A 27-year-old patient with a history of substance abuse is found unresponsive by emergency medical services
A 27-year-old patient with a history of substance abuse is found unresponsive by emergency Discussion: Alterations in Cellular Processes At its core, pathology is the study of disease. Diseases occur for many reasons. But some, such as cystic fibrosis and Parkinson’s Disease, occur because of alterations that prevent cells from functioning normally. Understanding of signals and symptoms of alterations in cellular processes is a critical step in diagnosis and treatment of many diseases. For the Advanced Practice Registered Nurse (APRN), this understanding can also help educate patients and guide them through their treatment plans. For this Discussion, you examine a case study and explain the disease that is suggested. You examine the symptoms reported and explain the cells that are involved and potential alterations and impacts. To prepare: By Day 1 of this week, you will be assigned to a specific scenario for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor. Scenario 4: A 27-year-old patient with a history of substance abuse is found unresponsive by emergency medical services (EMS) after being called by the patient’s roommate. The roommate states that he does not know how long the patient had been lying there. Patient received naloxone in the field and has become responsive. He complains of burning pain over his left hip and forearm. Evaluation in the ED revealed a large amount of necrotic tissue over the greater trochanter as well as the forearm. EKG demonstrated prolonged PR interval and peaked T waves. Serum potassium level 6.9 mEq/L. By Day 3 of Week 1 Post an explanation of the disease highlighted in the scenario you were provided. Include the following in your explanation: The role genetics plays in the disease. Why the patient is presenting with the specific symptoms described. The physiologic response to the stimulus presented in the scenario and why you think this response occurred. The cells that are involved in this process. How another characteristic (e.g., gender, genetics) would change your response. Expert Answer and Explanation Alterations in Cellular Process Role of Genes in the Disease According to a study done by McCance and Huether (2019), genetic variables contribute to the commencement of addictive substances and change from use to addiction. The authors also note that 40 to 60% of one’s vulnerability to substance use is accounted for by genetic factors. Another research by Muro (2018) found that PSD-95 is a specific protein gene that connects learning, memory, and addiction. The researchers also found that mice with a low rate of PSD-95 could not find their way out of the maze easily and were highly sensitive to cocaine. The study also found that a higher amount of PSD-95 gene made mice more sensitive to alcohol, nicotine, heroin, and morphine. Another gene that is responsible for addiction is the DARPP-32 gene. Abbasian, Lockington, Megharaj, and Naidu (2016) report that when DARPP-32 was extracted from mice, it failed to respond to hard drugs. Therefore, the 27-year-old is addicted to drugs because he inherited either DARPP-32 or PSD-95 from his family. Reasons for Presenting Described Symptoms Opioid overdose may cause effects, such as slow breathing, blue skin from poor blood circulation, small pupils, respiratory failure, lessened alertness, confusion, and loss of consciousness. This patient was unresponsive because he may have used opioid drugs in excess. The former is evident because he became responsive after receiving naloxone treatment. Naloxone is a non-addictive medication used to treat patients with opioid overdose to neutralize life-threatening depression of the respiratory system and central nervous system to allow the patient to regain normal breathing (Zhang, 2019). The medication only works when one’s body has opioid substances. The burning pain is the side effect of naloxone. The presence of necrotic tissue on the forearm and greater trochanter was due to fall when the patient was unconscious. Physiologic Response The physiological response is an involuntary reaction triggering a physical response to stimuli. An example of a physiologic response is fight or flight response. The physiological response can manifest itself through shaking, dry mouth, faster breathing, sweating, panic attacks, and heart palpitations. Abbasian et al. (2016) mention that one of the physiological responses to opioids is slowing the functions of the GI tract. Opioids may slow down the GT tract’s functioning by inhibiting the release of acetylcholine from the motor neurons. As a result, the victim may experience low excretion. Other physiological responses to opioid include dilatation of pupils, increased breathing, heart rate changes, and blood pressure, sweating, changes in body temperature and skin, and piloerection (Liu & Tang, 2020). Cells Involved Various cells are involved in physiological response. Dark, clear, and myoepithelial sweat cells are some of the cells involved in the process. When one feels the urge to abuse opioids, the brain will send a message to the cells above to produce sweat as a response. Other cells involved in the process are brown adipose tissue (BAT) and thermogenesis. These cells will either increase or reduce body temperature to respond to the urge to abuse opioids. The neurons in the hindbrain known as medulla and pons are the cells that regulate how one will breathe in the response of opioid stimulus (Liu & Tang, 2020). Overall, all these cells must be coordinated by the central nervous system. How another Factor can Influence the Response Genes will change how one response to opioids. For instance, a person with either DARPP-32 or PSD-95 will show physiological response symptoms when presented with opioids while the individual without the genes will not show any signs. References Abbasian, F., Lockington, R., Megharaj, M., & Naidu, R. (2016). A review on the genetics of aliphatic and aromatic hydrocarbon degradation. Applied biochemistry and biotechnology, 178(2), 224-250. https://link.springer.com/article/10.1007/s12010-015-1881-y Liu, N., & Tang, M. (2020). Toxic effects and involved molecular pathways of nanoparticles on cells and subcellular organelles. Journal of Applied Toxicology, 40(1), 16-36. https://onlinelibrary.wiley.com/doi/full/10.1002/jat.3817 McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis,
[ANSWERED 2024] For your Signature Assignment create a PowerPoint presentation that discusses any five legal issues or ethical concepts
For your Signature Assignment create a PowerPoint presentation that discusses any five legal issues or ethical concepts of your choice that Module 8 Assignment Signature Assignment: Legal and Ethical Considerations in Healthcare For your Signature Assignment create a PowerPoint presentation that discusses any five legal issues or ethical concepts of your choice that you feel are particularly important to the improvement of healthcare. Explain the impact of these five concepts on nursing practice, the healthcare institution, and on the quality of patient care. For your presentation: Select at least four (4) legal issues or ethical concepts that you feel influence or hinder nursing practice, healthcare institutions or quality patient outcomes. Explain how the selected legal issues or ethical concepts impact nursing practice, the healthcare institution, and the quality of patient outcomes. Develop a policy proposal with measures and recommendations that could positively impact nursing practice, allow healthcare institutions to thrive, and improve the quality of patient outcomes. Detail how nursing could act or advocate to incorporate the policy proposal into practice. Review the Signature Assignment Rubric before starting your presentation. Assignment Expectations Length: 16-20 slides minimum; answers must thoroughly address the questions in a clear, concise manner. Structure: Title: 1 slide Objectives: 1 slide List legal issues or ethical concepts: 1 slide Explain the issues or concepts: at least 4 – 5 slides Present a policy proposal incorporating the issues and concepts with measures and recommendations: at least 5 slides Explain how nursing can act or advocate to incorporate the policy proposal into practice: 1-5 slides Conclusion: 1 slide References: 1 slide Additionally, because a good presentation has few words on the slides include a script with the verbiage you would say when presenting; script should be a minimum of 50 words per slide. References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least four (4) scholarly sources to support your claims, at least one (1) per legal issue or ethical concept in addition to required texts. Format: Save your assignment as a Microsoft PowerPoint document and a Word document (.pptx) and (.doc or .docx) or Open Office Impress. File name: Name your saved file according to your first initial, last name, and the module number (for example, “RHall Module1.pptx”). Additionally, because a good presentation has few words on the slides include a script with the verbiage you would say when presenting; script should be a minimum of 50 words per slide. Expert Answer and Explanation The core goal of this assignment is to identify common legal issues and ethical concepts in nursing and to explain how the selected issues and concepts influence or hinder nursing practice. Also, the presentation seeks to determine the implications of these issues and concepts to the quality of patient outcomes and healthcare institutions, to develop policy proposals that have measures and recommendations that could impact nursing practices positively, and to show how the identified policies ad proposals improve the quality of patient care and promote thriving in the institutions The common ethical and legal issues in nursing include Malpractice and Negligence; Patient confidentiality; Informed consent; DNR orders; Physician-assisted Suicide; Access to care Each of these issues affect the ability of physicians to deliver quality care to the patients, while respecting the idea of patient-centered and holistic care. Other ethical issues that may not be discussed in detail herein include Equity of Resources, Conflict of Interest, Ethics of Privatization, Opposite sex issues, and Patient Rights Patient confidentiality is one of the core ethical issues in the nursing settings, and it mainly affects some stakeholders such as patients, nurses, and patient families (Dove et al., 2019). Doctors who violate patient confidentiality could have legal consequences. The Health Insurance Portability and Accountability Act (HIPPA) requires healthcare givers to protect the security and privacy of medical records of patients However, gray areas in the HIPPA such as the idea of having more harm after failing to disclose the patient information could lead to loopholes in the issue Medical malpractices and negligence among healthcare givers is one of the ways in which individuals get medical errors. Medical errors, on the other hand, are common in all hospitals and in the US, they serve as the third leading cause of death, which makes it an issue of urgency (Papavramidou & Voultsos, 2019). In some of the facilities, negligence is cased by the absence of the proper tools of care, where the physicians can barely work to the patient expectations because of things such as delays in diagnosis and also defective medical equipment (Rynecki et al., 2019). Do-Not-Resuscitate (DNR) orders instruct healthcare providers not to perform CPR on patients if their heart stops beating. Patients who perform such requests have the intention of reducing the amount of suffering they may have to face if they are allowed to live in critical condition (Osinski et al., 2017). Accepting DNR orders is a way of patient-centered care as it upholds the individual patient interests. When capacitated patients are asked to choose DNR, there are numerous ethical issues that arise, and the physicians involved could face prosecution Physician Assisted Suicide refers to the action of physicians helping terminally-ill patients to end their life by things such as removing life support during their stay in the hospital. Legalizing PAS in the US is dependent on the individual state laws. One of the conditions in the PAS is that the patients should be terminally ill, and those who have acute illnesses that are disturbing have to receive extensive scrutiny before the PAS. An ethical issue that arises in PAS is that States that are against PAS argue that it could create pressure on terminally ill patients to remove the disease burden for their families. Access to care is a common issue that faces patients, especially those from vulnerable communities such as homeless individuals. Insurance coverage is one of the most campaigned for healthcare issues (Shenoy & Appel, 2017). One in five people who are uninsured do not seek medications on the basis of lack of funds, and this is a worrying statistic Emergency departments, on the other hand, are expensive for all patients who are not insured, as the basic routine care could cost them over $900. the WHO argues that health facilities should work on reducing the administrative costs and overall prizes. Policy changes are the solution to solving the challenges associated with the issues and concepts. Foundations of policy proposal lie on assessing the individual values of the healthcare organizations (McRae, 2017). The development of ethics programs may be limited by present
[ANSWERED] Prepare a 1000-1250 word paper that presents your assessment and proposes a strategic plan to ensure readiness. Include the following
Prepare a 1000-1250 word paper that presents your assessment and proposes a strategic Research a health care organization or network that spans several states with in the United States (United Healthcare, Vanguard, Banner Health, etc.). Assess the readiness of the health care organization or network you chose in regard to meeting the health care needs of citizens in the next decade. Prepare a 1000-1250 word paper that presents your assessment and proposes a strategic plan to ensure readiness. Include the following: Describe the health care organization or network. Describe the organization’s overall readiness based on your findings. Prepare a strategic plan to address issues pertaining to network growth, nurse staffing, resource management, and patient satisfaction. Identify any current or potential issues within the organizational culture and discuss how these issues may affect aspects of the strategic plan. Propose a theory or model that could be used to support implementation of the strategic plan for this organization. Explain why this theory or model is best. 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. Expert Answer and Explanation Health Organization Evaluation One of the primary goals of healthcare organizations is providing different patient care and clinical services that are geared to eradicating some of the most common healthcare problems. In the recent few years, numerous technological developments have provided a window of improvement of healthcare organizations in their processes of delivering care to the citizens. Banner health is one of these organizations that serve as core contributors to the health and wellness of Americans (Kash, 2016). This essay explains some of the elements that show the readiness of Banner health in meeting the demands of citizens in the forthcoming decade. Whereas the organization is faced with different issues that negatively affect the organizational culture and operations, the application of PEST theory in managing the issues can help to align the organization to the right framework for delivering the objectives of care through the next decade. Description of the Organization Banner Health is a non-profit healthcare organization in the US that operates in different states offering health services ranging from rehabilitation, primary care, labs, long-term care, hospice, and hospital care. The history of the organization starts in 1999 when Samaritan Health System and Lutheran Health Systems merged to form one entity that operated in 14 states (Kash, 2016). Besides offering healthcare to populations, the organization offers teaching services, with the main institution being the Banner-University Medical Center, Phoenix. Also, it operates Medicare Advantage, and insurance plan called University Care Advantage and also a family based care called the Banner University Family care. The organization is impactful in some states more than others, such as in Arizona where it has more than 50,000 employees at present. The senior management of the organization, led by the President and CEO (currently Peter S. Fine), is the initiator of the major decisions throughout the organization (Sharma, Fleischut, & Barchi, 2017). Readiness of the Organization based on Evaluation The organization is ready to meet the rising healthcare demands of citizens in the next decade as it has been incorporating programs that allow efficient care in the light of the emerging technology. In 2006, the organization launched a telemonitoring program in which it extended patient care operations beyond the healthcare facilities (Sharma, Fleischut, & Barchi, 2017). One of the primary effects of this program was saving over 34,000 ICU days and reducing the mortality rates by a significant percentage (Sharma, Fleischut, & Barchi, 2017). Also, telemedicine operations reduced the overall length of stay in facilities and helped to boost the cost control operations. Specifically, organizations under Banner health would now spend less in the patient care operations and hence would optimize the costs of care to patients. Since the implementation of telemedicine, it is clear that there are many other technological developments that have helped banner health to achieve its current status (Pandian, 2016). Also, it is likely that it will be a pioneer in implementation of even higher forms of technology in primary care such as virtual reality and artificial intelligence, and hence it is generally ready to meet the healthcare demands in the coming decade. Another element that shows the readiness of the organization in meeting the upcoming healthcare demands is the culture of acquisition. In 2014, the organization acquired Casa Grande Medical Center, and in July 2020, it acquired Wyoming Medical Center. These acquisitions are valuable to the organization as they add to the overall productivity through direct injection of skills and resources to the present organization (Kash, 2016). In 2016, for instance, acquiring 32 of the urgent care facilities in Arizona left the organization almost as a monopoly of healthcare provision in the state, hence limiting the overall competition it faced. A continuous culture of acquisition is likely to make the organization reduce the hindrances of growth such as unhealthy competition and scarcity of skills through the next decade. The last element that shows the organization’s readiness to meet the healthcare demands in the next decade is the health education affiliation. While most of the healthcare organizations recognize the need for constant research and improvement of operations, very few of them get to the ground to produce results (Cairns, Bollinger, & Garcia, 2017). Most organizations tend to use knowledge that has been generated by other operators. For banner health, the present partnerships with different learning institutions serve as a core element of growth in the operations through the next decade. Strategic Plan to address issues within the Organizational Culture One of the issues that have negatively affected the organizational culture is the presence of data breaches and cyber-attacks. In 2016, banner health was caught in a security breach that exposed information of over three million patients and employees. If not addresses tactically, the issue can
[ANSWERED 2023] In the realm of marketing, a successful branding strategy is one of the most important contributors to organizational success. A solid branding strategy can help add visibility
In the realm of marketing, a successful branding strategy is one of the most important contributors to organizational success. In the realm of marketing, a successful branding strategy is one of the most important contributors to organizational success. A solid branding strategy can help add visibility and credibility to a company’s products. Similarly, nurse-scholars can build a personal brand to add visibility and credibility to their work. You can begin building your brand by developing and maintaining an academic portfolio. Such an activity can help share the results of your efforts and contribute to your success. This Module’s Discussion asks you to consider and share strategies for building your portfolio. Note: Unless otherwise noted, initial postings to Discussions are due on or before Day 3, and response postings are due on or before Day 6. You are required to participate in the Discussion on at least three different days (a different day for main post and each response). It is important to adhere to the weekly time frame to allow others ample time to respond to your posting. In addition, you are expected to respond to questions directed toward your own initial posting in a timely manner. To Prepare: Reflect on strategies that you can pursue in developing portfolios or portfolio elements that focus on academic achievements. Review one or more samples from your own research of resources focused on portfolio development. By Day 3 of Week 8 Post an explanation of at least two strategies for including academic activities and accomplishments into your professional development goals. Then, explain how those goals may align with the University’s emphasis on social change. Be specific and provide examples. By Day 6 of Week 8 Respond to at least two of your colleagues’ posts by offering additional ideas regarding academic achievements to include or offering alternative ways of presenting the current achievements. Rubric Detail Select Grid View or List View to change the rubric’s layout. Name: NURS_6003_Module05_Week08_Discussion_Rubric Excellent Good Fair Poor Main Posting 45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. 40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. 35 (35%) – 39 (39%) Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors. 0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style. Main Post: Timeliness 10 (10%) – 10 (10%) Posts main post by day 3. 0 (0%) – 0 (0%) 0 (0%) – 0 (0%) 0 (0%) – 0 (0%) Does not post by day 3. First Response 17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. 15 (15%) – 16 (16%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. 13 (13%) – 14 (14%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. 0 (0%) – 12 (12%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited. Second Response 16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Responds fully to questions posed by faculty. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. 14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. 12 (12%) – 13 (13%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no
[SOLVED 2023] Developing employees through the implementation of training and development opportunities
Developing employees through the implementation of training and development Unit IV Essay Developing employees through the implementation of training and development opportunities is a primary function of human resource management (HRM). Performance measurement and appraisals are one way to determine what type of additional training is needed to ensure employee success. Imagine that you have been hired as the human resource manager at an organization where you have previously worked or are currently working. Your first task is to assess areas for improving training and development and the performance appraisal system within the organization. Write an essay on your analysis of these two areas. Address the questions below in your assignment. Use headers to organize your paper and show what you are covering in your assignment. Training and Development Analysis What are the steps of the new hire training process? Are there any steps missing that you would add? As the human resource manager, how would you evaluate the training needs of your staff? How can you ensure that the training you would provide is effective? What data might be used to make your conclusion? What considerations would you make for employee learning styles? How would future training and development be impacted through human resource planning? Do you have a plan to shape employee behavior within your organization? Why, or why not? Performance Appraisal Analysis As the human resource manager, what are two best practices you would follow when planning for employee performance appraisals? What performance methods would you choose over other methods? What are two of the common problems with appraisals? How would you avoid them in your organization? What components do you think are required for effective human resource planning? Be sure to include an introduction. Support your essay with a minimum of two references. Your essay must be at least two pages in length, not counting the title or reference pages. Adhere to APA style when constructing this assignment, including in-text citations and references for all sources that are used. Please note that no abstract is needed. EXPERT ANSWER AND EXPLANATION Unit IV Essay In my former job, a thorough process was put in place to ensure that all new hires were conversant with the organizational culture and their tasks. Observably, the company invested a lot of time and resources in training new workers, and it was clear to see the results through the high performance of the workers. However, if I was rehired in the organization, there are different aspects of the process I would change to make it more accommodating to different employee skills. Training And Development Analysis Steps Of The New Hire Training Process The first step in the organization was to identify the training needs of the employees. The needs were mainly gotten from the job requirements. After identifying the needs, the employees were trained on how to perform them and how they can ensure they abide by the organization’s structure. After the training, the employees are given various tasks to complete post-training, and any questions asked are answered (Amegayibor, 2021). In training, I would add the importance of being innovative in the job to encourage evidence-based practice. How I Would Evaluate The Training Needs Of The Staff As a human resource manager, I would evaluate the training needs of the staff by observing their performance. There needs to be retraining in areas where employees do not perform well or as expected. Moreover, it is essential to constantly train employees, especially when there is a system change at the workplace (Amegayibor, 2021). This ensures that they can adapt to the changes efficiently and effectively. I would also evaluate the needs by asking them what they need more training on, as this would guarantee increased productivity on the issue. How To Ensure That The Training Is Effective To ensure the training is effective, I would collect data on their previous and later performances. If there is no improvement in the performance, I would know that the training was unsuccessful. However, if there were positive changes in the performance, I would know that the training is practical. Considerations For Employee Learning Styles Employees have varying learning styles, and incorporating them ensures that they can all understand what is needed in their performance. To ensure that all employees are included, Io would have varying options, including visual, audio, kinesthetic and reading. The employees would choose their preferred training method for better success. Plan To Shape Employee Behavior It is crucial to shaping employee behavior to ensure that it is in line with the goals and organizational structure of the company. Some employees tend to be arrogant, especially if they consider themselves good at their job (Mahadevan & Yap, 2019). I would shape their behavior to ensure that they are always ready to cooperate in their workplace. Performance Appraisal Analysis Two Best Practices When Planning Employee Performance Appraisal In a performance appraisal, a company can understand how the employee has contributed to the company’s development. One commendable practice in performance appraisal is creating a 360-degree feedback initiative. Through the initiative, employees get anonymous feedback from their coworkers, managers and other people they interact with (Hosain, 2016). Through the feedback, they can determine how their performance was and areas of improvement. It is, however, important to only use measurable numbers because of the employee does not get along with a coworker, they can quickly receive a negative review. Another practice is providing concrete examples of the performance. It is important to highlight both the positive areas and the areas that need improvement. This will ensure that the employee perceives the change positively, and while they are proud of their achievements, they are willing to work on improving various areas of performance. Why I Chose The Performance Methods Over Other Methods The two methods discussed are integral to understanding the employee’s performance in real-time. Employees can keep up a face of good performance to the managers, but the people interacting with the employee daily understand the actual performance (Hosain, 2016). By
[ANSWERED 2024] Using the criteria below (and explained in greater detail on pages 39 and 40), assess the potential organizational barriers to care in your work environment. Explore ways to decrease barriers
Using the criteria below (and explained in greater detail on pages 39 and 40), assess the Conduct an assessment of the health care environment where you work (i.e. health department, long-term care facility, specialty clinic, inpatient hospital, etc). Specifically, examine potential barriers that may exist for a member of a minority group that has a significant presence in your community (i.e. Native American, Cubans, Hmong). Using the criteria below (and explained in greater detail on pages 39 and 40), assess the potential organizational barriers to care in your work environment. Explore ways to decrease barriers to health care for this minority group so that your organization can strive for cultural competency. Write a 3-4 page APA essay, using two scholarly sources in addition to the textbook. Availability Accessibility Affordability Appropriateness Accountability Adaptability Acceptability Awareness Attitudes Approachability Alternative practices and practitioners Additional services Required source: Purnell, L., & Paulanka, B. (2013). Transcultural health care: A culturally competent approach (4th ed.). Philadelphia: F. A. Davis. Expert Answer and Explanation Analysis of Barriers to Access to Care Barriers within the organization can impede access to care for the Native American Indians, and these barriers can manifest in inpatient setting where the caregivers have to closely monitor patients. These challenges range from discrimination to an organizational culture that is unsupportive of the needs of the patients. Patients in the inpatient settings require monitoring, and caregivers have to equally distribute resources and time to each patient to address the patients’ medical needs. Because of discrimination, however, it becomes a challenge for the Native Americans to enjoy the same quality and amount of care like non-minority populations (Levesque, Harris, & Russell, 2013). Taking into consideration these organizational issues, it is important to look at challenges based on the various dimensions including the availability, accessibility, and affordability. Organizational Barriers Native Americans face in Inpatient Hospital Availability The organization-based challenges the Native Americans grapple with include the lack of medical opportunities. The lack of awareness on who to contact when they need to access medical services is inherently a problem that this group faces. This is a barrier because it limits access to care by hampering the capacity of this group from getting information which could be pertinent to accessing treatment, especially in the inpatient setting (Purnell, L., & Paulanka, 2013). Accessibility Accessibility is also a problem that Native Americans grapple with. This issue occurs because majority of the hospitals in areas where the Native Americans live only provide outpatient services. This poses the problem of access of care in inpatient setting for this population (Levesque et al., 2013). Affordability The insurance firms offer various packages at different prices, and for the Native Americans, affording these packages can be a challenge. This is because this group is economically disadvantaged, and majority of them faces the burden of the rising premiums. Even informal payments can be high for this group, and considering the inpatient setting where costs accumulate with time, paying for care in this context can be a burden. Appropriateness The appropriateness of care is another dimension in which the barriers to accessing health services are noticeable. For instance, some caregivers pay less attention to the cultural and spiritual needs of the Native American patients. For this reason, this group faces difficulties accessing a care that is culturally competent. Another issue under this dimension is that caregivers pay limited attention to the coordination of care with other providers, and this causes the duplication of resources, and the burden of cost goes to the Native Americans (Weinstein et al., 2017). Accountability For the indigenous Americans, accessing accountable care can be a challenge considering that issues such as harm related to negligence or unsafe clinical practices tend to risk the health and lives of this group. When caring for patients from this population, caregivers may not address the need of this group with much seriousness as they would with non-minority populations. This poses a significant risk to these indigenous Americans. Adaptability A sizable number of Indigenous Americans are highly spiritual, and according to this group, the interventions from the spiritual world can help one attain holistic healing. For providers, reconciling these beliefs with the doctrines of the modern care can be a challenge. Thus, adapting care to meet the spiritual and cultural needs of this population can be problematic for caregivers. Acceptability The challenges involving access to care also manifest in acceptability of the cultures and values of the Indigenous Americans. For a provider who identifies as a Christian, accepting the traditions and norms of the Ingenious American populations can be difficult because of the rituals associated with the group’s spiritual activities. Because accepting these traditions can be a challenge for providers, it can be difficult to provide culturally sensitive care to the Native Americans. Awareness An organization may not have effective structures of communication to communicate health information that is pertinent to the advancement of the health care for the American Indians. Lack of translators in a medical facility can create a communication barrier, and this can further make it difficult to help the patient be aware of how they can participate in treatment (Gurr, 2015). Attitudes In some instances, caregivers may have negative attitudes towards the cultures which they don’t identify with, and this negative attitude can have negative impact on the way they interact with patients from different cultures. This is one of the core issues which the American Indians struggle with. Approachability, Alternative Practices and Practitioners and other Services Because of the negative views they attach to other cultures, caregivers may make it difficult for Native American patients to approach them. The thought of the possibility of the caregiver not accepting to integrate the beliefs of a Native American patient into care can cause the patient to shy off from seeking treatment. Negative views attached to alternative health services can hamper the efforts focused on prescribing patients alternative solutions to care. Mechanisms of Mitigation of the Barriers for Native Americans Providers have the mandate to mitigate the barriers and provide the fair
[ANSWERED 2024] Your international business expansion plan should include the concepts and ideas that were covered over the past several weeks. You are to select a country that does not recognize all of the established
Your international business expansion plan should include the concepts and ideas that were Over the past several weeks, you have been learning about the various issues surrounding the challenges and numerous situations that exist legally that differ from those of the United States. You have been placed in charge of the Business Development and Expansion committee for your company. You are charged with the task of researching and identifying a country to expand your company’s operations. Take the feedback from the Phase 4 DB into consideration, and make any additions or deletions as you deem necessary. Your international business expansion plan should include the concepts and ideas that were covered over the past several weeks. You are to select a country that does not recognize all of the established legal guidelines reviewed previously, but the potential profit that could be realized warrants the risk. The following points need to be addressed in your international business expansion plan: The issue of common and civil law systems internationally Intellectual property, copyright infringements, and legal ramifications Violation of human rights of employees and child labor law violations Public perception of companies doing business with companies that engage in that kind of activity What has been the impact of the European Union of the business environment? Anything else that you deem important to support your international business expansion plan Expert Answer and Explanation Organizations and Globalization Common and International Civil Laws Globalization is one of the common aspects that companies aspire to attain after growing or when planning for international business. The identified and selected country that is essential for business expansion in China. China as a country has various laws and regulations but does not fully recognize all of the established legal guidelines (Sinagra, & Valvo, 2019). These create discrepancies in terms of employment rights and regulations. The availability of cheap labor and a high employee force has resulted in reduced adherence to employment rules and regulations. However, the country also has among the largest population in the world and better infrastructure to facilitate the production of goods and services (Brander, Cui, & Vertinsky, 2017). The availability of a ready market, use of technology to market and make sales is also a key benefit from the country which has the potential to improve profit realization. Legal Law Violation China as a country pays little to no consideration to violations of entities such as copyrights, intellectual property, and other forms of infringement. The country is arguably the number one producer of counterfeit products in the world. For instance, the high level of counterfeit products in China led to Windows operating system to provide usable systems without the need of keys as they could not be able to prevent the counterfeit or creation of image versions of the product (Gruffydd-Jones, 2019). However, there are laws on the issue and are being enforced on specific products. Violation of Human Rights and Public Perception China has a huge population with cheap labor for the market. While there is no violation of human rights, there are other cases regarding poor payment, unconducive working environments, minimal to know employee motivation, and challenges with employer provided insurance (Lewis, 2016). The availability of cheap labor will be beneficial to the expansion of the company as the additional proceeds can be used to provide insurance to the employees and attract qualified candidates while at the same time preventing turnover. Through international business expansion, the company can ensure that future employees are accorded better working environments, competitive compensation, and are insured against work-related injuries. These elements can improve employee motivation and increase the attainment of the goals and mission of the company. The implementation of improved working environments and better compensation can improve the perception of the public concerning the nature of the company. Being a foreign land, proper engagement with the locals, and offering better conditions can improve the correlations, sales, and marketing of the products (Chong, 2020). In a country where there are numerous counterfeit goods, focusing on quality products and ensuring they meet the needs standards is a positive development for both the company and towards the perception of the public. Impact of the European Union on Business Environment The EU has been at the forefront in ensuring that countries trade with each other in an orderly manner without discrimination and infringement on items of goods. The creation of a standard form of business and understanding between the member countries is a key focus on the EU in ensuring better collaboration and shared resources (Tomaš, & Radovic-Markovic, 2018). The EU also oversees the issues of conflict resolution to ensure that there is limited to no issues between the member states and the business operations are conducted expectedly. A company that seeks to attain globalization can become part of the EU and the host will accommodate the company in line with the regulations articulated by the treaty. References Brander, J. A., Cui, V., & Vertinsky, I. (2017). China and intellectual property rights: A challenge to the rule of law. Journal of International Business Studies, 48(7), 908-921. Chong, A. (2020, December). Bridging the common law-civil law divide? The 1985 Trusts Convention. In The Elgar Companion to the Hague Conference on Private International Law. Edward Elgar Publishing. Gruffydd-Jones, J. J. (2019). Citizens and condemnation: Strategic uses of international human rights pressure in authoritarian states. Comparative Political Studies, 52(4), 579-612. Lewis, M. K. (2016). Human rights and the US-China relationship. Geo. Wash. Int’l L. Rev., 49, 471. Sinagra, A., & Valvo, A. L. (2019). Internal Law and International Law: From Common Law To Civil Law. author proofs, 17. Tomaš, R., & Radovic-Markovic, M. (2018). Development of Small Countries in the Business Environment of the European Union. Transylvanian Review of Administrative Sciences, 14(53), 84-106. Place your order now on the similar assignment and get fast, cheap and best quality work written from scratch by our expert level assignment writers. FAQs Five factors that should be considered before making the decision to expand internationally Expanding a business internationally can bring new opportunities and growth potential, but it’s also a significant investment
[ANSWERED 2024] Briefly discuss the various organizational structures and share which one of these structures you would like to work in and why?
Briefly discuss the various organizational structures and share which one of these Question 1: When you think of the term Healthcare System what comes to your mind and why. Question 2: Describe the general involvement of hospitals from “warehouses for the dying” to institutions dedicated to healing and welfare of people. Question 3: Share your understanding of “Medicare Managed Care.” Question 4: Many, if not all health services organizations, have organizational structures and portals of care. What is your understanding of patient portals? Briefly discuss the various organizational structures and share which one of these structures you would like to work in and why? Expert Answer and Explanation When you think of the term, “Healthcare System,” what comes to your mind and why. When I think of the term “healthcare system,” several different aspects come to mind. First and foremost, I think of the various organizations and professionals that make up the healthcare system, such as hospitals, clinics, doctors, nurses, and other healthcare providers (World Health Organization, 2020). These individuals and institutions are responsible for providing medical care and treatment to individuals in need, whether it be through in-person visits, telemedicine appointments, or other means. I also think of the various policies and regulations that govern the healthcare system, such as insurance coverage, reimbursement rates, and quality standards (Centers for Medicare & Medicaid Services, 2020). These policies and regulations can have a significant impact on the accessibility and affordability of healthcare for individuals, as well as the overall quality and efficiency of the healthcare system. Finally, I think of the ongoing challenges and issues facing the healthcare system, such as rising costs, access to care, and disparities in healthcare outcomes (Centers for Disease Control and Prevention, 2021). These challenges highlight the need for ongoing efforts to improve the healthcare system and address the needs of all individuals, regardless of their socio-economic status or other factors. Overall, the healthcare system is a complex and multifaceted entity that plays a vital role in the health and well-being of individuals and communities. It is constantly evolving and adapting to the changing needs of society, and it will continue to be an important topic of discussion and debate in the years to come. References Centers for Disease Control and Prevention. (2021). Health Equity. Retrieved from https://www.cdc.gov/healthequity/ Centers for Medicare & Medicaid Services. (2020). Health Insurance Marketplace. Retrieved from https://www.healthcare.gov/ World Health Organization. (2020). Health Systems. Retrieved from https://www.who.int/topics/health_systems/en/ Describe the general involvement of hospitals from “warehouses for the dying” to institutions dedicated to healing and welfare of people Historically, hospitals were often viewed as “warehouses for the dying,” where individuals with serious illnesses or injuries were sent to receive medical care and treatment (Blumenthal, 2020). These early hospitals were often overcrowded, unsanitary, and lacking in basic amenities, and they were not always able to provide the best possible care for their patients (Blumenthal, 2020). However, over time, hospitals have evolved and transformed into institutions that are dedicated to the healing and welfare of people. Today’s hospitals are typically well-equipped and staffed with trained professionals who are committed to providing the highest quality of care to their patients (Blumenthal, 2020). They often offer a wide range of medical services and treatments, including preventive care, diagnostic testing, surgery, and rehabilitation, as well as support services such as nutrition, social work, and spiritual care (American Hospital Association, 2020). In addition to providing medical care, many hospitals are also actively involved in the wider community, working to address public health issues and promote the overall well-being of the people they serve (American Hospital Association, 2020). For example, hospitals may partner with local organizations to provide health education, screenings, and vaccination clinics, or they may participate in disaster preparedness and response efforts (American Hospital Association, 2020). Overall, the role of hospitals has changed significantly over time, and they are now widely recognized as important institutions that play a vital role in the health and well-being of individuals and communities. References American Hospital Association. (2020). Hospitals in Your Community. Retrieved from https://www.aha.org/advocacy-issues/local-hospitals Blumenthal, D. (2020). The History of Hospitals: From Ancient Times to Modern Medicine. Retrieved from https://www.medicalnewstoday.com/articles/323705 Share your understanding of “Medicare Managed Care.” Medicare managed care is a type of health insurance plan that is offered through Medicare, the federally funded healthcare program for individuals who are 65 and older or who have certain disabilities (Centers for Medicare & Medicaid Services, 2020). In a Medicare managed care plan, enrollees receive their healthcare services through a network of providers that is managed by a private insurance company (Centers for Medicare & Medicaid Services, 2020). These plans may include additional benefits and services beyond those offered through traditional Medicare, such as prescription drug coverage and preventive care services (Centers for Medicare & Medicaid Services, 2020). There are several types of Medicare managed care plans, including HMOs (health maintenance organizations), PPOs (preferred provider organizations), and Medicare Advantage plans (Centers for Medicare & Medicaid Services, 2020). Each type of plan has its own unique features and benefits, and enrollees can choose the plan that best fits their needs and preferences (Centers for Medicare & Medicaid Services, 2020). One of the main benefits of Medicare managed care is that it can provide more predictable and stable healthcare costs for enrollees, as the insurance company negotiates rates with providers and sets copayments and deductibles (Centers for Medicare & Medicaid Services, 2020). However, it is important to note that Medicare managed care plans may have more restrictive networks and require enrollees to choose a primary care provider, which can limit their access to certain providers and services (Centers for Medicare & Medicaid Services, 2020). Overall, Medicare managed care is a popular option for individuals who are enrolled in Medicare and are looking for a more coordinated and comprehensive approach to their healthcare. Reference Centers for Medicare & Medicaid Services. (2020). Medicare Managed Care. Retrieved from https://www.medicare.gov/manage-your-health/medicare-managed-care Many, if not all health services organizations, have organizational structures and portals of care. What is your understanding
[SOLVED 2024] There are several standardized training events in large organizations that are required annually or biannually. One of these is often sexual harassment. For this assignment
There are several standardized training events in large organizations that are required UNIT VI: Instructions There are several standardized training events in large organizations that are required annually or biannually. One of these is often sexual harassment. For this assignment, write a training plan for all employees in your firm to educate and develop their awareness of sexual harassment and understanding of legal and organizational policies. Be sure to include training aspects of planning, design, implementation, and evaluation. This plan should be in narrative form with a minimum requirement of 500 words. Discuss the following guidelines to complete your plan. Planning: Should all employees be trained at once? If not, who should be trained first? What are the anticipated outcomes or terminal learning objectives of the training? Design: In what format should the training be given, and why? What modalities will be used for employees on multiple shifts or in multiple locations? What are the core elements of the training that will align with the learning objectives? Implementation: Who will lead the training, and how will it be implemented? Will you be training for knowledge or behavior change? How will you conduct the actual training to account for knowledge and/or behavioral change? Evaluation: How will you know if the training was successful? What measures will you use to know if employees 1) learned from the training, 2) behaved differently after the training, and 3) the training has a bottom line impact to the firm? Any sources used, including the textbook, must be referenced; paraphrased and quoted material must have accompanying citations in APA format. Expert Answer and Explanation Training Plan Planning Before carrying out the sexual harassment training program, it is essential to identify the learning objectives that the employees are required to be aware of at the end of the session. At the end of the training program, all the employees are expected not to discriminate each other based on gender on issues like the failure of the manager to promote a worker due to decline on sexual advances. Also, the employees are expected to avoid indecent exposure through putting on clothes that expose private body parts, avoid stalking each other, and making obscene and threatening communications either through phones, emails, letters, and text messages. The training program should be done through shifts starting with the company executives, managers and key stakeholders then followed by the field employees. The executives act as the role model to the employees and change should start with them. Design The learning format should involve classroom training where the trainees come together, and the instructor shares the sexual harassment ethics. Use of classroom ensures that the employees have a proper learning environment that is safe, quiet and clean thus increasing understanding (Silberman and Biech, 2015). Modalities in the training program can be done through the use of instructor-led and virtual stimulation learning. The instructor-led training method enables the employees to receive feedback on their questions thus enhancing in-depth knowledge. Use of virtual stimulation allows the trainees to virtualize the behaviors of the actors; thus, able to make a situational judgment about themselves. The availability of training materials that cover topics on workplace sexual harassment is likely to be aligned with the objectives. Inclusively, the availability of training objectives, having professional trainers, and effective evaluation are essential elements in the achievement of goals. Implementation A professional on sexual harassment will be hired to carry out the training program. The implementation will involve the establishment of the training goals by looking at the objectives set by the company. Determination of the training modalities then follows through consideration of the learning needs and the easiest way of increasing understanding and creating awareness. The trainers then engage with the employees through the provision of the learning experiences like providing inspirational speech and coming up with the winning concepts. Time of training should be appropriate to ensure no employee is left out. Follow up activities are necessary to ensure the workers adopt the knowledge and behaviors from the training (Lacerenza et al., 2017). The training will be driven towards changing the character and imparting knowledge to the employees. This will be achieved through the instructor-led training that passes expertise and information on sexual harassment. The use of virtual simulation enables the employees to change their behavior through situational assessment. Evaluation The success of a training program will be known by looking at the training outcomes such as changes in the behavior, response to questions asked by the instructor, and the learning takeaways. Knowing whether the employees learned from the training needs checking the key takeaways that are linked with the objectives provided at the beginning of the training. The application of the training knowledge and behaviors in the learning program can be a useful tool in the determination of changes in behavior. A complete transition of sexual behavior of the employees within a firm is likely to be evident by increased customer relation, reduced interpersonal conflicts, regular promotions, and reduced problems associated with the labor union. References Lacerenza, C. N., Reyes, D. L., Marlow, S. L., Joseph, D. L., & Salas, E. (2017). Leadership training design, delivery, and implementation: A meta-analysis. Journal of Applied Psychology, 102(12), 1686. Silberman, M. L., & Biech, E. (2015). Active training: A handbook of techniques, designs, case examples and tips. John Wiley & Sons. Place your order now on a similar assignment and get fast, cheap and best quality work written by our expert level assignment writers. FAQs Workplace harassment policy sample Here is a sample workplace harassment policy that can be adapted for use in different organizations: Purpose Our organization is committed to maintaining a work environment free of harassment, discrimination, and retaliation. This policy outlines our expectations for all employees regarding behavior in the workplace, and our procedures for addressing complaints of harassment. Scope This policy applies to all employees, contractors, and volunteers of our organization. It covers all aspects of employment, including hiring, training, promotion, and termination. Prohibited Conduct Harassment of
[2024] Episodic SOAP Note Template Example
Episodic SOAP Note Template Example Episodic Focused SOAP Note Template Patient Information: TMF, 23, AAF S. CC “I noticed that I have an odor down there” HPI: Patient presents to office for a follow up from her appt on 02/6/23 well woman gynecological visit in which her pap smear resulted: ABNORMAL ASCUS, HPV + but neg. for 16,18,45. Patient is scheduled on today’s date for a colposcopy. Patient also reports that for the past week she has been having a “fishy” vaginal odor. Denies discharge, pain or itching. Current Medications: EluRyng 0.12 mg-0.015 mg/24 hr vaginal ring INSERT 1 RING VAGINALLY AS DIRECTED. Exchange ring every 4 weeks. Ibuprofen 800mg Tablet Use prn pain q 8 hours. Take with food. azithromycin 500 mg tablet TAKE 2 TABLETS BY MOUTH EVERY DAY FOR 1 DAY Allergies: Patient denies allergies to food or medicine PMHx: . Atypical squamous cells of undetermined significance – Onset: 02/10/2020 Vaginitis – Onset: 08/17/2022 – ureaplasma and AV organisms COVID-19 – Onset: 03/17/2020 HPV – Human papillomavirus test positive – Onset: 03/23/2018 – neg.16,18,45 Genital herpes simplex – Onset: 03/18/2018 Chlamydia –Onset: 03/18/2018 Soc & Substance Hx: Are you blind or do you have difficulty seeing?: No Are you deaf or do you have serious difficulty hearing? No Do you have difficulty concentrating, remembering or making decisions? No Do you have difficulty walking or climbing stairs? No Do you have difficulty dressing or bathing? No Do you have difficulty doing errands alone? No Diet and Exercise What type of diet are you following? Regular What is your exercise level? None Other Education: 12 History of inconsistent/no condom use: Yes Marital status: Single General stress level: Low Education and Occupation What is the highest grade or level of school you have completed or the highest degree you have received? High school graduate Are you currently employed? Yes What is your occupation? server/ leasing consultant Substance Use Do you or have you ever smoked tobacco? Never smoker How much tobacco do you smoke? None How many years have you smoked tobacco? NA Do you or have you ever used any other forms of tobacco or nicotine? No Do you or have you ever used e-cigarettes or vape? Never used electronic cigarettes Do you or have you ever used smokeless tobacco? Never used smokeless tobacco What was the date of your most recent tobacco screening? 02/06/2023 What is your level of alcohol consumption? Moderate (Notes: 1-3 times a week couple of drinks) Do you use any illicit or recreational drugs? Yes Which illicit or recreational drugs have you used? Cannabis What is your level of caffeine consumption? Occasional (Notes: 1 8-12oz coffee daily) Advance Directive Do you have an advance directive? No Is blood transfusion acceptable in an emergency? Yes Marriage and Sexuality What is your relationship status? Single Are you sexually active? Yes Public Health and Travel Have you been to an area known to be high risk for COVID-19? No In the 14 days before symptom onset, have you had close contact with a laboratory-confirmed COVID-19 while that case was ill? No In the 14 days before symptom onset, have you had close contact with a person who is under investigation for COVID-19 while that person was ill? No Lifestyle Do you feel stressed (tense, restless, nervous, or anxious, or unable to sleep at night)? Not at all Do you use your seat belt or car seat routinely? Yes Home and Environment Do you have smoke and carbon monoxide detectors in your home? Yes Are there any guns present in your home? No Do you use sunscreen routinely? Yes Gender Identity and LGBTQ Identity Gender identity: Identifies as Female Assigned sex at birth: Female Pronouns: she/her Sexual orientation: Straight or heterosexual Fam Hx: No children Father- No medical concerns or disabilities Mother-No medical concerns or disabilities Maternal Grandmother- DMII Maternal Grandfather- Medical hx unk Paternal Grandmother- Medical hx unk Paternal Grandfather- Medical hx unk Surgical Hx: Tonsillectomy (stated it was more than 15 years ago) Mental Hx: No reports of depression, anxiety or SI Violence Hx: States that neighborhood is safe, no guns in the home and feels safe in her relationship Reproductive Hx: Duration of Flow (days): 5. LMP: Definite (Notes: 01/07/23-01/12/23). Frequency of Cycle (Q days): 28. Menses Monthly: N. Flow: Moderate (Notes: uses regular pads changes 6 in 24 hours). Age at First Child: 0. Age at Menarche: 12. Current Birth Control Method: Condoms (Notes: removed vaginal ring to give her body a break). Abnormal Pap: Y (Notes: ASCUS HPV not typed). Colonoscopy: (Notes: none). Date of Last Pap Smear: 02/06/2023 (Notes: HPV + 16,18,45-). Hormone Replacement Therapy: N. Most Recent Bone Density: (Notes: none). Most Recent Mammogram: (Notes: none). Sexual Problems?: N. Sexually Active?: Yes (Notes: last active date 02/15/2023). STIs/STDs: Yes (Notes: herpes, had chlamydia years ago. HAs HPV). Total (1) Full (0) Pre (0) AB.1 (0) AB.S (1) Ectopic (0) Living (0) Multiple (0) Spontaneous abortion at 10 weeks age 15 ROS: GENERAL: Denies weight loss, fever, chills, weakness, or fatigue. HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat. SKIN: No rash or itching. Breast-lumps, pain, discharge CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema. RESPIRATORY: No shortness of breath, cough, or sputum. GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood. NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control. MUSCULOSKELETAL: No muscle pain, back pain, joint pain, or stiffness. HEMATOLOGIC: No anemia, bleeding, or bruising. LYMPHATICS: No enlarged nodes. No history of splenectomy. PSYCHIATRIC: No history of depression or anxiety. ENDOCRINOLOGIC: No reports of sweating or cold or heat intolerance. No polyuria or polydipsia. GENITOURINARY: Denies burning on urination, frequency and urgency. Reports vaginal odor ALLERGIES: No history of asthma, hives, eczema, or rhinitis. O. Constitiutional: Patient A&O x4. No deviations in gait.