Apply information from the Aquifer Case Study to answer the following discussion questions:
· Discuss the Mr. Payne’s history that would be pertinent to his genitourinary problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.
· Describe the physical exam and diagnostic tools to be used for Mr. Payne. Are there any additional you would have liked to be included that were not?
· Please list 3 differential diagnoses for Mr. Payne and explain why you chose them. What was your final diagnosis and how did you make the determination?
· What plan of care will Mr. Payne be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?
Forty-five-year-old white male truck driver complaining of two weeks of sharp, stabbing back pain. The pain was better after a couple of days but then got worse after playing softball with his daughter. This morning his pain is so bad that he had trouble getting out of bed.
You and Dr. Lee take a few minutes to review Mr. Payne’s chart:
Vital signs:
· Temperature: 98.6° Fahrenheit
· Heart rate: 80 beats/minute
· Respiratory rate: 12 breaths/minute
· Blood pressure: 130/82 mmHg
· Weight: 170 pounds
· Body Mass Index: 24 kg/m2
Past Medical History: Diabetes, well controlled. Hypertension, fair control. Hyperlipidemia, fair control.
Past Surgical History: None
Social History: Works as a truck driver, which involves lifting 20-35 lbs 4 hours of the day, married with 2 daughters,
Habits: Quit smoking two years ago, drinks 1 to 2 beers occasionally on the weekends, no history of IV drug use.
Medication:
· metformin 500mg 2 twice daily
· glyburide 5mg 2 twice daily
· amlodipine 2.5 mg daily
· lisinopril 40 mg daily
· simavastin 40 mg daily
Allergies: No known drug allergies.
Can you tell me about your back pain?”
“As I told the nurse, the pain started two weeks ago after I lifted a box at work. Right away, I got this sharp pain on the left side of my back. The box wasn’t even that heavy.
“I talked to the nurse at work; she said to ice it and to take ibuprofen. It got better after three days. But, I was playing softball with my daughter last weekend, and the pain came back. This time it was worse than before. This week, the pain is so bad I can hardly get out of bed. I get a sharp pain in my back which goes down my left leg to my ankle.”
“On a scale of 0 to 10, 10 being the worst, how severe is the pain?”
“It’s probably a 7.”
“Have you found anything that improves the pain?”
“Ibuprofen and Naproxen worked at first, but they are not helping much anymore.”
“What about positions that make things better or worse?”
“The pain is worse with any movement of my back or sitting for a long time. It is better when I lie down.”
“Have you had back pain before?”
“Yes, I have back pain from time to time. But I’m usually better after 2 to 3 days. This is the worst pain I have ever had.”
Review of Systems
Mr. Payne does not have numbness or weakness in his legs. The pain is better when he lies down. He denies urinary frequency, dysuria, problems with bowel or bladder control, fever or chills, nausea or vomiting, or weight loss. He denies any specific trauma, except for when he lifted a 10-pound box at work. He denies unrelenting night pain.
Based on your differential, you determine that it is highly likely that Mr. Payne is experiencing a mechanical cause of back pain with nerve involvement such as a disc herniation. It is possible that he has spinal fracture, but a lack of trauma history makes the latter unlikely. It is important to consider cauda equina syndrome, as it calls for immediate surgical investigation, but it is unlikely in the absence of neurological symptoms like loss of bowel or bladder control. Finally, infectious etiology, such as pyelonephritis, is unlikely without fever and chills, urinary frequency and dysuria.
Back Exam – Standing:
Mr. Payne has normal curvature, tenderness on palpation on the left lumbar paraspinous muscle with increase tone. Full range of motion, but has pain with movement. His gait is normal. He can walk on his heels and toes. He can do deep knee bends.
Back Exam – Seated:
Mr. Payne denies feeling pain when checked for CVA tenderness. He has no pain in his right leg with the modified version of SLR. While he does not exhibit a true tripod sign, he does complain of pain when his left leg is raised. Mr. Payne’s reflexes are 2+ and equal at the knees and 1+ at both ankles. The motor exam reveals no weakness of the muscles of the lower extremities. His sensory exam is normal.
Pulmonary Exam: His lungs are clear.
Cardiovascular Exam: His cardiac exam demonstrates a regular rhythm, no murmur or gallop.
Three weeks later, Mr. Payne returns for his follow-up appointment and you discover the following:
Pertinent History
Mr. Payne has had little relief with the treatment prescribed. He is frustrated that he has been in pain for more than a month. His pain has been progressively worse. It radiates down the lateral part of his left leg and side of his left foot. This pain is worse than the back pain. He does not have any problems with bowel or bladder control and there is no weakness of his leg.
Pertinent Exam Findings
Vital signs: stable
Neurologic: Normal gait, but moves slowly due to pain; range of motion is full, with pain on flexion; SLR is positive at 45 degree on the left; motor strength intact; reflexes 2+ bilaterally at the knees, absent at the left ankle, 1+ at the right ankle.
Dr. Lee agrees with your diagnosis of radiculopathy of S1 nerve root with progression. She orders an MRI and sets up an appointment to see Mr. Payne after the MRI.
You and Dr. Lee now return to Mr. Payne’s exam room to talk about treatment options with him. Dr. Lee tells Mr. Payne to avoid strenuous activities but to remain active. Dr. Lee increases the dosage of naproxen to 500 mg BID to take with food. Since his pain is intense (7/10), he is given a prescription for acetaminophen with codeine to take at night, when his pain is severe. Mr. Payne declines a muscle relaxant because they usually make him drowsy. He would like to be referred to physical therapy as it was helpful in the past.
FOLLOW-UP TREATMENT
MANAGEMENT
One week later, Mr. Payne returns for follow-up. You review the results of the MRI report.
MRI report:
1. Moderate-size, herniated disc at L5-S1 with associated marked impingement on the left S1 nerve root and mild to moderate impingement on the right S1 nerve root. There is mild central canal stenosis.
2. Annular tear with a small central disc herniation at L4-5 causing mild central canal stenosis.
You review the findings with Dr. Lee. She agrees with your diagnosis of radiculopathy of S1 nerve root due to a large herniated disc at L5-S1.
You call Mr. Payne two weeks later to see how he is doing. He reports that he is doing quite a bit better. He went to an osteopathic physician who did some manual therapy and started him on a strict walking program. He is very encouraged and plans on losing weight through exercise and diet.
Electrical Engineering homework help
UncategorizedAfter that, you need to apply a cyber-attack on the data set or in the forecasting method to affect the prediction performance.
Please let me know whether you can
>Biology homework help
UncategorizedAll living organisms have ways of meeting the challenges of their environment, but some animals have wildly interesting adaptations, like the one discussed in this video:
Discussion Vll please reply to question:
UncategorizedCan I please get the previous writer whom answered this discussion question for me on this week on Order#166477, to go back in and answer the question attached below. Also, I have attached the article in which the professor gave me to read in order to answer the question here on the link in the question.
Etta,
You make a good point about international market
Let’s talk about the fluctuation in exchange rates and what plays a role in these changes.
Global investors trade large amounts of foreign currency on a regular basis and there are a lot of factors to consider, such as the economy, savings, prices, public finances, and speculation. The BBC article below briefly talks about these factors as it pertains to the pound. Take a look!
https://www.bbc.com/news/business-49179234
Dr. Wade
Why are coding standards important for promoting consistent, high-quality care?
Nursing HomeworksNursing homework help
DISCUSSION-3
Standardized Coding Systems
As a result of the fragmented nature of the health care system, professionals in various specialty areas of medicine have developed their own unique sets of terminology to communicate within that specialty. In the past, limited attention has been given to codifying practices in order for them to be understood and utilized across disciplines or through different information technology systems. The implementation of a federally mandated electronic medical records system, therefore, poses a challenge to nursing professionals and others who must be prepared to utilize standardized codes for the new system. Why are coding standards important for promoting consistent, high-quality care?
According to Rutherford (2008, para. 15), “Improved communication with other nurses, health care professionals, and administrators of the institution in which nurses work is a key benefit of using a standardized nursing language.” In this Discussion you consider the reasoning behind and the value of standardized codification.
To prepare
Review the information in Nursing Informatics: Scope and Standards of Practice. Determine which set of terminologies are appropriate for your specialty or area of expertise.
Reflect on the importance of continuity in terminology and coding systems.
In the article, “Standardized Nursing Language: What Does It Mean for Nursing Practice?” the author recounts a visit to a local hospital to view its implementation of a new coding system. One of the nurses commented to her, “We document our care using standardized nursing languages but we don’t fully understand why we do” (Rutherford, 2008, para. 1). Consider how you would inform this nurse (and others like her) of the importance of standardized nursing terminologies.
Reflect on the value of using a standard language in nursing practice. Consider if standardization can be limited to a specialty area or if one standard language is needed across all nursing practice. Then, identify examples of standardization in your own specialty or area of expertise. Conduct additional research using the Walden Library that supports your thoughts on standardization of nursing terminology.
Please Provide References
Learning Resources
Required Readings
American Nurses Association. (2015). Nursing informatics: Scope & standards of practice (2nd ed.). Silver Springs, MD: Author.
“Metastructures, Concepts, and Tools of Nursing Informatics”
This chapter explores the connections between data, information, knowledge, and wisdom and how they work together in nursing informatics. It also covers the influence that concepts and tools have on the field of nursing.
McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.
Chapter 6, “Overview of Nursing Informatics”
This chapter defines the foundations of nursing informatics (NI). The authors specify the disciplines that are integrated to form nursing informatics, along with major NI concepts.
Brokel, J. (2010). Moving forward with NANDA-I nursing diagnoses with Health Information Technology for Economic and Clinical Health (HITECH) Act Legislation: News updates. International Journal of Nursing Terminologies & Classifications, 21(4), 182–185.
In this news brief, the author describes the initiatives that NANDA-I will implement to remain abreast of the HITECH legislation of 2009. The author explains two recommendations for the federal government’s role in managing vocabularies, value sets, and code sets throughout the health care system.
Matney, S., Brewster, P. J., Sward, K. A., Cloyes, K. G., & Staggers, N. (2011). Philosophical approaches to the nursing informatics data-information-knowledge-wisdom framework. Advances in Nursing Science, 34(1), 6–18.
This article proposes a philosophical foundation for nursing informatics in which data, information, and knowledge can be synthesized by computer systems to support wisdom development. The authors describe how wisdom can add value to nursing informatics and to the nursing profession as a whole.
Mastering In Nursing Advance Nurse Practice
UncategorizedApply information from the Aquifer Case Study to answer the following discussion questions:
· Discuss the Mr. Payne’s history that would be pertinent to his genitourinary problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.
· Describe the physical exam and diagnostic tools to be used for Mr. Payne. Are there any additional you would have liked to be included that were not?
· Please list 3 differential diagnoses for Mr. Payne and explain why you chose them. What was your final diagnosis and how did you make the determination?
· What plan of care will Mr. Payne be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?
Forty-five-year-old white male truck driver complaining of two weeks of sharp, stabbing back pain. The pain was better after a couple of days but then got worse after playing softball with his daughter. This morning his pain is so bad that he had trouble getting out of bed.
You and Dr. Lee take a few minutes to review Mr. Payne’s chart:
Vital signs:
· Temperature: 98.6° Fahrenheit
· Heart rate: 80 beats/minute
· Respiratory rate: 12 breaths/minute
· Blood pressure: 130/82 mmHg
· Weight: 170 pounds
· Body Mass Index: 24 kg/m2
Past Medical History: Diabetes, well controlled. Hypertension, fair control. Hyperlipidemia, fair control.
Past Surgical History: None
Social History: Works as a truck driver, which involves lifting 20-35 lbs 4 hours of the day, married with 2 daughters,
Habits: Quit smoking two years ago, drinks 1 to 2 beers occasionally on the weekends, no history of IV drug use.
Medication:
· metformin 500mg 2 twice daily
· glyburide 5mg 2 twice daily
· amlodipine 2.5 mg daily
· lisinopril 40 mg daily
· simavastin 40 mg daily
Allergies: No known drug allergies.
Can you tell me about your back pain?”
“As I told the nurse, the pain started two weeks ago after I lifted a box at work. Right away, I got this sharp pain on the left side of my back. The box wasn’t even that heavy.
“I talked to the nurse at work; she said to ice it and to take ibuprofen. It got better after three days. But, I was playing softball with my daughter last weekend, and the pain came back. This time it was worse than before. This week, the pain is so bad I can hardly get out of bed. I get a sharp pain in my back which goes down my left leg to my ankle.”
“On a scale of 0 to 10, 10 being the worst, how severe is the pain?”
“It’s probably a 7.”
“Have you found anything that improves the pain?”
“Ibuprofen and Naproxen worked at first, but they are not helping much anymore.”
“What about positions that make things better or worse?”
“The pain is worse with any movement of my back or sitting for a long time. It is better when I lie down.”
“Have you had back pain before?”
“Yes, I have back pain from time to time. But I’m usually better after 2 to 3 days. This is the worst pain I have ever had.”
Review of Systems
Mr. Payne does not have numbness or weakness in his legs. The pain is better when he lies down. He denies urinary frequency, dysuria, problems with bowel or bladder control, fever or chills, nausea or vomiting, or weight loss. He denies any specific trauma, except for when he lifted a 10-pound box at work. He denies unrelenting night pain.
Based on your differential, you determine that it is highly likely that Mr. Payne is experiencing a mechanical cause of back pain with nerve involvement such as a disc herniation. It is possible that he has spinal fracture, but a lack of trauma history makes the latter unlikely. It is important to consider cauda equina syndrome, as it calls for immediate surgical investigation, but it is unlikely in the absence of neurological symptoms like loss of bowel or bladder control. Finally, infectious etiology, such as pyelonephritis, is unlikely without fever and chills, urinary frequency and dysuria.
Back Exam – Standing:
Mr. Payne has normal curvature, tenderness on palpation on the left lumbar paraspinous muscle with increase tone. Full range of motion, but has pain with movement. His gait is normal. He can walk on his heels and toes. He can do deep knee bends.
Back Exam – Seated:
Mr. Payne denies feeling pain when checked for CVA tenderness. He has no pain in his right leg with the modified version of SLR. While he does not exhibit a true tripod sign, he does complain of pain when his left leg is raised. Mr. Payne’s reflexes are 2+ and equal at the knees and 1+ at both ankles. The motor exam reveals no weakness of the muscles of the lower extremities. His sensory exam is normal.
Pulmonary Exam: His lungs are clear.
Cardiovascular Exam: His cardiac exam demonstrates a regular rhythm, no murmur or gallop.
Three weeks later, Mr. Payne returns for his follow-up appointment and you discover the following:
Pertinent History
Mr. Payne has had little relief with the treatment prescribed. He is frustrated that he has been in pain for more than a month. His pain has been progressively worse. It radiates down the lateral part of his left leg and side of his left foot. This pain is worse than the back pain. He does not have any problems with bowel or bladder control and there is no weakness of his leg.
Pertinent Exam Findings
Vital signs: stable
Neurologic: Normal gait, but moves slowly due to pain; range of motion is full, with pain on flexion; SLR is positive at 45 degree on the left; motor strength intact; reflexes 2+ bilaterally at the knees, absent at the left ankle, 1+ at the right ankle.
Dr. Lee agrees with your diagnosis of radiculopathy of S1 nerve root with progression. She orders an MRI and sets up an appointment to see Mr. Payne after the MRI.
You and Dr. Lee now return to Mr. Payne’s exam room to talk about treatment options with him. Dr. Lee tells Mr. Payne to avoid strenuous activities but to remain active. Dr. Lee increases the dosage of naproxen to 500 mg BID to take with food. Since his pain is intense (7/10), he is given a prescription for acetaminophen with codeine to take at night, when his pain is severe. Mr. Payne declines a muscle relaxant because they usually make him drowsy. He would like to be referred to physical therapy as it was helpful in the past.
FOLLOW-UP TREATMENT
MANAGEMENT
One week later, Mr. Payne returns for follow-up. You review the results of the MRI report.
MRI report:
1. Moderate-size, herniated disc at L5-S1 with associated marked impingement on the left S1 nerve root and mild to moderate impingement on the right S1 nerve root. There is mild central canal stenosis.
2. Annular tear with a small central disc herniation at L4-5 causing mild central canal stenosis.
You review the findings with Dr. Lee. She agrees with your diagnosis of radiculopathy of S1 nerve root due to a large herniated disc at L5-S1.
You call Mr. Payne two weeks later to see how he is doing. He reports that he is doing quite a bit better. He went to an osteopathic physician who did some manual therapy and started him on a strict walking program. He is very encouraged and plans on losing weight through exercise and diet.
nursing interventions
Nursing Homeworks1. Identify and discuss two (2) signs or symptoms of clinical deterioration associated with the presenting problem, from chosen case study. This discussion should consider the potential impact of case study data (e.g. pathology results, past medical history) on the health status of the patient in the chosen case.
2. Following on from your presented discussion associated with point one (1), develop a clinical plan of care which identifies:
One (1) priority of clinical care and;
Discuss three (3) nursing interventions that directly address the identified clinical priority. The discussion should refer to relevant clinical assessments. Measurable outcome parameters for each intervention will be discussed to justify the intervention and evaluate its efficacy. Discussion is to be supported with contemporary research.
Management homework help
UncategorizedCompass 3: Final Assignment
Purpose
The final assignment provides you with an opportunity to identify and further develop an emotional intelligence competency. Through consistent and mindful practice, you will work toward mastery of the competency you selected. Over the course of several weeks, you will self-reflect on the impact in your life, both as an individual and as a teammate, your own effectiveness with respect to productive relationship building, and in your journey as an emotionally intelligent, authentic leader.
Your final assignment will focus on your application of what you learned in the Modules, through your team meetings, and/or from guest speakers.
Preparing for the Assignment
In preparation for the final assignment, you must first select the competency you will focus on and then actually practice that competency over several weeks .
Next, select a method to document your practice; for example, you may select to document your practice within the Compass 3 Real-Life Practice Journal (available within Canvas), a google document, notes, or even by texting yourself. Select whatever works best for you and your preferred style!
Once you determine your documentation method, consider when and where you can practice the competency. Your team meetings are a great place to practice new behaviors and you’ll have recordings of the meetings to reference. Aside from team meetings, you could also practice with team members from other classes, co-workers (if you have a job during the semester) or with friends, roommates, family members, etc. I know many of you are members of clubs and organizations as well. The opportunities are endless! Practicing in multiple situations and various environments will provide you with more potential content for your final project.
Once you are consistently practicing your selected competency, regularly enter notes in order to monitor your behavior, action, and/or impact. Your notes do not need to be organized in any particular way, they are primarily for your benefit and may even help you further reflect on your practice situations. Within your reflection notes, you can consider the following self-observations and outcomes, including:
· Objectively recounting what happened when you practiced the competency
· Factually describing what you said or did
· Neutrally (without interpretation of words or actions) explaining what others said or did
· Subjectively discussing how you felt
· Empathetically articulating how your behaviors affected others
And, then….
· Describe how your behaviors connect to course content and concepts
· Self-reflect as to whether or not you accomplished exactly what you intended
· Assess how you will move forward
· Determine how you will integrate these concepts into your life even after the semester is over
LinkedIn Article
You will write and publish an article (approximately 300 to 500 words) on LinkedIn which may provide a brief overview of the competency you selected, a description of your practice, an overview of its impact, the single most important thing you learned, and advice to the readers. You will submit the hyperlink (URL) to your article, as well as a screen shot of your article, to Canvas.
To publish a LinkedIn Article, first go to the “Home” page of your LinkedIn Profile and within the “Start a Post” portion, select “Write article.”
Once you click on “Write article,” it will take you to this screen (below). You can use all of the tools and then select “Publish.” It may work better for you to have your article already written (and pre-select non-copyrighted pictures) prior to this step.
Please note: this assignment should be taken very seriously because, as you know, anyone in the world will be able to read YOUR ARTICLE!!! (A major Personal Branding Opportunity, right?!) And, you’ll also be able to see how many people like, comment, and view your post / article. (I’ve included an example from my LI Page below.)
Possible Topics
Both the individual and team assignment option should cover a topic you learned about in Compass 3 either within the Modules, through your team meetings, and/or from guest speakers and must tie to a skill or competency in your Blue EQ report. The major topics we’ve covered this semester include:
· Leading A Virtual Team
· Self-Regard
· Optimism
· Self-Respect
· Self-Confidence
· Motivation
· Independence
· Self-Awareness
· Openness
· Self-Knowledge
· Integrity
· Monitoring
· Introspection
· Self Control
· Impulse Control
· Stress Tolerance
· Emotional Stability
· Resilience
· Delayed Gratification
· Social Perception
· Empathy
· Observation
· Anticipation
· Interpretation
· Mindfulness
· Social Effectiveness
· Influence
· Conflict Management
· Relationship Management
· Accountability
· Ego Management
>Accounting homework help
UncategorizedTOPIC D – posted Saturday
(1) Check out this format of the Balance Sheet using international accounting standards. What differences in classifications, from US rules, do you notice? Looks like non-current assets are listed first. Why do you think that is?
ACCT550BPBalanceSheet.png
(2) One of the best solvency ratio is “times-interest-earned”. Calculate the ratio and interpret the results in these income statements.
ACCT212income-statement-img2.pngACCT212incomestatement3.jpg
(3) Why do you think accounts receivable can be sold to a third party (called factoring)? What is management trying to do when they sell the receivables at the time of sale? Can cash discounts speed-up the cash conversion cycle? How so?
TOPIC C – posted Thursday
Journal entries are the way that accountants record business transactions. Using the debit/credit rules, prepare journal entries for these transactions:
ACCT212DebitCreditRules (1).pngPicture1.jpg
attachment
4EC1B62E-A104-4215-A047-C4B41D8CA4A8.jpeg
Information Systems homework help
UncategorizedOverview
Imagine that you are the information systems security specialist for a medium-sized federal government contractor. The chief security officer (CSO) is worried that the organization’s current methods of access control are no longer sufficient. In order to evaluate the different methods of access control, the CSO requested that you research mandatory access control (MAC), discretionary access control (DAC), and role-based access control (RBAC). Then, prepare a report addressing the positive and negative aspects of each access control method. This information will be presented to the board of directors at their next meeting. Further, the CSO would like your help in determining the best access control method for the organization.
Instructions
Write a 3–5 page paper in which you:
Strategic Plan Natural disaster
Nursing HomeworksNursing homework help
Strategic Plan Natural disaster
The Research Paper is a ten- to twelve-page paper (excluding title and references pages) that provides the student the opportunity to investigate a specific natural disaster topic, apply graduate-level critical thinking to the presentation of the information, and utilize and synthesize appropriate current research for your selected topic. The Research Paper utilizes professional health care knowledge and skills and applies those proficiencies to the context of quality improvement and risk management by developing a natural disaster strategic plan for community health: Mobilizing For Action Through Planning and Partnerships (MAPP) Process. The three-part Strategic Disaster Plan will be developed in Weeks Two, Four, and Six. Review Chapter 3 in the textbook. In this final part, the students will take the strategic issues identified in Part II (Week Four) and formulate goal statements and strategies for addressing issues, resulting in development and adoption of an interrelated set of strategy statements. Lastly, an action plan with an evaluation timeline that identifies outcomes to be reached and what steps would be taken to ensuing adjustments in the strategy plan if needed. The final draft with all three parts will be posted together for a final grade.
Writing the Research Paper The Research Paper:
1. Must be ten to twelve double-spaced pages in length (excluding title and reference pages) and formatted according to APA style as outlined in the Ashford Writing Center.
2. Must include a title page with the following:
a. Title of paper
b. Student’s name
c. Course name and number
d. Instructor’s name
e. Date submitted
3. Must include an introductory paragraph with a succinct thesis statement.
4. Must address the topic of the paper with critical thought.
5. Must end with a conclusion that reaffirms your thesis.
6. Must use at least ten scholarly and/or peer-reviewed sources published within the last five years, including a minimum of three from the Ashford University Library.
7. Must document all sources in APA style as outlined in the Ashford Writing Center.
8. Must include a separate reference page that is formatted according