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 Dobutamine is the medication for the 5th week.

 Dobutamine is the medication for the 5th week.

is a medication used in the treatment of cardiogenic shock and severe heart failure. It may also be used in certain types of cardiac stress tests. It is given by injection into a vein or intraosseous as a continuous infusion.

This will be done weekly and according to what we will be studying for that week, and will begin Week 2, and end Week 9.

Each student will be responsible for preparing one presentation on pharmacological management of the disease or pharmacological applications of a drug or group of drugs.

  1. Each student will clearly write a title for this topic. Examples are ‘Pharmacological Management of Deep Vein Thrombosis and/or Pulmonary Embolisms Using Anticoagulants/Thrombolytics and Nursing Implications’ or ‘Pharmacological Effects of Anti-hypertensive Medications in the Management of Hypertension and Nursing Implications’.
    • Nursing Implications are the nursing related consequences and what you as the nurse should be looking for in the treatment and care of your patient.
  2. Students must get their title approved by the professor before the deadline shown in your schedule. Unapproved titles will not be accepted
  3. The presentation must identify the Pharmacodynamic properties and actual/potential effects on the patient.
  4. This is worth 20 points.

Submission Details:

  • Submit your assignment to the Submissions Area by the due date assigned.

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 Chronic Disease ( Gastritis)

Soap Note  Chronic Conditions (15 Points)
 Chronic Disease ( Gastritis)

Follow the Soap Note Rubric as a guide:

Use APA format and must include minimum of 2 Scholarly Citations.

Soap notes will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

Turn it in Score must be less than 25% or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25%. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

Please use the sample templates for you soap note, keep these templates for when you start clinicals.

The use of templates is ok with regards of Turn it in, but the Patient History, CC, HPI, The Assessment and Plan should be of your own work and individualized to your made up patient. 

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Transforming Nursing and Healthcare Through Information Technology

NURS 5051/6051: Transforming Nursing and Healthcare Through Information Technology

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Person who is a fall risk using a walker Currently Reading

Week 1: Nursing Informatics and Patient Safety

In 2011, Mason General Hospital was named by Hospitals & Health Networks magazine as one of the “Most Wired” hospitals in the United States. What makes this particularly significant is that Mason General is a small, 25-bed, rural hospital in the state of Washington. It credits its success to nurse Eileen Branscome, director of clinical informatics. Under her leadership, the hospital adopted such innovations as visual smart boards where real-time patient information is always available. According to the magazine, those hospitals designated as “Most Wired” “show better outcomes in patient satisfaction, risk-adjusted mortality rates, and other key quality measures through the use of information technology (IT)” (Mason General Hospital and Family of Clinics, 2012).

Developments in information technology have enabled patients and health care providers to collaborate for quality improvement at an unprecedented level, and nurses have consistently been at the forefront of these efforts. This week you focus on the IOM report “To Err Is Human” and consider how health information technology has helped to address the issues of patient safety and quality health care.

References:

Weinstock, M., & Hoppszallern, S. (2011). Health care’s most wired 2011. Hospitals & Health Network Magazine, 85(7), 26–37.

 

Mason General Hospital and Family of Clinics. (2012). MGH&FC named most wired – Again! Retrieved from http://www.masongeneral.com/most_wired.html

Learning Objectives

Students will:
  • Analyze the utilization of health information technology to address issues raised in the IOM report “To Err Is Human”
  • Assess the role of informatics in improving health care safety

Photo Credit: Angela Schmidt/iStock/Getty Images


Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

American Nurses Association. (2015). Nursing informatics: Scope & standards of practice (2nd ed.). Silver Springs, MD: Author.

  • “Introduction”This portion of the text introduces nursing informatics and outlines the functions of the scope and standards.

McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.

    • Chapter 1, “Nursing Science and the Foundation of Knowledge”This chapter defines nursing science and details its relation to nursing roles and nursing informatics. The chapter also serves as an introduction to the foundation of knowledge model used throughout the text.
  • Chapter 2, “Introduction to Information, Information Science, and Information Systems”In this chapter, the authors highlight the importance of information systems. The authors specify the qualities that enable information systems to meet the needs of the health care industry.

Wakefield, M. K. (2008). The Quality Chasm series: Implications for nursing. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses (Vol. 1, pp. 47–66). Rockville, MD: U. S. Department of Health and Human Services.

  • Pages 1–12These 12 pages highlight the issues raised by the Quality Chasm Series and examine their long-term implications for nursing. The text reviews external drivers of safety and quality, design principles for safe systems, and guidelines for health care redesign.

Cipriano, P. F., & Murphy, J. (2011). Nursing informatics. The future of nursing and health IT: The quality elixir. Nursing Economic$, 29(5), 282, 286–289.

Retrieved from the Walden Library databases.

 

In this article, the authors focus on how nurses can use health information technology to help transform health care using the recommendations included in the 2010 Institute of Medicine report “The Future of Nursing, Leading Change, Advancing Health.” The author also discusses the 2011 National Strategy for Quality Improvement in Health Care.

Plawecki, L. H., & Amrhein, D. W. (2009). Clearing the err. Journal of Gerontological Nursing, 35(11), 26–29.

Retrieved from the Walden Library databases.

 

This article presents a summary of the Institute of Medicine report “To Err Is Human: Building a Safer Health System.” The authors provide an overview of what has been accomplished in the decade following the IOM report, focusing in particular on health information technology.

Required Media

Laureate Education (Producer). (2012e). Introduction to nursing informatics. Baltimore, MD: Author.

 

Note: The approximate length of this media piece is 8 minutes.

 

In this video, Doris Fischer, Richard Rodriguez, Carina Perez, and Carmen Ferrell introduce the concept of nursing informatics. These individuals provide insight into how informatics is transforming the health care system by improving efficiency and quality of care.

 

Optional Resources

Hilts, M. E. (2010). Up from the basement. Health Management Technology, 31(9), 14–15.

Retrieved from the Walden Library databases.

Institute of Medicine. (1999). To err is human: Building a safer health system. Retrieved from http://iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

Kohn, L. T., Corrigan, J. M., & Donaldson, M.S. (Eds.). (2000). To err is human: Building a safer health system. Washington, D. C.: Institute of Medicine. Retrieved from the National Academies Press website: https://download.nap.edu/catalog.php?record_id=9728


Discussion: The Effects of “To Err Is Human” in Nursing Practice

The 1999 landmark study titled “To Err Is Human: Building a Safer Health System” highlighted the unacceptably high incidence of U.S. medical errors and put forth recommendations to improve patient safety. Since its publication, the recommendations in “To Err Is Human’ have guided significant changes in nursing practice in the United States.

In this Discussion, you will review these recommendations and consider the role of health information technology in helping address concerns presented in the report.

To prepare:

    • Review the summary of “To Err Is Human” presented in the Plawecki and Amrhein article found in this week’s Learning Resources.
    • Consider the following statement:

“The most significant barrier to improving patient safety identified in “To Err Is Human” is a “lack of awareness of the extent to which errors occur daily in all health care settings and organizations (Wakefield, 2008).”

  • Review “The Quality Chasm Series: Implications for Nursing” focusing on Table 3: “Simple Rules for the 21st Century Health Care System.” Consider your current organization or one with which you are familiar. Reflect on one of the rules where the “current rule” is still in operation in the organization and consider another instance in which the organization has effectively transitioned to the new rule.

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People of Irish Heritage

1. People of Irish Heritage

2. People of Italian Heritage

3. People of Puerto Rican Heritage

-Describe the popular health care beliefs of these three culture and if there is any similarity in their beliefs.

-How the cultural health care beliefs of these three cultures influence the delivery of health care and how you as a professional  nurse can deal with them while providing nursing care.

– APA format

– A minimum of 500 words.

– A minimum of two evidence based references no older than 5 years.

2. People of Italian Heritage

3. People of Puerto Rican Heritage

-Describe the popular health care beliefs of these three culture and if there is any similarity in their beliefs.

-How the cultural health care beliefs of these three cultures influence the delivery of health care and how you as a professional  nurse can deal with them while providing nursing care.

– APA format

– A minimum of 500 words.

– A minimum of two evidence based references no older than 5 years.

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Neonatal Abstinence Syndrome.

Group A will complete the initial post. Group B will respond. You are called to the room and find Michael 2 hours old has been very irritable and spitting up large amounts of formula. He is very jittery. You do not know the maternal history before coming into the room so you advise the mother that you would like to return the baby to the nursery for an assessment and monitoring. In the medical record you focus on prenatal history. You witness the baby having some significant tremors. What would you suspect? Michaels VS are: T (axillary) – 36.0, RR- 70, HR- 166, he is very alert, irritable, and does not console easily. Is moving constantly, and sucking very vigorous on the pacifier you provide for comfort. You place the baby under the warmer and obtain what labs?It is determined that this baby is going through opioid withdrawal. Neonatal Abstinence Syndrome requires close observation and scoring. Methadone may be used. Neonatal Abstinence Syndrome Shows both the signs of withdrawal, scoring and the nursing care of a baby with Neonatal Abstinence Syndrome.
Group B Response
What is your feeling and knowledge regarding breastfeeding this baby?

DISCUSSION B

Group B will complete the initial post. Group A will respond. Baby Leah had a very traumatic vaginal birth. After a vacuum extraction for fetal heart rate tracing changes and a resultant shoulder dystocia, Leah has a mild Erb’s palsy, some facial and truncal bruising. Pediatrician has ordered physical therapy for the palsy and the doctor expects routine care to be provided to her. In addition, do not forget the education you must give to the new parents regarding this injury. Due to the bruising there is an increase in bilirubin levels and some behavioral changes occur with Leah. Please describe what is different and what will you discuss with the family to ensure safety? The bilirubin level requires phototherapy. What precautions must you take? What is essential to manage and treat the elevated bilirubin in addition to phototherapy?Group A Response Phototherapy is discontinued at the hospital, but at home the parents are encouraged to provide some ‘routine’ therapy for Hyperbilirubinemia. What would you suggest? Do not forget routine discharge instruction for this parent. Please Include answer all questions with 3-4 references

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Human Experience Across the   Health-Illness Continuum

Benchmark – Human Experience Across the   Health-Illness Continuum

The benchmark assesses the following competency:

Benchmark: 5.1. Understand the human experience across the health-illness continuum.

Research the health-illness continuum and its relevance to patient care. In a 750-1,000 word paper, discuss the relevance of the continuum to patient care and present a perspective of your current state of health in relation to the wellness spectrum. Include the following:

1. Examine the health-illness continuum and discuss why this perspective is important to consider in relation to health and the human experience when caring for patients.

2. Reflect on your overall state of health. Discuss what behaviors support or detract from your health and well-being. Explain where you currently fall on the health-illness continuum.

3. Discuss the options and resources available to you to help you move toward wellness on the health-illness spectrum. Describe how these would assist in moving you toward wellness (managing a chronic disease, recovering from an illness, self-actualization, etc.).

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

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

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.

Link for resourse- https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/#/chapter/5

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health care professionals

Write a short (50-100-word) paragraph response for each question. This assignment is to be submitted as a Microsoft Word document.

  1. Define patient compliance and explain its importance in your field.(Nursing)
  2. Identify the health care professionals’ role in compliance and give examples of ways in which the health care professional may actually contribute to noncompliance.
  3. Compare compliance and collaboration.
  4. Compare and contrast patient education in the past with that practiced today.
  5. Explain the importance of professional commitment in developing patient education as a clinical skill.
  6. Explain the three categories of learning and how they can be used in patient education.
  7. List three problems that may arise in patient education and how they would be solved?
  8. List some methods of documentation of patient education.

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Academic Success and Professional Development Plan Template 

In this Module’s Discussion, you were introduced to the concept of an academic portfolio to begin building your own brand. However, portfolios have value that goes beyond brand building. An academic and professional portfolio can also help you to build your own vision and mission and establish your development goals. In this regard, a portfolio becomes yet another tool in your toolbox as you build your success.

In this Assignment you will continue developing your Academic Success and Professional Development Plan by developing the fifth component–a portfolio for your academic and professional efforts.

To Prepare:

  • Consider your goals for academic accomplishments while a student of the MSN program.

The Assignment:

  • Using the Academic Success and Professional Development Plan Template document that you began to work on in Module 1 and have continued expanding throughout this course, you will develop a curriculum vitae (CV) in Part 5 based on your current education and professional background.
  • Write a statement identifying your professional development goals.
  • Write a statement proposing how you might align one or more of your professional development goals with the university’s emphasis on social change.

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Bipolar TherDescent/Ancestry

Bipolar TherDescent/Ancestry

Asian girl

BACKGROUND INFORMATION

The client is a 26-year-old woman of Korean descent who presents to her first appointment following a 21-day hospitalization for onset of acute mania. She was diagnosed with bipolar I disorder.

Upon arrival in your office, she is quite “busy,” playing with things on your desk and shifting from side to side in her chair. She informs you that “they said I was bipolar, I don’t believe that, do you? I just like to talk, and dance, and sing. Did I tell you that I liked to cook?”

She weights 110 lbs. and is 5’ 5”

SUBJECTIVE

Patient reports “fantastic” mood. Reports that she sleeps about 5 hours/night to which she adds “I hate sleep, it’s no fun.”

You reviewed her hospital records and find that she has been medically worked up by a physician who reported her to be in overall good health. Lab studies were all within normal limits. You find that the patient had genetic testing in the hospital (specifically GeneSight testing) as none of the medications that they were treating her with seemed to work.

Genetic testing reveals that she is positive for CYP2D6*10 allele.

Patient confesses that she stopped taking her lithium (which was prescribed in the hospital) since she was discharged two weeks ago.

MENTAL STATUS EXAM

The patient is alert, oriented to person, place, time, and event. She is dressed quite oddly- wearing what appears to be an evening gown to her appointment. Speech is rapid, pressured, tangential. Self-reported mood is euthymic. Affect broad. Patient denies visual or auditory hallucinations, no overt delusional or paranoid thought processes readily apparent. Judgment is grossly intact, but insight is clearly impaired. She is currently denying suicidal or homicidal ideation.

The Young Mania Rating Scale (YMRS) score is 22

RESOURCES

§ Chen, R., Wang, H., Shi, J., Shen, K., & Hu, P. (2015). Cytochrome P450 2D6 genotype affects the pharmacokinetics of controlled-release paroxetine in healthy Chinese subjects: comparison of traditional phenotype and activity score systems. European Journal of Clinical Pharmacology, 71(7), 835-841. doi:10.1007/s00228-015-1855-6

Decision Point One

Select what the PMHNP should do:

Begin Lithium 300 mg orally BIDBegin Risperdal 1 mg orally BIDBegin Seroquel XR 100 mg orally at HS

Decision Point One

Begin Lithium 300 mg orally BID

RESULTS OF DECISION POINT ONE

  • Client returns to clinic in four weeks
  • Client informs the PMHNP that she has been taking her drug “off and on” only when she “feels like she needs it”
  • Today’s presentation is similar to the first day you met her

Decision Point Two

Select what the PMHNP should do next:

Increase Lithium to 450 mg orally BID

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Client returns reports that she is still taking the medication when she feels that she needs it
  • She remains quite manic and reports that her family is getting really upset because she likes to play her new guitar at night

Decision Point Three

Select what the PMHNP should do next:

Assess for rationale for non-compliance and educate client

Guidance to Student
The PMHNP should further assess for dangerousness to self or others. The client should be assessed for self-care, to including hygiene, eating, sleeping, etc. Hospitalization may be indicated if the client remains non-compliant and is a danger to self. If the client is not a danger to self, and hospitalization is not indicated, the PMHNP needs to assess for rationale for non-compliance. Many clients enjoy mania as it is a nice feeling to be consistently happy. When clients are successfully treated for mania, they often describe themselves as feeling ‘down’ or ‘flat.’ The PMHNP needs to assess for depression at this point as opposed to normalization of mood. Abilify is also FDA approved as monotherapy for mania and mixed presentations, but at a dose of 15 mg. day., so although you may be tempted to begin Abilify- be certain to use correct dose. Also, because it can be “activating” you need to dose this drug in the morning. However, the client is non-compliant and therefore, eliciting reasons for non-compliance is essential to the care of this client.
Start Over

Consider hospitalization

Guidance to Student
The PMHNP should further assess for dangerousness to self or others. The client should be assessed for self-care, to including hygiene, eating, sleeping, etc. Hospitalization may be indicated if the client remains non-compliant and is a danger to self. If the client is not a danger to self, and hospitalization is not indicated, the PMHNP needs to assess for rationale for non-compliance. Many clients enjoy mania as it is a nice feeling to be consistently happy. When clients are successfully treated for mania, they often describe themselves as feeling ‘down’ or ‘flat.’ The PMHNP needs to assess for depression at this point as opposed to normalization of mood. Abilify is also FDA approved as monotherapy for mania and mixed presentations, but at a dose of 15 mg. day., so although you may be tempted to begin Abilify- be certain to use correct dose. Also, because it can be “activating” you need to dose this drug in the morning. However, the client is non-compliant and therefore, eliciting reasons for non-compliance is essential to the care of this client.
Start Over

Change to abilify 10 mg orally at HS

Guidance to Student
The PMHNP should further assess for dangerousness to self or others. The client should be assessed for self-care, to including hygiene, eating, sleeping, etc. Hospitalization may be indicated if the client remains non-compliant and is a danger to self. If the client is not a danger to self, and hospitalization is not indicated, the PMHNP needs to assess for rationale for non-compliance. Many clients enjoy mania as it is a nice feeling to be consistently happy. When clients are successfully treated for mania, they often describe themselves as feeling ‘down’ or ‘flat.’ The PMHNP needs to assess for depression at this point as opposed to normalization of mood. Abilify is also FDA approved as monotherapy for mania and mixed presentations, but at a dose of 15 mg. day., so although you may be tempted to begin Abilify- be certain to use correct dose. Also, because it can be “activating” you need to dose this drug in the morning. However, the client is non-compliant and therefore, eliciting reasons for non-compliance is essential to the care of this client.
Start Over

Assess rationale for non-compliance to elicit reason for non-compliance and educate client re: drug effects, and pharmacology

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Client states that the drug makes her nauseated and gives her diarrhea
  • Client states that she stops taking it until these symptoms abate, at which point she re-starts only to experience the symptoms again

Decision Point Three

Select what the PMHNP should do next:

Change to Depakote ER 500 mg at HS

Guidance to Student
In this case, the client is having nausea and diarrhea, classic side effects of lithium therapy. Changing the client to an extended release formulation can often prevent these symptoms while at the same time affording the client the benefit of lithium’s mood stabilizing properties. Also, lithium is a good choice for control of mania and has also been shown to decrease risk of suicide, which adds to its overall benefits. Depakote may be an option if changing to sustained release lithium does not alleviate the side effects. Oxcarbazpine (Trileptal) is an option, but is a second line therapy and is not appropriate at this stage as the client has not had an adequate trial of first line agents.
Start Over

Change Lithium to sustained release preparation at same dose and frequency

Guidance to Student
In this case, the client is having nausea and diarrhea, classic side effects of lithium therapy. Changing the client to an extended release formulation can often prevent these symptoms while at the same time affording the client the benefit of lithium’s mood stabilizing properties. Also, lithium is a good choice for control of mania and has also been shown to decrease risk of suicide, which adds to its overall benefits. Depakote may be an option if changing to sustained release lithium does not alleviate the side effects. Oxcarbazpine (Trileptal) is an option, but is a second line therapy and is not appropriate at this stage as the client has not had an adequate trial of first line agents.
Start Over

Change to trileptal 300 mg orally BID

Guidance to Student
In this case, the client is having nausea and diarrhea, classic side effects of lithium therapy. Changing the client to an extended release formulation can often prevent these symptoms while at the same time affording the client the benefit of lithium’s mood stabilizing properties. Also, lithium is a good choice for control of mania and has also been shown to decrease risk of suicide, which adds to its overall benefits. Depakote may be an option if changing to sustained release lithium does not alleviate the side effects. Oxcarbazpine (Trileptal) is an option, but is a second line therapy and is not appropriate at this stage as the client has not had an adequate trial of first line agents.
Start Over

Switch to Depakote ER 500 mg orally at HS

RESULTS OF DECISION POINT TWO

  • Client returns to clinic in four weeks
  • Client reports that she has been compliant and you notice a marked reduction in manic symptoms. Young Mania Rating Scale was 11 (50% reduction from first office visit)
  • Client reports that she has gained 6 pounds over the last 4 weeks and wants to stop the medication because of this

Decision Point Three

Select what the PMHNP should do next:

Educate client regarding diet/weight loss and continue client on the same drug/dose

Guidance to Student
The PMHNP should begin by educating the client regarding weight loss/and importance of diet/exercise while taking Depakote which can cause weight gain. Decreasing the dose of Depakote would not be appropriate as she still has symptoms and decreasing dose of Depakote may result in some weight loss, it may result in a return of manic symptoms. The PMHNP can switch to Zyprexa but if weight gain is the issue, then this will be compounded by Zyprexa which is associated with significant weight gain (up to 20 kg over a 24 month period).
Start Over

Decrease Depakote ER to 250 mg orally at HS

Guidance to Student
The PMHNP should begin by educating the client regarding weight loss/and importance of diet/exercise while taking Depakote which can cause weight gain. Decreasing the dose of Depakote would not be appropriate as she still has symptoms and decreasing dose of Depakote may result in some weight loss, it may result in a return of manic symptoms. The PMHNP can switch to Zyprexa but if weight gain is the issue, then this will be compounded by Zyprexa which is associated with significant weight gain (up to 20 kg over a 24 month period).
Start Over

Switch medication to Zyprexa 15 mg orally daily at HS

Guidance to Student
The PMHNP should begin by educating the client regarding weight loss/and importance of diet/exercise while taking Depakote which can cause weight gain. Decreasing the dose of Depakote would not be appropriate as she still has symptoms and decreasing dose of Depakote may result in some weight loss, it may result in a return of manic symptoms. The PMHNP can switch to Zyprexa but if weight gain is the issue, then this will be compounded by Zyprexa which is associated with significant weight gain (up to 20 kg over a 24 month period).
Start Over

The Assignment

Examine Case Study: An Asian American Woman With Bipolar Disorder. You will be asked to make three decisions concerning the medication to prescribe to this client. Be sure to consider factors that might impact the client’s pharmacokinetic and pharmacodynamic processes.

At each decision point stop to complete the following:

  • Decision #1
    • Which decision did you select?
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #1 and the results of the decision. Why were they different?
  • Decision #2
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #2 and the results of the decision. Why were they different?
  • Decision #3
    • Why did you select this decision? Support your response with evidence and references to the Learning Resources.
    • What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources.
    • Explain any difference between what you expected to achieve with Decision #3 and the results of the decision. Why were they different?

Also include how ethical considerations might impact your treatment plan and communication with clients.

 

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(EENT) disorders

In clinical settings, eye, ear, nose, and throat (EENT) disorders account for the majority of pediatric visits. With the prevalence of these disorders, you must be familiar with their signs and symptoms as well as evidence-based practices for assessment and treatment. Although many pediatric patients present with common EENT disorders such as ear infections, allergies, and strep throat, some patients present with rare disorders requiring specialist care. In your role, making this distinction between when to treat and when to refer is essential. For this Discussion, examine the following case studies and consider potential diagnoses and management strategies.

Case Study 1

A mother presents with her 2-year-old child with complaints of ear pain and decreased sleep. Earlier this week, he had a runny nose and congestion with a mild cough that occurred mostly when lying down. His temperature is 100.7°F. You note the following physical findings: shotty anterior cervical adenopathy, mild nasal congestion, clear postnasal drainage, and lungs clear to auscultation. Ear examination reveals the following: right tympanic membrane is red, translucent, in a neutral position, with no pus or fluid noted; left tympanic membrane is full, reddish orange in appearance, and opaque with pus.

Case Study 2

Kaitlyn is a 4-year-old with a 2-day history of nasal congestion and cough in the early morning. Her mother reports thick, green nasal discharge. She is afebrile, and appetite and sleep are normal. Physical examination reveals: lungs clear to auscultation, tympanic membranes pearly gray without fluid in a neutral position, no cervical adenopathy, nasal turbinates are red, and clear rhinorrhea and postnasal drip.

Case Study 3

Marcus is an 8-year-old with a 36-hour complaint of headache (frontal), sore throat, fever to 102°F, and nausea. Mom says his appetite is decreased and his breath smells “like a puppy dog’s.” Physical examination reveals: lungs clear to auscultation, tympanic membranes partially obscured by cerumen but in neutral position and transparent, enlarged tonsilar and anterior cervical lymph nodes, 2+ enlarged and red tonsils with exudate, strawberry tongue, and petechiae on the soft palate.

To prepare:

  • Review “Eye Disorders” and “Ear Disorders” in the Burns et al. text.
  • Review and select one of the three case studies. Analyze the patient information, including the parent’s perspective.
  • Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
  • Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
  • Consider strategies for educating parents on the child’s disorder and reducing any concerns/fears presented in the case study.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.a

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