Category: Nursing

Instructions
The answer should be in APA 7 format, at least two pages long, with in-text citations and references. American English and expound on responses. . You will consider case studies that describe abnormal findings in patients seen in a clinical setting.
Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative
style Discussion posting format. Remember that all Episodic/Focused SOAP notes have specific data in every patient case.
Case 1:
A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to
his left leg. In determining the cause of the back pain, based on your knowledge of anatomy,
1. what nerve roots might be involved?
2. How would you test each of them?
3. What other symptoms need to be explored?
4. What are your differential diagnoses for acute low back pain?
Consider the possible origins of using the Agency for Healthcare. Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform?
What special maneuvers will you perform?

Case Study Scenario
Chief Complaint
J.T. is a 48-year old male who presents to the primary care clinic with fatigue, weight loss, and extreme thirst and increased appetite.
History of Present Illness
J.T. has been in his usual state of health until three weeks ago when he began experiencing symptoms of fatigue, weight loss, and extreme thirst. He reports that he would like to begin a walking program, but he feels too fatigued to walk at any point during the day. Now he is very concerned about gaining more weight since he is eating more. He reports insomnia due to having to get up and urinate greater than 4 times per night.
Past Medical History
Hypertension
Hyperlipidemia
Obesity
Family History
Both parents deceased
Brother: Type 2 diabetes
Social History
Denies smoking
Denies alcohol or recreational drug use
Landscaper
Allergies
No Known Drug Allergies
Medications
Lisinopril 20 mg once daily by mouth
Atorvastatin 20 mg once daily by mouth
Aspirin 81 mg once daily by mouth
Multivitamin once daily by mouth
Review of Systems
Constitutional: – fever, – chills, – weight loss.
Neurological: denies dizziness or disorientation
HEENT: Denies nasal congestion, rhinorrhea or sore throat.
Chest: (-)Tachypnea. Denies cough.
Heart: Denies chest pain, chest pressure or palpitations.
Lymph: Denies lymph node swelling.
General Physical Exam
Constitutional: Alert and oriented male in no acute distress
Vital Signs: BP-136/80, T-98.6 F, P-78, RR-20
Wt. 240 lbs., Ht. 5’8″, BMI 36.5
HEENT
Eyes: Pupils equal, round and reactive to light and accommodation, normal conjunctiva.
Ears: Tympanic membranes intact.
Nose: Bilateral nasal turbinates without redness or swelling. Nares patent.
Mouth: Oropharynx clear. No mouth lesions. Teeth present and intact; Oral mucous membranes and lips dry.
Neck/Lymph Nodes
Neck supple without JVD.
No lymphadenopathy, masses or carotid bruits.
Lungs
Bilateral breath sounds clear throughout lung fields. Breathing quality deep with fruity breath odor
Heart
S1 and S2 regular rate and rhythm; – tachycardia; no rubs or murmurs.
Integumentary System
Skin warm, dry; Nail beds pink without clubbing.
Labs
Test Patient’s Result Reference
Glucose (fasting)
132
60-120 mg/dL
BUN
20
7-24 mg/dL
Creatinine
0.8
0.7-1.4 mg/dL
Sodium
141
135-145 mEq/L
Sodium
141
135-145 mEq/L
Chloride
97
95-105 mEq/L
HCO3
24
22-28 mEq/L
A1C
7.2
Urinalysis
Protein
Glucose
Ketones
Negative
Positive
Negative
Oral glucose tolerance test (OGTT)
220 mg/dL
J.T. is diagnosed with diabetes. Review all information provided in the case to answer the following questions.
Case Study Questions
Pathophysiology & Clinical Findings of the Disease
Review the lab findings and decide if the diagnosis is Type 2 or Type 1 Diabetes Mellitus.
Explain the pathophysiology associated with your chosen diagnosis
Identify at least three subjective findings from the case which support the chosen diagnosis.
Identify at least three objective findings from the case which support the chosen diagnosis.
Management of the Disease
*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.
Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.
Describe the mechanism of action for each of the medication classes identified above.
Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.
Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations

A 21-year-old female patient presents to the office for an annual exam. She has had normal, regular menstrual cycles since she was 14 but she has not had a menstrual cycle in over 6 months. A pregnancy test is negative. The FNP wants to order blood work to determine the cause of her secondary amenorrhea. When the patient hears that if all is normal the treatment will be giving progestins to initiate a menstrual cycle, she tells the FNP that she cannot do that because she does not believe in birth control pills. The FNP tries to advise the patient that it is not birth control pills, but a hormone to assist in regulating her periods and the patient leaves the office crying. What does the FNP do now to help this patient?
ANSWER
The FNP should first respect the patient’s decision to refuse progestins. It is important to understand the patient’s reasons for refusing and to provide her with accurate information about the treatment options available.
The FNP should also assess the patient’s risk factors for secondary amenorrhea. This includes asking about her medical history, medications, lifestyle, and diet. The FNP may also order additional tests, such as blood tests or imaging studies, to rule out underlying medical conditions.
Once the FNP has a better understanding of the patient’s case, she can discuss other treatment options. These options may include:
* **Lifestyle changes:** The FNP may recommend lifestyle changes, such as weight loss, stress management, and exercise, to help regulate the patient’s menstrual cycle.
* **Other medications:** There are other medications that can be used to induce menstruation, such as clomiphene citrate and letrozole. These medications may be an option for patients who are not able to take progestins.
* **Natural therapies:** Some patients may choose to try natural therapies, such as herbs and supplements, to help regulate their menstrual cycle. The FNP should advise patients about the potential risks and benefits of natural therapies before they use them.
It is also important to provide the patient with support and resources. The FNP can refer the patient to a specialist in reproductive endocrinology and infertility or to a counselor who can help her cope with the emotional challenges of secondary amenorrhea.
Here are some specific things the FNP can do to help the patient:
* **Validate the patient’s feelings:** The FNP should acknowledge that the patient is feeling upset and that she has the right to refuse progestins.
* **Educate the patient about her options:** The FNP should explain the other treatment options available to the patient and the potential risks and benefits of each option.
* **Respect the patient’s decision:** The FNP should respect the patient’s decision, even if she does not agree with it.
* **Provide support and resources:** The FNP can refer the patient to a specialist or counselor who can help her manage her condition.
It is important to remember that the patient is the ultimate decision-maker in her own healthcare. The FNP should work with the patient to develop a treatment plan that meets her individual needs and preferences.

After reviewing the materials in this module, and researching the best way to answer job interview questions (the internet has some great resources) please create your answers to the job interview questions below. This assignment requires you to have an employer or hiring manager review your answers to common job interview questions.
Your answers should be at your current skillset for a healthcare position. (I’m currently working as a medical assistant)
Please answer the following interview questions based on the learning from your Job Interview learning this week
1) What are your long-term career goals?
2) Why did you make a career change?
3) How do you effectively communicate with others?
4) Tell us about a situation that would demonstrate the level of confidence that you have in yourself.
5) Are you creative? Give us one example of your creativity.
6) Describe a situation where you came up with a creative solution to a problem.
7) Tell us about a pressure situation you were in that would demonstrate your ability to work under pressure.
8) What are some constructive methods of dealing with stress?
9) Briefly describe the most significant responsibility you have had in your career and what it taught you?
10) Your co-worker continually comes over to your desk to complain about management. Your supervisor seems to be paying particular attention to the two of you. How will you handle this situation?

1. Build a three–slide PowerPoint (or Prezi) presentation that includes text and graphics. Outline your answers to the following questions:
What are some specific questions you have concerning the final argument paper?
What is your time–management plan for compiling and editing your final paper?
What parts of your final paper do you anticipate will take the most time and attention? For example:
Incorporating instructor feedback in your perspective papers
Reworking the perspective papers into one cohesive paper
Writing the introduction, conclusion, or abstract
APA formatting
Revising for grammar, spelling, and punctuation

Thoroughly evaluate the journal article that provided below and complete a scholarly critique of the content. Your response must include the following:
Describe the public health significance of the study. Discuss whether the impact is local or global and what important public health gap might be filled by this article. Be specific.
Critique the methodology. Support your analysis of how effective this methodology was and what might have been done differently to be more effective.
Interpret the results in your own words and explain whether you agree or disagree with the author’s interpretation. Be specific.
Appraise whether the findings are actionable and if so, describe at least one action.
Chaiklieng, S., Suggaravestsiri, P., Kaminski, N., & Autrup, H. (2021). Exposure to benzene and toluene of gasoline station workers in Khon Kaen, Thailand and adverse effects. Human and Ecological Risk Assessment: An International Journal, 27(7), 1823–1837.

PLEASE RESPOND TO POST PLEASE DON’T CRITIQUE
1. What is the most appropriate next step to confirm the diagnosis of rhabdomyolysis in this patient? Provide an explanation for your answer.
Getting a blood test is the only way to be certain. The only reliable test for rhabdomyolysis is repeated blood tests for the muscle protein creatine kinase (CK or creatine phosphokinase [CPK]) in which a medical professional can check CK levels in blood when muscle tissue is harmed and when the muscle protein CK is released into the blood (Kodadek et al., 2022). In this patient’s case there is no more testing is necessary because it is generally agreed that a CK level larger than 5 to 10 times the upper limit of normal, as in the case of our patient, it is adequate to demonstrate the presence of rhabdomyolysis in this situation.
2. What is the most likely etiology of this patient’s recurrent rhabdomyolysis?
It is most likely an etiology of recurrent episodes of rhabdomyolysis in this patient, coupled with a reduced capacity for exertion when feeling well, clearly point to a metabolic abnormality. According to Joshi & Zierz, fatty acid oxidation is the main way that muscles get their energy during extended activity, fasting, and illness, but CPT-II deficiency is the condition that causes repeated rhabdomyolysis the most often (2022). The accumulation of acylcarnitine, which are necessary intermediates in the transport of long-chain fatty acids from the cytosol to the mitochondria for b-oxidation, can be utilized to identify certain metabolic diseases.
3. Rhabdomyolysis is a rapid breakdown of muscle. Detail the pathophysiology behind rhabdomyolysis.
An increase in intracellular free ionized calcium as a result of either cellular energy exhaustion or direct plasma membrane rupture is the pathophysiological hallmark of the condition in which trauma, ischemia, medications, toxins, metabolic problems, and infections are some of Rhabdomyolysis main causes (Kodadek et al., 2022). Rhabdomyolysis happens when the muscle tissue sustains direct physical trauma, ATP is depleted, and the muscle tissue membrane is damaged known as sarcolemma (Kodadek et al., 2022).
4. What are the possible complications of rhabdomyolysis?
The majority of patients experience acute kidney injury, which is the most severe complication of rhabdomyolysis in the days after initial presentation, in which other rhabdomyolysis complications include kidney damage or kidney failure, abnormal electrolyte levels, metabolic acidosis, compartment syndrome, and disseminated intravascular coagulation (Kodadek et al., 2022). According to Kodadek et al., one sign of rhabdomyolysis is red or dark urine, which patients frequently mistake for blood. Myoglobin, a toxin that can harm the kidneys, is what appears to be blood. When this occurs, your illness has worsened and you should seek medical attention right soon, according to him (2022).
5. Which medications may cause rhabdomyolysis?
Medications can result in rhabdomyolysis and is brought on by pressure-induced ischemia brought on by prolonged immobility, which is caused by general anesthetics and drug overdoses with CNS depressants such opioids, cyclic antidepressants, benzodiazepines, antihistamines, and barbiturates (Wen et al., 2029). According to Wen et al., medications such as antipsychotics, antidepressants, and antivirals can tear down muscle and rhabdomyolysis can also result from using statin drugs, particularly if you have diabetes or liver illness (2019).
References
Joshi, P. R., & Zierz, S. (2020). Muscle Carnitine Palmitoyltransferase II (CPT II) Deficiency: A Conceptual Approach. Molecules (Basel, Switzerland), 25(8), 1784. https://doi.org/10.3390/molecules25081784
Kodadek, L., Carmichael Ii, S. P., Seshadri, A., Pathak, A., Hoth, J., Appelbaum, R., Michetti, C. P., & Gonzalez, R. P. (2022). Rhabdomyolysis: an American Association for the Surgery of Trauma Critical Care Committee Clinical Consensus Document. Trauma surgery & acute care open, 7(1), e000836. https://doi.org/10.1136/tsaco-2021-000836
Wen, Z., Liang, Y., Hao, Y., Delavan, B., Huang, R., Mikailov, M., Tong, W., Li, M., & Liu, Z. (2019). Drug-Induced Rhabdomyolysis Atlas (DIRA) for idiosyncratic adverse drug reaction management. Drug discovery today, 24(1), 9–15. https://doi.org/10.1016/j.drudis.2018.06.006

Assignment:
Based on your practice exam question results from Week 2, identify strengths and areas of opportunity and create a tailored study plan to use throughout this course to help you prepare for the national certification exam. This will serve as an action plan to help you track your goals, tasks, and progress.
• test question results, and considering the national certification exam, summarize your strengths and opportunities for improvement
• Create a study plan for this quarter to prepare for the certification exam, including three or four SMART goals and the tasks you need to complete to accomplish each goal.
• Include a timetable for accomplishing them and a descriiption of how you will measure your progress.
• Describe resources you would use to accomplish your goals and tasks, such as ways to participate in a study group or review course, mnemonics and other mental strategies, and print or online resources you could use to study.
You are strongly advised to ensure your goals meet SMART criteria!
Here is the direct link to the reading resource on how to write a SMART goal: https://academicguides.waldenu.edu/ld.php?content_id=51901492
The exam/score attached

Hello , I am a nursing educator and I want to send an email regarding educational progress for new join staff to the hospital for their mangers and head nurses .
So I have 2 new staff named , ashjan and fatimah , which they are working Jubail General hospital in pediatric ward .
So i will start with. Ashjan ,
– ashjan completed her nursing orientation on the Thursday September 15, 2022 with pretest score of : 44 /100 , and post test score : 73 /100 ..
– we had finished with her almost all general nursing competency and we created for her a Elsiver Account with modules with due date , November 1, 2022 .
– we did not yet start with her a unit specific competency which she need it to start from now to provide a safe and efficient work toward patient , department and hospital
– here can you write a sentence about her performance : she is initiated , hard work , good communication with good nursing documenting .
– she need to improve the spelling , abbreviation and medication calculation .
For fatimah :
– fatimah competed her nursing orientation on Thursday September 15, 2022 . With one day missing because of sick leave with pretest score of 33/100 and post test score of 45/100 . Which not well performed from her , so we will set with her and discuss about the test , off course we need to work together to improve her gradually .
– fatimah completed all her elsiver competency and and checklist done by sister ventha ( nursing educator ) .
– Most of general competency were covered
– until specific not yet covered and that will be counted with CNE and headnurse for safety and quality of nursing service that provided toward our patient in hospital .
– Nursing documentation is good so far , need to improve the grammar and spelling .
– finally , I noticed there were punctually problem that staff need more to dissuaded with like coming to duty time , floater .
– finally fatimah has a good communication skills especially with patient , she is cooperative , fast learner and she want to improve .
I hope this email find you well and thank you for your cooperation
That’s all the report , i am not good in writing email as I not good in English .

Conflict is a normal process that can be constructive or destructive depending on how it is managed and resolved. Conflict occurs at all levels within an organization. The dynamic nature of health care offered by diverse health care providers caring for a diverse population may promote a higher level of conflict. A leader understands how to recognize conflict and engage in strategies for effective positive resolution. For this paper the following sections will be addressed
Define an area of conflict in current practice or a potential conflict situation you may face as an advanced practice leader including background evidence to demonstrate it is a problem
Identify potential or real barriers that create the conflict and how this particular conflict impacts quality outcomes and care including literature evidence that demonstrate it as a barrier to conflict resolution.
After reviewing the Thomas-Kilmann Instrument (TKI) categories from the lesson, identify, what you believe to be, your most common reaction mode to conflict and provide an example of how this reaction mode has been utilized in a conflict along with the outcome of the conflict. Address whether your reaction mode is assertive or cooperative in focus as demonstrated on the TKI model. Please note that you are not required to complete the TKI assessment.
Your reaction mode may not be the most appropriate and that is perfectly fine. It is important to be self-reflective in this assignment.
Identify the most appropriate reaction mode from the TKI model that should be utilized to promote resolution to this paper’s conflict topic. Why would this reaction mode be the most appropriate reaction to promote resolution? Give a brief example of how this reaction mode would support the conflict topic and promote resolution
Reflect on your learning about reaction modes to conflict during the process of writing this assignment. How you will apply this learning in your role as an advanced practice leader to resolve conflict.
Summary of key points
Assignment Instructions
Abide by the Chamberlain College of Nursing Academic Integrity Policy.
Sources older than five years may not be used without the permission of the class professor.
Title page, pagination, subheadings, body of paper, citation of sources, and reference page must follow APA guidelines as found in the most current edition of the manual.
Rules of grammar, spelling, word usage, punctuation, sentence and paragraph structure are followed and consistent with formal, scholarly writing as noted in the most current edition of the APA Manual.
Please note: If you do not receive a proficient rating in any major content category, you can re-submit your assignment with revisions in those content categories to receive a better grade. You have one additional opportunity to revise after the initial submission in order to make improvements. The initial submission must be a complete paper, rough publishs will not be graded. All revisions must be submitted no later than Sunday of Week 7 at 11:59pm. (You cannot revise your APA for a higher grade in that category)
Length:
Four to six pages (not including title and reference page)
Scholarly literature is required
A minimum of three (3) scholarly literature references must be used.
Submission: Submit your files via Dropbox: Last name_First initial_Module 6: Conflict Resolution
Title page
Body of paper (headings for each section)
Define an area of conflict in current practice or a potential conflict as an advanced practice leader including background evidence to demonstrate it is a problem
Identify potential or real barriers that create the conflict and how this particular conflict impacts quality outcomes and care including literature evidence that demonstrate it as a barrier to conflict resolution.
Based upon the Thomas-Kilmann Instrument (TKI) identify your most common reaction mode to conflict and provide an example of how this reaction mode has been utilized in a conflict along with the outcome of the conflict. Address whether your reaction mode is assertive or cooperative in focus as demonstrated on the TKI model. Please note that your reaction mode may not be the most appropriate and that is perfectly fine. It is important to be self-reflective in this assignment.
Identify the most appropriate reaction mode from the TKI model that should be utilized to promote resolution to this paper’s conflict topic. Why would this reaction mode be the most appropriate reaction to promote resolution? Give a brief example of how this reaction mode would support the conflict topic and promote resolution
Reflect on your learning about reaction modes to conflict during the process of writing this assignment. How you will apply this learning in your role as an advanced practice leader to resolve conflict.
Reference page