psychological Association.
[https://doi.org/10.1037/0000065-001](https://doi.org/10.1037/0000065-001)

Cheung, F. M., & Mak, W. W. S. (2018). Sociocultural factors in psychopathology. In J. N. Butcher & J. M. Hooley (Eds.),
_APA handbook of psychopathology: Vol. 1. Psychopathology: Understanding, assessing, and treating adult mental disorders_ (pp. 127–147). American Psychological Association.
[https://doi.org/10.1037/0000064-006](https://doi.org/10.1037/0000064-006)

Jackson, C. E., & Milberg, W. P. (2018). Examination of neurological and neuropsychological features in psychopathology. In J. N. Butcher & J. M. Hooley (Eds.),
_APA handbook of psychopathology: Vol. 1_ (pp. 65–90). American Psychological Association.
[https://doi.org/10.1037/0000064-004](https://doi.org/10.1037/0000064-004)

Masten, A. S., & Kalstabakken, A. W. (2018). Developmental perspectives on psychopathology in children and adolescents. In J. N. Butcher & P. C. Kendall (Eds.),
_APA handbook of psychopathology: Vol. 2_ (pp. 15–36). American Psychological Association.
[https://doi.org/10.1037/0000065-002](https://doi.org/10.1037/0000065-002)

Bryonna williamson

According to Boland psychopatholoy is the product of interacting biological, psychological, and sociocultural forces instead of just one single cause (Boland et al., 2022).

When we discuss biological factors, we often think of families with illnesses, but according to the literature, genes are not all defining if infact someone will get sick. It only increases the chances of their development. We have to consider chemicals like serotonin that also have an effect. Chemical imbalances, along with moods and sleep can also be important to consider. It has been proven that long periods of stress can change the mind. Tests have shown problems with memory, attention, and the ability to plan (Jackson & Milberg, 2018).

Psychological factors involve thinking and acting, and all too often anxiety is focused on. People with anxiety can sometimes hyperfocus on what scares them, which causes the fear to become stronger. Events that affect a 10-year-old may transpire differently than the same event for an 85-year-old Babushka. Interestingly, children with strong support, which causes resilience, tend to "bounce back" more quickly.

When talking about social and cultural factors, we think of poverty, violence, unjust treatment, and hard childhood experiences. It's been shown that having good friends and social support systems in place can help. Keep in mind that the culture of a person can be presented in ways differently than your own. This also affects how feelings are displayed. What may seem like an issue in our culture may be considered totally normal in another (Cheung & Mak, 2018).

As this is brought inside the scope of a Nurse Practitioner, we need to consider that most problems are multifacited, and with that comes the responsibility to be knowledgeable and sensitive towards each patient differently. Meds might not be the answer for an unsafe home. Each person is a tapestry of character that must be individualized to fully understand and properly treat.

**References**

Boland, R., Verduin, M. L., & Ruiz, P. (2022).
_Kaplan & Sadock's synopsis of psychiatry_ (12th ed.). Wolters Kluwer.

Butcher, J. N., & Kendall, P. C. (2018). Introduction to childhood and adolescent psychopathology. In J. N. Butcher & P. C. Kendall (Eds.),
_APA handbook of psychopathology: Vol. 2. Child and adolescent psychopathology_ (pp. 3–14). American Psychological Association.
[https://doi.org/10.1037/0000065-001](https://doi.org/10.1037/0000065-001)

Cheung, F. M., & Mak, W. W. S. (2018). Sociocultural factors in psychopathology. In J. N. Butcher & J. M. Hooley (Eds.),
_APA handbook of psychopathology: Vol. 1. Psychopathology: Understanding, assessing, and treating adult mental disorders_ (pp. 127–147). American Psychological Association.
[https://doi.org/10.1037/0000064-006](https://doi.org/10.1037/0000064-006)

Jackson, C. E., & Milberg, W. P. (2018). Examination of neurological and neuropsychological features in psychopathology. In J. N. Butcher & J. M. Hooley (Eds.),
_APA handbook of psychopathology: Vol. 1_ (pp. 65–90). American Psychological Association.
[https://doi.org/10.1037/0000064-004](https://doi.org/10.1037/0000064-004)

Masten, A. S., & Kalstabakken, A. W. (2018). Developmental perspectives on psychopathology in children and adolescents. In J. N. Butcher & P. C. Kendall (Eds.),
_APA handbook of psychopathology: Vol. 2_ (pp. 15–36). American Psychological Association.
[https://doi.org/10.1037/0000065-002](https://doi.org/10.1037/0000065-002)

**## WEEK1RESPONSES.docx**

Matthre f

According to Boland psychopatholoy is the product of interacting biological, psychological, and sociocultural forces instead of just one single cause (Boland et al., 2022).

When we discuss biological factors, we often think of families with illnesses, but according to the literature, genes are not all defining if infact someone will get sick. It only increases the chances of their development. We have to consider chemicals like serotonin that also have an effect. Chemical imbalances, along with moods and sleep can also be important to consider. It has been proven that long periods of stress can change the mind. Tests have shown problems with memory, attention, and the ability to plan (Jackson & Milberg, 2018).

Psychological factors involve thinking and acting, and all too often anxiety is focused on. People with anxiety can sometimes hyperfocus on what scares them, which causes the fear to become stronger. Events that affect a 10-year-old may transpire differently than the same event for an 85-year-old Babushka. Interestingly, children with strong support, which causes resilience, tend to "bounce back" more quickly.

When talking about social and cultural factors, we think of poverty, violence, unjust treatment, and hard childhood experiences. It's been shown that having good friends and social support systems in place can help. Keep in mind that the culture of a person can be presented in ways differently than your own. This also affects how feelings are displayed. What may seem like an issue in our culture may be considered totally normal in another (Cheung & Mak, 2018).

As this is brought inside the scope of a Nurse Practitioner, we need to consider that most problems are multifacited, and with that comes the responsibility to be knowledgeable and sensitive towards each patient differently. Meds might not be the answer for an unsafe home. Each person is a tapestry of character that must be individualized to fully understand and properly treat.

**References**

Boland, R., Verduin, M. L., & Ruiz, P. (2022).
_Kaplan & Sadock's synopsis of psychiatry_ (12th ed.). Wolters Kluwer.

Butcher, J. N., & Kendall, P. C. (2018). Introduction to childhood and adolescent psychopathology. In J. N. Butcher & P. C. Kendall (Eds.),
_APA handbook of psychopathology: Vol. 2. Child and adolescent psychopathology_ (pp. 3–14). American Psychological Association.
[https://doi.org/10.1037/0000065-001](https://doi.org/10.1037/0000065-001)

Cheung, F. M., & Mak, W. W. S. (2018). Sociocultural factors in psychopathology. In J. N. Butcher & J. M. Hooley (Eds.),
_APA handbook of psychopathology: Vol. 1. Psychopathology: Understanding, assessing, and treating adult mental disorders_ (pp. 127–147). American Psychological Association.
[https://doi.org/10.1037/0000064-006](https://doi.org/10.1037/0000064-006)

Jackson, C. E., & Milberg, W. P. (2018). Examination of neurological and neuropsychological features in psychopathology. In J. N. Butcher & J. M. Hooley (Eds.),
_APA handbook of psychopathology: Vol. 1_ (pp. 65–90). American Psychological Association.
[https://doi.org/10.1037/0000064-004](https://doi.org/10.1037/0000064-004)

Masten, A. S., & Kalstabakken, A. W. (2018). Developmental perspectives on psychopathology in children and adolescents. In J. N. Butcher & P. C. Kendall (Eds.),
_APA handbook of psychopathology: Vol. 2_ (pp. 15–36). American Psychological Association.
[https://doi.org/10.1037/0000065-002](https://doi.org/10.1037/0000065-002)

Bryonna williamson

According to Boland psychopatholoy is the product of interacting biological, psychological, and sociocultural forces instead of just one single cause (Boland et al., 2022).

When we discuss biological factors, we often think of families with illnesses, but according to the literature, genes are not all defining if infact someone will get sick. It only increases the chances of their development. We have to consider chemicals like serotonin that also have an effect. Chemical imbalances, along with moods and sleep can also be important to consider. It has been proven that long periods of stress can change the mind. Tests have shown problems with memory, attention, and the ability to plan (Jackson & Milberg, 2018).

Psychological factors involve thinking and acting, and all too often anxiety is focused on. People with anxiety can sometimes hyperfocus on what scares them, which causes the fear to become stronger. Events that affect a 10-year-old may transpire differently than the same event for an 85-year-old Babushka. Interestingly, children with strong support, which causes resilience, tend to "bounce back" more quickly.

When talking about social and cultural factors, we think of poverty, violence, unjust treatment, and hard childhood experiences. It's been shown that having good friends and social support systems in place can help. Keep in mind that the culture of a person can be presented in ways differently than your own. This also affects how feelings are displayed. What may seem like an issue in our culture may be considered totally normal in another (Cheung & Mak, 2018).

As this is brought inside the scope of a Nurse Practitioner, we need to consider that most problems are multifacited, and with that comes the responsibility to be knowledgeable and sensitive towards each patient differently. Meds might not be the answer for an unsafe home. Each person is a tapestry of character that must be individualized to fully understand and properly treat.

**References**

Boland, R., Verduin, M. L., & Ruiz, P. (2022).
_Kaplan & Sadock's synopsis of psychiatry_ (12th ed.). Wolters Kluwer.

Butcher, J. N., & Kendall, P. C. (2018). Introduction to childhood and adolescent psychopathology. In J. N. Butcher & P. C. Kendall (Eds.),
_APA handbook of psychopathology: Vol. 2. Child and adolescent psychopathology_ (pp. 3–14). American Psychological Association.
[https://doi.org/10.1037/0000065-001](https://doi.org/10.1037/0000065-001)

Cheung, F. M., & Mak, W. W. S. (2018). Sociocultural factors in psychopathology. In J. N. Butcher & J. M. Hooley (Eds.),
_APA handbook of psychopathology: Vol. 1. Psychopathology: Understanding, assessing, and treating adult mental disorders_ (pp. 127–147). American Psychological Association.
[https://doi.org/10.1037/0000064-006](https://doi.org/10.1037/0000064-006)

Jackson, C. E., & Milberg, W. P. (2018). Examination of neurological and neuropsychological features in psychopathology. In J. N. Butcher & J. M. Hooley (Eds.),
_APA handbook of psychopathology: Vol. 1_ (pp. 65–90). American Psychological Association.
[https://doi.org/10.1037/0000064-004](https://doi.org/10.1037/0000064-004)

Masten, A. S., & Kalstabakken, A. W. (2018). Developmental perspectives on psychopathology in children and adolescents. In J. N. Butcher & P. C. Kendall (Eds.),
_APA handbook of psychopathology: Vol. 2_ (pp. 15–36). American Psychological Association.
[https://doi.org/10.1037/0000065-002](https://doi.org/10.1037/0000065-002)

November 6, 2026
[Solved] O negative blood

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November 6, 2026
[Solved] Nursing unit 4 assignment

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see attached- i am having trouble accessing the rubric..as soon as i get it, i will attach it. – a month ago **files (2)** – ## 674unit4assignment.docx – ## MSN_SOAP_Note_Template_2402C1.docx **## 674unit4assignment.docx** **Case Study 4:** Mrs. Julie presents with mood symptoms and is at risk f…

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see attached- i am having trouble accessing the rubric..as soon as i get it, i will attach it.

– a month ago

**files (2)**

– ## 674unit4assignment.docx

– ## MSN_SOAP_Note_Template_2402C1.docx

**## 674unit4assignment.docx**

**Case Study 4:** Mrs. Julie presents with mood symptoms and is at risk for suicide. Refer to assignment directions in Tab #2 for further information.

Your writing assignment should:

· follow the conventions of Standard English (correct grammar, punctuation, etc.);

· be well ordered, logical, and unified, as well as original and insightful;

· display superior content, organization, style, and mechanics; and;

· use APA formatting and citation style.

**Case Study Scenario:**

Mrs. Julie is a widowed 77-year-old retired bank teller who has been brought to the emergency department by her son and daughter as they have been worried about her mood for the past couple of months. This afternoon, when they were both over for a visit, hoping to convince their mom to go out to dinner with the family, Mrs. Julie admitted to them that she felt so terrible that she wanted to die. Her family became very concerned and decided to bring her to the hospital for assessment.

Mrs. Julie was assessed by the emergency physician, who did not feel there were any acute systemic medical illnesses and referred her to the emergency psychiatric team to evaluate her suicidal risk. During her assessment with the on-call psychiatrist, Mrs. Julie admits that she has been feeling lonely and down for about the past 3 months. Her husband of 53 years had passed away 6 months ago suddenly from a massive heart attack. Mrs. Julie thought she managed quite well initially. Even though she was sad that he was gone, she could still do what was needed at the time — making funeral arrangements and dealing with the lawyer and all the necessary paperwork. Then, about 3 months ago, it all just “hit” her. She was feeling very lonely, particularly at nighttime when she would lie in bed, staring at the ceiling and unable to fall asleep. She continued to feel worse as time passed, walking around the house aimlessly during the daytime, looking for something to do, and eventually ending up sleeping on the couch, so she would no longer have to think. She became increasingly withdrawn and stopped calling her family and friends as she did not feel like talking to anyone.

Mrs. Julie was still keeping up with her personal hygiene but stopped doing housework about a month ago. In the past 2 weeks, she has not felt much like cooking and is just eating crackers and peanut butter. In the past 2 days, she has thought that it would be easier if she could join her husband in death and be at peace.

Before the arrival of her family at her house today, she was looking at her medications and thinking it would be nice to take all of her “sleeping pills” at once. She became very scared by her thoughts. When her children arrived, she told them what she had been thinking. Currently, while she has no plans to kill herself, she is afraid those thoughts would come back when she goes home alone as she does not see any reason to live.

Mrs. Julie states that she has never felt like this before in her life. She has always been a very upbeat and energetic person. While she may have gone through some difficult periods in the past, she states that she has always managed to get through these times without help. She has never needed to see a psychiatrist for any reason. She denies ever drinking alcohol excessively and denies the use of any illicit drugs.

Medical history revealed that she had a left-side stroke about 10 years ago with full recovery. She has hypertension and hyperlipidemia; these conditions are treated and controlled. Her primary care physician recently told her she is “borderline diabetic.” She also had a significant gastrointestinal bleed about 5 years ago due to a peptic ulcer. She had a remote tonsillectomy and an appendectomy about 15 years ago. Mrs. Julie has a younger sister who went through a “nervous breakdown” after a miscarriage. Mrs. Julie thinks her sister may have been on medication for her “nerves” for a while but does not know of her specific diagnosis or the name of the medication.

Mrs. Julie’s medications included rosuvastatin 10 mg daily, metoprolol 12.5 mg twice daily, aspirin 81 mg daily, pantoprazole 40 mg daily, clopidogrel 75 mg daily, and lorazepam 1 mg every 2 hour as needed (started by her primary care physician after her husband passed away; she takes it about three times a week). Laboratory investigations ordered by the emergency physician included CBC, electrolytes, creatinine (Cr), estimated glomerular filtration rate (eGFR), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), random glucose, and a urinalysis. Other than a slightly high random glucose of 13.4 mmol/L (241.2 mg/dl), all other blood test results were within normal limits.

Use the SOAP note template to complete the documentation with the information provided.

· Formulate appropriate diagnoses and design an appropriate treatment plan.

· Explain what further information you will explore to aid in forming an accurate diagnosis.

· What treatment management would you recommended for this patient?

· How would you predict Julie’s response to treatment?

· Discuss clinical judgment and interventions to enhance the client’s safety.

[**Unit 4 Assignment Grading Rubric**](https://purdueglobal.brightspace.com/d2l/common/dialogs/quickLink/quickLink.d2l?ou=398929&type=rubric&rCode=kaplan-3651864)

**## MSN_SOAP_Note_Template_2402C1.docx**

| | | |
| — | — | — |
| **Name:** | **Pt. Encounter Number:** |
| **Date:** | **Age:** | **Sex:** |
| **SUBJECTIVE** |
| **CC:**<br>_Reason given by the patient for seeking medical care “in quotes”_ |
| **HPI:**<br>_Describe the course of the patient’s illness, including when it began, character of symptoms, location where the symptoms began, aggravating or alleviating factors, pertinent positives and negatives, other related diseases, past illnesses, and surgeries or past diagnostic testing related to the present illness._ |
| **Medications:** _(List with reason for med )_ |
| **Allergies:** _(List with reaction)_<br>**Medication Intolerances:** |
| **Past Medical History:**<br>**Chronic Illnesses/Major traumas**<br>**Hospitalizations/Surgeries**<br>_“Have you ever been told that you have diabetes, HTN, peptic ulcer disease, asthma, lung disease, heart disease, cancer, TB, thyroid problems, kidney problems, or psychiatric diagnosis?”_ |
| **Family History**<br>_Does your mother, father, or siblings have any medical or psychiatric illnesses? Is anyone diagnosed with: lung disease, heart disease, HTN, cancer, TB, DM, or kidney disease?_ |
| **Social History**<br>_Education level, occupational history, current living situation/partner/marital status, substance use/abuse, ETOH, tobacco, and marijuana. Safety status_ |
| **ROS Student to ask each of these questions to the patient: “Have you had any…..”** |
| **General**<br>_Weight change, fatigue, fever, chills, night sweats, and energy level_ | **Cardiovascular**<br>_Chest pain, palpitations, PND, orthopnea, and edema_ |
| **Skin**<br>_Delayed healing, rashes, bruising, bleeding or skin discolorations, and any changes in lesions or moles_ | **Respiratory**<br>_Cough, wheezing, hemoptysis, dyspnea, pneumonia hx, and TB_ |
| **Eyes**<br>_Corrective lenses, blurring, and visual changes of any kind_ | **Gastrointestinal**<br>_Abdominal pain, N/V/D, constipation, hepatitis, hemorrhoids, eating disorders, ulcers, and black, tarry stools_ |
| **Ears**<br>_Ear pain, hearing loss, ringing in ears, and discharge_ | **Genitourinary/Gynecological**<br>_Urgency, frequency burning, change in color of urine._<br>_Contraception, sexual activity, STDs_<br>_Female: last pap, breast, mammo, menstrual complaints, vaginal discharge, pregnancy hx_<br>_Male: prostate, PSA, urinary complaints_ |
| **Nose/Mouth/Throat**<br>_Sinus problems, dysphagia, nose bleeds or discharge, dental disease, hoarseness, and throat pain_ | **Musculoskeletal**<br>_Back pain, joint swelling, stiffness or pain, fracture hx, and osteoporosis_ |
| **Breast**<br>_SBE, lumps, bumps, or changes_ | **Neurological**<br>_Syncope, seizures, transient paralysis, weakness, paresthesias, and black-out spells_ |
| **Heme/Lymph/Endo**<br>_HIV status, bruising, blood transfusion hx, night sweats, swollen glands, increase thirst, increase hunger, and cold or heat intolerance_ | **Psychiatric**<br>_Depression, anxiety, sleeping difficulties, suicidal ideation/attempts, and previous dx_ |
| **OBJECTIVE** |
| **Weight       BMI** | **Temp** | **BP** |
| **Height** | **Pulse** | **Resp** |
| **General Appearance**<br>_Healthy-appearing adult female in no acute distress. Alert and oriented; answers questions appropriately. Slightly somber affect at first and then brighter later._ |
| **Skin**<br>_Skin is brown, warm, dry, clean, and intact. No rashes or lesions noted._ |
| **HEENT**<br>_Head is normocephalic, atraumatic, and without lesions; hair evenly distributed. Eyes: PERRLA. EOMs intact. No conjunctival or scleral injection. Ears: Canals patent. Bilateral TMs pearly gray with positive light reflex; landmarks easily visualized. Nose: Nasal mucosa pink; normal turbinates. No septal deviation. Neck: Supple. Full ROM; no cervical lymphadenopathy; no occipital nodes. No thyromegaly or nodules. Oral mucosa, pink and moist. Pharynx is nonerythematous and without exudate. Teeth are in good repair_. |
| **Cardiovascular**<br>_S1, S2 with regular rate and rhythm. No extra sounds, clicks, rubs, or murmurs. Capillary refills two seconds. Pulses 3+ throughout. No edema._ |
| **Respiratory**<br>_Symmetric chest wall. Respirations regular and easy; lungs clear to auscultation bilaterally_. |
| **Gastrointestinal**<br>_Abdomen obese; BS active in all the four quadrants. Abdomen soft, nontender. No hepatosplenomegaly_. |
| **Breast**<br>_Breast is free from masses or tenderness, no discharge, no dimpling, wrinkling, or discoloration of the skin_. |
| **Genitourinary**<br>_Bladder is nondistended; no CVA tenderness. External genitalia reveals coarse pubic hair in normal distribution; skin color is consistent with general pigmentation. No vulvar lesions noted. Well estrogenized. A small speculum was inserted; vaginal walls are pink and well rugated; no lesions noted. Cervix is pink and nulliparous. Scant clear to cloudy drainage present. On bimanual exam, cervix is firm. No CMT. Uterus is antevert and positioned behind a slightly distended bladder; no fullness, masses, or tenderness. No adnexal masses or tenderness. Ovaries are nonpalpable._<br>_(Male: Both testes are palpable, no masses or lesions, no hernia, and no uretheral discharge.)_<br>_(Rectal as appropriate: No evidence of hemorrhoids, fissures, bleeding, or masses—Males: Prostrate is smooth, nontender, and free from nodules, is of normal size, and sphincter tone is firm)._ |
| **Musculoskeletal**<br>_Full ROM seen in all four extremities as the patient moved about the exam room._ |
| **Neurological**<br>_Speech clear. Good tone. Posture erect. Balance stable; gait normal._ |
| **Psychiatric**<br>_Alert and oriented. Dressed in clean slacks, shirt, and coat. Maintains eye contact. Speech is soft, though clear and of normal rate and cadence; answers questions appropriately._ |
| **Lab Tests**<br>_Urinalysis—point of care test done today in the office- results positive for nitrites and blood, negative for leukocytes._<br>_Urine culture collected in office—pending results, sent to lab_<br>_Wet prep collected in office—pending results, sent to lab_ |
| **Assessment** |
| · Include at least three differential diagnoses<br>· Provide rationale for each differential diagnosis<br>· Final diagnosis<br>· Pathophysiology of primary and rationale for choosing as final |
| **Plan** |
| · Medications<br>· Non-pharmacological recommendations<br>· Diagnostic tests<br>· Patient education<br>· Culture considerations<br>· Health promotion<br>· Referrals<br>· Follow up |

**## MSN_SOAP_Note_Template_2402C1.docx**

| | | |
| — | — | — |
| **Name:** | **Pt. Encounter Number:** |
| **Date:** | **Age:** | **Sex:** |
| **SUBJECTIVE** |
| **CC:**<br>_Reason given by the patient for seeking medical care “in quotes”_ |
| **HPI:**<br>_Describe the course of the patient’s illness, including when it began, character of symptoms, location where the symptoms began, aggravating or alleviating factors, pertinent positives and negatives, other related diseases, past illnesses, and surgeries or past diagnostic testing related to the present illness._ |
| **Medications:** _(List with reason for med )_ |
| **Allergies:** _(List with reaction)_<br>**Medication Intolerances:** |
| **Past Medical History:**<br>**Chronic Illnesses/Major traumas**<br>**Hospitalizations/Surgeries**<br>_“Have you ever been told that you have diabetes, HTN, peptic ulcer disease, asthma, lung disease, heart disease, cancer, TB, thyroid problems, kidney problems, or psychiatric diagnosis?”_ |
| **Family History**<br>_Does your mother, father, or siblings have any medical or psychiatric illnesses? Is anyone diagnosed with: lung disease, heart disease, HTN, cancer, TB, DM, or kidney disease?_ |
| **Social History**<br>_Education level, occupational history, current living situation/partner/marital status, substance use/abuse, ETOH, tobacco, and marijuana. Safety status_ |
| **ROS Student to ask each of these questions to the patient: “Have you had any…..”** |
| **General**<br>_Weight change, fatigue, fever, chills, night sweats, and energy level_ | **Cardiovascular**<br>_Chest pain, palpitations, PND, orthopnea, and edema_ |
| **Skin**<br>_Delayed healing, rashes, bruising, bleeding or skin discolorations, and any changes in lesions or moles_ | **Respiratory**<br>_Cough, wheezing, hemoptysis, dyspnea, pneumonia hx, and TB_ |
| **Eyes**<br>_Corrective lenses, blurring, and visual changes of any kind_ | **Gastrointestinal**<br>_Abdominal pain, N/V/D, constipation, hepatitis, hemorrhoids, eating disorders, ulcers, and black, tarry stools_ |
| **Ears**<br>_Ear pain, hearing loss, ringing in ears, and discharge_ | **Genitourinary/Gynecological**<br>_Urgency, frequency burning, change in color of urine._<br>_Contraception, sexual activity, STDs_<br>_Female: last pap, breast, mammo, menstrual complaints, vaginal discharge, pregnancy hx_<br>_Male: prostate, PSA, urinary complaints_ |
| **Nose/Mouth/Throat**<br>_Sinus problems, dysphagia, nose bleeds or discharge, dental disease, hoarseness, and throat pain_ | **Musculoskeletal**<br>_Back pain, joint swelling, stiffness or pain, fracture hx, and osteoporosis_ |
| **Breast**<br>_SBE, lumps, bumps, or changes_ | **Neurological**<br>_Syncope, seizures, transient paralysis, weakness, paresthesias, and black-out spells_ |
| **Heme/Lymph/Endo**<br>_HIV status, bruising, blood transfusion hx, night sweats, swollen glands, increase thirst, increase hunger, and cold or heat intolerance_ | **Psychiatric**<br>_Depression, anxiety, sleeping difficulties, suicidal ideation/attempts, and previous dx_ |
| **OBJECTIVE** |
| **Weight       BMI** | **Temp** | **BP** |
| **Height** | **Pulse** | **Resp** |
| **General Appearance**<br>_Healthy-appearing adult female in no acute distress. Alert and oriented; answers questions appropriately. Slightly somber affect at first and then brighter later._ |
| **Skin**<br>_Skin is brown, warm, dry, clean, and intact. No rashes or lesions noted._ |
| **HEENT**<br>_Head is normocephalic, atraumatic, and without lesions; hair evenly distributed. Eyes: PERRLA. EOMs intact. No conjunctival or scleral injection. Ears: Canals patent. Bilateral TMs pearly gray with positive light reflex; landmarks easily visualized. Nose: Nasal mucosa pink; normal turbinates. No septal deviation. Neck: Supple. Full ROM; no cervical lymphadenopathy; no occipital nodes. No thyromegaly or nodules. Oral mucosa, pink and moist. Pharynx is nonerythematous and without exudate. Teeth are in good repair_. |
| **Cardiovascular**<br>_S1, S2 with regular rate and rhythm. No extra sounds, clicks, rubs, or murmurs. Capillary refills two seconds. Pulses 3+ throughout. No edema._ |
| **Respiratory**<br>_Symmetric chest wall. Respirations regular and easy; lungs clear to auscultation bilaterally_. |
| **Gastrointestinal**<br>_Abdomen obese; BS active in all the four quadrants. Abdomen soft, nontender. No hepatosplenomegaly_. |
| **Breast**<br>_Breast is free from masses or tenderness, no discharge, no dimpling, wrinkling, or discoloration of the skin_. |
| **Genitourinary**<br>_Bladder is nondistended; no CVA tenderness. External genitalia reveals coarse pubic hair in normal distribution; skin color is consistent with general pigmentation. No vulvar lesions noted. Well estrogenized. A small speculum was inserted; vaginal walls are pink and well rugated; no lesions noted. Cervix is pink and nulliparous. Scant clear to cloudy drainage present. On bimanual exam, cervix is firm. No CMT. Uterus is antevert and positioned behind a slightly distended bladder; no fullness, masses, or tenderness. No adnexal masses or tenderness. Ovaries are nonpalpable._<br>_(Male: Both testes are palpable, no masses or lesions, no hernia, and no uretheral discharge.)_<br>_(Rectal as appropriate: No evidence of hemorrhoids, fissures, bleeding, or masses—Males: Prostrate is smooth, nontender, and free from nodules, is of normal size, and sphincter tone is firm)._ |
| **Musculoskeletal**<br>_Full ROM seen in all four extremities as the patient moved about the exam room._ |
| **Neurological**<br>_Speech clear. Good tone. Posture erect. Balance stable; gait normal._ |
| **Psychiatric**<br>_Alert and oriented. Dressed in clean slacks, shirt, and coat. Maintains eye contact. Speech is soft, though clear and of normal rate and cadence; answers questions appropriately._ |
| **Lab Tests**<br>_Urinalysis—point of care test done today in the office- results positive for nitrites and blood, negative for leukocytes._<br>_Urine culture collected in office—pending results, sent to lab_<br>_Wet prep collected in office—pending results, sent to lab_ |
| **Assessment** |
| · Include at least three differential diagnoses<br>· Provide rationale for each differential diagnosis<br>· Final diagnosis<br>· Pathophysiology of primary and rationale for choosing as final |
| **Plan** |
| · Medications<br>· Non-pharmacological recommendations<br>· Diagnostic tests<br>· Patient education<br>· Culture considerations<br>· Health promotion<br>· Referrals<br>· Follow up |

**## 674unit4assignment.docx**

**Case Study 4:** Mrs. Julie presents with mood symptoms and is at risk for suicide. Refer to assignment directions in Tab #2 for further information.

Your writing assignment should:

· follow the conventions of Standard English (correct grammar, punctuation, etc.);

· be well ordered, logical, and unified, as well as original and insightful;

· display superior content, organization, style, and mechanics; and;

· use APA formatting and citation style.

**Case Study Scenario:**

Mrs. Julie is a widowed 77-year-old retired bank teller who has been brought to the emergency department by her son and daughter as they have been worried about her mood for the past couple of months. This afternoon, when they were both over for a visit, hoping to convince their mom to go out to dinner with the family, Mrs. Julie admitted to them that she felt so terrible that she wanted to die. Her family became very concerned and decided to bring her to the hospital for assessment.

Mrs. Julie was assessed by the emergency physician, who did not feel there were any acute systemic medical illnesses and referred her to the emergency psychiatric team to evaluate her suicidal risk. During her assessment with the on-call psychiatrist, Mrs. Julie admits that she has been feeling lonely and down for about the past 3 months. Her husband of 53 years had passed away 6 months ago suddenly from a massive heart attack. Mrs. Julie thought she managed quite well initially. Even though she was sad that he was gone, she could still do what was needed at the time — making funeral arrangements and dealing with the lawyer and all the necessary paperwork. Then, about 3 months ago, it all just “hit” her. She was feeling very lonely, particularly at nighttime when she would lie in bed, staring at the ceiling and unable to fall asleep. She continued to feel worse as time passed, walking around the house aimlessly during the daytime, looking for something to do, and eventually ending up sleeping on the couch, so she would no longer have to think. She became increasingly withdrawn and stopped calling her family and friends as she did not feel like talking to anyone.

Mrs. Julie was still keeping up with her personal hygiene but stopped doing housework about a month ago. In the past 2 weeks, she has not felt much like cooking and is just eating crackers and peanut butter. In the past 2 days, she has thought that it would be easier if she could join her husband in death and be at peace.

Before the arrival of her family at her house today, she was looking at her medications and thinking it would be nice to take all of her “sleeping pills” at once. She became very scared by her thoughts. When her children arrived, she told them what she had been thinking. Currently, while she has no plans to kill herself, she is afraid those thoughts would come back when she goes home alone as she does not see any reason to live.

Mrs. Julie states that she has never felt like this before in her life. She has always been a very upbeat and energetic person. While she may have gone through some difficult periods in the past, she states that she has always managed to get through these times without help. She has never needed to see a psychiatrist for any reason. She denies ever drinking alcohol excessively and denies the use of any illicit drugs.

Medical history revealed that she had a left-side stroke about 10 years ago with full recovery. She has hypertension and hyperlipidemia; these conditions are treated and controlled. Her primary care physician recently told her she is “borderline diabetic.” She also had a significant gastrointestinal bleed about 5 years ago due to a peptic ulcer. She had a remote tonsillectomy and an appendectomy about 15 years ago. Mrs. Julie has a younger sister who went through a “nervous breakdown” after a miscarriage. Mrs. Julie thinks her sister may have been on medication for her “nerves” for a while but does not know of her specific diagnosis or the name of the medication.

Mrs. Julie’s medications included rosuvastatin 10 mg daily, metoprolol 12.5 mg twice daily, aspirin 81 mg daily, pantoprazole 40 mg daily, clopidogrel 75 mg daily, and lorazepam 1 mg every 2 hour as needed (started by her primary care physician after her husband passed away; she takes it about three times a week). Laboratory investigations ordered by the emergency physician included CBC, electrolytes, creatinine (Cr), estimated glomerular filtration rate (eGFR), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), random glucose, and a urinalysis. Other than a slightly high random glucose of 13.4 mmol/L (241.2 mg/dl), all other blood test results were within normal limits.

Use the SOAP note template to complete the documentation with the information provided.

· Formulate appropriate diagnoses and design an appropriate treatment plan.

· Explain what further information you will explore to aid in forming an accurate diagnosis.

· What treatment management would you recommended for this patient?

· How would you predict Julie’s response to treatment?

· Discuss clinical judgment and interventions to enhance the client’s safety.

[**Unit 4 Assignment Grading Rubric**](https://purdueglobal.brightspace.com/d2l/common/dialogs/quickLink/quickLink.d2l?ou=398929&type=rubric&rCode=kaplan-3651864)

**## MSN_SOAP_Note_Template_2402C1.docx**

| | | |
| — | — | — |
| **Name:** | **Pt. Encounter Number:** |
| **Date:** | **Age:** | **Sex:** |
| **SUBJECTIVE** |
| **CC:**<br>_Reason given by the patient for seeking medical care “in quotes”_ |
| **HPI:**<br>_Describe the course of the patient’s illness, including when it began, character of symptoms, location where the symptoms began, aggravating or alleviating factors, pertinent positives and negatives, other related diseases, past illnesses, and surgeries or past diagnostic testing related to the present illness._ |
| **Medications:** _(List with reason for med )_ |
| **Allergies:** _(List with reaction)_<br>**Medication Intolerances:** |
| **Past Medical History:**<br>**Chronic Illnesses/Major traumas**<br>**Hospitalizations/Surgeries**<br>_“Have you ever been told that you have diabetes, HTN, peptic ulcer disease, asthma, lung disease, heart disease, cancer, TB, thyroid problems, kidney problems, or psychiatric diagnosis?”_ |
| **Family History**<br>_Does your mother, father, or siblings have any medical or psychiatric illnesses? Is anyone diagnosed with: lung disease, heart disease, HTN, cancer, TB, DM, or kidney disease?_ |
| **Social History**<br>_Education level, occupational history, current living situation/partner/marital status, substance use/abuse, ETOH, tobacco, and marijuana. Safety status_ |
| **ROS Student to ask each of these questions to the patient: “Have you had any…..”** |
| **General**<br>_Weight change, fatigue, fever, chills, night sweats, and energy level_ | **Cardiovascular**<br>_Chest pain, palpitations, PND, orthopnea, and edema_ |
| **Skin**<br>_Delayed healing, rashes, bruising, bleeding or skin discolorations, and any changes in lesions or moles_ | **Respiratory**<br>_Cough, wheezing, hemoptysis, dyspnea, pneumonia hx, and TB_ |
| **Eyes**<br>_Corrective lenses, blurring, and visual changes of any kind_ | **Gastrointestinal**<br>_Abdominal pain, N/V/D, constipation, hepatitis, hemorrhoids, eating disorders, ulcers, and black, tarry stools_ |
| **Ears**<br>_Ear pain, hearing loss, ringing in ears, and discharge_ | **Genitourinary/Gynecological**<br>_Urgency, frequency burning, change in color of urine._<br>_Contraception, sexual activity, STDs_<br>_Female: last pap, breast, mammo, menstrual complaints, vaginal discharge, pregnancy hx_<br>_Male: prostate, PSA, urinary complaints_ |
| **Nose/Mouth/Throat**<br>_Sinus problems, dysphagia, nose bleeds or discharge, dental disease, hoarseness, and throat pain_ | **Musculoskeletal**<br>_Back pain, joint swelling, stiffness or pain, fracture hx, and osteoporosis_ |
| **Breast**<br>_SBE, lumps, bumps, or changes_ | **Neurological**<br>_Syncope, seizures, transient paralysis, weakness, paresthesias, and black-out spells_ |
| **Heme/Lymph/Endo**<br>_HIV status, bruising, blood transfusion hx, night sweats, swollen glands, increase thirst, increase hunger, and cold or heat intolerance_ | **Psychiatric**<br>_Depression, anxiety, sleeping difficulties, suicidal ideation/attempts, and previous dx_ |
| **OBJECTIVE** |
| **Weight       BMI** | **Temp** | **BP** |
| **Height** | **Pulse** | **Resp** |
| **General Appearance**<br>_Healthy-appearing adult female in no acute distress. Alert and oriented; answers questions appropriately. Slightly somber affect at first and then brighter later._ |
| **Skin**<br>_Skin is brown, warm, dry, clean, and intact. No rashes or lesions noted._ |
| **HEENT**<br>_Head is normocephalic, atraumatic, and without lesions; hair evenly distributed. Eyes: PERRLA. EOMs intact. No conjunctival or scleral injection. Ears: Canals patent. Bilateral TMs pearly gray with positive light reflex; landmarks easily visualized. Nose: Nasal mucosa pink; normal turbinates. No septal deviation. Neck: Supple. Full ROM; no cervical lymphadenopathy; no occipital nodes. No thyromegaly or nodules. Oral mucosa, pink and moist. Pharynx is nonerythematous and without exudate. Teeth are in good repair_. |
| **Cardiovascular**<br>_S1, S2 with regular rate and rhythm. No extra sounds, clicks, rubs, or murmurs. Capillary refills two seconds. Pulses 3+ throughout. No edema._ |
| **Respiratory**<br>_Symmetric chest wall. Respirations regular and easy; lungs clear to auscultation bilaterally_. |
| **Gastrointestinal**<br>_Abdomen obese; BS active in all the four quadrants. Abdomen soft, nontender. No hepatosplenomegaly_. |
| **Breast**<br>_Breast is free from masses or tenderness, no discharge, no dimpling, wrinkling, or discoloration of the skin_. |
| **Genitourinary**<br>_Bladder is nondistended; no CVA tenderness. External genitalia reveals coarse pubic hair in normal distribution; skin color is consistent with general pigmentation. No vulvar lesions noted. Well estrogenized. A small speculum was inserted; vaginal walls are pink and well rugated; no lesions noted. Cervix is pink and nulliparous. Scant clear to cloudy drainage present. On bimanual exam, cervix is firm. No CMT. Uterus is antevert and positioned behind a slightly distended bladder; no fullness, masses, or tenderness. No adnexal masses or tenderness. Ovaries are nonpalpable._<br>_(Male: Both testes are palpable, no masses or lesions, no hernia, and no uretheral discharge.)_<br>_(Rectal as appropriate: No evidence of hemorrhoids, fissures, bleeding, or masses—Males: Prostrate is smooth, nontender, and free from nodules, is of normal size, and sphincter tone is firm)._ |
| **Musculoskeletal**<br>_Full ROM seen in all four extremities as the patient moved about the exam room._ |
| **Neurological**<br>_Speech clear. Good tone. Posture erect. Balance stable; gait normal._ |
| **Psychiatric**<br>_Alert and oriented. Dressed in clean slacks, shirt, and coat. Maintains eye contact. Speech is soft, though clear and of normal rate and cadence; answers questions appropriately._ |
| **Lab Tests**<br>_Urinalysis—point of care test done today in the office- results positive for nitrites and blood, negative for leukocytes._<br>_Urine culture collected in office—pending results, sent to lab_<br>_Wet prep collected in office—pending results, sent to lab_ |
| **Assessment** |
| · Include at least three differential diagnoses<br>· Provide rationale for each differential diagnosis<br>· Final diagnosis<br>· Pathophysiology of primary and rationale for choosing as final |
| **Plan** |
| · Medications<br>· Non-pharmacological recommendations<br>· Diagnostic tests<br>· Patient education<br>· Culture considerations<br>· Health promotion<br>· Referrals<br>· Follow up |

**## 674unit4assignment.docx**

**Case Study 4:** Mrs. Julie presents with mood symptoms and is at risk for suicide. Refer to assignment directions in Tab #2 for further information.

Your writing assignment should:

· follow the conventions of Standard English (correct grammar, punctuation, etc.);

· be well ordered, logical, and unified, as well as original and insightful;

· display superior content, organization, style, and mechanics; and;

· use APA formatting and citation style.

**Case Study Scenario:**

Mrs. Julie is a widowed 77-year-old retired bank teller who has been brought to the emergency department by her son and daughter as they have been worried about her mood for the past couple of months. This afternoon, when they were both over for a visit, hoping to convince their mom to go out to dinner with the family, Mrs. Julie admitted to them that she felt so terrible that she wanted to die. Her family became very concerned and decided to bring her to the hospital for assessment.

Mrs. Julie was assessed by the emergency physician, who did not feel there were any acute systemic medical illnesses and referred her to the emergency psychiatric team to evaluate her suicidal risk. During her assessment with the on-call psychiatrist, Mrs. Julie admits that she has been feeling lonely and down for about the past 3 months. Her husband of 53 years had passed away 6 months ago suddenly from a massive heart attack. Mrs. Julie thought she managed quite well initially. Even though she was sad that he was gone, she could still do what was needed at the time — making funeral arrangements and dealing with the lawyer and all the necessary paperwork. Then, about 3 months ago, it all just “hit” her. She was feeling very lonely, particularly at nighttime when she would lie in bed, staring at the ceiling and unable to fall asleep. She continued to feel worse as time passed, walking around the house aimlessly during the daytime, looking for something to do, and eventually ending up sleeping on the couch, so she would no longer have to think. She became increasingly withdrawn and stopped calling her family and friends as she did not feel like talking to anyone.

Mrs. Julie was still keeping up with her personal hygiene but stopped doing housework about a month ago. In the past 2 weeks, she has not felt much like cooking and is just eating crackers and peanut butter. In the past 2 days, she has thought that it would be easier if she could join her husband in death and be at peace.

Before the arrival of her family at her house today, she was looking at her medications and thinking it would be nice to take all of her “sleeping pills” at once. She became very scared by her thoughts. When her children arrived, she told them what she had been thinking. Currently, while she has no plans to kill herself, she is afraid those thoughts would come back when she goes home alone as she does not see any reason to live.

Mrs. Julie states that she has never felt like this before in her life. She has always been a very upbeat and energetic person. While she may have gone through some difficult periods in the past, she states that she has always managed to get through these times without help. She has never needed to see a psychiatrist for any reason. She denies ever drinking alcohol excessively and denies the use of any illicit drugs.

Medical history revealed that she had a left-side stroke about 10 years ago with full recovery. She has hypertension and hyperlipidemia; these conditions are treated and controlled. Her primary care physician recently told her she is “borderline diabetic.” She also had a significant gastrointestinal bleed about 5 years ago due to a peptic ulcer. She had a remote tonsillectomy and an appendectomy about 15 years ago. Mrs. Julie has a younger sister who went through a “nervous breakdown” after a miscarriage. Mrs. Julie thinks her sister may have been on medication for her “nerves” for a while but does not know of her specific diagnosis or the name of the medication.

Mrs. Julie’s medications included rosuvastatin 10 mg daily, metoprolol 12.5 mg twice daily, aspirin 81 mg daily, pantoprazole 40 mg daily, clopidogrel 75 mg daily, and lorazepam 1 mg every 2 hour as needed (started by her primary care physician after her husband passed away; she takes it about three times a week). Laboratory investigations ordered by the emergency physician included CBC, electrolytes, creatinine (Cr), estimated glomerular filtration rate (eGFR), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), random glucose, and a urinalysis. Other than a slightly high random glucose of 13.4 mmol/L (241.2 mg/dl), all other blood test results were within normal limits.

Use the SOAP note template to complete the documentation with the information provided.

· Formulate appropriate diagnoses and design an appropriate treatment plan.

· Explain what further information you will explore to aid in forming an accurate diagnosis.

· What treatment management would you recommended for this patient?

· How would you predict Julie’s response to treatment?

· Discuss clinical judgment and interventions to enhance the client’s safety.

[**Unit 4 Assignment Grading Rubric**](https://purdueglobal.brightspace.com/d2l/common/dialogs/quickLink/quickLink.d2l?ou=398929&type=rubric&rCode=kaplan-3651864)

**## MSN_SOAP_Note_Template_2402C1.docx**

| | | |
| — | — | — |
| **Name:** | **Pt. Encounter Number:** |
| **Date:** | **Age:** | **Sex:** |
| **SUBJECTIVE** |
| **CC:**<br>_Reason given by the patient for seeking medical care “in quotes”_ |
| **HPI:**<br>_Describe the course of the patient’s illness, including when it began, character of symptoms, location where the symptoms began, aggravating or alleviating factors, pertinent positives and negatives, other related diseases, past illnesses, and surgeries or past diagnostic testing related to the present illness._ |
| **Medications:** _(List with reason for med )_ |
| **Allergies:** _(List with reaction)_<br>**Medication Intolerances:** |
| **Past Medical History:**<br>**Chronic Illnesses/Major traumas**<br>**Hospitalizations/Surgeries**<br>_“Have you ever been told that you have diabetes, HTN, peptic ulcer disease, asthma, lung disease, heart disease, cancer, TB, thyroid problems, kidney problems, or psychiatric diagnosis?”_ |
| **Family History**<br>_Does your mother, father, or siblings have any medical or psychiatric illnesses? Is anyone diagnosed with: lung disease, heart disease, HTN, cancer, TB, DM, or kidney disease?_ |
| **Social History**<br>_Education level, occupational history, current living situation/partner/marital status, substance use/abuse, ETOH, tobacco, and marijuana. Safety status_ |
| **ROS Student to ask each of these questions to the patient: “Have you had any…..”** |
| **General**<br>_Weight change, fatigue, fever, chills, night sweats, and energy level_ | **Cardiovascular**<br>_Chest pain, palpitations, PND, orthopnea, and edema_ |
| **Skin**<br>_Delayed healing, rashes, bruising, bleeding or skin discolorations, and any changes in lesions or moles_ | **Respiratory**<br>_Cough, wheezing, hemoptysis, dyspnea, pneumonia hx, and TB_ |
| **Eyes**<br>_Corrective lenses, blurring, and visual changes of any kind_ | **Gastrointestinal**<br>_Abdominal pain, N/V/D, constipation, hepatitis, hemorrhoids, eating disorders, ulcers, and black, tarry stools_ |
| **Ears**<br>_Ear pain, hearing loss, ringing in ears, and discharge_ | **Genitourinary/Gynecological**<br>_Urgency, frequency burning, change in color of urine._<br>_Contraception, sexual activity, STDs_<br>_Female: last pap, breast, mammo, menstrual complaints, vaginal discharge, pregnancy hx_<br>_Male: prostate, PSA, urinary complaints_ |
| **Nose/Mouth/Throat**<br>_Sinus problems, dysphagia, nose bleeds or discharge, dental disease, hoarseness, and throat pain_ | **Musculoskeletal**<br>_Back pain, joint swelling, stiffness or pain, fracture hx, and osteoporosis_ |
| **Breast**<br>_SBE, lumps, bumps, or changes_ | **Neurological**<br>_Syncope, seizures, transient paralysis, weakness, paresthesias, and black-out spells_ |
| **Heme/Lymph/Endo**<br>_HIV status, bruising, blood transfusion hx, night sweats, swollen glands, increase thirst, increase hunger, and cold or heat intolerance_ | **Psychiatric**<br>_Depression, anxiety, sleeping difficulties, suicidal ideation/attempts, and previous dx_ |
| **OBJECTIVE** |
| **Weight       BMI** | **Temp** | **BP** |
| **Height** | **Pulse** | **Resp** |
| **General Appearance**<br>_Healthy-appearing adult female in no acute distress. Alert and oriented; answers questions appropriately. Slightly somber affect at first and then brighter later._ |
| **Skin**<br>_Skin is brown, warm, dry, clean, and intact. No rashes or lesions noted._ |
| **HEENT**<br>_Head is normocephalic, atraumatic, and without lesions; hair evenly distributed. Eyes: PERRLA. EOMs intact. No conjunctival or scleral injection. Ears: Canals patent. Bilateral TMs pearly gray with positive light reflex; landmarks easily visualized. Nose: Nasal mucosa pink; normal turbinates. No septal deviation. Neck: Supple. Full ROM; no cervical lymphadenopathy; no occipital nodes. No thyromegaly or nodules. Oral mucosa, pink and moist. Pharynx is nonerythematous and without exudate. Teeth are in good repair_. |
| **Cardiovascular**<br>_S1, S2 with regular rate and rhythm. No extra sounds, clicks, rubs, or murmurs. Capillary refills two seconds. Pulses 3+ throughout. No edema._ |
| **Respiratory**<br>_Symmetric chest wall. Respirations regular and easy; lungs clear to auscultation bilaterally_. |
| **Gastrointestinal**<br>_Abdomen obese; BS active in all the four quadrants. Abdomen soft, nontender. No hepatosplenomegaly_. |
| **Breast**<br>_Breast is free from masses or tenderness, no discharge, no dimpling, wrinkling, or discoloration of the skin_. |
| **Genitourinary**<br>_Bladder is nondistended; no CVA tenderness. External genitalia reveals coarse pubic hair in normal distribution; skin color is consistent with general pigmentation. No vulvar lesions noted. Well estrogenized. A small speculum was inserted; vaginal walls are pink and well rugated; no lesions noted. Cervix is pink and nulliparous. Scant clear to cloudy drainage present. On bimanual exam, cervix is firm. No CMT. Uterus is antevert and positioned behind a slightly distended bladder; no fullness, masses, or tenderness. No adnexal masses or tenderness. Ovaries are nonpalpable._<br>_(Male: Both testes are palpable, no masses or lesions, no hernia, and no uretheral discharge.)_<br>_(Rectal as appropriate: No evidence of hemorrhoids, fissures, bleeding, or masses—Males: Prostrate is smooth, nontender, and free from nodules, is of normal size, and sphincter tone is firm)._ |
| **Musculoskeletal**<br>_Full ROM seen in all four extremities as the patient moved about the exam room._ |
| **Neurological**<br>_Speech clear. Good tone. Posture erect. Balance stable; gait normal._ |
| **Psychiatric**<br>_Alert and oriented. Dressed in clean slacks, shirt, and coat. Maintains eye contact. Speech is soft, though clear and of normal rate and cadence; answers questions appropriately._ |
| **Lab Tests**<br>_Urinalysis—point of care test done today in the office- results positive for nitrites and blood, negative for leukocytes._<br>_Urine culture collected in office—pending results, sent to lab_<br>_Wet prep collected in office—pending results, sent to lab_ |
| **Assessment** |
| · Include at least three differential diagnoses<br>· Provide rationale for each differential diagnosis<br>· Final diagnosis<br>· Pathophysiology of primary and rationale for choosing as final |
| **Plan** |
| · Medications<br>· Non-pharmacological recommendations<br>· Diagnostic tests<br>· Patient education<br>· Culture considerations<br>· Health promotion<br>· Referrals<br>· Follow up |

November 6, 2026
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November 6, 2026
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[Solved] provide a reply sample as a DNP student. 300 words. NO AI or plagiarism

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tam Among healthcare providers prescribing medications for adults aged 65 years and older in a primary care clinic (P), how does implementation of the 2023 American Geriatrics Society Beers Criteria through provider education, a clinical decision-making tool, and audit and feedback (I), compared wit…

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tam

Among healthcare providers prescribing medications for adults aged 65 years and older in a primary care clinic (P), how does implementation of the 2023 American Geriatrics Society Beers Criteria through provider education, a clinical decision-making tool, and audit and feedback (I), compared with current prescribing practices (C), affect provider knowledge and adherence to evidence-based prescribing recommendations and reduce potentially inappropriate medications (O) over eight weeks (T)?

1. Objectives for the first week

The primary objective for the first week of implementation was to inform all participating providers about the DNP project and to develop a standard methodology for identifying potentially inappropriate medication use in adults aged 65 years and older. The DNP project objectives included developing a method to improve prescribing practices through incorporation of the 2023 American Geriatric Society Best Practices criteria into the clinic's medication-review process. Education and the distribution of project tools were also priorities for the first week along with administering the preimplementation knowledge survey and initiating the audit and feedback process.

In addition to increasing awareness among providers regarding the differences between polypharmacy and inappropriate polypharmacy, another main priority was to increase providers' awareness that having five or more prescribed medications does not necessarily equate to poor prescribing practices. Multiple medications can be clinically necessary for individuals with many chronic conditions; however, there is an increased likelihood of adverse outcomes due to the cumulative medication burden. Adverse outcomes include drug-drug interactions, drug-disease interactions, therapeutic duplication, medication non-adherence, falls, cognitive decline, and adverse drug reactions. Thus, the focus of the project is on the appropriateness of each medication rather than just counting the number of medications.

The 2023 AGS Beers Criteria update outlines evidence-based recommendations relative to medications that generally should be avoided, medications that may exacerbate specific disease states or syndromes, medications that should be used with caution, clinically significant drug interactions, and medications requiring avoidance or dose adjustment based upon renal function (American Geriatrics Society Beers Criteria update expert panel, 2023). As such, one of the important objectives of Week 1 was to ensure that the providers understand how to utilize the Beers Criteria as a clinical decision support tool rather than a definitive "do not prescribe" criterion.

Other priorities for Week 1 included confirmation of provider participation in the study, protection of participant confidentiality, establishment of a uniform mechanism for analyzing clinical encounters, and ensuring that any activities implemented would not negatively impact the quality of patient care. Since the providers are considered part of the population of interest for the project, no patients were recruited or enrolled in the study. The only identifiable information recorded in the study database would relate to provider prescribing behavior.

2. Activities completed during this week

Prior to the start of the week, I met with the project preceptor and clinic leadership to review the implementation timeline and discuss roles and responsibilities of all stakeholders. During this meeting, we discussed the project schedule, provider education plan, preimplementation survey, clinical decision-making tool, and audit-and-feedback tracking tool. The meeting also allowed me to confirm the procedure for selecting eligible medication management encounters for analysis involving patients aged 65 years and older.

Structured provider education occurred during a previously scheduled clinic time. The educational program introduced clinicians to the clinical implications of polypharmacy and potentially inappropriate medication use in older adults. Clinicians were informed that age-related changes in both pharmacokinetic properties and pharmacodynamic responses to drugs may result in increased susceptibility to various types of adverse effects related to specific classes of drugs. The presentation highlighted common medications that can cause adverse effects in older adults, including centrally acting anti-cholinergics, sedatives/hypnotics, certain types of pain medications, selected diabetes therapies, and medications that may cause falls or bleeding.

Practical patient examples were presented to illustrate the application of the Beers Criteria and assist clinicians in making evidence-based clinical decisions. Clinicians were directed to analyze the reason each medication was ordered; evaluate whether each medication was still medically necessary; assess potential therapeutic duplication; examine possible adverse effects resulting from drug-drug or drug-disease interactions; and consider safer alternative treatments (either pharmacological or non-pharmacological) whenever possible. The educational presentation emphasized that treatment decisions should be individualized and take into account factors including prior treatment responses; life expectancy; patient preferences; patient-specific diagnoses; patient-specific treatment goals; etc.

Following completion of the educational presentation, participating clinicians completed a preimplementation knowledge survey. Study identification codes were assigned to protect participant anonymity and facilitate pairing with subsequent surveys. The surveys were reviewed for completeness. Individual clinician survey results were not disseminated to clinic administrators or other clinicians.

Participating clinicians also received a BEERS criteria-based clinical decision-making tool. This resource was created to provide a simple-to-use tool that can be integrated into typical ambulatory practice encounters. It prompts clinicians to assess the necessity for continued medication therapy; identify potential adverse effects of medication therapy; identify patient-specific considerations for dosing adjustments due to decreased renal function; identify duplicate prescriptions; identify possible harmful drug-drug or drug-disease interactions; identify necessary monitoring requirements; and identify opportunities for either de-prescription or substitution of prescription therapies.

Audit-and-feedback tracking began during this week. Data collected via this tool will include whether a review of the medication list has occurred; whether a potentially inappropriate medication was identified; whether the clinician documented a medical justification for continuation of therapy; and whether any type of intervention was initiated. Interventions may include discontinuing therapy, reducing dosage, substituting one medication with another, increasing monitoring frequency, educating patients about medications, and referring patients for a comprehensive medication review by a specialist pharmacist.

Initial reviews of charts were performed to verify whether the approved variables could be uniformly extracted from clinical documentation. No patient names, medical record numbers, birthdays, or other unique identifiers were captured in the tracking tool. All information collected was maintained under strict confidential procedures outlined within the project protocol.

A recent systematic review demonstrated that polypharmacy and multimorbidity are common among older adults. However, since studies employ varying definitions and samples of populations examined, considerable variability exists across studies (Nicholson et al., 2024). This variability reinforces why it is essential for projects to employ well-defined project measures. For example, while medication count may be informative regarding the description of the quantity of medication usage, quantification is secondary to determination as to whether medications conform to the project-established definition of potentially inappropriate medication utilization.

3. Positive features of this week

Positive features included high levels of enthusiasm among participating clinicians relative to enhancing safety of medication use among older adults. Productive discussions occurred during educational presentations when clinicians presented examples where medications appeared to be contraindicated based on criteria, yet were determined to be medically necessary for their patient. Such discussions supported emphasis on individualized decision-making processes and documentation.

Support from clinic leadership and the project preceptor regarding developmentally supportive approaches toward implementation efforts assisted with facilitating schedules, distributing educational materials, providing access to information necessary for evaluations purposes, and describing the Beer's criteria-based tool as concise and clinically applicable—possibly leading to greater consistency in its use throughout the remaining duration of project implementation.

Additionally, success was achieved regarding dissemination of the preimplementation knowledge survey. Participating clinicians completed the survey without major difficulty. Review of survey items revealed that they were easily understandable. Initial audit findings suggested that most variables studied could be obtained from existing documentation.

4. Unforeseen challenges experienced this week

One unforeseen challenge encountered was that several participating clinicians missed originally scheduled educational sessions due to changes in patient schedules or competing clinical obligations. Educational materials were distributed; however, a follow-up educational session will need to occur so that all participating clinicians receive similar training materials, as well as an opportunity to ask questions.

Unforeseen challenges encountered included variability in documentation related to medication reconciliation. Documentation varied widely depending on the areas where information was located. For example, documentation existed regarding assessments of both the necessity and safety of continued medication therapy; however, some clinical notes simply indicated that the medication list had been reviewed. Due to a lack of supporting rationale, it is unclear whether continuation of a PIM represents intentional clinical decision-making or inadequate review.

Similarly, audit activities took longer than expected because the location of pertinent information within EHRs varied. Identification of an indication for a particular medication often requires reference back to previous notes or a problem list. While these challenges necessitated neither modification nor deviation from approved project protocol, they represented opportunities for improvement in data collection efficiency and consistency.

5. Changes required for next week

During next week I will conduct a brief educational session specifically designed for clinicians who were unable to participate in the initial session. The same educational slides, examples, survey instructions, and decision-support tools will be utilized so that identical material is delivered regardless of timing.

I will emphasize the importance of clinicians documenting rationales for continuing PIMs. Clinicians will be asked to document reasons for continuing PIMs, including whether benefits exceed risks; whether previous alternatives were ineffective or intolerable; and what monitoring plan is being followed. Clinical decisions regarding continuation/discontinuation/substitution/depression of PIMs will not be required by project protocol. Instead, the project will evaluate whether the clinician has acknowledged concern regarding PIMs and made evidence-supported decision.

With regard to improvements in the chart-review process, I intend to assign discrete timeslots for collecting data and specify a consistent sequence for reviewing medication lists, diagnoses, lab values, and clinical documentation. I will collaborate with the project preceptor regarding any uncertain cases without entering patient identifiers into the database. Each week will continue to provide constructive feedback based on aggregate trends rather than individual clinician performance.

6. Practicum Hours

Approximately **12 hours** will be spent at the practicum site this week. These site hours will encompass conducting an educational session for clinicians; meeting with clinic leadership and the project preceptor regarding implementation timelines and role assignments; distributing instructional materials; administering the preimplementation knowledge survey; and distributing the clinical decision-making tool based on the 2023 AGS Beers Criteria: conducting chart reviews and data collection; and providing technical assistance and support to participating clinicians.

A total of **18 hours** will be reported in the practicum log. These hours consist of **12 hours completed at the practicum site and 6 additional hours dedicated to practicum-related activities outside the site**. The additional activities will include meeting with the DNP mentor, preceptor, faculty, or Associate Dean; reviewing the evidence supporting the project; preparing instructional materials; maintaining project documentation; reviewing weekly implementation metrics and procedures; and planning modifications or enhancements for subsequent weeks.

Overall, the first week provided an excellent foundation for the remainder of the eight-week implementation period. Participation/engagement from clinicians, support from clinic leadership/project preceptor, and success in initiating educational/audit processes were notable achievements. Identified site-level scheduling/documentation/workflow issues will serve as the basis for practical adjustments aimed at enhancing implementation fidelity/data validity.

References:

American Geriatrics Society Beers Criteria update expert panel. (2023). American geriatrics society 2023 updated ags beers criteria(r) for potentially inappropriate medication use in older Adults. Journal of the American Geriatrics Society, 71(7), 2052–2081. Doi:10.1111/jgs.18372

Nicholson, K., Liu, W., Fitzpatrick, D., Hardacre, K. A., Roberts, S., Salerno, J., Stranges, S., Fortin, M., & Mangin, D. (2024). Prevalence of multimorbidity and polypharmacy among adults and older adults: a systematic review. _The lancet. Healthy longevity_, _5_(4), e287–e296. https://doi.org/10.1016/S2666-7568(24)00007-2

– a month ago

November 6, 2026
[Solved] Nursing health clinic point of view

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Research the range of contemporary issues teenagers face today. Select one issue (besides teen pregnancy) that a teenager might come to discuss with a nurse in a health clinic at a local high school

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Research the range of contemporary issues teenagers face today. Select one issue (besides teen pregnancy) that a teenager might come to discuss with a nurse in a health clinic at a local high school

November 6, 2026
[Solved] FOUNDATION OF PSYCHOTHERAPY Reply 1 LS

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**WEEK ONE DISCUSSION: FOUNDATION OF PSYCHOTHERAPY** **LAURA SIMPSON** **POSTMASTER CERTIFICATE In PMH, WALDEN UNIVERSITY** **PRAC-6645C- PSYCHOTHERAPY WITH MULTIPLE MODALITIES** **PROFESSOR:** **Dr. Tiffany James** **SEPTEMBER 01, 2026.** Psychotherapy is a form of talk therapy where the patient ca…

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**WEEK ONE DISCUSSION: FOUNDATION OF PSYCHOTHERAPY**

**LAURA SIMPSON**

**POSTMASTER CERTIFICATE In PMH, WALDEN UNIVERSITY**

**PRAC-6645C- PSYCHOTHERAPY WITH MULTIPLE MODALITIES**

**PROFESSOR:** **Dr. Tiffany James**

**SEPTEMBER 01, 2026.**

Psychotherapy is a form of talk therapy where the patient can express psychological, physical, and emotional issues that affects mental wellbeing.

Psychotherapy is a collaborative treatment based on the relationship between an individual and a psychologist. Grounded in dialogue, it provides a supportive environment that allows you to talk openly with someone who’s objective, neutral, and nonjudgmental (American Psychological Association, 2023).

– **Explained whether psychotherapy has a biological basis.**

Psychotherapy has a biological basis because therapeutic interventions and psychological exposure determine how the brain functions. The entire body can be affected by mental illness due to changes in the neural pathway and the stress response system. Cognitive behavioral therapy (CBT), Dialectical Behavioral Therapy (DBT) and Psychodynamic therapies are just a few talk therapies that helps the client to accept and manage their mental issues.

People receiving Cognitive behavioral therapy (CBT) for depression consistently show changes in the fronto-cingulate–limbic circuitry, specifically in the medial prefrontal cortex and ventral anterior cingulate cortex (Gul et al., 2026). There are numerous neurotransmitters in the brain that controls various psychological issues such as anxiety and depression theses are serotonin, norepinephrine and dopamine.

– **Explain how culture, religion, and socioeconomics might influence one’s perspective on the value of psychotherapy treatments.**

An individual cultural belief can determine if the individual will utilize psychotherapy treatments. Some culture believes that talking to others about your mental illness is embarrassing and is showing a sign of weakness and as a result may not accept treatment.

Religion plays an intragyral part of many people’s lives. A patient will have a mental illness but because of their religion may or may not accept treatment. Some people will pray and fast hoping that their mental issues will resolve while others may embrace psychotherapy treatment viewing it as the answer to their problem.

Socioeconomic plays a major role in the type of psychotherapy treatment the individual with mental illness received. The individual may not have the money to pay for the treatment, continue treatment or select the type of psychotherapy treatment that is necessary based on the diagnosis.

– **Describe how legal and ethical considerations for group and family therapy differ from those for individual therapy**

Therapy is a form of treatment for individuals struggling with mental illnesses and obtaining consent to provide treatment is both legal and ethical.

Group and family therapy legal and ethical considerations may be different from an individual therapy. The group therapy may lack privacy, and the family therapy involves family members and sometimes a close friend in the sessions with permission from the patient. These individuals would address issues that may have gone unnoticed or refused to be discussed by the patient.

The individual therapy allows the individual to control what information divulged and having the ability to make decisions independently without pressure from family and friends. Ethical issues in psychiatry and psychotherapy include the value judgments inherent in the irreducibly subjective aspects of the processes of formulating a diagnosis and setting treatment goals (Geppert et al., 2021).

– **Explain how these differences might impact your therapeutic approaches for clients in group, individual, and family therapy.**

The therapeutic approached for group therapy is to establish the need for confidentiality, respect and professionalism. There is no guarantee that individuals in the group will keep the information confidential therefore, rules and regulations will initially be discussed. The individual approach is much controlled, and the therapist will be able to develop a one-to-one professional relationship. Family therapy can be more difficult because each member will have their opinion on the type of treatments to initiate, which can result in confusion and resentment.

– **Explain why each of your supporting sources is considered scholarly.**

**The first reference**

This supporting source is scholarly. The author’s information is credible, concise and current. The information is delivered in a manner that can be easily understood by the reader.

**The second reference**

This peer reviewed article is credible, current and well research. The writers provide information that is well researched and is easy to understand. This information can be utilized and share with colleagues, patients and families.

**The third reference**

The supporting source I used is considered scholarly because it was written by qualified professionals or researchers with expertise in the subject. The article was published by reputable academic or professional sources. Scholarly articles are peer-reviewed. The expert reviewed, scrutinized ensuring the article is factual before publication. Evidence based research, supported by current research and appropriate references, and not entertain opinion.

**References**

American Psychological Association. (2023, December 12). _Understanding psychotherapy and how it works_. American Psychological Association. [https://www.apa.org/topics/psychotherapy/understanding](https://www.apa.org/topics/psychotherapy/understanding)

Geppert, C. M. A., Brendel, R. W., & Trachsel, M. (2021). Editorial: Ethics in Psychiatry and Psychotherapy. _Frontiers in Psychiatry_, _12_. https://doi.org/10.3389/fpsyt.2021.742218

Gul, N., Uppal, G., Maryum, M., Padiyan, K., & Babu, B. M. (2026). Biological Mechanisms of Psychotherapeutic Change: A Systematic Review of Neuroimmune, Autonomic and Epigenetic Changes Following CBT, Mindfulness Based and Trauma-Focused Therapies. In _BJPsych Open_ (Vol. 12, Issue Suppl 1, pp. S88–S89). Cambridge University Press; PubMed Central. [https://doi.org/10.1192/bjo.2026.11143](https://doi.org/10.1192/bjo.2026.11143)

– a month ago

November 6, 2026