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Category: Nursing

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    In response to your peers, offer feedback on their implementation and ways to improve their program proposals. – [\ \ Responses.docx](https://www.sweetstudy.com/files/responses-docx-10271815 "Responses.docx") – 2 years ago

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    In response to your peers, offer feedback on their implementation and ways to improve their program proposals.

    – [\
    \
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  • [Solved] Lorem

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    case study – a year ago **files (1)** – ## Gowalk94.docx **## Gowalk94.docx** STI Due: Saturday, 4/26 **Patient** B.G. is a 22-year-old Caucasian female presenting with a 1-week history of painful genital sores. She reports a burning sensation with urination and notes the presence of multiple small …

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    Assignment Prompt & Instructions

    case study

    – a year ago

    **files (1)**

    – ## Gowalk94.docx

    **## Gowalk94.docx**

    STI

    Due: Saturday, 4/26

    **Patient**

    B.G. is a 22-year-old Caucasian female presenting with a 1-week history of painful genital sores. She reports a burning sensation with urination and notes the presence of multiple small blisters on her vulva that ruptured into ulcers. She denies any prior episodes of similar symptoms. She also reports low-grade fever and general malaise. Associated symptoms: Dysuria, Itching, Tingling sensation before the appearance of sores, No vaginal discharge.

    **instructions**

    · Please complete STI SOAP Note precisely like the SOAP note you completed earlier for me in Asthma.

    · Must have a primary diagnosis and three differential diagnoses

    · Every idea is cited and referenced with literature within 5 years

    · Must have the Medication the patient is taking, Allergies. Social history, Sexual history, family history

    · Must have a review of systems

    · Physical examination

    · Diagnostic studies

    · Treatment

    · Patient education

    · Follow up

    · Must be in a basic Microsoft Word document

    · APA format.

    References reachable and within 5 years

    **Sample Note – Please follow this exact to complete**

    ID: D. K is a 70-year-old African American female, born on 06/10/1969, who presents to the clinic for a follow-up and laboratory review. The patient is accompanied by her husband, and she is a reliable source of information.

    **Subjective:**

    **CC:** “I feel tired all the time, and I have had increased thirst and urination in the past three months.”

    **HPI:**

    D.K. is a 70-year-old African American female who presents for follow-up for lab review and management of symptoms of polydipsia, polyuria, and fatigue and a possible diagnosis of type 2 diabetes mellitus. The patient reported experiencing increased thirst, increased hunger, urinary frequency, and fatigue in the past three months. D. K thought it was due to her consumption of cucumber, which she had just started consuming, but decided to seek help when she observed occasional blurred vision. She has also noted a 6-pound weight loss in these in these months. The patient’s fasting blood glucose level last visit was 150mg/dl, and HbA1c was 7.5%, which led to a diagnosis of type 2 diabetes mellitus. D.K. has a family history of diabetes, and she is currently not on any diabetes medication. She is following up for lab review and management. The last dental examination was on February 23rd, 2024. The last eye exam was on August 1st, 2023.

    **Past Medical History:** Denies any past medical history.

    **Hospitalization / Surgical**:

    Denies past or current
    surgeries/hospitalizations since the last visit

    **Allergies:**

    Denies drug allergies.

    Denies food allergies

    Denies seasonal allergies

    **Medications:**

    1. Melatonin for Insomnia for sleep

    2. Ibuprofen 200mg, 8 hours by mouth as needed for aches and pain

    3. Centrum Multivitamin 1 tablet by mouth daily

    4. Denies any prescription medication

    **Vaccinations:**

    · All childhood vaccines are current

    · Last flu shot 09/15/ 2024.

    · Covid Vaccines 01/14/2023, Covid Booster 03/15/2023

    **LMP:** The patient is post-menopausal

    **Family History:**

    The patient’s mother is 74 years old – with a history of type 2 diabetes and hypertension (HTN)

    Father is 76 years old – Osteoarthritis

    Sister is 54 years old – No history
    Maternal Grandma deceased at age 72 years – Diabetes, Neuropathy, HTN

    Maternal Grandfather deceased at age 78 years – Congestive heart failure (CHF)

    Paternal Grandmother is 80 years old and living – HTN

    Paternal Grandfather died at 64 years – Basal cell carcinoma, Seasonal allergies

    **Social History:**

    ·
    **Tobacco:** Denies tobacco, illicit drugs, and e-cigarette use.

    ·
    **Alcohol:** Drinks alcohol occasionally. The last drink was February 10th, 2025

    ·
    **Marital History:** Lives with husband

    ·
    **Occupation:** Social worker

    ·
    **Sleep/Stress:** Denies stress at home and work. Sleeps well

    ·
    **Exercise/Diet:** Eats a regular diet

    ·
    **Safety:** Uses seat belts in vehicles and does not own a gun.

    ·
    **Hobbies:** Swimming, reading

    ·
    **Spiritual affiliation:** Denies any affiliation

    **Sexual History:**

    · D. K. has one sexual partner

    · she
    is
    sexually active

    · She prefers males

    ·
    D. K.
    denies sexually transmitted diseases (STIs)

    · She does not use any form of protection

    · Patient has no plans for pregnancy.

    **Review of Systems (ROS)**

    ·
    **General:** D. K. reports 6lbs weight loss, weakness, and fatigue,
    denies fever and chills

    ·
    **Eyes:** Reports occasional blurred vision, denies pain, redness, and eye tearing,

    ·
    **Ears/ Nose/Throat/mouth:** Denies difficulty hearing, ringing in the ear, ear pain, or drainage. Denies sinus pain or epistaxis. Denies sore throat or hoarse voice. Denies bleeding gum and dry mouth. Reports last dental exam was on September 2024.

    ·
    **Cardiovascular:** Denies chest pain or palpitations.

    ·
    **Pulmonary**: Denies cough, hemoptysis, difficulty breathing, wheezing or chest tightness

    ·
    **Gastrointestinal:** Denies nausea and vomiting.

    ·
    **Genitourinary:** Denies difficulty passing Urine, blood in urine, urgency and frequency

    ·
    **Musculoskeletal:** Denies joint pain and stiffness

    ·
    **Endocrine:** Denies hot or cold intolerance, polyurea, polydipsia and polyphagia.

    ·
    **Integumentary:** Denies any rash, masses and wounds

    ·
    **Neurological:** Denies headache, dizziness, numbness and tingling

    ·
    **Lymphatic:** Denies feeling any swollen lymph nodes in the neck.

    ·
    **Allergy:** Denies seasonal or environmental allergies
    **,**

    ·
    **Hematologic/lymphatic:** Denies abnormal, anemia and easy bruising

    ·
    **Infectious diseases:** Denies history of infectious diseases

    ·
    **Cancer:** Denies history of colon or lung cancer

    ·
    **Psychiatric:** Denies
    depression,
    anxiety, and
    suicidal ideation

    **Objective**

    **Vital Sign**: Temperature: 97.9 F

    **Pulse:** 82

    **Respirations:** 18

    **BP:** 128/77

    **O2 sat:** 100% on room air

    **Pain Scale:** 0/10

    **Weight:** 210lb, Ht: 65in, BMI: 34.9

    **Physical Exam**

    **General Survey:** Patient is pleasant, well groomed, and in no acute distress

    **Laboratory results:** HbA1c 7.5%, fasting blood glucose 150mg/dL, Lipid level

    **HEENT:**

    **Head:** Atraumatic, symmetric scalp, hair has equal distribution and full thickness, no rashes

    **Eyes:** Sclera is white PERRLA, red reflex present, cup to disc ratio 1:3

    **Ear:** The ear canal is moist, the tympanic membrane is pearly grey and intact, no discharge

    **Nose:** Nasal mucosa is pink and moist, no discharge, no septum deviation

    **Mouth/Throat:** Mucous membrane is pink and moist, and tonsils are midline. No palpable mass or lymph node.

    **Skin:** Normal for ethnicity, smooth, warm, and dry. Good skin turgor, no lesions, rashes, ecchymosis, or moles. Nails are without clubbing or cyanosis.

    **Neurology:** Alert and oriented to person, place, and time. The patient is appropriate and answering questions well.

    **Cardiovascular:** Regular rate and rhythm. S1 S2, no clicks, heaves, thrills, or murmurs.

    **Pulmonary:** Chest is symmetric with bilateral expansion. Respirations are even and unlabored. Lung sounds are clear, with no accessory muscle use and no nasal flaring. Lung sounds are clear bilaterally in all fields.

    **Gastrointestinal:** Active bowel sounds in all quadrants, no palpable masses

    **Genitourinary:** No bladder distention noted

    **Psychiatric:** Behavior
    is age-appropriate, no anxiety or depression noted

    **Assessment**

    **Diagnosis**

    1.
    **Adult Type 2 Diabetes Mellitus (ICD-10: E11.9)**

    Diabetes results when the pancreas produces insulin that is not enough for the body's metabolism and when the body is not able to use available insulin. Diabetes is a chronic disease that leads to hypercalcemia, and uncontrolled diabetes causes problems to the body system, especially the nerves and blood vessels. Symptoms of diabetes include Polydipsia, which is excessive thirst, polyuria which is frequent urination, unintentional weight loss, feeling fatigued or tired, and blurred vision (WHO, 2024). These correlate with D. K’s symptoms at the time.

    **Differential Diagnosis**

    2.
    **Metabolic syndrome (ICD-10: E88.810)**

    Metabolic syndrome consists of metabolic abnormalities, including central obesity, insulin resistance, hypertension, and dyslipidemia, which are risk factors leading to atherosclerosis, cardiovascular disease, and type diabetes mellitus. Metabolic syndrome is diagnosed in the presence of three or more metabolic abnormalities. This diagnosis is ruled out due to the patient’s normal blood pressure (Swarup et al., 2024).

    3.
    **Drug-Induced Diabetes (ICD-10: E09.65)**

    Drug-induced diabetes mellitus occurs as a result of the use of a particular medication. It is a form of secondary diabetes that may be reversible when the use of the medication is discontinued, or diabetes may become permanent. The use of drugs such as corticosteroids, Betablockers, thiazide diuretics, antipsychotics, and statins can lead to drug-induced diabetes (Diabetes.co.uk, 2023). This condition is ruled out because D. K. is not on any of these medications.

    4.
    **Hyperthyroidism (ICD10: E03.9)**

    When the thyroid gland secretes excessive thyroid hormone, it is known as hyperthyroidism. Hyperthyroidism is more prevalent in women over 60 years of age. Risk factors include a family history of thyroid disease, pernicious anemia, and primary adrenal insufficiency. Symptoms are weight loss regardless of increased appetite, rapid or irregular heart rate, and irritability (NIH, 2025). Hyperthyroidism is ruled out due to the patient's age of less than 60 years, no complaints of irritability, and no family history of the disease.

    **Plan:**

    ·
    **Diagnostics:** Hemoglobin A1c (HbA1c) measures a person’s average blood glucose control over 90 days used to diagnose diabetes (Eyth & Naik, 2023).

    · A lipid panel is drawn to measure the patient’s cholesterol levels which should managed with statins if levels are high (ADA, 2023).

    · Thorough foot exam to assess for diabetic neuropathy, foot ulcers, and eye examination for diabetic retinopathy.

    **Patient results:** Hemoglobin AIC is 7.5%, Total cholesterol 210, BP 128/77

    **Treatment**

    · Patient is prescribed Metformin 500mg by mouth daily for elevated blood glucose.

    · 80mg of Atorvastatin by mouth daily for elevated cholesterol

    **Education**

    · Patient education is focused on home blood glucose self-monitoring according to ADA (2023).

    · Patient teaching about Hyperglycemia and hypoglycemia (ADA, 2023)

    · Emphasizing the importance of lifestyle modification, including eating a healthy diet low in carbohydrates and a regular aerobic exercise regimen of 150 minutes every week (ADA, 2023).

    · Importance of medication adherence (ADA, 2023).

    · Daily foot inspection (ADA, 2023)

    · Yearly eye exam (ADA, 2023)

    **Follow Up**

    Follow up with NP in two weeks to evaluate medication treatment with lifestyle changes. Medication adjustment will be required for blood glucose above the recommended level (ADA, 2023).

    References

    American Diabetes Association (ADA) (2023). Standards of medical care in diabetes

    2023.
    _Diabetes Care_,
    _46_(1), S1–S150.
    [https://doi.org/10.2337/dc23-S001](https://doi.org/10.2337/dc23-S001)

    Diabetes.co.uk. (2023). Drug induced diabetes.
    [https://www.diabetes.co.uk](https://www.diabetes.co.uk/)

    Swarup, s., Ahmed, I., Grigorova, Y., & Zeltser, R. (2024). Metabolic syndrome.

    In StatPearls. Treasure Island, (FL).
    [Https://www.ncbi.nlm.nih.gov/books/NBK](https://www.ncbi.nlm.nih.gov/books/NBK)

    World Health Organization (WHO). (2024). Diabetes.
    [Www.who.int/news-room/fac](http://www.who.int/news-room/fac)

    ·

    **## Gowalk94.docx**

    STI

    Due: Saturday, 4/26

    **Patient**

    B.G. is a 22-year-old Caucasian female presenting with a 1-week history of painful genital sores. She reports a burning sensation with urination and notes the presence of multiple small blisters on her vulva that ruptured into ulcers. She denies any prior episodes of similar symptoms. She also reports low-grade fever and general malaise. Associated symptoms: Dysuria, Itching, Tingling sensation before the appearance of sores, No vaginal discharge.

    **instructions**

    · Please complete STI SOAP Note precisely like the SOAP note you completed earlier for me in Asthma.

    · Must have a primary diagnosis and three differential diagnoses

    · Every idea is cited and referenced with literature within 5 years

    · Must have the Medication the patient is taking, Allergies. Social history, Sexual history, family history

    · Must have a review of systems

    · Physical examination

    · Diagnostic studies

    · Treatment

    · Patient education

    · Follow up

    · Must be in a basic Microsoft Word document

    · APA format.

    References reachable and within 5 years

    **Sample Note – Please follow this exact to complete**

    ID: D. K is a 70-year-old African American female, born on 06/10/1969, who presents to the clinic for a follow-up and laboratory review. The patient is accompanied by her husband, and she is a reliable source of information.

    **Subjective:**

    **CC:** “I feel tired all the time, and I have had increased thirst and urination in the past three months.”

    **HPI:**

    D.K. is a 70-year-old African American female who presents for follow-up for lab review and management of symptoms of polydipsia, polyuria, and fatigue and a possible diagnosis of type 2 diabetes mellitus. The patient reported experiencing increased thirst, increased hunger, urinary frequency, and fatigue in the past three months. D. K thought it was due to her consumption of cucumber, which she had just started consuming, but decided to seek help when she observed occasional blurred vision. She has also noted a 6-pound weight loss in these in these months. The patient’s fasting blood glucose level last visit was 150mg/dl, and HbA1c was 7.5%, which led to a diagnosis of type 2 diabetes mellitus. D.K. has a family history of diabetes, and she is currently not on any diabetes medication. She is following up for lab review and management. The last dental examination was on February 23rd, 2024. The last eye exam was on August 1st, 2023.

    **Past Medical History:** Denies any past medical history.

    **Hospitalization / Surgical**:

    Denies past or current
    surgeries/hospitalizations since the last visit

    **Allergies:**

    Denies drug allergies.

    Denies food allergies

    Denies seasonal allergies

    **Medications:**

    1. Melatonin for Insomnia for sleep

    2. Ibuprofen 200mg, 8 hours by mouth as needed for aches and pain

    3. Centrum Multivitamin 1 tablet by mouth daily

    4. Denies any prescription medication

    **Vaccinations:**

    · All childhood vaccines are current

    · Last flu shot 09/15/ 2024.

    · Covid Vaccines 01/14/2023, Covid Booster 03/15/2023

    **LMP:** The patient is post-menopausal

    **Family History:**

    The patient’s mother is 74 years old – with a history of type 2 diabetes and hypertension (HTN)

    Father is 76 years old – Osteoarthritis

    Sister is 54 years old – No history
    Maternal Grandma deceased at age 72 years – Diabetes, Neuropathy, HTN

    Maternal Grandfather deceased at age 78 years – Congestive heart failure (CHF)

    Paternal Grandmother is 80 years old and living – HTN

    Paternal Grandfather died at 64 years – Basal cell carcinoma, Seasonal allergies

    **Social History:**

    ·
    **Tobacco:** Denies tobacco, illicit drugs, and e-cigarette use.

    ·
    **Alcohol:** Drinks alcohol occasionally. The last drink was February 10th, 2025

    ·
    **Marital History:** Lives with husband

    ·
    **Occupation:** Social worker

    ·
    **Sleep/Stress:** Denies stress at home and work. Sleeps well

    ·
    **Exercise/Diet:** Eats a regular diet

    ·
    **Safety:** Uses seat belts in vehicles and does not own a gun.

    ·
    **Hobbies:** Swimming, reading

    ·
    **Spiritual affiliation:** Denies any affiliation

    **Sexual History:**

    · D. K. has one sexual partner

    · she
    is
    sexually active

    · She prefers males

    ·
    D. K.
    denies sexually transmitted diseases (STIs)

    · She does not use any form of protection

    · Patient has no plans for pregnancy.

    **Review of Systems (ROS)**

    ·
    **General:** D. K. reports 6lbs weight loss, weakness, and fatigue,
    denies fever and chills

    ·
    **Eyes:** Reports occasional blurred vision, denies pain, redness, and eye tearing,

    ·
    **Ears/ Nose/Throat/mouth:** Denies difficulty hearing, ringing in the ear, ear pain, or drainage. Denies sinus pain or epistaxis. Denies sore throat or hoarse voice. Denies bleeding gum and dry mouth. Reports last dental exam was on September 2024.

    ·
    **Cardiovascular:** Denies chest pain or palpitations.

    ·
    **Pulmonary**: Denies cough, hemoptysis, difficulty breathing, wheezing or chest tightness

    ·
    **Gastrointestinal:** Denies nausea and vomiting.

    ·
    **Genitourinary:** Denies difficulty passing Urine, blood in urine, urgency and frequency

    ·
    **Musculoskeletal:** Denies joint pain and stiffness

    ·
    **Endocrine:** Denies hot or cold intolerance, polyurea, polydipsia and polyphagia.

    ·
    **Integumentary:** Denies any rash, masses and wounds

    ·
    **Neurological:** Denies headache, dizziness, numbness and tingling

    ·
    **Lymphatic:** Denies feeling any swollen lymph nodes in the neck.

    ·
    **Allergy:** Denies seasonal or environmental allergies
    **,**

    ·
    **Hematologic/lymphatic:** Denies abnormal, anemia and easy bruising

    ·
    **Infectious diseases:** Denies history of infectious diseases

    ·
    **Cancer:** Denies history of colon or lung cancer

    ·
    **Psychiatric:** Denies
    depression,
    anxiety, and
    suicidal ideation

    **Objective**

    **Vital Sign**: Temperature: 97.9 F

    **Pulse:** 82

    **Respirations:** 18

    **BP:** 128/77

    **O2 sat:** 100% on room air

    **Pain Scale:** 0/10

    **Weight:** 210lb, Ht: 65in, BMI: 34.9

    **Physical Exam**

    **General Survey:** Patient is pleasant, well groomed, and in no acute distress

    **Laboratory results:** HbA1c 7.5%, fasting blood glucose 150mg/dL, Lipid level

    **HEENT:**

    **Head:** Atraumatic, symmetric scalp, hair has equal distribution and full thickness, no rashes

    **Eyes:** Sclera is white PERRLA, red reflex present, cup to disc ratio 1:3

    **Ear:** The ear canal is moist, the tympanic membrane is pearly grey and intact, no discharge

    **Nose:** Nasal mucosa is pink and moist, no discharge, no septum deviation

    **Mouth/Throat:** Mucous membrane is pink and moist, and tonsils are midline. No palpable mass or lymph node.

    **Skin:** Normal for ethnicity, smooth, warm, and dry. Good skin turgor, no lesions, rashes, ecchymosis, or moles. Nails are without clubbing or cyanosis.

    **Neurology:** Alert and oriented to person, place, and time. The patient is appropriate and answering questions well.

    **Cardiovascular:** Regular rate and rhythm. S1 S2, no clicks, heaves, thrills, or murmurs.

    **Pulmonary:** Chest is symmetric with bilateral expansion. Respirations are even and unlabored. Lung sounds are clear, with no accessory muscle use and no nasal flaring. Lung sounds are clear bilaterally in all fields.

    **Gastrointestinal:** Active bowel sounds in all quadrants, no palpable masses

    **Genitourinary:** No bladder distention noted

    **Psychiatric:** Behavior
    is age-appropriate, no anxiety or depression noted

    **Assessment**

    **Diagnosis**

    1.
    **Adult Type 2 Diabetes Mellitus (ICD-10: E11.9)**

    Diabetes results when the pancreas produces insulin that is not enough for the body's metabolism and when the body is not able to use available insulin. Diabetes is a chronic disease that leads to hypercalcemia, and uncontrolled diabetes causes problems to the body system, especially the nerves and blood vessels. Symptoms of diabetes include Polydipsia, which is excessive thirst, polyuria which is frequent urination, unintentional weight loss, feeling fatigued or tired, and blurred vision (WHO, 2024). These correlate with D. K’s symptoms at the time.

    **Differential Diagnosis**

    2.
    **Metabolic syndrome (ICD-10: E88.810)**

    Metabolic syndrome consists of metabolic abnormalities, including central obesity, insulin resistance, hypertension, and dyslipidemia, which are risk factors leading to atherosclerosis, cardiovascular disease, and type diabetes mellitus. Metabolic syndrome is diagnosed in the presence of three or more metabolic abnormalities. This diagnosis is ruled out due to the patient’s normal blood pressure (Swarup et al., 2024).

    3.
    **Drug-Induced Diabetes (ICD-10: E09.65)**

    Drug-induced diabetes mellitus occurs as a result of the use of a particular medication. It is a form of secondary diabetes that may be reversible when the use of the medication is discontinued, or diabetes may become permanent. The use of drugs such as corticosteroids, Betablockers, thiazide diuretics, antipsychotics, and statins can lead to drug-induced diabetes (Diabetes.co.uk, 2023). This condition is ruled out because D. K. is not on any of these medications.

    4.
    **Hyperthyroidism (ICD10: E03.9)**

    When the thyroid gland secretes excessive thyroid hormone, it is known as hyperthyroidism. Hyperthyroidism is more prevalent in women over 60 years of age. Risk factors include a family history of thyroid disease, pernicious anemia, and primary adrenal insufficiency. Symptoms are weight loss regardless of increased appetite, rapid or irregular heart rate, and irritability (NIH, 2025). Hyperthyroidism is ruled out due to the patient's age of less than 60 years, no complaints of irritability, and no family history of the disease.

    **Plan:**

    ·
    **Diagnostics:** Hemoglobin A1c (HbA1c) measures a person’s average blood glucose control over 90 days used to diagnose diabetes (Eyth & Naik, 2023).

    · A lipid panel is drawn to measure the patient’s cholesterol levels which should managed with statins if levels are high (ADA, 2023).

    · Thorough foot exam to assess for diabetic neuropathy, foot ulcers, and eye examination for diabetic retinopathy.

    **Patient results:** Hemoglobin AIC is 7.5%, Total cholesterol 210, BP 128/77

    **Treatment**

    · Patient is prescribed Metformin 500mg by mouth daily for elevated blood glucose.

    · 80mg of Atorvastatin by mouth daily for elevated cholesterol

    **Education**

    · Patient education is focused on home blood glucose self-monitoring according to ADA (2023).

    · Patient teaching about Hyperglycemia and hypoglycemia (ADA, 2023)

    · Emphasizing the importance of lifestyle modification, including eating a healthy diet low in carbohydrates and a regular aerobic exercise regimen of 150 minutes every week (ADA, 2023).

    · Importance of medication adherence (ADA, 2023).

    · Daily foot inspection (ADA, 2023)

    · Yearly eye exam (ADA, 2023)

    **Follow Up**

    Follow up with NP in two weeks to evaluate medication treatment with lifestyle changes. Medication adjustment will be required for blood glucose above the recommended level (ADA, 2023).

    References

    American Diabetes Association (ADA) (2023). Standards of medical care in diabetes

    2023.
    _Diabetes Care_,
    _46_(1), S1–S150.
    [https://doi.org/10.2337/dc23-S001](https://doi.org/10.2337/dc23-S001)

    Diabetes.co.uk. (2023). Drug induced diabetes.
    [https://www.diabetes.co.uk](https://www.diabetes.co.uk/)

    Swarup, s., Ahmed, I., Grigorova, Y., & Zeltser, R. (2024). Metabolic syndrome.

    In StatPearls. Treasure Island, (FL).
    [Https://www.ncbi.nlm.nih.gov/books/NBK](https://www.ncbi.nlm.nih.gov/books/NBK)

    World Health Organization (WHO). (2024). Diabetes.
    [Www.who.int/news-room/fac](http://www.who.int/news-room/fac)

    ·

  • [Solved] Nursing Assignment

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  • [Solved] Nursing

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    – [\ \ 17454477450247985300608778083179.jpg](https://www.sweetstudy.com/files/17454477450247985300608778083179-jpg "17454477450247985300608778083179.jpg") – a year ago

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    – a year ago

  • [Solved] Nursing

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    – [\ \ 17454472973887190704661350295176.jpg](https://www.sweetstudy.com/files/17454472973887190704661350295176-jpg "17454472973887190704661350295176.jpg") – [\ \ 17454474749974286903997371169884.jpg](https://www.sweetstudy.com/files/17454474749974286903997371169884-jpg "1745447474997428690399737…

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    – [\
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    17454472973887190704661350295176.jpg](https://www.sweetstudy.com/files/17454472973887190704661350295176-jpg "17454472973887190704661350295176.jpg")
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  • [Solved] Peer response

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    **different research projects in the form of a PICOT question and a PIO question.** – a year ago

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    Assignment Prompt & Instructions

    **different research projects in the form of a PICOT question and a PIO question.**

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  • [Solved] Nursing homework

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  • [Solved] DISC 9 RESPONSES

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    RESPONSES FOR REVIEW – 2 years ago **files (1)** – ## DISCUSSION9RESPONSES.docx **## DISCUSSION9RESPONSES.docx** **Daniela Gomez Vasquez** **Apr 21 8:35pm** **Manage Discussion by Daniela Gomez Vasquez** **Reply from Daniela Gomez Vasquez** ****Main Post**** ****Evaluation of Mental Health Program a…

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    RESPONSES FOR REVIEW

    – 2 years ago

    **files (1)**

    – ## DISCUSSION9RESPONSES.docx

    **## DISCUSSION9RESPONSES.docx**

    **Daniela Gomez Vasquez**

    **Apr 21 8:35pm**

    **Manage Discussion by Daniela Gomez Vasquez**

    **Reply from Daniela Gomez Vasquez**

    ****Main Post****

    ****Evaluation of Mental Health Program and Policy****

    **In 2022, the 988 Suicide and Crisis Lifeline program was launched in the US, designed to prevent suicide and assist people experiencing emotional distress through a simple three-digit phone call, text message, or online chat (Stephanie et al., 2023). At the start of this program, many questions arose regarding whether these centers were truly prepared for the launch, prompting several researchers to conduct studies to assess their readiness (Matthews et al., 2023).**

    **The results indicated that while some centers were prepared, many still lacked the necessary resources to operate effectively (Matthews et al., 2023). Insufficient funding and a shortage of trained personnel, such as mental health professionals, were the primary causes of this lack of preparedness (Stephanie et al., 2023). Research also showed that some facilities in certain regions did not receive the same level of training as others, or there were not enough mental health care facilities available to transfer people for treatment in specific rural areas. Additionally, some facilities in locations with Hispanic or Latino residents did not report effective preparation, while remote towns benefited from telehealth (Matthews et al., 2023).**

    **A lack of staff and resources was believed to lead to missed calls and a low quality of service (Stephanie et al., 2023). Despite these challenges, the program continues. In 2022, 79% of calls were answered, but this figure rose to 89% in 2024, and so far in 2025, 92% of calls have been answered (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023a). Each state has its own policies regarding funding for the 988 Lifeline program (Stephanie et al., 2023). In states with legislation supporting the 988 Lifeline program, every county has at least one center, and those that have funded this program have seen positive growth in care and development, unlike states that rejected this proposal (Burns et al., 2024). The Tennessee government has allocated $5 million for the development and continuation of this program (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023b). Nursing advocacy for the 988 Lifeline can also benefit the population by sharing these programs within the community (Glodstein, 2023).**

    ****References****

    **Burns, A., Nir M., Olena M., Salyers, M. P., & Yeager, V. A. (2024). State Policies Associated with Availability of Mobile Crisis Teams.**
    **_Administration and Policy in Mental Health and Mental Health Services Research_.**
    **[https://doi.org/10.1007/s10488-024-01368-0Links to an external site.](https://doi.org/10.1007/s10488-024-01368-0)**

    **Glodstein, S. L. (2023). The lifeline and advanced practice nursing/intervention prevention perspective.**
    **_Archives of Psychiatric Nursing_,**
    **_47_, 47–49.**
    **[https://doi.org/10.1016/j.apnu.2023.10.008Links to an external site.](https://doi.org/10.1016/j.apnu.2023.10.008)**

    **Matthews, S., Cantor, J. H., Brooks Holliday, S., Bialas, A., Eberhart, N. K., Breslau, J., & McBain, R. K. (2023). National preparedness for 988-the new mental health emergency hotline in the United States.**
    **_Preventive medicine reports_,**
    **_33_, 102208.**
    **[https://doi.org/10.1016/j.pmedr.2023.102208Links to an external site.](https://doi.org/10.1016/j.pmedr.2023.102208)**

    **Stephanie, B. H., Matthews, S., Bialas, A., McBain, R. K., Cantor, J. H., Eberhart, N. K., & Breslau, J. (2023).**
    **_A Qualitative Investigation of Preparedness for the Launch of 988: Implications for the Continuum of Emergency Mental Health Care_.**
    **_50_(4), 616–629.**
    **[https://doi.org/10.1007/s10488-023-01263-0Links to an external site.](https://doi.org/10.1007/s10488-023-01263-0)**

    **Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). 988 Lifeline Performance Metrics.**
    **[https://www.samhsa.gov/mental-health/988/performance-metricsLinks to an external site.](https://www.samhsa.gov/mental-health/988/performance-metrics)**

    **Substance Abuse and Mental Health Services Administration (SAMHSA). (2023, May 11).**
    **_Cooperative Agreements for 988 Suicide and Crisis Lifeline Crisis Center Follow-Up Programs_.**
    **[https://www.samhsa.gov/grants/grant-announcements/fg-23-003Links to an external site.](https://www.samhsa.gov/grants/grant-announcements/fg-23-003)**

    **[Carlos R Astacio](https://waldenu.instructure.com/courses/157824/users/153915)**

    **Apr 22 10:37am| Last reply Apr 22 12:20pm**

    **Manage Discussion by Carlos R Astacio**

    **Reply from Carlos R Astacio**

    ****Policy & Advocacy for Pop Hlth****

    **Carlos Astacio**

    **Walden University**

    **Dr. Bob**

    **April 22, 2025.**

    ****Evaluation of Medicaid Expansion Program under the Affordable Care Act****

    **Within the framework of the Affordable Care Act, the Medicaid expansion policy stands as one of the most far-reaching public health policy measures introduced in the last decade across the United States (Fox & Kahn-Troster, 2022). The main objective of this policy has been to expand access to health services for adults whose incomes fall within 138% of the federal poverty thresholds because they lack affordable health coverage. Evaluation studies of this policy demonstrate several positive effects, including reduced uninsured rates and increased preventive care, reduced uncompensated hospital expenditures, and improved detection and treatment of chronic diseases (Donohue et al., 2022). Follow-up has revealed improvements in certain health outcomes, such as diabetes control and accessibility to mental health services, while minorities see reductions in preventable deaths (Donohue et al., 2022).**

    **Evaluating the effectiveness of Medicaid expansion requires a thorough understanding of the broader framework of the social determinants of health. The social determinants, namely economic stability and educational attainment, along with the physical environment and geographic access to health care, along with the social context, directly determine how people are able to take full advantage of their health coverage (Parzuchowski et al., 2023). People living in rural areas and underserved urban neighborhoods have difficulty obtaining medical services because their communities lack medical providers who accept Medicaid coverage. The combination of limited health literacy and low educational attainment makes it difficult for these individuals to process their health entitlements and effectively use the health system to obtain authorized services (Parzuchowski et al., 2023).**

    **In addition to food insecurity and unemployment and inadequate housing and lack of transportation help determine patients' ability to follow treatment guidelines and maintain disease prevention measures. Both the quality of medical treatment as well as patient willingness to access medical services must include the study of structural racism and discriminatory practices (Shao & Stoecker, 2022). The health care expansion of Medicaid does not eliminate the systematic obstacles which force African Americans along with Hispanics and Native Americans and other oppressed groups to maintain unequal health standards (Shao & Stoecker, 2022).**

    **The provision of care services remains essential but nursing professionals assume a vital duty to examine and execute as well as make improvements to public health policies. Healthcare professionals can be equity advocates and social situation experts to find disparities while supporting evidence-driven initiatives for social determinants reform. Through the combination of clinical judgment and social justice perspective nursing establishes itself as a fundamental force that drives change in healthcare policies like Medicaid expansion to achieve equal benefits outcomes for the population (Fox & Kahn-Troster, 2022).**

    ****References****

    **Fox, K. S., & Kahn-Troster, S. (2022). Advancing health equity in health care coverage: a public-private partnership to engage underserved communities in medicaid expansion.**
    **_Journal of Health Care for the Poor and Underserved_,**
    **_33_(4S), 44–60.**
    **[https://doi.org/10.1353/hpu.2022.0158Links to an external site.](https://doi.org/10.1353/hpu.2022.0158)**

    **Donohue, J. M., Cole, E. S., James, C. V., Jarlenski, M., Michener, J. D., & Roberts, E. T. (2022). The US medicaid program: coverage, financing, reforms, and implications for health equity.**
    **_JAMA_, 328(11), 1085–1099.**
    **[https://doi.org/10.1001/jama.2022.14791Links to an external site.](https://doi.org/10.1001/jama.2022.14791)**

    **Kaiser Family Foundation. (2023).**
    **_Status of_**
    **_State Medicaid Expansion Decisions: Interactive Map_.**
    **[https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/Links to an external site.](https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/)**

    **Parzuchowski, A., Oronce, C., Guo, R., Tseng, C. H., Fendrick, A. M., & Mafi, J. N. (2023). Evaluating the accessibility and value of U.S. ambulatory care among Medicaid expansion states and non-expansion states, 2012-2015.**
    **_BMC Health Services Research_,**
    **_23_(1), 723. https://doi.org/10.1186/s12913-023-09696-x**

    **Shao, Y., & Stoecker, C. (2022). The effect of louisiana medicaid expansion on affordability of health care.**
    **_Public Health Reports (Washington, D.C. : 1974)_,**
    **_137_(5), 912–920. https://doi.org/10.1177/00333549211041410**

    **## DISCUSSION9RESPONSES.docx**

    **Daniela Gomez Vasquez**

    **Apr 21 8:35pm**

    **Manage Discussion by Daniela Gomez Vasquez**

    **Reply from Daniela Gomez Vasquez**

    ****Main Post****

    ****Evaluation of Mental Health Program and Policy****

    **In 2022, the 988 Suicide and Crisis Lifeline program was launched in the US, designed to prevent suicide and assist people experiencing emotional distress through a simple three-digit phone call, text message, or online chat (Stephanie et al., 2023). At the start of this program, many questions arose regarding whether these centers were truly prepared for the launch, prompting several researchers to conduct studies to assess their readiness (Matthews et al., 2023).**

    **The results indicated that while some centers were prepared, many still lacked the necessary resources to operate effectively (Matthews et al., 2023). Insufficient funding and a shortage of trained personnel, such as mental health professionals, were the primary causes of this lack of preparedness (Stephanie et al., 2023). Research also showed that some facilities in certain regions did not receive the same level of training as others, or there were not enough mental health care facilities available to transfer people for treatment in specific rural areas. Additionally, some facilities in locations with Hispanic or Latino residents did not report effective preparation, while remote towns benefited from telehealth (Matthews et al., 2023).**

    **A lack of staff and resources was believed to lead to missed calls and a low quality of service (Stephanie et al., 2023). Despite these challenges, the program continues. In 2022, 79% of calls were answered, but this figure rose to 89% in 2024, and so far in 2025, 92% of calls have been answered (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023a). Each state has its own policies regarding funding for the 988 Lifeline program (Stephanie et al., 2023). In states with legislation supporting the 988 Lifeline program, every county has at least one center, and those that have funded this program have seen positive growth in care and development, unlike states that rejected this proposal (Burns et al., 2024). The Tennessee government has allocated $5 million for the development and continuation of this program (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023b). Nursing advocacy for the 988 Lifeline can also benefit the population by sharing these programs within the community (Glodstein, 2023).**

    ****References****

    **Burns, A., Nir M., Olena M., Salyers, M. P., & Yeager, V. A. (2024). State Policies Associated with Availability of Mobile Crisis Teams.**
    **_Administration and Policy in Mental Health and Mental Health Services Research_.**
    **[https://doi.org/10.1007/s10488-024-01368-0Links to an external site.](https://doi.org/10.1007/s10488-024-01368-0)**

    **Glodstein, S. L. (2023). The lifeline and advanced practice nursing/intervention prevention perspective.**
    **_Archives of Psychiatric Nursing_,**
    **_47_, 47–49.**
    **[https://doi.org/10.1016/j.apnu.2023.10.008Links to an external site.](https://doi.org/10.1016/j.apnu.2023.10.008)**

    **Matthews, S., Cantor, J. H., Brooks Holliday, S., Bialas, A., Eberhart, N. K., Breslau, J., & McBain, R. K. (2023). National preparedness for 988-the new mental health emergency hotline in the United States.**
    **_Preventive medicine reports_,**
    **_33_, 102208.**
    **[https://doi.org/10.1016/j.pmedr.2023.102208Links to an external site.](https://doi.org/10.1016/j.pmedr.2023.102208)**

    **Stephanie, B. H., Matthews, S., Bialas, A., McBain, R. K., Cantor, J. H., Eberhart, N. K., & Breslau, J. (2023).**
    **_A Qualitative Investigation of Preparedness for the Launch of 988: Implications for the Continuum of Emergency Mental Health Care_.**
    **_50_(4), 616–629.**
    **[https://doi.org/10.1007/s10488-023-01263-0Links to an external site.](https://doi.org/10.1007/s10488-023-01263-0)**

    **Substance Abuse and Mental Health Services Administration (SAMHSA). (2023). 988 Lifeline Performance Metrics.**
    **[https://www.samhsa.gov/mental-health/988/performance-metricsLinks to an external site.](https://www.samhsa.gov/mental-health/988/performance-metrics)**

    **Substance Abuse and Mental Health Services Administration (SAMHSA). (2023, May 11).**
    **_Cooperative Agreements for 988 Suicide and Crisis Lifeline Crisis Center Follow-Up Programs_.**
    **[https://www.samhsa.gov/grants/grant-announcements/fg-23-003Links to an external site.](https://www.samhsa.gov/grants/grant-announcements/fg-23-003)**

    **[Carlos R Astacio](https://waldenu.instructure.com/courses/157824/users/153915)**

    **Apr 22 10:37am| Last reply Apr 22 12:20pm**

    **Manage Discussion by Carlos R Astacio**

    **Reply from Carlos R Astacio**

    ****Policy & Advocacy for Pop Hlth****

    **Carlos Astacio**

    **Walden University**

    **Dr. Bob**

    **April 22, 2025.**

    ****Evaluation of Medicaid Expansion Program under the Affordable Care Act****

    **Within the framework of the Affordable Care Act, the Medicaid expansion policy stands as one of the most far-reaching public health policy measures introduced in the last decade across the United States (Fox & Kahn-Troster, 2022). The main objective of this policy has been to expand access to health services for adults whose incomes fall within 138% of the federal poverty thresholds because they lack affordable health coverage. Evaluation studies of this policy demonstrate several positive effects, including reduced uninsured rates and increased preventive care, reduced uncompensated hospital expenditures, and improved detection and treatment of chronic diseases (Donohue et al., 2022). Follow-up has revealed improvements in certain health outcomes, such as diabetes control and accessibility to mental health services, while minorities see reductions in preventable deaths (Donohue et al., 2022).**

    **Evaluating the effectiveness of Medicaid expansion requires a thorough understanding of the broader framework of the social determinants of health. The social determinants, namely economic stability and educational attainment, along with the physical environment and geographic access to health care, along with the social context, directly determine how people are able to take full advantage of their health coverage (Parzuchowski et al., 2023). People living in rural areas and underserved urban neighborhoods have difficulty obtaining medical services because their communities lack medical providers who accept Medicaid coverage. The combination of limited health literacy and low educational attainment makes it difficult for these individuals to process their health entitlements and effectively use the health system to obtain authorized services (Parzuchowski et al., 2023).**

    **In addition to food insecurity and unemployment and inadequate housing and lack of transportation help determine patients' ability to follow treatment guidelines and maintain disease prevention measures. Both the quality of medical treatment as well as patient willingness to access medical services must include the study of structural racism and discriminatory practices (Shao & Stoecker, 2022). The health care expansion of Medicaid does not eliminate the systematic obstacles which force African Americans along with Hispanics and Native Americans and other oppressed groups to maintain unequal health standards (Shao & Stoecker, 2022).**

    **The provision of care services remains essential but nursing professionals assume a vital duty to examine and execute as well as make improvements to public health policies. Healthcare professionals can be equity advocates and social situation experts to find disparities while supporting evidence-driven initiatives for social determinants reform. Through the combination of clinical judgment and social justice perspective nursing establishes itself as a fundamental force that drives change in healthcare policies like Medicaid expansion to achieve equal benefits outcomes for the population (Fox & Kahn-Troster, 2022).**

    ****References****

    **Fox, K. S., & Kahn-Troster, S. (2022). Advancing health equity in health care coverage: a public-private partnership to engage underserved communities in medicaid expansion.**
    **_Journal of Health Care for the Poor and Underserved_,**
    **_33_(4S), 44–60.**
    **[https://doi.org/10.1353/hpu.2022.0158Links to an external site.](https://doi.org/10.1353/hpu.2022.0158)**

    **Donohue, J. M., Cole, E. S., James, C. V., Jarlenski, M., Michener, J. D., & Roberts, E. T. (2022). The US medicaid program: coverage, financing, reforms, and implications for health equity.**
    **_JAMA_, 328(11), 1085–1099.**
    **[https://doi.org/10.1001/jama.2022.14791Links to an external site.](https://doi.org/10.1001/jama.2022.14791)**

    **Kaiser Family Foundation. (2023).**
    **_Status of_**
    **_State Medicaid Expansion Decisions: Interactive Map_.**
    **[https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/Links to an external site.](https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/)**

    **Parzuchowski, A., Oronce, C., Guo, R., Tseng, C. H., Fendrick, A. M., & Mafi, J. N. (2023). Evaluating the accessibility and value of U.S. ambulatory care among Medicaid expansion states and non-expansion states, 2012-2015.**
    **_BMC Health Services Research_,**
    **_23_(1), 723. https://doi.org/10.1186/s12913-023-09696-x**

    **Shao, Y., & Stoecker, C. (2022). The effect of louisiana medicaid expansion on affordability of health care.**
    **_Public Health Reports (Washington, D.C. : 1974)_,**
    **_137_(5), 912–920. https://doi.org/10.1177/00333549211041410**

  • [Solved] Nursing need help with an assignment

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    based on the following article: https://learn.americansentinel.edu/pluginfile.php/1130467/mod_assign/intro/Study%204.pdf – 2 years ago

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    – 2 years ago

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    – a year ago **files (1)** – ## nurs507CLm6discussion.docx **## nurs507CLm6discussion.docx** Patient came in with stomach cramps and has not been able to stool in 4 days Describe your clinical experience for this week. · Did you face any challenges, any success? If so, what were they? · Describe the…

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    **## nurs507CLm6discussion.docx**

    Patient came in with stomach cramps and has not been able to stool in 4 days

    Describe your clinical experience for this week.

    · Did you face any challenges, any success? If so, what were they?

    · Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.

    · Mention the health promotion intervention for this patient.

    · What did you learn from this week's clinical experience that can beneficial for you as an advanced practice nurse?

    · Support your plan of care with the current peer-reviewed research guideline.

    **Submission Instructions:**

    · Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

    **## nurs507CLm6discussion.docx**

    Patient came in with stomach cramps and has not been able to stool in 4 days

    Describe your clinical experience for this week.

    · Did you face any challenges, any success? If so, what were they?

    · Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.

    · Mention the health promotion intervention for this patient.

    · What did you learn from this week's clinical experience that can beneficial for you as an advanced practice nurse?

    · Support your plan of care with the current peer-reviewed research guideline.

    **Submission Instructions:**

    · Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.