[ANSWERED 2023] Apply Guidos MORAL model to resolve the dilemma presented in the case study described in EXERCISE 4–3 (Guido textbook). How might the nurses in this
Apply Guidos MORAL model to resolve the dilemma presented Start by reading and following these instructions: Quickly skim the questions or assignment below and the assignment rubric to help you focus. Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully. Consider thecoursediscussions so far and any insights gained from it. Create your Assignment submission and be sure to cite your sources if needed, use APA style as required, and check your spelling. Assignment: Complete both case studies: Apply Guidos MORAL model to resolve the dilemma presented in the case study described in EXERCISE 4–3 (Guido textbook). How might the nurses in this scenario respond to the physician’s request? How would this scenario begin to cause moral distress among thenursingstaff, and what are the positive actions that the nurses might begin to take to prevent moral distress? 2. Read the case study entitled You be the Ethicist, presented at the end of Chapter 3 (Guido textbook). What are the compelling rights that this case addresses? Whose rights should take precedence? Does a child (specifically this competent 14-year-old) have the right to determine what will happen to him? Should he ethically have this right? How would you have decided the outcome if his disease state had not intervened? Now, examine the scenario from the perspective of health care policy. How would you begin to evaluate the need for the policy and the possible support or lack of support for the policy from your peers, nursing management, and others who might be affected by the policy? Do the 10 framework questions outlined by Malone in chapter 4 (Guido textbook) assist in this process? Create a process proposal for the organization with possible guidelines, procedures, and policies to address the issues you have identified. REQUIRED SOURCES: Guido, G. W. (2014). Legal and ethical issues in nursing (6th ed.). Upper Saddle River, NJ: Prentice Hall. (Chapter 3 and 4) Pozgar, G. D. (2013). Legal and ethical issues for health professionals (3rd ed.). Boston: Jones and Bartlett. (Chapter 1 and 4) Expert Answer and Explanation Ethical and Legal Issues in Nursing Professionals in nursing get faced with several ethical and legal issues in the course of carrying out their practice. Nurses experience different kinds of stress in their practice environment when dealing with different medical circumstances. Moral distress is a situation that occurs when a nurse gets confronted with two conflicting principles of ethics. For example, deciding between acting upon the patient’s wishes and what the nurse knows to be the best thing to do for the patient. This paper aims to discuss the ethical dilemmas with regard to moral distress and determination of rights. Case Study; Exercise 4-3 Nurses’ Response to the Physician’s Request In responding to the request of the physicians to the nurses for them to talk to the family of the patient about the transfer of the patient to another facility. The nurses are bound to experience uncertainty in their morals in which they are unsure about what the right course of action is based on the sentiments of the family and the patient’s medical history. The patient’s condition seems hopeless to the extent that she no longer recognizes family who as such, intended to stop visiting her. However, the nurses can follow the instructions of the physician, but the final decision gets made by the family since the patient lacks capacity. Link to Moral Distress among the Nursing Staff The nursing staff in the scenario would begin experiencing initial moral distress based on the fact that the physician and the family of the patient have different opinions of what should be done and the burden lies on the nurses to decide whose instructions to follow. The family of the patient have voiced their concerns on what the patient would have wanted with regard to the use of the ventilator support, which, according to them, the patient would never have accepted. Trying to convince the family to transfer the patient for advanced treatment with instructions from her primary physician would cause significant distress to the nursing staff because they would be caught between what the patient’s family want and what the physician thinks is right for the patient (Campbell et al., 2018). The physician has his reasons just like the patient’s family do, and as such, trying to convince the family otherwise would be a stressful task for the nurses. Positive Actions that the Nurses Might Begin to Take to Prevent Moral Distress Medical studies present several actions that the nurses in this kind of stressful scenarios can begin taking in a bid to manage moral distress. They may start by voicing their ethical concerns, which is something that should be allowed in their practice environment as this will allow them to cope better with such situations in future thus minimize the possibility of them experiencing moral distress (Guido, 2014). Raising their ethical concerns will help them to cope better with situations when they experience moral distress. The orientation programs for new nursing employees should include use of experts in ethics to provide them with information concerning moral distress to be discussed in settings that are neutral to educate them on identifying, understanding as well as making use of the available resources in the organization to prevent moral distress. Some of these resources may include making use of the services for counselling to help them understand what moral distress entails and how to manage it in the course of their practice (Lachman, 2016). The nurses can also begin by asking the healthcare organization to provide intervention programs for nurses to help them reduce moral distress. Case Study, You Be the Ethicist; Chapter 3 Compelling Rights Addressed by this Case This case addresses some rights that are compelling, with the most significant being the right to refuse treatment. After the nurses and physicians have exercised veracity by telling the patient the whole truth about his condition, then providing options for treatment and the expected outcomes, the patient is
[ANSWERED 2023] Each week contribute 150-200 words 1250-2,000 words total) to reflect and journal the professional practice, skills, and responses used in approaching or achieving the course
Each week contribute 150-200 words 1250-2,000 words total) to reflect and journal the professional Reflective Journal Learners must maintain a reflective journal integrating self-reflection and inquiry demonstrated in the current Doctor of Nursing Practice (DNP) course. General Requirements: Use the following information to ensure successful completion of the assignment: Download the \”Reflective Journal Template,\” located in the DNP PI Workspace, for submission. A minimum of three peer-reviewed references published within the last 5 years is required. Doctoral learners are required to use the current APA style for their essay writing assignments. The current APA Style Guide is located in the Student Success Center. This assignment uses a rubric. Review the rubric before beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Course Materials if you need assistance. Directions: Each week contribute 150-200 words 1250-2,000 words total) to reflect and journal the professional practice, skills, and responses used in approaching or achieving the course objectives in the course syllabus and the AACN Essentials Doctoral Education of Advanced Practice (2006). Describe examples of your accomplishments or challenges experienced while taking the course. Align at least three of the AACN DNP Essentials to these experiences as provided in the \”Reflective Journal Template.\” Discuss additional resources discovered and new abilities that have influenced more optimal learning outcomes in the course. Lastly, describe and conclude how the competencies were approached or accomplished in this course. In addition to personal reflections about the course, the journal must reflect on at least three of the following AACN DNP Essentials: Essential I: Scientific Underpinnings for Practice Essential III: Clinical Scholarship and Analytical Methods for Evidence-Based Practice Essential IV: Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care Essential V: Health Care Policy for Advocacy in Health Care Essential VI: Interprofessional Collaboration for Improving Patient and Population Health Outcomes Essential VII: Clinical Prevention and Population Health for Improving the Nation\’s Health Essential VIII: Advanced Nursing Practice Submit your reflective journal to both the course faculty using the course assignment dropbox and upload it into the Typhon Tracking System under the corresponding course section at the end of the course. Learners must submit this deliverable in Typhon and the LMS. Failure to submit in both locations can result in an Incomplete for the course. Expert Answer and Explanation Reflection The American Association of Colleges of Nursing (AACN) published the essentials of Doctoral Education for Advanced Nursing Practice last in 2006 (AACN, 2011). The essentials address the core foundational competencies in all ANP roles. However, the focus and depth of the essentials depend on the nursing role a student has partaken in. For instance, a student-focused on nursing leadership would improve their knowledge in systems and organizational leadership. DNP graduates should always reflect and document the essentials they have achieved in the course of their learning. The purpose of this assignment is to describe the essentials and reflect on how the course has helped achieve them. Achievements and Challenges I have achieved a lot since I started the course. One of the skills I have achieved in designing and evaluating quality improvement practices that can improve the target population’s health. Newman (2017) notes that the overall quality improvement in healthcare settings can improve the reliability and cost-effectiveness of healthcare delivery systems, thus enhancing patient outcomes. In my prospectus, I focused on improving the health of patients with diabetes and are obese. A study by Ahmed et al. (2017) showed that the readmission rate is high among patients with diabetes and are obese. Hence, my program aimed to help the patients improve their body weight and reduce readmission rates and other comorbidities related to obesity. I also improved my leadership skills during the course. The skills helped me design and advocate for various policies that impact the health of patients. I improved my communication skills which can help me further advocate for care policies. Thelen (2020) reports that communication is essential when it comes to policy advocacy. The author argues that nursing leaders should have proper communication skills to effectively communicate their policies to stakeholders. Another accomplishment is using nursing theories in improving patient care. I have learned various nursing theories that have improved my theoretical knowledge in nursing care. I learned that environment is a vital aspect of nursing care, and thus nurses should always ensure that healthcare settings contribute to the betterment of the patient health. Lastly, I have also accomplished much when it comes to the development and evaluation of research methodologies. I developed a research methodology for my DNP prospectus draft, which has improved my research methods knowledge. However, I also experienced challenges during the course. The main was analyzing data using SPSS. As a DNP graduate, I am supposed to know to analyze data using technological instruments. However, I found it so challenging to analyze data using SPSS. Another challenge was finding the right sources for my literature review. Resources Discovered and New Abilities I discovered various resources that I can use to improve patient care. One of the resources was the American Nursing Association. The ANA always publishes various resources that can be useful to nurses in the research and ANP sectors. The CDC is another vital resource I discovered in the course. It publishes resources about various diseases and innervations and can be vital for ANPs. AACN Essentials for DNP Essential 1: Scientific Underpinnings for Practice According to AACN (2011), the DNP program should apply terminal academic activities to prepare students for nursing practice. After the program, a nurse should know the laws and principles governing the well-being, life process, and optimal functioning of a human being when sick or well. The nurse should also know the nursing processes or actions used to positively affect changes in their health status after completing the program. I achieved this essential by learning various nursing theories that I would use to explain the functioning of human beings in either a healthy or sick state. One of the theories I have learned in the course is Environmental Theory by Florence Nightingale. According to
[ANSWERED 2022] Historians use different analytical methods to make sense of the past. Some focus on social and economic issues, such as class conflict or who profits from a particular policy choice
Historians use different analytical methods to make sense of the past. Some focus on social Debating the Annexation of the Philippines Historians use different analytical methods to make sense of the past. Some focus on social and economic issues, such as class conflict or who profits from a particular policy choice. Other historians focus more on culture to understand how ideas, values, and beliefs have shaped the actions of historical figures. For this assignment, we will examine how different analytical methods result in contrasting explanations for why the United States annexed and retained the Philippines following the defeat of Spain in 1898. For this exercise you have two tasks: Part 1: Compare the two secondary sources on why the United States annexed the Philippines. Part 2: Using primary sources, evaluate the arguments of the two secondary sources. Part 1: Comparing Secondary Sources Two secondary sources from different analytical perspectives are included below. In Standing at Armageddon: The United States, 1877–1919, Nell Irvin Painter of Princeton University weaves together economic and foreign-policy concerns with the lives of ordinary Americans to explain the annexation of the Philippines. Kristin L. Hoganson of the University of Illinois, a gender historian, explores the question of why the United States annexed the Philippines in Fighting for American Manhood: How Gender Politics Provoked the Spanish-American and Philippine-American Wars. While both works contain elements of economic and cultural history, each historian emphasizes a particular analytical methodology. Compare the views of these two scholars by answering the following questions. Be sure to find specific examples in the selections to support your answers. According to each author, what problems in society did supporters of annexation think American control of the Philippines would solve? Which author focuses on economic explanations, and which author focuses on cultural explanations, to explain imperialist support for annexation? Do you think the authors’ arguments are contradictory or complementary? In other words, can they both be correct? Secondary Source 1 Nell Irvin Painter, “The White Man’s Burden” (1989) The foreign markets explanation sought the cause of depressions not in currency, distribution of wealth, or monopoly. The culprit, it seemed, was agricultural and industrial overproduction. Americans produced too much, it was said; it seemed to matter little that during the recent hard times thousands had run out of the very foodstuffs and manufactured goods reputedly overproduced. What was needed were new markets, especially in Asia, especially in the most populous country in the world, China. . . . While foreign markets had beckoned American businessmen for decades, this more urgent quest included the novel expectation that the government of the United States should play an active part in fostering exports. The Philippine Islands—like Hawaii—represented the perfect stepping-stones to China, stops along the way where coal burning ships bound for Asia could refuel. Expansionists saw the islands as the opportunity of the century. Manila might become an American version of Hong Kong, the British market city that tapped the markets and produce of South China. . . . For many Americans, expansion was the inevitable result of the machine age that had already filled up the continental United States and now seemed to demand the raw materials and foreign markets that overseas colonies promised. The vision of factories fuming nonstop and workers employed without interruption made this economic argument for annexation straightforward and persuasive. Source: Painter, Nell Irvin. Standing at Armageddon: The United States, 1877–1919. New York: W. W. Norton & Company, 1989. 146–147. Secondary Source 2 Kristin L. Hoganson, “The National Manhood Metaphor” (1998) Whether they imagined the Filipinos as savages, children, or feminine figures, imperialists regarded them as a means for American men to develop their ability to govern. One adherent of imperialism summed up this belief when he averred that “the necessities involved in the unexpected annexation of strange dependencies will call forth the governing faculty.” The savage, childlike, and feminine stereotypes appealed to imperialists because they not only suggested the Filipinos’ incapacity for self-government, but also enabled imperialists to cast themselves as civilizers and authoritative heads of household—that is, as men who wielded power. Heedful of British imperialists’ claims that empire made men and interpreting colonial endeavors as unparalleled challenges, imperialists looked to the Philippines to turn white, middle- and upper-class American men into what they considered to be ideal citizens—physically powerful men who would govern unmanly subordinates with a firm hand, men accustomed to wielding authority, men who had overcome the threat of degeneracy. . . . In response to the accusations that their Philippine policies violated the nation’s deepest convictions, imperialists brandished a national manhood metaphor. The youthful republic had become an adult, they declared, and should assume the responsibilities of a mature man. Rather than dwelling on its childish past, the nation should manfully shoulder its new obligations. . . . . Imperialists implied that failing to assume responsibility for dependents would reveal an unwillingness to advance from childlike dependency to paternalistic power. In short, it would reveal a lack of manhood in the nation. Source: Hoganson, Kristin L. Fighting for American Manhood: How Gender Politics Provoked the Spanish-American and Philippine- American Wars. New Haven: Yale University Press, 1998. 155, 157. Part 2: Using Primary Sources to Evaluate Secondary Sources When historians are faced with competing interpretations of the past, they often look at primary source material to help evaluate the different arguments. Four speeches follow, each by an American politician who supported U.S. annexation and rule over the Philippines. The first is from President William McKinley’s State of the Union speech following U.S. annexation of the Philippines and the start of the Philippine-American War. The second is from Henry Cabot Lodge, a Republican senator from Massachusetts who was a leading supporter of American imperialism. The third speech is from Albert Beveridge, senator from Indiana, who supported Lodge’s imperialist policies. And the last speech, from Vice President Theodore Roosevelt, was delivered twelve days prior to assuming the presidency following McKinley’s death. While these four politicians offer very different justifications for American annexation and rule over the Philippines, they were all
[ANSWERED 2023] Mrs. Cason brings her 10-year-old child to the clinic stating my son “just isn’t breathing right, he doesn’t want to play, he just sits on my lap or lays on the couch, and this happens all the time
Mrs. Cason brings her 10-year-old child to the clinic stating my son “just isn’t breathing Case Study Mrs. Cason brings her 10-year-old child to the clinic stating my son “just isn’t breathing right, he doesn’t want to play, he just sits on my lap or lays on the couch, and this happens all the time.” Appearance of both mother and child is disheveled. The child’s wheezing can be heard across the room. When asked if her son is better at any certain time of the day the mother responds: “It’s like this all the time and has been for the past year, we just don’t come to the doctor because we don’t have any money.” Mrs. Cason’s son was diagnosed of asthma. 1. Discuss short and long term treatment options for this child, inhaled beta2-adrenergic agonists. Include rationale for your recommendations. 2.What is your educational plan for the child? Expert Answer and Explanation Case Study: Asthma Short and Long Term Treatment Options Mrs. Carson’s son is a case of newly diagnosed asthma. The child is visibly stabl12q12qe and without signs of acute exacerbations. However, he has had longstanding respiratory distress and has an audible wheeze. The initial management of the patient will revolve around the alleviation of symptoms and relief of the suffering due to the distress. White et al. (2018) recommends provision of short-acting beta-adrenergic agonist (SABA), more commonly salbutamol inhalation via a nebulizer, to enhance bronchodilation and provide relief to the patient. After that, the performance of spirometry is recommended once the patient has stabilized as subsequent management relies on the knowledge of the lung functionality (Mendes & Palmer, 2018; Horak et al., 2016). Mrs. Carson’s son will, therefore, be put after that on maintenance therapy with low dose pediatric inhaled corticosteroids. Provision of corticosteroids follows on the same guidelines, GINA (2015), which recommends provision of the same to children with SABA unresponsive asthma or those with asthma-related symptoms for more than three times a week. The latter provision fits the patient in this case. As regards the long term therapy, the patient will be put on long-acting inhaled corticosteroids to modify the course of the disease (Ballas, 2018). However, reviews should be done monthly to assess the improvement in lung function as well as look out for the adverse effects of prolonged steroid use (Ballas, 2018). Patient Education Involves the following: Informing the child and the mother that the condition warrants long term therapy. Explaining to them the correct use and disposing of the nebulizers to maximize therapeutic benefits. Describing to them the mechanism of control and measures to do so when the condition deteriorates. Talking to them about the importance of avoiding allergens. References Ballas, Z. K. (2018). Asthma clinical practice guidelines: Time for an update. Journal of Allergy and Clinical Immunology, 142(3), 787. Horak, F., Doberer, D., Eber, E., Horak, E., Pohl, W., Riedler, J., … & Studnicka, M. (2016). Diagnosis and management of asthma–Statement on the 2015 GINA Guidelines. Wiener klinische Wochenschrift, 128(15-16), 541-554. Mendes, A., & Palmer, S. J. (2018). NICE overhauls asthma management and treatment recommendations. White, J., Paton, J. Y., Niven, R., & Pinnock, H. (2018). Guidelines for the diagnosis and management of asthma: a look at the key differences between BTS/SIGN and NICE. Thorax, 73(3), 293-297. Place your order now for a similar assignment and get fast, cheap and best quality work written by our expert level assignment writers.Use Coupon Code: NEW30 to Get 30% OFF Your First Order FAQs Nasal spray for enlarged adenoids in adults Enlarged adenoids in adults can cause nasal congestion, difficulty breathing, and recurrent sinus infections. While nasal sprays can help alleviate symptoms, they may not be the most effective treatment for significantly enlarged adenoids. If your adenoids are significantly enlarged, you should see an ear, nose, and throat (ENT) specialist for evaluation and treatment recommendations. Treatment options may include medication, surgery, or a combination of both. However, if your symptoms are mild, a nasal spray may help reduce inflammation and congestion. Nasal steroid sprays such as fluticasone (Flonase) or mometasone (Nasonex) are often prescribed to reduce inflammation and swelling in the nasal passages. Saline nasal sprays or rinses can also help relieve congestion by flushing out mucus and allergens from the nasal passages. It’s important to follow your doctor’s recommendations and use nasal sprays as directed. Overuse of nasal sprays can lead to rebound congestion and other side effects, so it’s important to use them only as prescribed. Complications of adenoid hypertrophy Adenoid hypertrophy refers to the enlargement of the adenoid tissue located at the back of the nose and the roof of the throat. While adenoids are an important part of the immune system, when they become enlarged, they can cause several complications. Some of the complications of adenoid hypertrophy include: Difficulty breathing: Enlarged adenoids can obstruct the airway, leading to difficulty breathing through the nose. This can result in mouth breathing, snoring, and sleep apnea. Recurrent sinus infections: Enlarged adenoids can block the drainage of the sinuses, leading to recurrent sinus infections. Ear infections: Enlarged adenoids can also block the Eustachian tubes, which connect the middle ear to the back of the throat. This can lead to fluid buildup in the middle ear, increasing the risk of ear infections. Speech and language problems: Enlarged adenoids can affect the resonance of the voice and lead to speech problems, such as hypernasal speech. Facial abnormalities: In rare cases, severe and prolonged adenoid hypertrophy can cause facial abnormalities, such as long, narrow facial structure or open-mouth posture. Malnutrition: In children, enlarged adenoids can lead to malnutrition because they may have difficulty swallowing solid foods and may prefer soft, easy-to-swallow foods. Dental problems: Enlarged adenoids can cause changes in the position of the teeth and jaw, leading to dental problems such as malocclusion or misaligned teeth. If you or your child are experiencing any of these complications, it’s important to see an ENT specialist for evaluation and treatment. Treatment may include medication, surgery, or a
[ANSWERED] A 35-year-old comes to the clinic. He states, “It’s getting close to allergy season and I need something to keep me from getting sick
A 35-year-old comes to the clinic. He states, “It’s getting close to allergy season and I need A 35-year-old comes to the clinic. He states, “It’s getting close to allergy season and I need something to keep me from getting sick. Last year the doc gave me a shot, a spray, some pills, and an inhaler. They worked really well but I don’t remember what they were. Can I have those things again? I just can’t afford to miss work.” Please answer the following questions in a narrative format: 1–Discuss the epidemiology of allergies. 2—What are your treatment options (consider pharmacoeconomic)? Compare first and second-generation antihistamines. 3– What education will you provide to the patient? Expert Answer and Explanation Allergies Epidemiology of Allergies Epidemiology can be defined as the branch of medicine that studies diseases by identifying their distribution, risk factors, and possible control measures. According to a study done by Öçal, Muluk, and Mullol (2020), allergies affect more than 45% of school-aged people in the US. One of the most popular allergic diseases is allergic rhinitis. This disease affected more than 30% of the population across the globe as of 2018 (Öçal et al., 2020). The authors report that the allergy is caused by Immunoglobin E antibodies (IgE). When the body releases IgE at a higher rate, the antibodies with target the immune system and causes a reaction that produces chemicals that lead to an allergic reaction. The second most popular allergic condition is drug allergy. The research by Namysłowski et al. (2018) shows that one out of 10 people in the US is likely to suffer drug allergy. The rate of drug allergy is high in hospitalized patients. This disease accounts for about 1 in every 5 anaphylactic deaths. The risk factors of this allergy include the current health conditions of the population, the type of medication, and genetic factors. People with Acetylator status and HLA type genetic factors risk contracting drug allergy. The duration of drug administration and dose are also risk factors of the allergy. The last type of allergy is a food allergy. This disease has affected more than 40,000 children and 8% of adults in the US. The most common food allergy is caused by peanut, followed by milk (Chong & Chew, 2018). Other foods, such as eggs, tree nuts, soy, eggs, shellfish, fish, and grains with gluten, also cause food allergy. Treatment Options of Allergies This patient can be prescribed antihistamines to help fight the chemicals released during an allergic reaction. Tan, Sugita, and Akdis (2016) antihistamines can be used to relieve pain caused by different forms of allergies. The patient should be prescribed second-generation antihistamines. The second-generation antihistamines are appropriate in this situation because they are less central and can be used as antiallergic medications. However, H1antihistamines have central effects on the human body and can be used as sedatives to reduce pain. Over-the-counter antihistamine that should be considered in this situation is Zyrtec. This medication works faster and is also affordable compared to others. Allegra (fexofenadine), desloratadine (Clarinex), loratadine (Alavert) or Claritin can be used as alternative medications. Education Provided to the Patient First, the patient should be educated on how to avoid an allergic reaction. He can do this by trying to try as much as possible to avoid the allergic stimulus that can be avoidable. For instance, if the patient is allergic to dust, he or she should try hard to avoid dust. The second educational competency should focus on educating the patient about the names of the over-the-counter medications he can buy in case he is far from the medical facility (Farrokhi et al., 2017). The patient has visited the facility because he does not remember the medications; he was previously prescribed. Lastly, the patient can be educated about the medication schedule. The competency of this education program is to ensure that the patient maintains the medication schedule. References Chong, S. N., & Chew, F. T. (2018). Epidemiology of allergic rhinitis and associated risk factors in Asia. World Allergy Organization Journal, 11(1), 17. https://waojournal.biomedcentral.com/articles/10.1186/s40413-018-0198-z?optIn=false Farrokhi, S., Abbasirad, N., Movahed, A., Khazaei, H. A., Pishjoo, M., & Rezaei, N. (2017). TLR9-based immunotherapy for the treatment of allergic diseases. Immunotherapy, 9(4), 339-346. https://www.futuremedicine.com/doi/full/10.2217/imt-2016-0104 Namysłowski, A., Samoliński, B. K., Lipiec, A., Zieliński, W., Sybilski, A. J., Walkiewicz, A., … & Raciborski, F. (2018). The importance of specific IgE antibodies in epidemiology of allergic rhinitis and asthma–the Epidemiology of Allergic Diseases in Poland (ECAP) survey: part one. Influence of allergy risk factors on concentration of specific IgE antibodies in serum. Advances in Dermatology and Allergology/Postȩpy Dermatologii i Alergologii, 35(5), 520. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6232542/ Öçal, R., Muluk, N. B., & Mullol, J. (2020). Epidemiology of Allergic Rhinitis. In All Around the Nose (pp. 297-301). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-030-21217-9_33 Tan, H. T. T., Sugita, K., & Akdis, C. A. (2016). Novel biologicals for the treatment of allergic diseases and asthma. Current allergy and asthma reports, 16(10), 70. https://link.springer.com/article/10.1007/s11882-016-0650-5 Alternative Answer Epidemiology of Allergies Allergic reactions can worsen one’s health, and in the United States (U.S.), patients with some medical conditions including asthma can experience worsened health status following exposure to the allergies. These allergies are prevalent across the U.S., and their level of prevalence differ across different demographic populations. Allergic rhinitis, is one of these allergies, and it affects 7.8% of the U.S.’s population. Still, a close to 10% of the global population is likely to experience allergic reactions related to the use of certain drugs (Mathur & Viswanathan, 2014). In children and adolescents, 8% of cases involving food allergy occur in this group. Pharmacological interventions can help the 35-year-old patient. Recommending a prednisone medication to this patient can help reduce his risk of experiencing asthmatic attacks which occur because of the allergies. This medication is a cheaper alternative, and the patient may not have difficulty purchasing it. The patient can take the medication in different dosages depending on number of times they want to take the medication a day. Caregivers can recommend either first or
[ANSWERED 2023] AB a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough
AB a 21-year-old WF college student reports to your clinic with external bumps on her GENITALIA ASSESSMENT Subjective: CC: “I have bumps on my bottom that I want to have checked out.” HPI: AB a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed. PMH: Asthma Medications: Symbicort 160/4.5mcg Allergies: NKDA FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys) Objective: VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs Heart: RRR, no murmurs Lungs: CTA, chest wall symmetrical Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia. Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, negMcBurney Diagnostics: HSV specimen obtained Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature. Analyze the subjective portion of the note. List additional information that should be included in the documentation. Analyze the objective portion of the note. List additional information that should be included in the documentation. Is the assessment supported by the subjective and objective information? Why or why not? Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis? Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature. Expert Answer and Explanation The diagnosis of sexually transmitted diseases includes choosing the type of discharge, blood tests, urine tests, and the examination of other physical symptoms such as pain during sexual intercourse or burning sensations during urination. The similarity of the symptoms of different STIs makes it hard for healthcare givers to easily pinpoint the exact disease that the patient suffers from (Ball et al., 2017). A close assessment of the objective and subjective information of AB, a 21 y.o. pt. with the symptoms of STIs, helps to assess the truthfulness of the diagnosis provided as well as to provide her a preferential diagnosis. Subjective Data The patient has painless bumps in her genitalia, and these feel rough time to time. She does not have any abnormal vaginal discharge, and is unsure about the time the vaginal bumps appeared. However, she says she realized she has them about two weeks ago. Besides being sexually active since the age of 18, she says that she has had at least two sexual partners over the past one year. She has NKDA allergy, a past medical history of asthma, and she is also taking some medications including Symbicort. She also got Chlamydia at 19, and a pap smear conducted three years ago confirmed the absence of dysplasia. He has no breast cancer or cervical cancer history, but both parents have hx of HTN and GERD. The last part of the subjective information is that she has three children, abuses alcohol occasionally, but does not smoke. The additional subjective information could be assessing whether or not she is pre gnant. Objective Data The vitals of the patient are as follows: Temp 98.6; HT 5’10”; BP 120/86; P 92; WT 169lbs, and RR 16. Her hurt does not show visible signs of murmurs, and a CTA of the lungs shows that they are symmetrical. The genital assessment shows the absence of swellings or masses, intact urethral meatus, and normal hair distribution. Also, the vaginal mucosa is pink as expected, but there is rugae. Also, there is a painless ulcer on the external labia of the vagina. The abdominal assessment shows soft bowel sounds that are normative, neg murphies, and neg rebound. For the diagnostics, a HSV specimen is obtained. Much of the objective information was captured, but the assessor should have collected blood and urine samples to assess them. Support of the Assessment Following the assessment of the objective and subjective data, the patient is diagnosed to have chancer, which is right considering the individual symptoms in the genital mucosa characteristics. Painless sores also confirm the presence of the condition (Asai et al., 2020). The Appropriateness of the Diagnostics While the diagnostics could appear perfect for the scenario, I believe they were not as appropriate as they failed to include crucial assessments that would help in clarity of the diagnosis. Specifically, there should have been the obtaining of blood, fluid, and urine samples which could not only help to identify the illness, but would indicate the exact stage (Janssen et al., 2020). Rejecting the Diagnosis I would be quick to reject the diagnosis because the screening was not sufficient enough to make a decision. That is, there is need for further examinations of fluids such as saliva, vaginal discharge, urine, and blood to identify whether the patient had chancre or other sexually transmitted infections or several combined disorders (Abdool Karim et al., 2019). Differential Diagnosis In the differential diagnosis, I would consider HPV to be one of the candidates of further examination as it is evident the patient was not aware of the rough sores, which could be indicative of an overgrowth of sores (McCabe et al., 2017). Also, after asking the patient whether
[ANSWERED 2023] As you establish your goals and objectives for this course, you are committing to an organized plan that will frame your practicum experience in a clinical setting
As you establish your goals and objectives for this course, you are committing to an Assignment 2: Practicum Experience Plan (PEP) As you establish your goals and objectives for this course, you are committing to an organized plan that will frame your practicum experience in a clinical setting, including planned activities, assessment, and achievement of defined outcomes. In particular, they must address the categories of clinical reasoning, quality in your clinical specialty, and interpersonal collaborative practice. For this Assignment, you will consider the areas you aim to focus on to gain practical experience as an advanced practice nurse. Then, you will develop a Practicum Experience Plan (PEP) containing the objectives you will fulfil in order to achieve your aims. In this practicum experience, when developing your goals and objectives, be sure to keep psychotherapy approaches and techniques in mind. To Prepare Review your Clinical Skills Self-Assessment Form you submitted last week and think about areas for which you would like to gain application-level experience and/or continued growth as an advanced practice nurse. How can your experiences in the Practicum help you achieve these aims? Review the information related to developing objectives provided in this week’s Learning Resources. Your practicum learning objectives that you want to achieve during your Practicum experience must be: Specific Measurable Attainable Results-focused Time-bound Reflective of the higher-order domains of Bloom’s taxonomy (i.e., application level and above) Discuss your professional aims and your proposed practicum objectives with your Preceptor to ascertain if the necessary resources are available at your practicum site. Select one nursing theory and one counseling theory to best guide your practice in psychotherapy. Explain why you selected these theories. Support your approach with evidence-based literature. Create a timeline of practicum activities that demonstrates how you plan to meet these goals and objectives based on your practicum requirements. Assignment Record the required information in each area of the Practicum Experience Plan template, including 3–4 measurable practicum learning objectives you will use to facilitate your learning during the practicum experience. By Day 7 Submit the Practicum Experience Plan for assessment and Faculty approval. When your Instructor has approved your plan, forward the signed PEP to your Preceptor and retain a copy for your records. Submission and Grading Information To submit your completed Assignment for review and grading, do the following: Please save your Assignment using the naming convention “WK2Assgn2+last name+first initial.(extension)” as the name. Click the Week 2 Assignment 2 Rubric to review the Grading Criteria for the Assignment. Click the Week 2 Assignment 2 link. You will also be able to “View Rubric” for grading criteria from this area. Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK2Assgn2+last name+first initial.(extension)” and click Open. If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database. Click on the Submit button to complete your submission. Rubric Detail Select Grid View or List View to change the rubric’s layout. Excellent Good Fair Poor Record the required information in each area of the Practicum Experience Plan (PEP): Part 1: Quarter/Term/Year and Contact Information: ᵒ Identify Quarter/Term/Year: ᵒ Identify Student Contact Information, including: Name, Street Address, City, State, Zip, Home Phone, Work Phone, Cell Phone, Fax, and Walden University Email ᵒ Identify Preceptor Contact Information, including: Name, Organization, Street Address, City, State, Zip, Work Phone, Cell Phone, Fax, and Professional/Work Email. 5 (5%) – 5 (5%) The response accurately and clearly identifies the Quarter/Term/Year, all Student Contact Information, and all Preceptor Contact Information. 4 (4%) – 4 (4%) The response identifies the Quarter/Term/Year, and at least 90% of Student Contact Information and Preceptor Contact Information. 3.5 (3.5%) – 3.5 (3.5%) The response identifies the Quarter/Term/Year, and at least 80% of Student Contact Information and Preceptor Contact Information. 0 (0%) – 3 (3%) The response is inaccurate, incomplete, or is missing identification of the Quarter/Term/Year and/or identifies less than 80% of Student Contact Information and Preceptor Contact Information. Part 2: Individualized Practicum Learning Objectives: Explain three Individualized Practicum Learning Objectives that address your self-assessment of the skills found in the Clinical Skills Self-Assessment, are SMART (i.e., Specific, Measurable, Attainable, Results-Focused, Time-Focused), and meet the requirements for this course. Each Practicum Learning Objective must describe planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills you would like to improve from your self-assessment. 69 (69%) – 75 (75%) The response clearly, accurately, and thoroughly explains three (3) Individualized Practicum Learning Objectives that address the self-assessment of the skills found in the Clinical Skills Self-Assessment, are SMART (i.e., Specific, Measurable, Attainable, Results-Focused, Time-Focused), and meet the requirements for this course. For each Learning Objective, the response clearly, accurately, and thoroughly describes planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills to be improved from the self-assessment. 60 (60%) – 68 (68%) The response accurately explains three (3) Individualized Practicum Learning Objectives that address the self-assessment of the skills found in the Clinical Skills Self-Assessment, are SMART (i.e., Specific, Measurable, Attainable, Results-Focused, Time-Focused), and meet the requirements for this course. For each Learning Objective, the response accurately describes planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills to be improved from the self-assessment. 53 (53%) – 59 (59%) The response somewhat vaguely explains three (3) Individualized Practicum Learning Objectives that address the self-assessment of the skills found in the Clinical Skills Self-Assessment, are SMART (i.e., Specific, Measurable, Attainable, Results-Focused, Time-Focused), and meet the requirements for this course. For each Learning Objective, the response somewhat vaguely describes planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills to be improved from the self-assessment. 0 (0%) – 52 (52%) The response inaccurately or incompletely explains three (3) Individualized Practicum Learning Objectives that address the self-assessment of the skills found in the Clinical Skills Self-Assessment, are SMART (i.e., Specific, Measurable, Attainable, Results-Focused, Time-Focused), and meet the requirements for this course. For each Learning Objective, the response has a vague, inaccurate, and/or incomplete or missing description of planned activities, mode of assessment, and PRAC course outcome(s) addressed for the skills to be improved from the self-assessment. Part 3: Projected Timeline/Schedule: Describe your Practicum timeline/schedule,
[ANSWERED 2023] Find an article or website that provides guidelines for developing an innovative organization
Find an article or website that provides guidelines for developing an innovative 1. Use your favorite Internet search engine and find an example of a successful innovation and one that was not so successful. (Finding failures is difficult.) o What were the reasons given for success? o For failure? o Which of these reasons relate to poor planning? o What does this tell you about the keys to success in innovation? 2. Do you believe creativity can be learned? Find an article or website that is devoted to capturing creativity in the work environment. o What does the author say about individual creativity and group creativity? 3. Find an article or website that provides guidelines for developing an innovative organization. o What do you think of the advice given? 4. In developing an organizational climate that supports innovation, management often overlooks critical issues. This is true especially when setting up and nurturing communication networks. Many good ideas are lost because the right person is not available at the right place at the right time to bring the innovation to fruition. o What issues do you believe are critical in planning for the integration and sharing of information in an innovative firm? o How do these issues differ for product and process innovations? Assignment Expectations Length: 1750 – 2000 words; answers must thoroughly address the questions in a clear, concise manner. Structure: Include a title page and reference page in APA style. These do not count towards the minimum word count for this assignment. References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least three (3) scholarly sources to support your claims. Format: Save your assignment as a Microsoft Word document (.doc or .docx). File name: Name your saved file according to your first initial, last name, and the assignment number (for example, “RHall Assignment 1.docx”) Expert Answer and Explanation Successful Innovation The success or failure of innovation depends on various factors that occur before and during the implementation of a project. Addressing these issues can increase the chances of success while also ensuring the reduction of risks (White & Bruton, 2017). A project manager must come up with means of tracking a project to ensure that all the designed timelines and milestones are met. Other attributes such as the skillset of the team and the availability of resources can be one of the major reasons for a project to fail or succeed. As a project manager, it is also important to understand these key determinants of success and implement them within the project. Successful and Not So Successful Innovation Successful Innovation One of the major successful innovation is Tesla, Inc.’s electric car. Over time the motor industry has dwelled on diesel or petrol-powered engines. The innovation of cars that can use battery power or electricity is one of the successful innovations of the 21st century. Electricity use minimizes carbon emissions and the expense that would be used to purchase fuel. The success of the project has made the owner, Elon Musk, the richest person in the world as the company increases its production of sleek and electric cars (Chen & Perez, 2018). The reasons for the success can also be attributed to various measures that were taken and the timing of the innovation. To begin with, the company hires highly skilled personnel who share the vision of coming up with products that have limited or no impact on the environment. The current global standpoint is also ensuring that products and innovations that are environmentally friendly are incorporated into the world to help reduce the aspect of global warming. Additionally, the success of the company also rises from the ready market of electric cars and other forms of transport that would have reduced impact on fuel consumption. The high cost of fuel in many nations has increased the demand for products from Tesla, Inc. (Chen & Perez, 2018). The availability of new and sophisticated technologies also contributes to the success of the company and its innovative technologies. There is also excitement and acceptance of the technology within the mainstream and corporate worlds. This raises the demands of cars throughout the world. Tesla, Inc. is also set to expand its factory and production lines to fast-track the production to meet the demand. The company is also based on a direct sales model and services, which makes the company interact directly with the clients other than using the franchised dealership (Alghalith, 2018). The organization is also diversifying into other fields such as aerospace and home energy. Reasons for Failure One innovation that failed upon its startup was the On-demand Delivery Platform, Shyp (2013-2018). The concept of the innovation was basic as users could take pictures of the item that they required to be shipped and then make use of the Shyp application to schedule a pick-up (Corporate Venturing, 2019). The package would then be picked and dropped at the provided destination at a flat rate of $5. The collapse of the innovation began after it secured a grant of $62 million from different investors that were used to expand its services to include new cities such as Chicago and New York. With the high presence in various cities, the consumer growth reached a saturation point and began to slow, leading to the inability to sustain the expansion. With the reduced number of clients, the company was not able to maintain different outlets with the $5 flat rate on all commodities. Another reason for the failure is the decision to increase the charges for larger packages, which led to client backlash. Similarly, the target audience for the company was individuals whose shipment was sporadic and could not be depended upon for continuity of the company (Corporate Venturing, 2019). The management of the company was also slow in re-evaluating the direction of the company, and by the time they were scaling down, it was already too late as the customer loyalty had been affected adversely. The low number of customers led to the untimely collapse of a rather
[ANSWERED 2023] Based on the public health issue selected, in 750-1,000 words address the following
Based on the public health issue selected, in 750-1,000 words address the following The purpose of this assignment is to discuss the impact of an environmental public health issue and make recommendations for policy change. Research public health issues located on the American Public Health Association (APHA) website, found in the topic Resources. Select a public health issue related to an environmental issue within the U.S. health care delivery system and examine its effect on a specific population. Based on the public health issue selected, in 750-1,000 words address the following: Describe the public health issue. Include the following information: (a) what population is affected, (b) at what level does it occur (local, state, or national), and (c) evidence about the issue supported by resources. Discuss how the public health issue is addressed by the current policies. Include what changes you would propose to the existing policies. Describe what steps are required to initiate policy change. Identify the necessary stakeholders required to initiate policy change (government officials, administrator) and explain the importance of their role, such as budgeting or funding. Discuss the impact on the health care delivery system. Include three peer-reviewed sources and two other sources to support the policy brief. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. 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. A link to the LopesWrite technical support articles is located in Course Resources if you need assistance. Expert Answer and Explanation Healthcare Environmental Policy Issue Brief The Policy Health Issue The United States Environmental Protection Agency (EAP) is a body given responsibility to create public health policies that protect Americans from unhealthy environmental pollutions and changes. The institution is also responsible for ensuring that communities around the US are clean and safe. However, EAP has failed to protect Americans from environmental harm. The institution has changed air quality standards, and this has made American children vulnerable to asthma. According to Hasaneen and El-Halwagi (2017), the EAP has changed several policies and thus, allowing manufacturing companies to release soot and smog-forming pollutants in the air. Some of these firms include power plants, industrial facilities, and oil and gas extraction. The system has allowed manufacturing companies to release toxic contaminants such as lead, arsenic, and mercury into the air. The policy issue has affected most people in the Black, Asia, and Latino American communities. The change of the Clean Air Act has affected people across the United States. This paper recommends steps that can be taken to reduce the effects of emitted toxic pollutants into the air. Problem Statement The pollutant allowed into the air as a result of changed Clean Air Act has adverse effects on people. Witten (2016) reports that the impurities can affect a person’s cardiac health by hardening the heart’s blood vessels and thus, increasing the risks of heart failure, stroke, and attacks. Also, the pollutants are linked with certain psychological conditions such as schizophrenia, Parkinson’s disease, and Alzheimer’s disease. Further, contaminants such as arsenic and mercury are linked with respiratory conditions such as lung cancer, emphysema, as well as bronchitis. According to DeSalvo et al. (2016), pollutants can also cause asthma in children. Also, the toxins may damage children’s brain and thus, affecting their cognitive development. Lead and mercury toxins also cause pneumonia in children. According to Wysokińska (2016), about one million children aged five years and below lose their lives every year from pneumonia caused by air pollution. DeSalvo et al. (2016) argue that this is evident because compared to adults, children spend more time outside. Moreover, air pollution caused by lead, mercury, and arsenic has been associated with miscarriages during pregnancies. Toxins have also led to autism spectrum condition in children and premature birth. Lastly, according to Wysokińska (2016), the pollutants might reduce a person’s immune system and thus, making him or her susceptible to other diseases. Solution to the Issue Every American must do their best to ensure that they live in clean and safe air as far as their health is concerned. Oil and gas and coal industry are the largest emitters of toxic gases into the air. Therefore, the United States government should work on replacing oil, gas, and coal with less polluting fuels such as solar power, wind, fusion nuclear energy, and natural gas. DeSalvo et al. (2016) argue that this can be done by creating a body to regulate and conduct researches on green energy. The stakeholders that must be included in forming the body are the general public, the congress, and the executive. After the formation of the body, the government should avail finances for so that it can start working on researches about solar power, wind, fusion nuclear energy, and natural gas. Wysokińska (2016) estimates that replacing half of the coal, oil and gas energy might cost the US taxpayers about $180 billion. Another way of mitigating air pollution is by enacting laws that ensure that the EAP is an independent body. According to Evans (2017), this can be done by tabling a bill in parliament which protects the EAP from external influence, including the executive branch and allowing it to make policies that ensure clean and safe air. The Impact of the Issue on the Health Care Delivery System Healthcare industry is one of the disciplines which will benefit when the above policies are implemented. Today, the government of the US spends billions of dollars to solve environmental health problems. However, if the policy issue is addressed, sectors such as healthcare entirely will receive more funding from the government. The funds can be used to improve the healthcare delivery system by offering scholarships to more youths who want to become nurses. The health sector may also use the funds to employ more nurses in the healthcare facilities across the United States. Moreover, the
[ANSWERED 2023] In Weeks 4, 7, and 9 of the course, you will participate in clinical discussions called grand rounds. In one of these three weeks, you will be a presenter as well as help facilitate the online discussion
In Weeks 4, 7, and 9 of the course, you will participate in clinical discussions called grand rounds In Weeks 4, 7, and 9 of the course, you will participate in clinical discussions called grand rounds. In one of these three weeks, you will be a presenter as well as help facilitate the online discussion; in the others you will be an active discussion participant. When it is your week to present, you will create a Focused SOAP note and a short didactic (teaching) video presenting a real (but de-identified) complex patient case from your practicum experience. You should have received an assignment from your Instructor letting you know which week of the course you are assigned to present. To prepare: Review this week’s Learning Resources and consider the insights they provide. Select a child/adolescent or adult patient from your clinical experience that presents with a significant concern. Create a focused SOAP note for this patient using the template in the Resources. Then, based on your SOAP note of this patient, develop a video case study presentation. Your presentation should include objectives for your audience, at least 3 possible discussion questions/prompts for your classmates to respond to, and at least 5 scholarly resources to support your diagnostic reasoning and treatment plan. State 3–4 objectives for the presentation that are targeted, clear, use appropriate verbs from Bloom’s taxonomy, and address what the audience will know or be able to do after viewing. Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management. Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value. Pose three questions or discussion prompts, based on your presentation, that your colleagues can respond to after viewing your video. Be succinct in your presentation, and do not exceed 8 minutes. Specifically address the following for the patient, using your SOAP note as a guide. Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life? Objective: What observations did you make during the psychiatric assessment? Assessment: Discuss their mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis, and why? Describe how your primary diagnosis aligns with DSM-5 diagnostic criteria and is supported by the patient’s symptoms. Plan: What was your plan for psychotherapy (include one health promotion activity and patient education)? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Reflection notes: What would you do differently with this patient if you could conduct the session again? If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow-up, discuss what your next intervention would be. Expert Answer and Explanation Subjective: CC (chief complaint): “I have difficulty falling asleep, am always sad, and am easily distracted.’ HPI: The patient is a 26-year-old female who presented to the office complaining of anxiety, depression, and insomnia. The patient notes that she has been having problems with falling asleep, is easily distracted, is always sad, and has difficulties completing tasks. The patient also complains that she has trouble wanting to see people and associating with people. The patient notes that she finds comfort in isolating herself. She reports anhedonia and cried during the interview. She also reports severe anxiety. She says that her anxiety became more severe when she had that the person who raped her was released from jail. The symptoms have negatively affected her life. Her therapist pulled her out of work, and she hardly made friends with people. She rates her anxiety and depression as 8/10. Substance Current Use: She reports no current use of illicit drugs. Medical History: The patient has no medical problems. Current Medications: She is not on any medications at the moment. Allergies: She reports no allergies. Reproductive Hx: No reproductive problems. ROS: GENERAL: She denies fatigue, weight loss, chills, or fever. HEENT: Eyes: No yellow sclerae, visual loss, or double vision. Ears, Nose, Throat: No hearing problems, runny nose, congestion, sore throat, or sneezing. SKIN: No rash or itching. CARDIOVASCULAR: No chest pain, edema, chest discomfort, or palpitations. RESPIRATORY: No shortness of breath. GASTROINTESTINAL: No diarrhea, vomiting, abdominal blood, or pain. GENITOURINARY: She reports no odd urine color, no odor of urine, or burning on urination. NEUROLOGICAL: No dizziness, headache, syncope, ataxia, paralysis, numbness, or tingling in the extremities. MUSCULOSKELETAL: No joint or muscle stiffness or pain. HEMATOLOGIC: No anemia, HIV, bleeding, or bruising. LYMPHATICS: No enlarged nodes. ENDOCRINOLOGIC: No reports of health intolerance, cold, or sweating abnormities. Objective: Vital Signs: BP 102/90, P 67, RR 17, Ht. 5’4″, Wt. 67kgs, Temp 36.5. Physical Exam HEENT: Noncontributory. Skin: No rash or itching. Cardiovascular: Regular heart rhythm and heart rate. No cracks on the chest walls. No edema. Respiratory: Normal breathing sounds, no wheezing, no fluids in the lungs, crackles, and no inspiratory crackles. Diagnostic results: Beck Anxiety Inventory (BAI): Lemos et al. (2019) noted that BAI is used to measure the severity of patients’ anxiety. The authors found that the tool’s reliability is (Cronbach’s α=0.92) in terms of internal consistency. The patient scored 37, meaning that she has severe anxiety. Beck’s Depression Inventory (BDI): BID is a screening tool used to screen for depression (García-Batista et al., 2018). The patient scored 23, meaning that she has moderate depression. Assessment: Mental Status Examination: The patient is well-dressed, and her clothing is consistent with the