Best, best

 Introduction and conclusion

Purpose:  Summarize and appraise an article for bias and validity in a collaborative environment.

Assessment: The DBs are worth 35 points. It will be graded based quality of 3 posts made on 3 different days. Please see the grading rubric embedded below for complete criteria.

Instructions: Carefully read, summarize, and appraise your group’s assigned article.  The discussion board for this week should cover the following concepts in order to have a complete draft by the end of the week. As you provide input to your peers, be sure to state a rationale for your claims. 

  1. Identify and discuss the broader importance of the topic of the study as it applies to patients and organizations. What it means to the population 
  2. Discuss the nursing implications of the findings of the research.  Consider the following questions:
    • Were the results statistically significant, if reported?   
    • What is the clinical significance of the findings? 
    • What are the risks vs. benefits to practice of the findings?  
    • Are the findings feasible to implement?

Pain Assessment

With the realization that pain is highly prevalent among older adults, please answer the following

questions.

Questions:

1.What are some ways you as the nurse can utilize to determine pain in the older adult?

2.What are some of the potential barriers related to self-reporting of pain in the older adult?

3.What is the prevalence of pain in the older adult?

4.Describe and compare your findings for each of the following:

a.Numeric rating scale

b.Visual analog scale

c.McGill pain questionnaire

d.Pain in dementia patients

Clinical Supervision

I NEED A RESPONSE FOR THIS ASSIGNMENT

2 REFERENCES

1 PAGE

This week we focus on group therapy paying special attention to children and adolescents.  Children and adolescents have different needs when it comes to therapy.  The therapy should be tailored to the child’s developmental level and should be delivered within the here and now.  With that in mind, we will review the case study, “I feel like I’m going crazy” and offer treatment options that are evidence based.  

The case study presents a Native American child that is 15 years old.  He lives with his single mom who works a lot and is not home often.  He has been inflicting self harm for about 10 months by cutting with a razor. The client reports problems with sleep onset, low self-esteem, low energy level, and previous suicide attempts. He reports feelings of abandonment from his boyfriend and a recent loss of friendships.  He also reports that he identifies as a pansexual and has been dating a male peer for two months.  The client’s chief complaint is, “I am feeling like I’m going crazy!”.  

The client needs further assessment and evaluation to rule out major depressive disorder (MDD), borderline personality disorder (BPD), and other potential personality and anxiety disorders. At this assessment the client is denying any suicidal ideation.  With that, the most appropriate diagnosis is nonsuicidal self injury (NSSI). NSSI is a behavior that includes cutting, burning, scratching, hair pulling, hitting, head banging, and interfering with wound healing (Hornor, 2016). NSSI has a close relationship with borderline personality disorder.  However, the DSM-5 allowed for NSSI to stand alone as its own diagnosis.  This was the first time NSSI was not tied to the diagnosis of BPD as a symptom only. NSSI is also differentiated from suicidal behavior disorder in the DSM-5.  

According to the DSM-5 the criteria for NSSI are: five days of self harming in the last year, patient self harm actions are unlikely to result in death, the client engages in self harm to resolve an interpersonal difficulty, the behavior is not sanctioned such as tattoos or piercings, the self harm interferes with clients academics, the self harm did not occur during an acute manic or psychotic episode nor while on or withdrawing from substances (American Psychiatric Association [APA], 2015). The client meets the diagnostic criteria to make this diagnosis.  The clients behaviors appear to surround feelings of abandonment, and low self esteem, The client has been cutting for 10 months and has scarring.  The client was unable to attend class one day due to bleeding.  Additionally, the client does not appear psychotic or manic on current assessment.  If the clients suicide attempts had been related to the cutting then a diagnosis of suicidal behavior disorder may be appropriate.  The gold standard is to assess for suicidal ideation before, during, and after diagnosis of NSSI (Plener et al., 2016).

Treatment for NSSI should be outpatient if possible to minimize impaired functioning.  Mentalization based treatment (MBT) and dialectical behavior therapy (DBT) are both recommended for the treatment of NSSI (Plener et al., 2016).  While evidence is lacking in regards to adolescents and much more research is needed, these approaches have shown improvement in symptoms and have been found effective with adults.  MBT focuses on secure attachment through the clients’ capacity to mentalize.  Basically the client should learn to think about thinking in that they are attempting to understand how the mental state of oneself directly affects overt behaviors.  DBT has an interesting focus on opposites occurring at the same time and both being truthful (Dbt 101: What Does ‘Dialectical’ Even Mean?, n.d.).  For example, I can love my sister very much, AND be very angry with her for not calling me for a month.  These are seemingly opposing facts, but both are truthful at the same time.  Through these dialectics the client and therapist look for acceptance and change. With either or both treatments I would expect outcomes that show symptom reduction from NSSI.  Clients may want to also consider individual therapy.  It is also important to note that medications are not recommended for this client (Plener et al., 2016).

Ethical concerns are ever present when working with children and families.  In regard to NSSI it is important for the therapist to check their biases at the door and approach treatment nonjudgementally.  NSSI has been shown to evoke intense emotion from counselors often evoking enough fear that the therapist may want to enter into a “safety contract” right away prior to giving the client substitute coping skills.  Additionally, therapists may find themselves lecturing clients that self harm, ultimately reducing the therapeutic alliance (Whisenhunt et al., 2016).

References

American Psychiatric Association. (2015). Use of the manual. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.useofdsm5

Dbt 101: What does ‘dialectical’ even mean? (n.d.). Sheppard Pratt. https://www.sheppardpratt.org/news-views/story/dbt-101-what-does-dialectical-even-mean/

Hornor, G. (2016). Nonsuicidal self-injury. Journal of Pediatric Health Care, 30(3), 261–267. https://doi.org/10.1016/j.pedhc.2015.06.012

Plener, P. L., Brunner, R., Fegert, J. M., Groschwitz, R. C., In-Albon, T., Kaess, M., Kapusta, N. D., Resch, F., & Becker, K. (2016). Treating nonsuicidal self-injury (nssi) in adolescents: Consensus based german guidelines. Child and Adolescent Psychiatry and Mental Health, 10(1). https://doi.org/10.1186/s13034-016-0134-3

Whisenhunt, J., Stargell, N., & Perjessy, C. (2016, July 24). Addressing ethical issues in treating client self-injury – counseling today. Counseling Today. https://ct.counseling.org/2016/07/addressing-ethical-issues-treating-client-self-injury/

Zetterqvist, M. (2015). The dsm-5 diagnosis of nonsuicidal self-injury disorder: A review of the empirical literature. Child and Adolescent Psychiatry and Mental Health, 9(1). https://doi.org/10.1186/s13034-015-0062-7

strategies

Exercises: 

  1. How is strategy formulation related to situational analysis?
  2. How might a retrenchment strategy and a penetration strategy be linked together? What are some other logical combinations of strategies? How may a combination of strategies be related to vision?

Professional Development: 

  1. Collect examples of mission, vision, and values statements from various health care organizations — be sure to include those that are for-profit, not-for-profit, public and private. The Internet provides a useful tool for obtaining real-time examples to review and evaluate. Utilizing the criteria discussed in the textbook readings, determine the extent to which the actual statements apply the principles discussed. Identify the similarities and differences between “for profit” and “not-for-profit” examples. Compare and contrast statements obtained from public and private health care organizations.
  2. Work through Exhibit 6-4 (p. 212), “Strategic Thinking Map – Hierarchy of Strategic Decisions and Alternatives,” for an organization with which you are familiar. Practice selecting different alternatives under each strategy type.

nursing

 

Instructions:

Watch the video then evaluate the speech by answering these questions: 

  • Audience: What was the speaker’s target audience? How do you know?
  • Introduction: Identify the speaker’s attention-getter, topic, and thesis. Did the attention-getter grab your interest? Why or why not? What was the speaker’s thesis or central idea? 
  • Body: What pattern of the organization did the speaker use? What types of persuasion did the speaker use? Were they effective? Why or why not? 
  • Conclusion: Did the speaker end strongly? Why or why not?  
  • Presentation Aids: How did the speaker use presentation aids? 
  • Delivery: Was the delivery of the speech effective? Why or why not?

Bob’s Failure of a Persuasive Speech

 Please be sure to validate your opinions and ideas with citations and references in APA format. 

Peer review

Instructions:

Please post 1 peer response.

In the response post, include the following:

  • What suggestions would you offer the speaker to strengthen the persuasive speech?
  • What advice would you give the speaker?

Please be sure to validate your opinions and ideas with citations and references in APA format.

Discussion Question

 1-Which level of measurement would you prefer to utilize for quantitative research? Defend your answer. 

2-APA style

3- 3 paragraphs of 3 sentences each

4- 2 references not older than 2015

Barriers to evidence translation in addressing cancer.

 

Reflect upon the selected practice problem in Weeks 1 and 2 *(cancer ) and consider the following.

  • What are the common barriers to evidence translation in addressing this problem?
  • What strategies might you adopt to be aware of new evidence?
  • How will you determine which evidence to implement?
  • How will you ensure the continuation or sustainability of the change?

  

Instructions:

Use an APA style and a minimum of 200 words. Provide support from a minimum of at least three (3) scholarly sources. The scholarly source needs to be: 1) evidence-based, 2) scholarly in nature, 3) Sources should be no more than five years old (published within the last 5 years), and 4) an in-text citation. citations and references are included when information is summarized/synthesized and/or direct quotes are used, in which APA style standards apply. 

• Textbooks are not considered scholarly sources. 

• Wikipedia, Wikis, .com website or blogs should not be used.

nur634wk16d2

this is an assignment

CONJUNCTIVITIS

 Imagine a patient comes into your office with your selected condition or disorder.  What elements in the patient history and physical exam would indicate the patient has the selected condition or disorder? Select two differential diagnoses that could be applied to this patient. How did you arrive at the two differential diagnoses? Include history and physical examination findings that would support each of the two alternative diagnoses.

Knowlege check

QUESTION 1
1. A ten-year-old boy is brought to clinic by his mother who states that the boy has been listless and not eating. She also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen. Maternal history negative for pre, intra, or post-partum problems. Child’s past medical history negative and he easily reached developmental milestones. Physical exam reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern. The APRN orders complete blood count (CBC), and complete metabolic profile (CMP). The CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl. The APRN recognizes that the patient appears to have acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his mother. The diagnosis of acute lymphoblastic leukemia (ALL) was made after extensive testing.  
Question 1 of 2:
What is ALL?  
1 points   
QUESTION 2
1. A ten-year-old boy is brought to clinic by his mother who states that the boy has been listless and not eating. She also notes that he has been easily bruising without trauma as he says he is too tired to go out and play. He says his bones hurt sometimes. Mother states the child has had intermittent fevers that respond to acetaminophen. Maternal history negative for pre, intra, or post-partum problems. Child’s past medical history negative and he easily reached developmental milestones. Physical exam reveals a thin, very pale child who has bruises on his arms and legs in no particular pattern. The APRN orders complete blood count (CBC), and complete metabolic profile (CMP). The CBC revealed Hemoglobin of 6.9/dl, hematocrit of 19%, and platelet count of 80,000/mm3. The CMP demonstrated a blood urea nitrogen (BUN) of 34m g/dl and creatinine of 2.9 mg/dl. The APRN recognizes that the patient appears to have acute leukemia and renal failure and immediately refers the patient to the Emergency Room where a pediatric hematologist has been consulted and is waiting for the boy and his mother. The diagnosis of acute lymphoblastic leukemia (ALL) was made after extensive testing.  
Question 2 of 2:
How does renal failure occur in some patients with ALL? 
1 points   
QUESTION 3
1. A 12-year-old female with known sickle cell disease (SCD) present to the Emergency Room in sickle cell crisis. The patient is crying with pain and states this is the third acute episode she has had in the last nine months. Both parents are present and appear very anxious and teary eyed. A diagnosis of acute sickle cell crisis was made. Appropriate therapeutic interventions were initiated by the APRN and the patient’s pain level decreased, and she was transferred to the pediatric intensive care unit (PICU) for observation and further management.  
Question 1 of 2:
What is the pathophysiology of acute SCD crisis and why is pain the predominate feature of acute crises?  
1 points   
QUESTION 4
1. A 12-year-old female with known sickle cell disease (SCD) present to the Emergency Room in sickle cell crisis. The patient is crying with pain and states this is the third acute episode she has had in the last nine months. Both parents are present and appear very anxious and teary eyed. A diagnosis of acute sickle cell crisis was made. Appropriate therapeutic interventions were initiated by the APRN and the patient’s pain level decreased, and she was transferred to the pediatric intensive care unit (PICU) for observation and further management.  
Question 2 of 2:
Discuss the genetic basis for SCD.
1 points   
QUESTION 5
1. The parents of a 9-month boy bring the infant to the pediatrician’s office for evaluation of a swollen right knee and excessive bruising. The parents have noticed that the baby began having bruising about a month ago but thought the bruising was due to the child’s attempts to crawl. They became concerned when the baby woke up with a swollen knee. Infant up to date on all immunizations, has not had any medical problems since birth and has met all developmental milestones. Pre-natal, intra-natal, and post-natal history of mother noncontributory. Family history negative for any history of bleeding disorders or other major genetic diseases. Physical exam within normal limits except for obvious bruising on the extremities and right knee. Knee is swollen but no warmth appreciated. Range of motion of knee limited due to the swelling. The pediatrician suspects the child has hemophilia and orders a full bleeding panel workup which confirms the diagnosis of hemophilia A.    
Question 1 of 2:
Explain the genetics of hemophilia.
1 points   
QUESTION 6
1. The parents of a 9-month boy bring the infant to the pediatrician’s office for evaluation of a swollen right knee and excessive bruising. The parents have noticed that the baby began having bruising about a month ago but thought the bruising was due to the child’s attempts to crawl. They became concerned when the baby woke up with a swollen knee. Infant up to date on all immunizations, has not had any medical problems since birth and has met all developmental milestones. Pre-natal, intra-natal, and post-natal history of mother noncontributory. Family history negative for any history of bleeding disorders or other major genetic diseases. Physical exam within normal limits except for obvious bruising on the extremities and right knee. Knee is swollen but no warmth appreciated. Range of motion of knee limited due to the swelling. The pediatrician suspects the child has hemophilia and orders a full bleeding panel workup which confirms the diagnosis of hemophilia A.    
Question 2 of 2:
Briefly describe the pathophysiology of Hemophilia.
1 points   
QUESTION 7
1. During a routine 16-week pre-natal ultrasound, spina bifida with myelomeningocele was detected in the fetus. The parents continued the pregnancy and labor was induced at 38 weeks with the birth of a female infant with an obvious defect at Lumbar Level 2. The Apgar Score was 7 and 9. The infant was otherwise healthy. The sac was leaking cerebral spinal fluid and the child was immediately taken to the operating room for coverage of the open sac. The infant remained in the neonatal intensive care unit (NICU) for several weeks then discharged home with the parents after a prescribed treatment plan was developed and the parents were educated on how to care for this infant.  
Question 1 of 2:
What is the underlying pathophysiology of myelomeningocele? 
1 points   
QUESTION 8
1. During a routine 16-week pre-natal ultrasound, spina bifida with myelomeningocele was detected in the fetus. The parents continued the pregnancy and labor was induced at 38 weeks with the birth of a female infant with an obvious defect at Lumbar Level 2. The Apgar Score was 7 and 9. The infant was otherwise healthy. The sac was leaking cerebral spinal fluid and the child was immediately taken to the operating room for coverage of the open sac. The infant remained in the neonatal intensive care unit (NICU) for several weeks then discharged home with the parents after a prescribed treatment plan was developed and the parents were educated on how to care for this infant.  
Question 2 of 2:
Describe the pathophysiology of hydrocephalus in infants with myelomeningocele. 
1 points   
QUESTION 9
1. A preterm infant was delivered at 32 weeks gestation and was taken to the NICU for critical care management. Physical assessment of the chest and heart remarkable for a continuous-machinery type murmur best heard at the left upper sternal border through systole and diastole. The infant had bounding pulses, an active precordium, and a palpable thrill. The infant was diagnosed with a patent ductus arteriosus (PDA).  
Question:
Discuss the hemodynamic consequences of a PDA. 
QUESTION 10
1. A 7-year-old male was referred to the school psychologist for disruptive behavior in the classroom. The parents told the psychologist that the boy has been difficult to manage at home as well. His scholastic work has gotten worse over the last 6 months and he is not meeting educational benchmarks. His parents are also worried that he isn’t growing like the other kids in the neighborhood. He has been bullied by other children which is contributing to his behaviors. The psychologist suggests that the parents have some blood work done to check for any abnormalities. The complete blood count (CBC) revealed a hypochromic microcytic anemia. Further testing revealed the child had a venous lead level of 21 mcg/dl (normal is < 10 mcg/dl). The child was diagnosed with lead poisoning and it was discovered he lived in public housing that had not finished stripping lead paint from the walls and woodwork.  
Question:
How does lead poisoning account for the child’s symptoms? 
QUESTION 11
1. Emergency Medical Services (EMS) was dispatched to a home to evaluate the report of an unresponsive 3-month-old infant. Upon arrival, the EMS found a frantic attempt by the presumed father to resuscitate an infant. The EMS took over and attempted CPR but was unable to restore pulse or respiration. The infant was transported to the Emergency Room where the physician pronounced the child dead of Sudden Infant Death Syndrome (SIDS). The distraught parents were questioned as to the events surrounding the discovery of the baby. Parents state the child was in good health, had taken a full 6-ounce bottle of formula prior to being put down for the evening. The child had been sleeping through the night prior to this. Parents stated the baby had had some “sniffles” a few days before and was taken to the pediatrician who diagnosed the child with a mild upper respiratory tract viral syndrome. No other pertinent history. 
Question:
What is thought to be the underlying pathophysiology of SIDS? 
QUESTION 12
1. A 4-year-old female is brought to the pediatrician by her mother who states the child has been running a fever to 102.0 F, has “pink eye”, and that her tongue looks very bright red and swollen. The mother states the fever has been present for 5 days, noticed the child had developed a rash and that the child’s legs look “puffy”. No other symptoms noted. Past medical history noncontributory. All immunizations up to date. Physical exam remarkable for current fever of 102.8 F, bilateral conjunctivitis without purulent material, oral mucosa with bright red erythema, dry, with fissuring of the lips. Legs noted to have peripheral edema and are also erythematous. Palmar desquamation noted. There is fine maculopapular rash and + cervical adenopathy. The presumptive diagnosis currently (pending laboratory data) is Kawasaki Disease. 
Question 1 of 2:
What is Kawasaki Disease and what is the pathophysiology? 
QUESTION 13
1. A 4-year-old female is brought to the pediatrician by her mother who states the child has been running a fever to 102.0 F, has “pink eye”, and that her tongue looks very bright red and swollen. The mother states the fever has been present for 5 days, noticed the child had developed a rash and that the child’s legs look “puffy”. No other symptoms noted. Past medical history noncontributory. All immunizations up to date. Physical exam remarkable for current fever of 102.8 F, bilateral conjunctivitis without purulent material, oral mucosa with bright red erythema, dry, with fissuring of the lips. Legs noted to have peripheral edema and are also erythematous. Palmar desquamation noted. There is fine maculopapular rash and + cervical adenopathy. The presumptive diagnosis currently (pending laboratory data) is Kawasaki Disease. 
Question 2 of 2:
How does Kawasaki Disease cause coronary aneurysms? 
QUESTION 14
1. A 9-year-old boy was brought to the Urgent Care Center by his parents who state that the child had a sudden onset of difficulty catching his breath, has a new cough and is making a “funny sound” when he breathes.  The parents state there is no prior history of this, and the child had not been ill prior to the start of the symptoms. Past medical history noncontributory. No family history of respiratory problems. No known allergies to drugs or food. Physical exam positive for respiratory rate of 26, use of accessory muscles, with suprasternal retractions, heart rate of 132 beats per minute, an audible inspiratory and expiratory wheeze noted, and the pulse oximetry is 89% on room air. After the APRN institutes appropriate urgent treatment, the child’s breathing slowly returned to normal, vital signs normalize, and the pulse oximetry increases to 97%. The APRN suspects the child has asthma and tells the parents that they need to bring the child to a pulmonologist for further evaluation and care.  
Question:
What is the underlying pathophysiology of asthma? 
QUESTION 15
1. A 24-year-old female with known cystic fibrosis (CF) has been admitted to the hospital for evaluation for possible lung transplant. She was diagnosed with CF when she was 9 months old and has had multiple hospitalizations for pneumonia, respiratory failure, and small bowel obstructions. She currently is oxygen dependent and has been told by her physicians that she has end stage pulmonary disease secondary to CF. The only recourse for her currently is lung transplant.  
Question 1 of 2:
What is cystic fibrosis and discuss the pathophysiology.
QUESTION 16
1. A 24-year-old female with known cystic fibrosis (CF) has been admitted to the hospital for evaluation for possible lung transplant. She was diagnosed with CF when she was 9 months old and has had multiple hospitalizations for pneumonia, respiratory failure, and small bowel obstructions. She currently is oxygen dependent and has been told by her physicians that she has end stage pulmonary disease secondary to CF. The only recourse for her currently is lung transplant.  
Question 2 of 2:
What is the reason people with CF are often malnourished? 
QUESTION 17
1. A 14-year old girl who was trying out for cheerleading underwent a physical examination by the APRN who notices that the girl had uneven hip height, asymmetry of the shoulder height, shoulder and scapular prominence and rib prominence. The rest of the physical exam was normal and the APRN referred the girl to an orthopaedist for evaluation for possible scoliosis. Radiographs in the orthopaedic office confirms the diagnosis of idiopathic scoliosis. The spinal curve was measured at 26 degrees and it was recommended that the girl be fit for a low-profile back brace.  
Question:
What is thought to be the pathophysiology of idiopathic scoliosis? 
QUESTION 18
1. A 2-year-old boy was brought to Urgent Care by his parents who state the boy has been having large amounts of diarrhea, been very irritable and very pale. The parents noticed there was blood in the diarrhea and when the boy’s legs became swollen, they sought care. Past medical history noncontributory and all immunizations up to date.  Social history noncontributory and the child is in day care 5 days a week. No known exposure to other sick children and the only new event the parents could think of is the day care workers took the children to a local petting zoo about a week ago. Physical exam revealed a pale, ill appearing child with swollen legs, tender abdomen, and petechia on the legs and abdomen. The APRN suspects the child may have been exposed to a bacterium at the petting zoo and arranges for the patient to be transferred to the Emergency Room. There the child was found to be in renal failure, have hypertension and was diagnosed with hemolytic uremic syndrome (HUS).  
Question:
What is the pathophysiology of HUS?  
QUESTION 19
1. The parents of a 3-year-old boy bring the child to the pediatrician with concerns that their child seems “small for his age”. The parents state that the boy has always been small but did not worry until the child went to day care and they noticed other children of the same age were much bigger. They also note that his teeth were very late in coming in. Normal prenatal, perinatal and postnatal history and no medical history on either side of family regarding issues with growth and development. Physical exam is normal except for short limbs and small teeth. The pediatrician suspects the child has pituitary dwarfism. A complete laboratory and radiographic work up confirmed the diagnosis.  
Question:
What is the pathophysiology of pituitary dwarfism? 
   
QUESTION 20
1. A 4-year-old boy was brought to the Emergency Room by his parents with a suspected femur fracture. The parents state the child was playing on the couch when he rolled off and cried out in pain. There were no other injuries noted. Review of the child’s chart revealed this was the 4th Emergency Room visit in the last 15 months for fractures after low impact injury. The parents were suspected of child abuse and Child and Protective Services were consulted. The APRN assessing the child noted that the child had unusually thin and translucent skin, poor dentition, and blue sclera. The APRN suspects the child may have osteogenesis imperfecta (OI). Laboratory results revealed an elevated serum alkaline phosphatase and the diagnosis OI was made based on the clinical picture and elevated alkaline phosphatase.  
Question:
What is the pathophysiology of OI? 

Migraine

The patient is a 24-year-old female administrative assistant who comes to the emergency department with a chief complaint of severe right-sided headache. She states that this is the sixth time in the last 2 months she has had this headache. She says the headaches last 2–3 days and have impacted her ability to concentrate at work. She complains of nausea and has vomited three times in the last 3 hours. She states, “the light hurts my eyes.” She rates her pain as a 10/10 at this time. Ibuprofen and acetaminophen ease her symptoms somewhat but do not totally relieve them. No other current complaints.