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

For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.

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To prepare:

With the information presented in Chapter 1 of Ball et al. in mind, consider the following:

• By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the Course Announcements section of the classroom for your new patient profile assignment. 

1. Case study : 16-year-old white pregnant female living in an inner-city neighborhood

• How would your communication and interview techniques for building a health history differ with each patient?
• How might you target your questions for building a health history based on the patients social determinants of health?
• What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
• Identify any potential health-related risks based upon the patients age, gender, ethnicity, or environmental setting that should be taken into consideration.
• Select one of the risk assessment instruments presented in Chapter 1 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
• Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

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

 Week 8

Chapters 18-19.

Female Genitalia;male Genitalia.
 Midsagittal view of the female pelvic organs.

Summarize the ovulation cycle and identify the functions of the hormones produced

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An older woman who has stopped regular menstruation asks whether she can still become pregnant. What is the best response you can give this patient?

What is the name of the tissue that separates the anterior wall of the vagina from the bladder and urethra?

Name the four bones that form the pelvis

why it is important to teach mothers correct perineal care for their newborn infant daughters.

What possibility must you consider if in a child you observe vaginal swelling of the vulvar tissues accompanied by bruising or foul-smelling discharge?

Describe premenstrual syndrome (PMS).   

Identify and explain positions other than the lithotomy in which a pelvic examination can be performed.  

You are about to conduct a pelvic examination on an adolescent girl. What should you take time to do before carrying out the examination?

A 12-year-old girl is experiencing a vaginal mucus discharge. What can you tell this girl to decrease her anxiety?

A new mother is frightened by the appearance of blood-tinged mucus at her newborn daughters vaginal entrance. What response can alleviate this womans anxiety?

MC is a 28-year-old patient who presents to the urgent care for complaints of abdominal pain and cramping. Today she has noticed a yellow vaginal discharge. 

Her past medical history is noncontributory. She admits to having multiple sexual partners with unprotected intercourse

1-What additional questions regarding her vaginal discharge could you ask at this point?

2- Describe the stages of salpingitis.

3- What physical assessment findings on the vaginal examination and bimanual would you expect to see if the patient has salpingitis?

Male pelvic organs
A 60-year-old man asks you whether it is still possible for him to become a father. How would you respond to this patient? What effect does aging have on male fertility?

 Which part of the male genitalia is a soft, comma-shaped structure located on the posterolateral and upper aspect of the testis in 90% of males and provides for storage, maturation, and transit of sperm?

Differentiate between the external genitalia for a male and female fetus at both 8 weeks and 12 weeks of gestation.

Summarize the pros and cons of newborn circumcision.

The mother of a newborn you are examining voices concern that one of her sons testicles has not yet appeared. What can you tell this mother to reassure her? 

What is the expected time for final descent of the testes into the scrotal sac? 

Discuss how do you could effectively work with a child to evaluate the testicles.

You are performing a genital examination on a 12-year-old boy who seems noticeably embarrassed and nervous. What communication measures can be included to decrease anxiety and facilitate the examination?

A patient has an erection while you are performing a genital examination. What is the best response to decrease anxiety and embarrassment? 

Describe the cremasteric reflex.

  Additionally, you are expected to reply to two other students and include a reference that justifies your post.  Your reply must be at least 3 paragraphs. 

the following answer is the post to another student that I have to reply to. 

Question 1

            I am a doctors nurse at a local clinic where I meet Alex who, while the M.D. examining his genitalia and me as the providers assistant nurse, informs us that he is HIV positive. I counsel Alex to inform his sex partner Ann so that she can also get to know her HIV status. Twelve months later, Ann is expecting a baby in three months.

            Clearly, Alex is yet to inform Ann of his status yet steps needed to be taken to know the status of Ann and the unborn baby so that necessary treatment can commence. Alex threatens that if his status is disclosed to Ann without his consent, he would stop coming for treatment. I found myself in a dilemma on whether to inform Ann of Alex status or hid to Alex words.

            To utilize critical thinking, I ought to refer to paragraph 53 of the GMC guidelines on confidentiality. The principle explains that disclosure of confidential information is justified when the failure to do so exposes a third party to risk of death or serious harm (Dolan, 2004).

Question 2

            Patients can avoid medical errors to ensure their safety taking their medication as prescribed, communicating effectively with their caregivers and clinicians and lowering infection rates. Patients must also keep the health care team involved and learning more about their conditions (Keohane & Bates, 2008).

            Family caregivers need to have adequate training on how to handle the patient and ensure adequate communication between the patient and the clinician to ensure patient safety. The family should also ensure that the patient is free from household hazards. Clinicians can promote safety and reduce errors by adhering to procedures, listening to patients and effectively communicating with the health care team (Keohane & Bates, 2008).

.

            The healthcare team should embrace teamwork to eliminate issues of burnouts that may lead to medical errors. The team should also work together to solve problems that may lead to medical errors. The system can improve communication skills among members of staff in the facility, develop team strategies and develop safety culture in the hospital setting to ensure safety and reduce errors.

Question 3

            Patient involvement is a core factor in creating the culture of safety. Clinicians must involve patients in decisions pertaining to their treatment and discharge plans (Clancy, Farquhar & Sharp, 2005). Such practices allow patients know much about their care to avoid misunderstanding.

            Teamwork also creates a culture of safety. The skills generated in interprofessional communication encourage safety culture. Teamwork is critical during transitions in care.

            Access to accurate information is another factor that creates a culture of safety. Access patient records, evidence-based-practice protocol and lab reports enhance the culture of safety in health care. The formation required must be accurate and received in good time.

References

Clancy, C. M., Farquhar, M. B., & Sharp, B. A. C. (2005). Patient safety in nursing           practice. Journal of Nursing Care Quality, 20(3), 193-197.

Dolan, B. (2004). Medical records: Disclosing confidential clinical information. Psychiatric             Bulletin, 28(2), 53-56.

Keohane, C. A., & Bates, D. W. (2008). Medication safety. Obstetrics and gynecology clinics of North America, 35(1), 37-52.

 As a psychiatric mental health nurse practitioner, it is essential for you to have a strong background in foundational neuroscience. In order to diagnose and treat clients, you must not only understand the pathophysiology of psychiatric disorders, but also how medications for these disorders impact the central nervous system. These concepts of foundational neuroscience can be challenging to understand. Therefore, this Discussion is designed to encourage you to think through these concepts, develop a rationale for your thinking, and deepen your understanding by interacting with your colleagues. 

 

Post a response to each of the following:

1. Explain the agonist-to-antagonist spectrum of action of psychopharmacologic agents.
2. Compare and contrast the actions of g couple proteins and ion gated channels.
3. Explain the role of epigenetics in pharmacologic action.
4. Explain how this information may impact the way you prescribe medications to clients. Include a specific example of a situation or case with a client in which the psychiatric mental health nurse practitioner must be aware of the medications action.

ZERO PLAGIARISM

FOUR REFERENCES FROM THE FILES ATTACHED AND OTHER RESOURCES

 

Examine the importance of professional associations in nursing. Choose a professional nursing organization that relates to your specialty area, or a specialty area in which you are interested. Provide a detailed overview the organization and its advantages for members. Include the following:

1. Describe the organization and its significance to nurses in the specialty area. Include its purpose, mission, and vision. Describe the overall benefits, or “perks,” of being a member.
2. Explain why it is important for a nurse in this specialty field to network. Discuss how this organization creates networking opportunities for nurses.
3. Discuss how the organization keeps its members informed of health care changes and changes to practice that affect the specialty area.
4.  Discuss opportunities for continuing education and professional development.

 

Rough Draft Qualitative Research Critique and Ethical Considerations 

             

Write  a critical appraisal that demonstrates comprehension of two qualitative  research studies. Use the “Research Critique Guidelines Part 1”  document to organize your essay. Successful completion of this  assignment requires that you provide rationale, include examples, and  reference content from the studies in your responses.

Use the  practice problem and two qualitative, peer-reviewed research article you  identified in the Topic 1 assignment to complete this assignment.

In  a 1,0001,250 word essay, summarize two qualitative studies, explain  the ways in which the findings might be used in nursing practice, and  address ethical considerations associated with the conduct of the study.

Prepare  this assignment according to the guidelines found in the APA Style  Guide, located in the Student Success Center. An abstract is not  required.

This assignment uses a rubric. Please review the rubric  prior to beginning the assignment to become familiar with the  expectations for successful completion.

Research a health care organization or network that spans several states with in the United States (United Healthcare, Vanguard, Banner Health, etc.). Assess the readiness of the health care organization or network you chose in regard to meeting the health care needs of citizens in the next decade.

Prepare a 1,000-1,250 word paper that presents your assessment and proposes a strategic plan to ensure readiness. Include the following:

1. Describe the health care organization or network.
2. Describe the organization’s overall readiness based on your findings.
3. Prepare a strategic plan to address issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction.
4. Identify any current or potential issues within the organizational culture and discuss how these issues may affect aspects of the strategic plan.
5. Propose a theory or model that could be used to support the implementation of the strategic plan for this organization. Explain why this theory or model is best

 

WEEK 8

As an advanced practice nurse, one can engage in activism in order to achieve desired policy change at various levels including their own organization. Examine the following questions, should nurses be unionized and how does being unionized impact a workforce culture of safety? Be sure to include one MSN Essential in your discussion that relates to this topic.

 

**As a reminder, all questions must be answered to receive full credit for this discussion.

 

Chief complaint: Im here for a medication refill because I ran out of my medicines.

HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.

She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.

PMH: Primary Hypertension, Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History:  Up-to-date

Social history:

High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.

Psychiatric: Non-contributory.

Physical examination:

Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111,  R 22 and non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.

Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Congestive Heart Failure (CHF)

Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA)

Differential Diagnosis: Peripheral Vascular Disease (PVD)

Plan:

Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.

Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %

BNP not available.

As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).

Questions:

1.     According to the ACC/AHA guidelines, what medications should this patient be prescribed?

2.     Does he need medication(s) given his history of MI?

Compare vulnerable populations. Describe an example of one of these groups in the United States or from another country. Explain why the population is designated as “vulnerable.” Include the number of individuals belonging to this group and the specific challenges or issues involved. Discuss why these populations are unable to advocate for themselves, the ethical issues that must be considered when working with these groups, and how nursing advocacy would be beneficial.