Week 5 

Discussion question worth 5 points

Discussion question due by Sunday, 11:59 pm. 

Following Case Study Question: As an NP student, needs to determine the medications for Tinea Pedis.

RX format: Medication, SIG: Instructions (Route, frequency, location, duration), Dispense #, Refills, ?

According to the ACC/AHA Guidelines, what antifungal medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format and SOAP (subjective, objective, assesment, plan) format. 

Please include patient education regarding the selected medication therapy. Please choose a medication to treat tinea pedis that would not exacerbate other patient’s symptoms. You may order labs for baseline before starting the therapy and specify which labs. 

Next to the chosen medication therapy, please choose references to support your treatment choice of medication or lab for baseline and follow up of therapy ordered. Specify when to refer the patient after therapy and why ?

WEEK 5: DISCUSSION QUESTION IN DISCUSSION BOARD

DERMATOLOGY CASE STUDY

ACC/AHA Guidelines

Chief complaint:  “ I have scaly crust in sole of feet and moist white crusts between my toes since I started using boots warm weather” for past 2 weeks.

HPI: E.D a 45-year-old hispanic female presents to the clinic for complaint of itching in feet and scaly curst in sole of feet and moist white crusts between toes. She developed a red, itchy rash consistent with hypersensitivity reaction. She also indicates that she has noticed that her symptoms are worsening for past 2 weeks and it started after she started to use boots in warm weather. She has symptoms of red, itching rash consistent with a hypersensitivity reaction and tinea pedis. She wore about 2 weeks ago her mother’s shoes without socks and her mother has history of Tinea Pedis.

She has tried lotrimin AF cream for itching and it did not help relief her symptoms. She has not tried other remedies.

Denies associated symptoms of fever, chills, pain or any other symptoms.

PMH:

Diabetes Mellitus, type 2. Peripheral Vascular disease. Varicose Veins.

Surgeries: None

Allergies: Penicillin

Vaccination History:

She receives an annual flu shot. Last flu shot was this year

Social history:

High school graduate, married and no children. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.

Family history:

Both parents are alive. Father has history of DM type 2, Tinea Pedis.

mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.

ROS:

Constitutional: Negative for fever. Negative for chills.

Respiratory: No Shortness of breath. No Orthopnea

Cardiovascular: + 1 pitting leg edema. + Varicose veins.

Skin: + rash crusted white in feet and inter-digit in feet.

Psychiatric: No anxiety. No depression.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0 po P 88 R 22, non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.

NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.

LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.

HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.

MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.

SKIN: +Dryness, No open lesions. +Dry crusts in sole of feet. + moist crust in between toes.

PSYCH: Normal affect. Cooperative.

Labs:: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98

A:

Primary Diagnosis: Tinea Pedis

Secondary Diagnoses:

Atopic Dermatitis

Xerosis

Pruritus

Differential Diagnosis:

Peripheral Vascular Disease (PVD) (173.9)

P:

Medications:

Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: CBC with diff to evaluate for infection and baseline lab. CMP, PT/INR to evaluate status of liver and kidneys.

Referrals: may refer based on effect of medication therapy given for 2 weeks.

Follow up: return to office in 2 weeks to evaluate her symptoms.

Additional lab results:

Fungal culture confirm that she has fungal infection.

Question: As an NP student, needs to determine the medications for Tinea Pedis.

According to the ACC/AHA Guidelines, what antifungal medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format. Write her complete prescriptions using the prescription writing format and SOAP (subjective, objective, assesment, plan) format. 

Next to the chosen medication therapy, please choose references to support your treatment choice of medication or lab for baseline and follow up of therapy ordered. Specify when to refer the patient after therapy and why ? Choose a medication to treat the patient’s condition of tinea pedis that would not exacerbate other patient’s symptoms. You may order labs for baseline before start of therapy and specify which labs.

need prove in turnitin

Epidemiology of Health and Illness.

Community Health Planning

Implementation and evaluation

Read chapter 5, 7 and 8 of the class textbook and review the attached PowerPoint presentations.  Once done answer the following questions;

1. Identify and discuss the epidemiological moles use to explain disease and health patterns in populations.
2. Discuss how the use of epidemiological methods in primary, secondary and tertiary prevention.
3. Describe and discuss the concept of “community as a client”.
4. Discuss the nurse’s role in community education within the sociopolitical and cultural context.

Please present your assignment following the syllabus instructions.  Word document, 12 Arial font attached to the forum in the discussion tab of the blackboard titled “Week 2 discussion questions”.  A minimum of 700 words is required (words on the first page and on the reference page does not count).  A minimum of two references (excluding the class textbook) no older than 5 years old is required.

The assignment also must be posted in Turnitin to verify originality.

Identify a potential individual who has been living in a culture other than the one of origin for at least 2 years. This individual must be born outside the United States. The individual can be a patient, friend, or colleague, such as a physician, or acquaintance, but cannot be a relative. The individual must be living in your community and must be currently receiving or have previously received healthcare services in your community. The individual’s race, ethnicity, language, religion, and culturally based beliefs about healthcare and illness should be quite different from yours. The individual must speak your language. An interpreter is not permitted for the actual assessment, which occurs in Milestone 3 (Week 6).

Note: This is the same individual for whom you will develop verbal assessment questions in Milestone 2 and whom you will ask those questions in Milestone 3 and then reflect on your learning about the Course Project and the assessment.

Individuals can come from a variety of settings. Recent immigrants, migrant workers, exchange students, international students, long-term care residents, refugees, coworkers, physicians, patients, employees at local ethnic businesses, religious venues, community centers, and individuals who have recently moved to your community are some suggestions. The individual does not need to be a healthcare worker but must have received healthcare services in the country of origin as well as since arriving in the United States. Speak with the individual, and obtain permission to conduct an assessment later in the course.

. Although you are not performing the official assessment until Milestone 3, it will be necessary to obtain some general information about your individual to complete Milestone 1. This information may come from the individual or Internet sources.

Fill in information about the potential individual using the template. You are expected to write clearly and use proper grammar and spelling and eliminate typos.

Example: KC was born in Hwidiem, Ghana, a small village in Africa, where he did not graduate from high school. He is 72 years old. He immigrated to the United States at age 28 and has lived in Grove City near Columbus, Ohio since then. Hwidiem is considered the provincial capital (fill in information about the community or city as you can find). He was married but divorced after a traumatic brain injury. Since then, he has had many part-time jobs and studies his Bible faithfully. Grove City is a town in Ohio (fill in information about the city or community). Currently, he receives healthcare for his hypertension control. I met him 3 years ago at a senior citizens’ center where I volunteer.

Pre-Briefing Simulation And Drug Cards

PATIENT: Keola Akana

THIS ASSIGNMENT HAS TWO PART QUESTIONS

INSTRUCTION

Please keep in mind you will also be required to recognize a variety of signs and symptoms linked to abnormalities in these skills.

Therefore, in order to prepare for the simulation, you are required to complete the Pre-Briefing questions & Drug Cards below and submit to the faculty facilitating the simulation prior to the start of pre-briefing. If you do not complete the pre-briefing questions below and submit to faculty facilitating the simulation prior to the start of pre-briefing, you will not be permitted to participate in the simulation.

PART 1 QUESTIONS

SCENARIO OVERVIEW:

Keola Akana is a 70-year-old male with a history of heart failure. He was admitted to the medical-surgical unit early on Monday morning for medication adjustment, monitoring, and cardiac rehabilitation. The scenario takes place on Monday at 0900, at which time morning medications are due.

1. What are the nutritional implications, key assessment findings, and nursing interventions for a patient with hypokalemia?

2. What are the signs and symptoms of digoxin toxicity and how would the nurse assess for these symptoms? In your response, be sure to include specific body systems.

3. How would the nurse provide family-centered care?

PLEASE USE REFERENCE LESS THAN 5 YEARS OLD AND APA FORMAT NEEDED.

PART 11 QUESTIONS

SCENARIO OVERVIEW:

Keola Akana is a 70-year-old male with a history of heart failure. He was admitted to the medical-surgical unit early on Monday morning for medication adjustment, monitoring and cardiac rehabilitation. During this scenario, students will have the opportunity to assess and manage medication administration for a patient experiencing digoxin toxicity.

FOR EACH OF THE FOLLOWING DRUGS BELOW THAT WAS PRESCRIBED FOR THE ABOVE PATIENT WITH HEART FAILURE, WRITE OUT IN DRUG CARD FORMAT FOLLOWING THE HEADING BELOW

1) THE INDICATION, (2) DOSAGE, (3) CONTRAINDICATION, (4) SIDE EFFECTS, (5) ADVERSE EFFECTS AND (6) NURSING CONSIDERATION

⦁ Patient: Keola Akana Drug Lists

Lasix 40 mg po now and daily

Potassium Chloride CR 10 mEq po daily

Digoxin 0.25 mg po now and daily

Atenolol 50mg po now and daily

Acetaminophen 650 mg po Q 4 hrs PRN mild pain or temp greater than 101.3

IV saline flush Q 8hrs and PRN

N:B: SEE THE ATTACHED SAMPLE OF THE DRUG CARD LIST

Assessing and Planning Care for an Elderly Person

In order to gain an insight into the world of elder adults, it is important to understand how they view themselves and the values they hold. Additionally it is important to assess and determine his/her needs and establish appropriate interventions for this individual.

By the due date assigned, choose an older adult to interview. This cannot be a patient in your clinical setting. You can use a friend, family member, or co-worker. The older adult should be 65 years or older. Use the format provided to record the responses. A list of questions is available for you to start with. Include 2–3 questions of your own to get a complete picture of the older adult. Summarize your findings and also contrast the responses with findings in your readings and other current literature.

Download a patient questionnaire (SEE ATTACHED DOCUMENT). This form should be used as an example.

After gaining permission, conduct a physical and mental functional assessment of the older adult you have chosen. Review your readings for the process of functional assessment.

Make use of the tools discussed this week to complete a comprehensive assessment of your patient. Search the Internet for resources on these tools.

1. Tinetti Balance and Gait Evaluation
2. Katz Index of Activities of Daily Living
3. Assessment of Home Safety
4. The Barthel Index

Make sure the older adult is clearly identified on the tools. Do not include their name, but do include professional or other designation, and age. Your name should also be identified on the tool. (This should be a part of your Appendix.)

Compare and contrast the age-related changes of the older person you interviewed and assessed with those identified in this week’s reading assignment. During this data analysis process provide at least 4–6 preliminary issues that you have identified. Identify three alterations in health that you would propose and describe them. Identify a minimum of three comprehensive interventions for each problem.

Make sure that you integrate personal cultural awareness and cultural competency.

Paper should be 5–6 pages, not including the questionnaire or tools used. These should be attached as an Appendix. Remember to use headings to identify the different sections in your paper.

On a separate references page, cite all sources using APA format.

• Use this APA Citation Helper as a convenient reference for properly citing resources.
• This handout will provide you the details of formatting your essay using APA style.
• You may create your essay in this APA-formatted template.

Submission Details

• Name your document _………………W2_A2_LastName_FirstInitial.doc.
• Submit your document to the Submissions Area by the due date assigned.