Tag: Nursing

  • [Solved] Medication administration

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  • [Solved] Describe three key features of the system that supported positive client or organizational outcomes.

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  • [Solved] AG CL D2 R

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  • [Solved] help with home work

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    – ## NU505.Unit4.Assignment.Set.Up.docx **## NU505.Unit4.Assignment.Set.Up.docx** 1 **Title Page** **Unit 4 Assignment** **Date** **Introduction** **Conceptual Model** · A health promotion program theory or conceptual model is identified and described · Explanation of how model or theory is applicab…

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    – ## NU505.Unit4.Assignment.Set.Up.docx

    **## NU505.Unit4.Assignment.Set.Up.docx**

    1

    **Title Page**

    **Unit 4 Assignment**

    **Date**

    **Introduction**

    **Conceptual Model**

    · A health promotion program theory or conceptual model is identified and described

    · Explanation of how model or theory is applicable to the initiative included

    **Populating Assessment and Screening**

    · Screening topic is identified as an A or B preventive screening from the USPSTF.

    · Identifies the location with population characteristics numerically: 1) multi-cultural diversity, 2) age and 3) sex.

    · Includes rates of risk factors, and aligned with the population in the guidelines

    · Includes 2 components of topic- related community statistics, numerically

    · Provides an advocacy appraisal that addresses 1) 1) screening 2) related risk factors and 3) multicultural considerations and 4) policy

    **Screening Venue**

    · Includes venue, date, time

    · Evidence based explanation of appropriateness included

    **Screening Activity**

    · Screening activity plan aligns with guidelines

    · Aim or objective included

    · Measures are aligned with guideline

    · Normal and abnormal measures included

    · Education description included with three sample motivational questions

    · Follow up and referral section included

    **Cost Table/Statement**

    · Cost statement overview present.

    · Table includes:

    · Estimated number of attendees

    · Testing instrument costs with source for pricing

    · Staff costs

    · Rental cost estimate

    · Simple supply costs

    · Any attendee cost

    · Total

    | | | | |
    | — | — | — | — |
    | **Item** | **Cost Per Item** | **Number Needed** | **Total Cost** |
    | **Supplies** | $ | | $ |
    | **Staff** | $ | | $ |
    | **Rentals** | $ | | $ |
    | **Testing Instruments** | $ | | $ |
    | **Attendance Fees** | $ | | $ |

    **Summary**

    · Summary includes evidence based content from assessment re: multiculturalism and diversity toward change agent

    **Conclusion**

    **Reference**

    **Appendix**

    · Education flyer present with evidence based, patient centered content

    **References**

    **## NU505.Unit4.Assignment.Set.Up.docx**

    1

    **Title Page**

    **Unit 4 Assignment**

    **Date**

    **Introduction**

    **Conceptual Model**

    · A health promotion program theory or conceptual model is identified and described

    · Explanation of how model or theory is applicable to the initiative included

    **Populating Assessment and Screening**

    · Screening topic is identified as an A or B preventive screening from the USPSTF.

    · Identifies the location with population characteristics numerically: 1) multi-cultural diversity, 2) age and 3) sex.

    · Includes rates of risk factors, and aligned with the population in the guidelines

    · Includes 2 components of topic- related community statistics, numerically

    · Provides an advocacy appraisal that addresses 1) 1) screening 2) related risk factors and 3) multicultural considerations and 4) policy

    **Screening Venue**

    · Includes venue, date, time

    · Evidence based explanation of appropriateness included

    **Screening Activity**

    · Screening activity plan aligns with guidelines

    · Aim or objective included

    · Measures are aligned with guideline

    · Normal and abnormal measures included

    · Education description included with three sample motivational questions

    · Follow up and referral section included

    **Cost Table/Statement**

    · Cost statement overview present.

    · Table includes:

    · Estimated number of attendees

    · Testing instrument costs with source for pricing

    · Staff costs

    · Rental cost estimate

    · Simple supply costs

    · Any attendee cost

    · Total

    | | | | |
    | — | — | — | — |
    | **Item** | **Cost Per Item** | **Number Needed** | **Total Cost** |
    | **Supplies** | $ | | $ |
    | **Staff** | $ | | $ |
    | **Rentals** | $ | | $ |
    | **Testing Instruments** | $ | | $ |
    | **Attendance Fees** | $ | | $ |

    **Summary**

    · Summary includes evidence based content from assessment re: multiculturalism and diversity toward change agent

    **Conclusion**

    **Reference**

    **Appendix**

    · Education flyer present with evidence based, patient centered content

    **References**

  • [Solved] 4 soaps needed RW

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    4 soaps needed RW – ## AGPCSOAPNoteAssignmentInstructions.pdf – ## SOAPNoteTemplate-Final1_124176454.PDF **## AGPCSOAPNoteAssignmentInstructions.pdf** 1 SOAP Note Assignment Instructions Consider constructing a Word document ‘SOAP note template’ and use it to assemble your note. By doing this you c…

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    Assignment Prompt & Instructions

    4 soaps needed RW

    – ## AGPCSOAPNoteAssignmentInstructions.pdf

    – ## SOAPNoteTemplate-Final1_124176454.PDF

    **## AGPCSOAPNoteAssignmentInstructions.pdf**

    1

    SOAP Note Assignment Instructions

    Consider constructing a Word document ‘SOAP note template’ and use it to assemble your
    note. By doing this you can use the template for efficiently constructing your SOAP notes such
    that you will be able to copy-and-paste for your weekly assignments. NOTE: If your faculty
    person requests to see your SOAP note template you will be required to send it to them for
    review.

    Sections of the SOAP note should be addressed if they are pertinent to the presenting chief
    complaint.

    Typhon Encounter #:

    Type of Note: Focused or Comprehensive

    Subjective (S):

    CC: chief complaint – What are they being seen for? This is the reason that the patient sought
    care, stated in their own words/words of their caregiver, or paraphrased.

    HPI: Who is the historian? Is the historian reliable? History of Present Illness – use the “OLDCART”
    approach for collecting data and documenting findings. [O=onset, L=location, D=duration,
    C=characteristics, A=associated/aggravating factors, R=relieving factors, T=treatment,
    S=summary]

    Past medical history (PMH) – This should include illness/diagnosis, conditions, traumas,
    hospitalizations, and surgical history that is pertinent to the visit. Include dates if possible.

    Reproductive history: GTPAL, STIs, prenatal care, LMP, contraceptive methods, sexual and
    menstrual history. Include dates if possible.

    Allergies: State the offending medication/food and the reactions.

    Medications: Names, dosages, routes, frequency, and indications.

    Social history: Related to the problem, educational level/literacy, smoking, alcohol, drugs, HIV
    risk, sexually active, caffeine, work, and other stressors. Cultural and spiritual beliefs that
    impact health and illness. Financial resources.

    Family history: Use terms like maternal, paternal and the diseases and the ages they were
    deceased or diagnosed if known.

    Health Maintenance/Promotion – Required for all SOAP notes: Immunizations, exercise, diet,
    screening, etc. Remember to use the United States Clinical Preventative Services Task Force
    (USPSTF) guidelines for age-appropriate indicators, Healthy People 2030, and Centers for
    Disease Control and Prevention (CDC). This should reflect patient’s current recommendations.
    Up to date on health maintenance/promotion will NOT be accepted. Requires references.

    Review of systems (ROS) –

    • [Refer to your course modules and the Bickley E-text (Bates Guide) as a guide when
    conducting your ROS to make sure you have not missed any important symptoms,

    2


    particularly in areas that you have not already thoroughly explored while discussing the
    history of present illness.]

    You would also want to include any pertinent negatives or positives that would help with your
    differential diagnosis. For acute episodic or follow-up visits (focused note) you may be omitting
    certain areas such as GYN, Rectal, GI/Abd, etc. As opposed to a comprehensive visit which
    would address each system.

    Perform either a focused or comprehensive ROS based on the visit type.

    General: May include if patient has had a fever, chills, fatigue, malaise, etc.

    Skin:

    HEENT: head, eyes, ears, nose, and throat

    Neck:

    Breast:

    CV: cardiovascular

    Resp: respiratory

    GI: gastrointestinal

    GYN: gynecologic

    GU: genito-urinary

    PV: peripheral vascular

    MSK: musculoskeletal

    Neuro: neurological

    Endo: endocrine

    Psych:

    Objective (O):

    Physical exam (PE) –
    • [Refer to your course modules and the Bickley E-text (Bates Guide) as a guide when

    determining what physical assessments, you want to include to further explore what you
    have learned from your subjective data collection]

    Perform either a focused or comprehensive exam based on the visit type.

    This area should confirm your findings related to the diagnosis. For acute episodic or follow-up
    visits (focused) you may be omitting certain areas such as GYN, Rectal, Abd, etc. While a
    comprehensive visit will exam each area.

    Ensure that you include appropriate male and female specific physical assessments when
    applicable to the encounter. Your physical exam information should be organized using the

    3

    same body system format as the ROS section. Appropriate medical terminology describing the
    objective examination is mandatory.
    Gen: general statement of appearance if there is any acute distress.

    VS: vital signs, height and weight, BMI

    Skin:

    HEENT: head, eyes, ears, nose, and throat

    Neck:

    Breast:

    CV: cardiovascular

    Resp: respiratory

    GI: gastrointestinal

    GU: genito-urinary

    Gyn: gynecologic

    PV: peripheral vascular

    MSK: musculoskeletal

    Neuro: neurological

    Endo: endocrine

    Psych:

    Diagnostic Tests: This area is for tests that were completed during the patient’s appointment
    that ruled the differential diagnosis in or out (e.g. – Rapid Strep Test, CXR, etc.).

    Assessment (A):
    This section should be a write-up utilizing your clinical decision-making with your
    diagnosis/diagnoses being supported by your ‘S’ data set and the ‘O’ data set. Pertinent
    positives and negatives must be found in the write-up. References required.

    Diagnosis/Diagnoses: Start with the presenting chief complaint diagnosis first. Number each
    diagnosis.

    Remember to include the appropriate ICD-10 code for each diagnosis.

    A statement of current condition and all other chronic illnesses that were addressed during the
    visit must be included (i.e., HTN-well managed on medication).

    Plan (P):

    Your plan should be supported by evidence-based guidelines with appropriate citations utilizing
    APA formatting. Your evidence-based plan may be deviated from your preceptor’s plan. Be sure
    to comment if there is a deviation in standard of care.

    4

    Document individual plans directly after each corresponding assessment (i.e., Diagnosis #1
    found in the assessment should correlate with Plan #1). Address the following aspects (it should
    be separated out as listed below):

    Diagnostics: labs, diagnostics testing – tests that you planned for/ordered during the encounter
    that you plan to review/evaluate relative to your work up for the patient’s chief complaint.
    Therapeutic: changes in meds, skin care, counseling, include full prescribing information for
    any pharmacologic interventions including the name of the medication, dose, route,
    quantity, and number of refills for any new or refilled medications.

    Educational: information clients need in order to address their health problems including the
    diagnosis itself, education on diagnostics, and therapies. Include follow-up care. Anticipatory
    guidance and counseling.

    Consultation/Collaboration: referrals or consult while in clinic with another provider. If no
    referral made was there a possible referral you could make and why? Advance care planning.

    CPT:

    References
    Reference should support your patient’s management plan, including evidence-based practice,
    and utilize APA formatting.

    **## SOAPNoteTemplate-Final1_124176454.PDF**

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    S: SUBJECTIVE DATA
    CC: What are they being seen for? This is the reason that the patient sought

    care, stated in their own words/words of their caregiver, or paraphrased.

    HPI: Use the “OLDCART” approach for collecting data and documenting

    findings. [O=onset, L=location, D=duration, C=characteristics,

    A=associated/aggravating factors, R=relieving factors, T=treatment,

    S=summary]

    PMH: This should include past illness/diagnosis, conditions, traumas,

    hospitalizations, and surgical history. Include dates if possible.

    ALLERGIES State the offending medication/food and the reactions.

    MEDICATIONS Names, dosages, and routes of administration along with indication of

    use.

    SH Related to the problem, educational level/literacy, smoking, alcohol,

    drugs, HIV risk, sexually active, caffeine, work and other stressors.

    Cultural and spiritual beliefs that impact health and illness. Financial

    resources.

    FH Use terms like maternal, paternal, and the diseases along with the ages

    they were deceased or diagnosed if known.

    HEALTH

    PROMOTION &

    MAINTENANCE

    Required for all SOAP notes: Immunizations, exercise, diet, etc.

    Remember to use the United States Clinical Preventative Services Task

    Force (USPSTF) for age-appropriate indicators. This should reflect what

    the patient is presently doing regarding the guidelines. Other wellness

    visits including but not limited to dental and eye exams.

    ROS

    (put N/A in sections

    not completed day of

    exam)

    Constitutional

    Head

    Eyes

    Ears, Nose, Mouth, Throat
    Neck
    Cardiovascular/Peripheral

    Vascular

    Respiratory

    Breast

    Gastrointestinal

    [https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations)

    [https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations)

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    Genitourinary
    Musculoskeletal

    Integumentary

    Neurological

    Psychiatric (screening tools: Ex:

    PHQ-9, MMSE, GAD-7)

    Endocrine

    Hematologic/Lymphatic
    Allergic/Immunologic

    Other

    O: OBJECTIVE DATA
    VITALS: HR: RR: BP: Temp:

    SpO2%: Ht: Wt: BMI:

    Age: LMP: PAIN:

    PHYSICAL

    EXAM

    (Pertinent data

    related to

    presenting

    problem or

    visit type. Put

    N/A in sections

    not completed

    day of exam)

    General Appearance

    Head

    Eyes

    ENT, Mouth
    Neck
    Cardiovascular/Peripheral Vascular

    Respiratory

    Breast

    Gastrointestinal
    Genitourinary Male

    • External Exam

    • Internal Exam

    Genitourinary Female

    • External Exam

    • Internal Exam

    Musculoskeletal

    Integumentary

    Neurological

    Psychiatric

    Endocrine

    Hematologic/Lymphatic

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    Allergic/Immunologic

    Other

    A: ASSESSMENT AND DIAGNOSIS
    DIAGNOSIS ICD-10 CODES

    PRIORITIZE
    DIAGNOSIS

    1.

    2.

    3.

    VISIT CODES CPT BILLING CODES

    DIAGNOSTICS

    POC TESTING

    TESTS REVIEWED

    P: PLAN
    ACTIONS 1. Diagnosis:

    Diagnostics Order: labs, diagnostics testing (tests that you planned

    for/ordered during the encounter that you plan to review/evaluate

    relative to your work up for the patient’s chief complaint.)

    Therapeutic: changes in meds, skin care, counseling, include full

    prescribing information for any pharmacologic interventions

    including quantity and number of refills for any new or refilled

    medications. (Ex: Amoxicillin 500mg, PO, q12h, x 7 days, #14, no

    refills)

    Education: information clients need in order to address their health

    problems. Include follow-up care. Anticipatory guidance and

    counseling.

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    Consultation/Collaboration: referrals or consult while in clinic with

    another provider. If no referral made was there a possible referral

    you could make and why? Advance care planning.

    2. Diagnosis:

    Diagnostics Order:

    Therapeutic:

    Education:

    Consultation/Collaboration:

    3. Diagnosis:

    Diagnostics Order:

    Therapeutic:

    Education:

    Consultation/Collaboration:

    PREVENTITIVE

    (Used for

    comprehensive exams)

    Enter Guidance, Health Promotion, and/or Disease Prevention for

    patient, family, and/or caregiver.

    FOLLOW UP

    **## SOAPNoteTemplate-Final1_124176454.PDF**

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    S: SUBJECTIVE DATA
    CC: What are they being seen for? This is the reason that the patient sought

    care, stated in their own words/words of their caregiver, or paraphrased.

    HPI: Use the “OLDCART” approach for collecting data and documenting

    findings. [O=onset, L=location, D=duration, C=characteristics,

    A=associated/aggravating factors, R=relieving factors, T=treatment,

    S=summary]

    PMH: This should include past illness/diagnosis, conditions, traumas,

    hospitalizations, and surgical history. Include dates if possible.

    ALLERGIES State the offending medication/food and the reactions.

    MEDICATIONS Names, dosages, and routes of administration along with indication of

    use.

    SH Related to the problem, educational level/literacy, smoking, alcohol,

    drugs, HIV risk, sexually active, caffeine, work and other stressors.

    Cultural and spiritual beliefs that impact health and illness. Financial

    resources.

    FH Use terms like maternal, paternal, and the diseases along with the ages

    they were deceased or diagnosed if known.

    HEALTH

    PROMOTION &

    MAINTENANCE

    Required for all SOAP notes: Immunizations, exercise, diet, etc.

    Remember to use the United States Clinical Preventative Services Task

    Force (USPSTF) for age-appropriate indicators. This should reflect what

    the patient is presently doing regarding the guidelines. Other wellness

    visits including but not limited to dental and eye exams.

    ROS

    (put N/A in sections

    not completed day of

    exam)

    Constitutional

    Head

    Eyes

    Ears, Nose, Mouth, Throat
    Neck
    Cardiovascular/Peripheral

    Vascular

    Respiratory

    Breast

    Gastrointestinal

    [https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations)

    [https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations)

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    Genitourinary
    Musculoskeletal

    Integumentary

    Neurological

    Psychiatric (screening tools: Ex:

    PHQ-9, MMSE, GAD-7)

    Endocrine

    Hematologic/Lymphatic
    Allergic/Immunologic

    Other

    O: OBJECTIVE DATA
    VITALS: HR: RR: BP: Temp:

    SpO2%: Ht: Wt: BMI:

    Age: LMP: PAIN:

    PHYSICAL

    EXAM

    (Pertinent data

    related to

    presenting

    problem or

    visit type. Put

    N/A in sections

    not completed

    day of exam)

    General Appearance

    Head

    Eyes

    ENT, Mouth
    Neck
    Cardiovascular/Peripheral Vascular

    Respiratory

    Breast

    Gastrointestinal
    Genitourinary Male

    • External Exam

    • Internal Exam

    Genitourinary Female

    • External Exam

    • Internal Exam

    Musculoskeletal

    Integumentary

    Neurological

    Psychiatric

    Endocrine

    Hematologic/Lymphatic

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    Allergic/Immunologic

    Other

    A: ASSESSMENT AND DIAGNOSIS
    DIAGNOSIS ICD-10 CODES

    PRIORITIZE
    DIAGNOSIS

    1.

    2.

    3.

    VISIT CODES CPT BILLING CODES

    DIAGNOSTICS

    POC TESTING

    TESTS REVIEWED

    P: PLAN
    ACTIONS 1. Diagnosis:

    Diagnostics Order: labs, diagnostics testing (tests that you planned

    for/ordered during the encounter that you plan to review/evaluate

    relative to your work up for the patient’s chief complaint.)

    Therapeutic: changes in meds, skin care, counseling, include full

    prescribing information for any pharmacologic interventions

    including quantity and number of refills for any new or refilled

    medications. (Ex: Amoxicillin 500mg, PO, q12h, x 7 days, #14, no

    refills)

    Education: information clients need in order to address their health

    problems. Include follow-up care. Anticipatory guidance and

    counseling.

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    Consultation/Collaboration: referrals or consult while in clinic with

    another provider. If no referral made was there a possible referral

    you could make and why? Advance care planning.

    2. Diagnosis:

    Diagnostics Order:

    Therapeutic:

    Education:

    Consultation/Collaboration:

    3. Diagnosis:

    Diagnostics Order:

    Therapeutic:

    Education:

    Consultation/Collaboration:

    PREVENTITIVE

    (Used for

    comprehensive exams)

    Enter Guidance, Health Promotion, and/or Disease Prevention for

    patient, family, and/or caregiver.

    FOLLOW UP

    **## AGPCSOAPNoteAssignmentInstructions.pdf**

    1

    SOAP Note Assignment Instructions

    Consider constructing a Word document ‘SOAP note template’ and use it to assemble your
    note. By doing this you can use the template for efficiently constructing your SOAP notes such
    that you will be able to copy-and-paste for your weekly assignments. NOTE: If your faculty
    person requests to see your SOAP note template you will be required to send it to them for
    review.

    Sections of the SOAP note should be addressed if they are pertinent to the presenting chief
    complaint.

    Typhon Encounter #:

    Type of Note: Focused or Comprehensive

    Subjective (S):

    CC: chief complaint – What are they being seen for? This is the reason that the patient sought
    care, stated in their own words/words of their caregiver, or paraphrased.

    HPI: Who is the historian? Is the historian reliable? History of Present Illness – use the “OLDCART”
    approach for collecting data and documenting findings. [O=onset, L=location, D=duration,
    C=characteristics, A=associated/aggravating factors, R=relieving factors, T=treatment,
    S=summary]

    Past medical history (PMH) – This should include illness/diagnosis, conditions, traumas,
    hospitalizations, and surgical history that is pertinent to the visit. Include dates if possible.

    Reproductive history: GTPAL, STIs, prenatal care, LMP, contraceptive methods, sexual and
    menstrual history. Include dates if possible.

    Allergies: State the offending medication/food and the reactions.

    Medications: Names, dosages, routes, frequency, and indications.

    Social history: Related to the problem, educational level/literacy, smoking, alcohol, drugs, HIV
    risk, sexually active, caffeine, work, and other stressors. Cultural and spiritual beliefs that
    impact health and illness. Financial resources.

    Family history: Use terms like maternal, paternal and the diseases and the ages they were
    deceased or diagnosed if known.

    Health Maintenance/Promotion – Required for all SOAP notes: Immunizations, exercise, diet,
    screening, etc. Remember to use the United States Clinical Preventative Services Task Force
    (USPSTF) guidelines for age-appropriate indicators, Healthy People 2030, and Centers for
    Disease Control and Prevention (CDC). This should reflect patient’s current recommendations.
    Up to date on health maintenance/promotion will NOT be accepted. Requires references.

    Review of systems (ROS) –

    • [Refer to your course modules and the Bickley E-text (Bates Guide) as a guide when
    conducting your ROS to make sure you have not missed any important symptoms,

    2


    particularly in areas that you have not already thoroughly explored while discussing the
    history of present illness.]

    You would also want to include any pertinent negatives or positives that would help with your
    differential diagnosis. For acute episodic or follow-up visits (focused note) you may be omitting
    certain areas such as GYN, Rectal, GI/Abd, etc. As opposed to a comprehensive visit which
    would address each system.

    Perform either a focused or comprehensive ROS based on the visit type.

    General: May include if patient has had a fever, chills, fatigue, malaise, etc.

    Skin:

    HEENT: head, eyes, ears, nose, and throat

    Neck:

    Breast:

    CV: cardiovascular

    Resp: respiratory

    GI: gastrointestinal

    GYN: gynecologic

    GU: genito-urinary

    PV: peripheral vascular

    MSK: musculoskeletal

    Neuro: neurological

    Endo: endocrine

    Psych:

    Objective (O):

    Physical exam (PE) –
    • [Refer to your course modules and the Bickley E-text (Bates Guide) as a guide when

    determining what physical assessments, you want to include to further explore what you
    have learned from your subjective data collection]

    Perform either a focused or comprehensive exam based on the visit type.

    This area should confirm your findings related to the diagnosis. For acute episodic or follow-up
    visits (focused) you may be omitting certain areas such as GYN, Rectal, Abd, etc. While a
    comprehensive visit will exam each area.

    Ensure that you include appropriate male and female specific physical assessments when
    applicable to the encounter. Your physical exam information should be organized using the

    3

    same body system format as the ROS section. Appropriate medical terminology describing the
    objective examination is mandatory.
    Gen: general statement of appearance if there is any acute distress.

    VS: vital signs, height and weight, BMI

    Skin:

    HEENT: head, eyes, ears, nose, and throat

    Neck:

    Breast:

    CV: cardiovascular

    Resp: respiratory

    GI: gastrointestinal

    GU: genito-urinary

    Gyn: gynecologic

    PV: peripheral vascular

    MSK: musculoskeletal

    Neuro: neurological

    Endo: endocrine

    Psych:

    Diagnostic Tests: This area is for tests that were completed during the patient’s appointment
    that ruled the differential diagnosis in or out (e.g. – Rapid Strep Test, CXR, etc.).

    Assessment (A):
    This section should be a write-up utilizing your clinical decision-making with your
    diagnosis/diagnoses being supported by your ‘S’ data set and the ‘O’ data set. Pertinent
    positives and negatives must be found in the write-up. References required.

    Diagnosis/Diagnoses: Start with the presenting chief complaint diagnosis first. Number each
    diagnosis.

    Remember to include the appropriate ICD-10 code for each diagnosis.

    A statement of current condition and all other chronic illnesses that were addressed during the
    visit must be included (i.e., HTN-well managed on medication).

    Plan (P):

    Your plan should be supported by evidence-based guidelines with appropriate citations utilizing
    APA formatting. Your evidence-based plan may be deviated from your preceptor’s plan. Be sure
    to comment if there is a deviation in standard of care.

    4

    Document individual plans directly after each corresponding assessment (i.e., Diagnosis #1
    found in the assessment should correlate with Plan #1). Address the following aspects (it should
    be separated out as listed below):

    Diagnostics: labs, diagnostics testing – tests that you planned for/ordered during the encounter
    that you plan to review/evaluate relative to your work up for the patient’s chief complaint.
    Therapeutic: changes in meds, skin care, counseling, include full prescribing information for
    any pharmacologic interventions including the name of the medication, dose, route,
    quantity, and number of refills for any new or refilled medications.

    Educational: information clients need in order to address their health problems including the
    diagnosis itself, education on diagnostics, and therapies. Include follow-up care. Anticipatory
    guidance and counseling.

    Consultation/Collaboration: referrals or consult while in clinic with another provider. If no
    referral made was there a possible referral you could make and why? Advance care planning.

    CPT:

    References
    Reference should support your patient’s management plan, including evidence-based practice,
    and utilize APA formatting.

    **## SOAPNoteTemplate-Final1_124176454.PDF**

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    S: SUBJECTIVE DATA
    CC: What are they being seen for? This is the reason that the patient sought

    care, stated in their own words/words of their caregiver, or paraphrased.

    HPI: Use the “OLDCART” approach for collecting data and documenting

    findings. [O=onset, L=location, D=duration, C=characteristics,

    A=associated/aggravating factors, R=relieving factors, T=treatment,

    S=summary]

    PMH: This should include past illness/diagnosis, conditions, traumas,

    hospitalizations, and surgical history. Include dates if possible.

    ALLERGIES State the offending medication/food and the reactions.

    MEDICATIONS Names, dosages, and routes of administration along with indication of

    use.

    SH Related to the problem, educational level/literacy, smoking, alcohol,

    drugs, HIV risk, sexually active, caffeine, work and other stressors.

    Cultural and spiritual beliefs that impact health and illness. Financial

    resources.

    FH Use terms like maternal, paternal, and the diseases along with the ages

    they were deceased or diagnosed if known.

    HEALTH

    PROMOTION &

    MAINTENANCE

    Required for all SOAP notes: Immunizations, exercise, diet, etc.

    Remember to use the United States Clinical Preventative Services Task

    Force (USPSTF) for age-appropriate indicators. This should reflect what

    the patient is presently doing regarding the guidelines. Other wellness

    visits including but not limited to dental and eye exams.

    ROS

    (put N/A in sections

    not completed day of

    exam)

    Constitutional

    Head

    Eyes

    Ears, Nose, Mouth, Throat
    Neck
    Cardiovascular/Peripheral

    Vascular

    Respiratory

    Breast

    Gastrointestinal

    [https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations)

    [https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations)

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    Genitourinary
    Musculoskeletal

    Integumentary

    Neurological

    Psychiatric (screening tools: Ex:

    PHQ-9, MMSE, GAD-7)

    Endocrine

    Hematologic/Lymphatic
    Allergic/Immunologic

    Other

    O: OBJECTIVE DATA
    VITALS: HR: RR: BP: Temp:

    SpO2%: Ht: Wt: BMI:

    Age: LMP: PAIN:

    PHYSICAL

    EXAM

    (Pertinent data

    related to

    presenting

    problem or

    visit type. Put

    N/A in sections

    not completed

    day of exam)

    General Appearance

    Head

    Eyes

    ENT, Mouth
    Neck
    Cardiovascular/Peripheral Vascular

    Respiratory

    Breast

    Gastrointestinal
    Genitourinary Male

    • External Exam

    • Internal Exam

    Genitourinary Female

    • External Exam

    • Internal Exam

    Musculoskeletal

    Integumentary

    Neurological

    Psychiatric

    Endocrine

    Hematologic/Lymphatic

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    Allergic/Immunologic

    Other

    A: ASSESSMENT AND DIAGNOSIS
    DIAGNOSIS ICD-10 CODES

    PRIORITIZE
    DIAGNOSIS

    1.

    2.

    3.

    VISIT CODES CPT BILLING CODES

    DIAGNOSTICS

    POC TESTING

    TESTS REVIEWED

    P: PLAN
    ACTIONS 1. Diagnosis:

    Diagnostics Order: labs, diagnostics testing (tests that you planned

    for/ordered during the encounter that you plan to review/evaluate

    relative to your work up for the patient’s chief complaint.)

    Therapeutic: changes in meds, skin care, counseling, include full

    prescribing information for any pharmacologic interventions

    including quantity and number of refills for any new or refilled

    medications. (Ex: Amoxicillin 500mg, PO, q12h, x 7 days, #14, no

    refills)

    Education: information clients need in order to address their health

    problems. Include follow-up care. Anticipatory guidance and

    counseling.

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    Consultation/Collaboration: referrals or consult while in clinic with

    another provider. If no referral made was there a possible referral

    you could make and why? Advance care planning.

    2. Diagnosis:

    Diagnostics Order:

    Therapeutic:

    Education:

    Consultation/Collaboration:

    3. Diagnosis:

    Diagnostics Order:

    Therapeutic:

    Education:

    Consultation/Collaboration:

    PREVENTITIVE

    (Used for

    comprehensive exams)

    Enter Guidance, Health Promotion, and/or Disease Prevention for

    patient, family, and/or caregiver.

    FOLLOW UP

    **## AGPCSOAPNoteAssignmentInstructions.pdf**

    1

    SOAP Note Assignment Instructions

    Consider constructing a Word document ‘SOAP note template’ and use it to assemble your
    note. By doing this you can use the template for efficiently constructing your SOAP notes such
    that you will be able to copy-and-paste for your weekly assignments. NOTE: If your faculty
    person requests to see your SOAP note template you will be required to send it to them for
    review.

    Sections of the SOAP note should be addressed if they are pertinent to the presenting chief
    complaint.

    Typhon Encounter #:

    Type of Note: Focused or Comprehensive

    Subjective (S):

    CC: chief complaint – What are they being seen for? This is the reason that the patient sought
    care, stated in their own words/words of their caregiver, or paraphrased.

    HPI: Who is the historian? Is the historian reliable? History of Present Illness – use the “OLDCART”
    approach for collecting data and documenting findings. [O=onset, L=location, D=duration,
    C=characteristics, A=associated/aggravating factors, R=relieving factors, T=treatment,
    S=summary]

    Past medical history (PMH) – This should include illness/diagnosis, conditions, traumas,
    hospitalizations, and surgical history that is pertinent to the visit. Include dates if possible.

    Reproductive history: GTPAL, STIs, prenatal care, LMP, contraceptive methods, sexual and
    menstrual history. Include dates if possible.

    Allergies: State the offending medication/food and the reactions.

    Medications: Names, dosages, routes, frequency, and indications.

    Social history: Related to the problem, educational level/literacy, smoking, alcohol, drugs, HIV
    risk, sexually active, caffeine, work, and other stressors. Cultural and spiritual beliefs that
    impact health and illness. Financial resources.

    Family history: Use terms like maternal, paternal and the diseases and the ages they were
    deceased or diagnosed if known.

    Health Maintenance/Promotion – Required for all SOAP notes: Immunizations, exercise, diet,
    screening, etc. Remember to use the United States Clinical Preventative Services Task Force
    (USPSTF) guidelines for age-appropriate indicators, Healthy People 2030, and Centers for
    Disease Control and Prevention (CDC). This should reflect patient’s current recommendations.
    Up to date on health maintenance/promotion will NOT be accepted. Requires references.

    Review of systems (ROS) –

    • [Refer to your course modules and the Bickley E-text (Bates Guide) as a guide when
    conducting your ROS to make sure you have not missed any important symptoms,

    2


    particularly in areas that you have not already thoroughly explored while discussing the
    history of present illness.]

    You would also want to include any pertinent negatives or positives that would help with your
    differential diagnosis. For acute episodic or follow-up visits (focused note) you may be omitting
    certain areas such as GYN, Rectal, GI/Abd, etc. As opposed to a comprehensive visit which
    would address each system.

    Perform either a focused or comprehensive ROS based on the visit type.

    General: May include if patient has had a fever, chills, fatigue, malaise, etc.

    Skin:

    HEENT: head, eyes, ears, nose, and throat

    Neck:

    Breast:

    CV: cardiovascular

    Resp: respiratory

    GI: gastrointestinal

    GYN: gynecologic

    GU: genito-urinary

    PV: peripheral vascular

    MSK: musculoskeletal

    Neuro: neurological

    Endo: endocrine

    Psych:

    Objective (O):

    Physical exam (PE) –
    • [Refer to your course modules and the Bickley E-text (Bates Guide) as a guide when

    determining what physical assessments, you want to include to further explore what you
    have learned from your subjective data collection]

    Perform either a focused or comprehensive exam based on the visit type.

    This area should confirm your findings related to the diagnosis. For acute episodic or follow-up
    visits (focused) you may be omitting certain areas such as GYN, Rectal, Abd, etc. While a
    comprehensive visit will exam each area.

    Ensure that you include appropriate male and female specific physical assessments when
    applicable to the encounter. Your physical exam information should be organized using the

    3

    same body system format as the ROS section. Appropriate medical terminology describing the
    objective examination is mandatory.
    Gen: general statement of appearance if there is any acute distress.

    VS: vital signs, height and weight, BMI

    Skin:

    HEENT: head, eyes, ears, nose, and throat

    Neck:

    Breast:

    CV: cardiovascular

    Resp: respiratory

    GI: gastrointestinal

    GU: genito-urinary

    Gyn: gynecologic

    PV: peripheral vascular

    MSK: musculoskeletal

    Neuro: neurological

    Endo: endocrine

    Psych:

    Diagnostic Tests: This area is for tests that were completed during the patient’s appointment
    that ruled the differential diagnosis in or out (e.g. – Rapid Strep Test, CXR, etc.).

    Assessment (A):
    This section should be a write-up utilizing your clinical decision-making with your
    diagnosis/diagnoses being supported by your ‘S’ data set and the ‘O’ data set. Pertinent
    positives and negatives must be found in the write-up. References required.

    Diagnosis/Diagnoses: Start with the presenting chief complaint diagnosis first. Number each
    diagnosis.

    Remember to include the appropriate ICD-10 code for each diagnosis.

    A statement of current condition and all other chronic illnesses that were addressed during the
    visit must be included (i.e., HTN-well managed on medication).

    Plan (P):

    Your plan should be supported by evidence-based guidelines with appropriate citations utilizing
    APA formatting. Your evidence-based plan may be deviated from your preceptor’s plan. Be sure
    to comment if there is a deviation in standard of care.

    4

    Document individual plans directly after each corresponding assessment (i.e., Diagnosis #1
    found in the assessment should correlate with Plan #1). Address the following aspects (it should
    be separated out as listed below):

    Diagnostics: labs, diagnostics testing – tests that you planned for/ordered during the encounter
    that you plan to review/evaluate relative to your work up for the patient’s chief complaint.
    Therapeutic: changes in meds, skin care, counseling, include full prescribing information for
    any pharmacologic interventions including the name of the medication, dose, route,
    quantity, and number of refills for any new or refilled medications.

    Educational: information clients need in order to address their health problems including the
    diagnosis itself, education on diagnostics, and therapies. Include follow-up care. Anticipatory
    guidance and counseling.

    Consultation/Collaboration: referrals or consult while in clinic with another provider. If no
    referral made was there a possible referral you could make and why? Advance care planning.

    CPT:

    References
    Reference should support your patient’s management plan, including evidence-based practice,
    and utilize APA formatting.

    **## SOAPNoteTemplate-Final1_124176454.PDF**

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    S: SUBJECTIVE DATA
    CC: What are they being seen for? This is the reason that the patient sought

    care, stated in their own words/words of their caregiver, or paraphrased.

    HPI: Use the “OLDCART” approach for collecting data and documenting

    findings. [O=onset, L=location, D=duration, C=characteristics,

    A=associated/aggravating factors, R=relieving factors, T=treatment,

    S=summary]

    PMH: This should include past illness/diagnosis, conditions, traumas,

    hospitalizations, and surgical history. Include dates if possible.

    ALLERGIES State the offending medication/food and the reactions.

    MEDICATIONS Names, dosages, and routes of administration along with indication of

    use.

    SH Related to the problem, educational level/literacy, smoking, alcohol,

    drugs, HIV risk, sexually active, caffeine, work and other stressors.

    Cultural and spiritual beliefs that impact health and illness. Financial

    resources.

    FH Use terms like maternal, paternal, and the diseases along with the ages

    they were deceased or diagnosed if known.

    HEALTH

    PROMOTION &

    MAINTENANCE

    Required for all SOAP notes: Immunizations, exercise, diet, etc.

    Remember to use the United States Clinical Preventative Services Task

    Force (USPSTF) for age-appropriate indicators. This should reflect what

    the patient is presently doing regarding the guidelines. Other wellness

    visits including but not limited to dental and eye exams.

    ROS

    (put N/A in sections

    not completed day of

    exam)

    Constitutional

    Head

    Eyes

    Ears, Nose, Mouth, Throat
    Neck
    Cardiovascular/Peripheral

    Vascular

    Respiratory

    Breast

    Gastrointestinal

    [https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations)

    [https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations)

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    Genitourinary
    Musculoskeletal

    Integumentary

    Neurological

    Psychiatric (screening tools: Ex:

    PHQ-9, MMSE, GAD-7)

    Endocrine

    Hematologic/Lymphatic
    Allergic/Immunologic

    Other

    O: OBJECTIVE DATA
    VITALS: HR: RR: BP: Temp:

    SpO2%: Ht: Wt: BMI:

    Age: LMP: PAIN:

    PHYSICAL

    EXAM

    (Pertinent data

    related to

    presenting

    problem or

    visit type. Put

    N/A in sections

    not completed

    day of exam)

    General Appearance

    Head

    Eyes

    ENT, Mouth
    Neck
    Cardiovascular/Peripheral Vascular

    Respiratory

    Breast

    Gastrointestinal
    Genitourinary Male

    • External Exam

    • Internal Exam

    Genitourinary Female

    • External Exam

    • Internal Exam

    Musculoskeletal

    Integumentary

    Neurological

    Psychiatric

    Endocrine

    Hematologic/Lymphatic

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    Allergic/Immunologic

    Other

    A: ASSESSMENT AND DIAGNOSIS
    DIAGNOSIS ICD-10 CODES

    PRIORITIZE
    DIAGNOSIS

    1.

    2.

    3.

    VISIT CODES CPT BILLING CODES

    DIAGNOSTICS

    POC TESTING

    TESTS REVIEWED

    P: PLAN
    ACTIONS 1. Diagnosis:

    Diagnostics Order: labs, diagnostics testing (tests that you planned

    for/ordered during the encounter that you plan to review/evaluate

    relative to your work up for the patient’s chief complaint.)

    Therapeutic: changes in meds, skin care, counseling, include full

    prescribing information for any pharmacologic interventions

    including quantity and number of refills for any new or refilled

    medications. (Ex: Amoxicillin 500mg, PO, q12h, x 7 days, #14, no

    refills)

    Education: information clients need in order to address their health

    problems. Include follow-up care. Anticipatory guidance and

    counseling.

    SOAP Note _______
    NU___:_________

    Herzing University

    Name:_________________________
    Typhon Encounter #: _____________________

    Comprehensive:____Focused:____

    Consultation/Collaboration: referrals or consult while in clinic with

    another provider. If no referral made was there a possible referral

    you could make and why? Advance care planning.

    2. Diagnosis:

    Diagnostics Order:

    Therapeutic:

    Education:

    Consultation/Collaboration:

    3. Diagnosis:

    Diagnostics Order:

    Therapeutic:

    Education:

    Consultation/Collaboration:

    PREVENTITIVE

    (Used for

    comprehensive exams)

    Enter Guidance, Health Promotion, and/or Disease Prevention for

    patient, family, and/or caregiver.

    FOLLOW UP

    – 1
    – 2

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    – ## NUR630Wk2response.pdf **## NUR630Wk2response.pdf** Reply from Kelly Thompson NUR 630 Discussion Module Two One common dilemma faced by psychiatric nurse practitioners is determining who the “client” is. Given that children are typically brought for treatment by their parents, describe how the p…

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    Reply from Kelly Thompson

    NUR 630 Discussion Module Two
    One common dilemma faced by psychiatric nurse practitioners is determining who the
    “client” is. Given that children are typically brought for treatment by their parents,
    describe how the psychiatric nurse practitioner would respond to a child who discloses they
    are indulging in illicit behavior and asks you not to tell his or her parents.

    This clinical situation depicts an important ethical and legal consideration that must be
    contemplated when taking care of children and adolescents, the balance between confidentiality
    of a minor and the duty to involve their parents or caregivers. The research has consistently been
    demonstrating that concerns about confidentiality entail significant consequences for mental
    health behaviors in adolescent patients (Kafka et al., 2024.) In caring for the pediatric population,
    the patient/client is viewed as both the child and the parent. Morally, ethically and clinically the
    focus and treatment plan is centered on the child, but the parents or caregivers have the legal
    decision-making authority for the child. Each state defines a different age, and Florida Statue
    349.4784 defines the age of consent for mental health treatment without parental involvement at
    age thirteen during an emotional crisis (Florida Senate, 2012.) Although, the limitations of the
    statue are glaringly obvious in that when the emotional crisis has calmed, the child will have to
    involve the parent/guardian/caregiver in the treatment plan in order for effective care to be
    administered. Parental consent is still required prior to any interventions, medications, treatments
    or referrals.

    Minors articulate fear regarding their physician informing the parents about the reason of
    their consultation, particularly if sensitive issues are involved. This leads to an increased
    reluctance to seek medical care and may result in foregoing treatment all together (Kakfa et al.,
    2024.) I feel like the most proactive way to address this issue is clearly define the parameters of
    confidentiality at the initial consultation with the child and parent. Explaining in age-appropriate
    language to the child and their parent the boundaries of confidentiality will help establish rapport
    and aid in building trust in the relationship. Also, outlining concepts such as HIPAA and
    mandatory reporting should be included in this review. If a child was to reveal illicit behavior
    after the initial interview, I feel that the best approach would be to validate the child/adolescent’s
    feelings by acknowledging their statement. After assessing the severity and risk implications
    together with the child/adolescent, explain to them that we would need to share this information
    with their parent to protect their safety, health, legality, etc. It would be important to engage the
    child/adolescent in formulating and creating a plan in sharing that information with the parent/
    caregiver. Another integral facet would be reinforcing the fact that the psychiatric mental health
    nurse practitioner (PMHNP) is not in a role of judgement but rather protection and safety for the
    child/adolescent. The PMHNP should remain honest in their communication and continue to
    advocate for the child/adolescent’s role in the treatment plan by respecting their autonomy but
    balancing the other roles of safety and legal considerations. A recent systematic review
    demonstrated that adolescents perceive trust and confidentiality in therapeutic relationships as a

    significant facilitator or barrier in the case of a lack thereof, to consulting mental health care
    services (Rowan, 2024.) Perhaps by addressing this salient concern in the very beginning of a
    child or adolescents’ treatment plan will help keep the lines of communication open and safe.
    Revisiting the concept briefly as treatment progresses would be helpful as well so that
    communication remains flowing. Even more concerning, Zucker and colleagues found that most
    adolescents have never had a conversation about confidentiality with their mental health provider
    at all (Kafka et al., 2024.)

    Reply from Darya Valoshyna

    Ethical Challenges in Caring for Pediatric Patients

    When caring for patients under 18, a common dilemma is determining who the client truly
    is. Providing psychiatric care to children and adolescents raises a distinct set of ethical issues,
    challenges, and interests that may include patient autonomy, parental values and preferences, and
    the collective welfare and safety of the patient and family (Barican et al., 2022). If a child
    confided in me about illicit behavior and asked me not to tell their parents, this must be handled
    carefully and appropriately.

    Confidentiality and Safety

    Although ensuring confidentiality is at the forefront of the nurse practitioner's role in
    providing patient care, another essential priority is promoting safety. These two issues can
    conflict at times, similar to when someone threatens violence against another, and then the
    provider must warn that person and temporarily break that confidentiality. Children and
    adolescents can be impulsive and take risks due to the nature of their developing brains and
    bodies. The prefrontal cortex is not fully developed until age 25, and this is a key area of the
    brain that helps someone say no and override impulses. This fact highlights the need for adults to
    monitor them closely and intervene when potentially dangerous decisions and behaviors occur.
    Adolescents' engagement in risky behavior results in substantial mortality and morbidity, and
    studies reveal that in the U.S., approximately ten thousand 15- to 19-year-olds die every year,
    mostly from preventable causes related to risky behavior (Walter et al., 2020). Upholding
    confidentiality is vital to ensure the patient feels safe and trusts the provider; however, safety
    risks override confidentiality. In mental health care, confidentiality must be balanced against
    safety and policy considerations that might justify a breach (Barican et al., 2022).

    Beneficence, Malfeasance, and Consent

    Considering the role of a nurse practitioner also includes the ethical principles of doing
    good and doing no harm and risk-taking behavior such as casual sex, driving too fast, or drug use
    can significantly negatively impact a person's safety and mental well-being than not addressing
    these risks will lead to poor outcomes for the patient. Even though the child is the patient and the
    focus of the care because they are not 18 yet, they do not have full rights to make their own
    medical decisions yet and fully decide who is given information about their health. Although
    minor patients usually cannot provide legal consent, they should be involved in treatment-related
    choices to the degree possible, following their ability to understand options and express coherent
    preferences (Barican et al., 2022). For the child in this situation, their parents are their legal
    guardians and should have full access to their records and what they disclose to the provider.

    Handling the Situation

    Ultimately, I would disagree with the child withholding information about their illicit
    behaviors from their parents. Instead, I would first focus the interview closely on those behaviors
    to assess the thoughts and feelings behind these behaviors and develop an effective treatment
    plan. I would also educate them on the risks of these behaviors to their health and well-being.
    Common strategies to mitigate risk-taking behaviors are teaching refusal skills and providing
    information about a given behavior's risks (Walter et al., 2020). Next, I would ensure I let the
    child know that I must disclose that information to the parents and explain why. My hope in
    doing this is that although, from their immediate perspective, I might be breaking their trust, I
    hope they can understand I am doing it in their best interest. This hopefully will retain the
    therapeutic relationship between them and I. Lastly, I would involve the parents in a plan to help
    safeguard the child and prevent these behaviors, such as close monitoring of their phone,
    implementing a curfew, not being around certain friends, etc. based on what the behaviors are.
    Because the child does not want me to tell their parents, it makes me believe that they inherently
    know the parents would disapprove, so that potentially is a good sign because not only does the
    child recognize these behaviors are wrong, but the parents most likely will not be accepting of it
    and rather be more apt to engage in a parenting plan to reduce these behaviors.

    [https://stu.instructure.com/courses/48604/modules/items/1827955](https://stu.instructure.com/courses/48604/modules/items/1827955)

    **## NUR630Wk2response.pdf**

    Reply from Kelly Thompson

    NUR 630 Discussion Module Two
    One common dilemma faced by psychiatric nurse practitioners is determining who the
    “client” is. Given that children are typically brought for treatment by their parents,
    describe how the psychiatric nurse practitioner would respond to a child who discloses they
    are indulging in illicit behavior and asks you not to tell his or her parents.

    This clinical situation depicts an important ethical and legal consideration that must be
    contemplated when taking care of children and adolescents, the balance between confidentiality
    of a minor and the duty to involve their parents or caregivers. The research has consistently been
    demonstrating that concerns about confidentiality entail significant consequences for mental
    health behaviors in adolescent patients (Kafka et al., 2024.) In caring for the pediatric population,
    the patient/client is viewed as both the child and the parent. Morally, ethically and clinically the
    focus and treatment plan is centered on the child, but the parents or caregivers have the legal
    decision-making authority for the child. Each state defines a different age, and Florida Statue
    349.4784 defines the age of consent for mental health treatment without parental involvement at
    age thirteen during an emotional crisis (Florida Senate, 2012.) Although, the limitations of the
    statue are glaringly obvious in that when the emotional crisis has calmed, the child will have to
    involve the parent/guardian/caregiver in the treatment plan in order for effective care to be
    administered. Parental consent is still required prior to any interventions, medications, treatments
    or referrals.

    Minors articulate fear regarding their physician informing the parents about the reason of
    their consultation, particularly if sensitive issues are involved. This leads to an increased
    reluctance to seek medical care and may result in foregoing treatment all together (Kakfa et al.,
    2024.) I feel like the most proactive way to address this issue is clearly define the parameters of
    confidentiality at the initial consultation with the child and parent. Explaining in age-appropriate
    language to the child and their parent the boundaries of confidentiality will help establish rapport
    and aid in building trust in the relationship. Also, outlining concepts such as HIPAA and
    mandatory reporting should be included in this review. If a child was to reveal illicit behavior
    after the initial interview, I feel that the best approach would be to validate the child/adolescent’s
    feelings by acknowledging their statement. After assessing the severity and risk implications
    together with the child/adolescent, explain to them that we would need to share this information
    with their parent to protect their safety, health, legality, etc. It would be important to engage the
    child/adolescent in formulating and creating a plan in sharing that information with the parent/
    caregiver. Another integral facet would be reinforcing the fact that the psychiatric mental health
    nurse practitioner (PMHNP) is not in a role of judgement but rather protection and safety for the
    child/adolescent. The PMHNP should remain honest in their communication and continue to
    advocate for the child/adolescent’s role in the treatment plan by respecting their autonomy but
    balancing the other roles of safety and legal considerations. A recent systematic review
    demonstrated that adolescents perceive trust and confidentiality in therapeutic relationships as a

    significant facilitator or barrier in the case of a lack thereof, to consulting mental health care
    services (Rowan, 2024.) Perhaps by addressing this salient concern in the very beginning of a
    child or adolescents’ treatment plan will help keep the lines of communication open and safe.
    Revisiting the concept briefly as treatment progresses would be helpful as well so that
    communication remains flowing. Even more concerning, Zucker and colleagues found that most
    adolescents have never had a conversation about confidentiality with their mental health provider
    at all (Kafka et al., 2024.)

    Reply from Darya Valoshyna

    Ethical Challenges in Caring for Pediatric Patients

    When caring for patients under 18, a common dilemma is determining who the client truly
    is. Providing psychiatric care to children and adolescents raises a distinct set of ethical issues,
    challenges, and interests that may include patient autonomy, parental values and preferences, and
    the collective welfare and safety of the patient and family (Barican et al., 2022). If a child
    confided in me about illicit behavior and asked me not to tell their parents, this must be handled
    carefully and appropriately.

    Confidentiality and Safety

    Although ensuring confidentiality is at the forefront of the nurse practitioner's role in
    providing patient care, another essential priority is promoting safety. These two issues can
    conflict at times, similar to when someone threatens violence against another, and then the
    provider must warn that person and temporarily break that confidentiality. Children and
    adolescents can be impulsive and take risks due to the nature of their developing brains and
    bodies. The prefrontal cortex is not fully developed until age 25, and this is a key area of the
    brain that helps someone say no and override impulses. This fact highlights the need for adults to
    monitor them closely and intervene when potentially dangerous decisions and behaviors occur.
    Adolescents' engagement in risky behavior results in substantial mortality and morbidity, and
    studies reveal that in the U.S., approximately ten thousand 15- to 19-year-olds die every year,
    mostly from preventable causes related to risky behavior (Walter et al., 2020). Upholding
    confidentiality is vital to ensure the patient feels safe and trusts the provider; however, safety
    risks override confidentiality. In mental health care, confidentiality must be balanced against
    safety and policy considerations that might justify a breach (Barican et al., 2022).

    Beneficence, Malfeasance, and Consent

    Considering the role of a nurse practitioner also includes the ethical principles of doing
    good and doing no harm and risk-taking behavior such as casual sex, driving too fast, or drug use
    can significantly negatively impact a person's safety and mental well-being than not addressing
    these risks will lead to poor outcomes for the patient. Even though the child is the patient and the
    focus of the care because they are not 18 yet, they do not have full rights to make their own
    medical decisions yet and fully decide who is given information about their health. Although
    minor patients usually cannot provide legal consent, they should be involved in treatment-related
    choices to the degree possible, following their ability to understand options and express coherent
    preferences (Barican et al., 2022). For the child in this situation, their parents are their legal
    guardians and should have full access to their records and what they disclose to the provider.

    Handling the Situation

    Ultimately, I would disagree with the child withholding information about their illicit
    behaviors from their parents. Instead, I would first focus the interview closely on those behaviors
    to assess the thoughts and feelings behind these behaviors and develop an effective treatment
    plan. I would also educate them on the risks of these behaviors to their health and well-being.
    Common strategies to mitigate risk-taking behaviors are teaching refusal skills and providing
    information about a given behavior's risks (Walter et al., 2020). Next, I would ensure I let the
    child know that I must disclose that information to the parents and explain why. My hope in
    doing this is that although, from their immediate perspective, I might be breaking their trust, I
    hope they can understand I am doing it in their best interest. This hopefully will retain the
    therapeutic relationship between them and I. Lastly, I would involve the parents in a plan to help
    safeguard the child and prevent these behaviors, such as close monitoring of their phone,
    implementing a curfew, not being around certain friends, etc. based on what the behaviors are.
    Because the child does not want me to tell their parents, it makes me believe that they inherently
    know the parents would disapprove, so that potentially is a good sign because not only does the
    child recognize these behaviors are wrong, but the parents most likely will not be accepting of it
    and rather be more apt to engage in a parenting plan to reduce these behaviors.

    [https://stu.instructure.com/courses/48604/modules/items/1827955](https://stu.instructure.com/courses/48604/modules/items/1827955)

  • [Solved] Module 05 Nursing Clinical Rounds

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    **Introduction** Safety and infection prevention are foundational elements of nursing practice, critical to ensuring positive patient outcomes and protecting vulnerable populations. Nurses must identify risk factors, implement evidence-based interventions, and respond to complications to reduce harm…

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    **Introduction**
    Safety and infection prevention are foundational elements of nursing practice, critical to ensuring positive patient outcomes and protecting vulnerable populations. Nurses must identify risk factors, implement evidence-based interventions, and respond to complications to reduce harm. Whether managing environmental hazards, preventing falls, or controlling infectious diseases, nurses are responsible for maintaining a safety culture through detailed assessment, prevention, and education. This discussion integrates safe care and infection control concepts, applying the nursing process to promote wellness and respond to potential threats.
    ##### **???? Case Study**
    Mrs. Velma Chan, an 84-year-old widow with diabetes and mild cognitive impairment, is admitted to the hospital for pneumonia. She lives alone, is hard of hearing, and uses a walker. During the first 24 hours of admission, the nurse observed clutter around her bedside, poor lighting, and her bed alarm not activated. Velma becomes disoriented at night, tries to ambulate unassisted, and falls, sustaining a wrist sprain. A fall risk and infection control assessment reveals multiple concerns: improper catheter care, missed hand hygiene by visitors, and nonadherence to PPE use. Post-fall, Velma develops a urinary tract infection (UTI) requiring antibiotics. The interdisciplinary team initiates a safety review, including hand hygiene training and environmental modifications. The nurse must assess Velma’s safety and infection risks, implement preventive measures, and evaluate outcomes across multiple care domains.
    ##### **???? Discussion Prompt**
    **Choose ONE** of the following topic areas and respond thoroughly:
    **1. Assessing Safety and Infection Risk**
    – What are the key components of a safety and infection risk assessment in older adult clients?
    – What red flags in Mrs. Chan’s case should have prompted early intervention?
    – What data should nurses collect to evaluate fall potential and infection susceptibility?
    **2. Preventing Falls and Breaking the Chain of Infection**
    – What specific nursing interventions reduce fall risk in hospitalized clients like Mrs. Chan?
    – How can the nurse break the infection cycle using standard precautions and aseptic technique?
    – What complications should the nurse monitor for related to safety or infection breakdowns?
    **3. Responding to Infection and Supporting Recovery**
    – What nursing actions are required after Mrs. Chan develops a UTI?
    – What strategies support healing in high-risk clients with cognitive or mobility impairments?
    – How should the nurse evaluate treatment effectiveness and educate for long-term safety?
    ##### **???? Instructions for Participation**
    – Post your initial discussion by Saturday at 11:59 PM CST.

  • [Solved] Module 06 Nursing Clinical Rounds:

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    ##### **Introduction** The immune system is a complex network that protects the body from infection and abnormal cells. When functioning optimally, it identifies foreign invaders and mounts a targeted response. However, in clients with immune disorders—ranging from autoimmune conditions to HIV/AIDS—…

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    ##### **Introduction**
    The immune system is a complex network that protects the body from infection and abnormal cells. When functioning optimally, it identifies foreign invaders and mounts a targeted response. However, in clients with immune disorders—ranging from autoimmune conditions to HIV/AIDS—this protective system becomes compromised or overactive. Nurses must be equipped to identify risks, collect relevant clinical data, and implement interventions that promote immune health, prevent complications, and support recovery. This discussion explores the immunity processes and evidence-based strategies for managing patients with altered immune responses.
    ##### **???? Case Study**
    Mr. Devon Lee, a 58-year-old male with a history of hypertension and type 2 diabetes, is admitted to the hospital with persistent fatigue, weight loss, and low-grade fever. His recent labs reveal leukopenia, a low CD4+ T-cell count, and positive ELISA and Western Blot tests, confirming HIV infection. He is started on combination antiretroviral therapy (cART). During his hospital stay, he develops oral candidiasis and a productive cough. The nurse assesses for signs of opportunistic infections and notes decreased appetite and mild confusion. In addition to managing Devon’s current symptoms, the care team must educate him on immune health promotion, monitor for complications, and initiate safety protocols to prevent infection transmission.
    ##### **???? Discussion Prompt**
    **Choose ONE** of the following topic areas and respond thoroughly:
    **1. The Immune Response in HIV and Other Conditions**
    – Describe the process of immunity, including the roles of T cells, B cells, and antibodies.
    – How is the immune response altered in HIV, autoimmune conditions, or allergic reactions?
    – What are the clinical implications of these changes in nursing care?
    **2. Identifying and Assessing Immune Disorders**
    – What clients are at higher risk for immune dysfunction, and why?
    – What assessment data (labs, history, symptoms) should the nurse prioritize for early detection?
    – How can nurses distinguish immune-related concerns from other health problems?
    **3. Promoting Immune Health and Preventing Infection**
    – What interventions support immune function in high-risk clients like Mr. Lee?
    – How can nurses promote nutrition, hygiene, and vaccination adherence?
    – How should the nurse evaluate effectiveness and monitor for complications such as opportunistic infections?
    ##### **???? Instructions for Participation**
    – Post your initial discussion by Saturday at 11:59 PM CST.

  • [Solved] shel4045.1

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