Posts in category: Uncategorized

Hematopoietic:
J.D. is a 37 years old white woman who presents to her gynecologist complaining of a 2-month history of intermenstrual bleeding, menorrhagia, increased urinary frequency, mild incontinence, extreme fatigue, and weakness. Her menstrual period occurs every 28 days and lately there have been 6 days of heavy flow and cramping. She denies abdominal distension, back-ache, and constipation. She has not had her usual energy levels since before her last pregnancy.

Past Medical History (PMH):
Upon reviewing her past medical history, the gynecologist notes that her patient is a G5P5with four pregnancies within four years, the last infant having been delivered vaginally four months ago. All five pregnancies were unremarkable and without delivery complications. All infants were born healthy. Patient history also reveals a 3-year history of osteoarthritis in the left knee, probably the result of sustaining significant trauma to her knee in an MVA when she was 9 years old. When asked what OTC medications she is currently taking for her pain and for how long she has been taking them, she reveals that she started taking ibuprofen, three tablets each day, about 2.5 years ago for her left knee. Due to a slowly progressive increase in pain and a loss of adequate relief with three tablets, she doubled the daily dose of ibuprofen. Upon the recommendation from her nurse practitioner and because long-term ibuprofen use can cause peptic ulcers, she began taking OTC omeprazole on a regular basis to prevent gastrointestinal bleeding. Patient history also reveals a 3-year history of HTN for which she is now being treated with a diuretic and a centrally acting antihypertensive drug. She has had no previous surgeries.

Case Study Questions

1. Name the contributing factors on J.D that might put her at risk to develop iron deficiency anemia.
2. Within the case study, describe the reasons why J.D. might be presenting constipation and or dehydration.
3. Why Vitamin B12 and folic acid are important on the erythropoiesis? What abnormalities their deficiency might cause on the red blood cells?
4. The gynecologist is suspecting that J.D. might be experiencing iron deficiency anemia.
   In order to support the diagnosis, list and describe the clinical symptoms that J.D. might have positive for Iron deficiency anemia.
5. If the patient is diagnosed with iron deficiency anemia, what do you expect to find as signs of this type of anemia? List and describe.
6. Labs results came back for the patient. Hb 10.2 g/dL; Hct 30.8%; Ferritin 9 ng/dL; red blood cells are smaller and paler in color than normal. Research list and describe for appropriate recommendations and treatments for J.D.

Cardiovascular
Mr. W.G. is a 53-year-old white man who began to experience chest discomfort while playing tennis with a friend. At first, he attributed his discomfort to the heat and having had a large breakfast. Gradually, however, discomfort intensified to a crushing sensation in the sternal area and the pain seemed to spread upward into his neck and lower jaw. The nature of the pain did not seem to change with deep breathing. When Mr. G. complained of feeling nauseated and began rubbing his chest, his tennis partner was concerned that his friend was having a heart attack and called 911 on his cell phone. The patient was transported to the ED of the nearest hospital and arrived within 30 minutes of the onset of chest pain. In route to the hospital, the patient was placed on nasal cannula and an IV D5W was started. Mr. G. received aspirin (325 mg po) and 2 mg/IV morphine. He is allergic to meperidine (rash). His pain has eased slightly in the last 15 minutes but is still significant; was 9/10 in severity; now7/10. In the ED, chest pain was not relieved by 3 SL NTG tablets. He denies chills.

Case Study Questions

1. For patients at risk of developing coronary artery disease and patients diagnosed with acute myocardial infarct, describe the modifiable and non-modifiable risk factors.
2. What would you expect to see on Mr. W.G. EKG and which findings described on the case are compatible with the acute coronary event?
3. Having only the opportunity to choose one laboratory test to confirm the acute myocardial infarct, which would be the most specific laboratory test you would choose and why?
4. How do you explain that Mr. W.G temperature has increased after his Myocardial Infarct, when that can be observed and for how long? Base your answer on the pathophysiology of the event.
5. Explain to Mr. W.G. why he was experiencing pain during his Myocardial Infarct. Elaborate and support your answer.

Submission Instructions:

• Include both case studies in your post.
• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. 

Asthma is a chronic inflammatory respiratory condition that affects the airways, leading to intermittent narrowing, swelling, and excessive mucus production (Mayo Clinic, n.d.). It is characterized by shortness of breath, wheezing, and coughing, which can make breathing difficult and sometimes lead to respiratory distress (National Heart, Lung, and Blood Institute, 2007). Janessa presents with shortness of breath, weakness, and dizziness but does not have wheezing or a cough. Her lungs are clear to auscultation bilaterally, and she has pale mucous membranes. While asthma is a possible diagnosis, anemia should also be considered as a contributing factor to her symptoms.

Asthma develops due to chronic airway inflammation, bronchial hyperresponsiveness, and episodes of airflow obstruction (Hashmi & Cataletto, 2024). The inflammatory response leads to airway narrowing, increased mucus production, and structural changes. Although wheezing and coughing are common, some individuals with mild or well-controlled asthma may not exhibit these symptoms, which may explain why Janessa’s lung sounds remain clear despite her shortness of breath (Global Initiative for Asthma, 2023).

To accurately diagnose asthma, there must be consistent respiratory symptoms and evidence of variable airflow obstruction, typically confirmed through pulmonary function testing (Hashmi & Cataletto, 2024). One of the most common tests is spirometry, which measures lung function by assessing forced expiratory volume and forced vital capacity. An increase in forced expiratory volume of twelve percent or more after using a bronchodilator suggests reversible airway obstruction, supporting an asthma diagnosis (Cleveland Clinic, 2025). Additional tests include measuring peak expiratory flow rate to assess airflow variability and bronchodilator responsiveness testing to evaluate how well a person’s breathing improves after using a fast-acting inhaler. Measuring nitric oxide in exhaled air can also help detect airway inflammation (National Heart, Lung, and Blood Institute, 2024). Blood work can help identify signs of inflammation, such as an increase in white blood cells, or rule out anemia as a contributing factor to fatigue and dizziness.

If asthma is confirmed, treatment begins with fast-acting bronchodilators such as albuterol for immediate symptom relief and inhaled corticosteroids such as fluticasone to reduce inflammation. For persistent symptoms, inhaled corticosteroids combined with a long-acting bronchodilator, such as budesonide and formoterol, may be required (Global Initiative for Asthma, 2023). Asthma management also includes avoiding triggers, monitoring lung function, and using inhalers correctly to ensure proper medication delivery. If anemia or another underlying condition is contributing to her symptoms, appropriate treatment should be integrated alongside asthma management.

While Janessa’s symptoms suggest possible asthma, her pale mucous membranes raise concerns about other conditions that may be worsening her fatigue and dizziness. A detailed diagnostic evaluation, including pulmonary function testing, nitric oxide measurement, and blood work, is necessary to confirm asthma and rule out other potential causes. If diagnosed, treatment should focus on controlling airway inflammation with inhaled corticosteroids and bronchodilators while addressing any additional health concerns to improve her overall well-being.

References

Cleveland Clinic. (2025, February 11). Spirometry. Cleveland Clinic. https://my.clevelandclinic.org/health/diagnostics/17833-spirometryLinks to an external site.

Global Initiative for Asthma. (2023). Global strategy for asthma management and prevention. https://ginasthma.org/Links to an external site.

Hashmi, M. F., & Cataletto, M. E. (2024, May 3). Asthma. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK430901/Links to an external site.

Mayo Clinic. (n.d.). Asthma – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653Links to an external site.

This part includes the summary of the project, main points and findings, the significance of the project to the advanced practice nursing profession, and recommendations for future research. Address the following:

1. Address your recommendations and implications for clinical practice. Discuss how it could be extended beyond the proposed settings, depending on findings. 

1. Provide a summary of study and discuss any limitations of the study.
   • Suggest directions for future research.
   • Consider changes in theoretical constructs
   • Provide suggestions for public policy and/or changes in practice.
2. Tie the theoretical framework to the overall product.
3. Conclude with an overall wrap-up. 
4.  4–5 pages in length, not including the cover or reference pages. You must reference a minimum of two scholarly sources.

Use current APA format and cite your sources.

• Reflect on change projects in your setting and describe what elements in the process of the change were effective and what elements were not effective? Has the anticipated outcome been sustained over time? Give specific evidence related to how well the change has been sustained. What would you do differently in planning and implementing a similar project?
• Using the article by Sharma (2021), cited below, is it possible for research/project findings to have clinical significance even if they do not have statistical significance? Explain your answer.

Sharma H. (2021). Statistical significance or clinical significance? A researcher’s dilemma for appropriate interpretation of research results. Saudi Journal of Anaesthesia, 15(4), 431–434. https://doi.org/10.4103/sja.sja_158_21Links to an external site.

Directions: Read over the SOAP note and formulate a primary diagnosis.  Based on the diagnosis complete the SOAP note with the details that would be expected for the diagnosis. Use UptoDate and/or Dyna MedPlus to find out what is expected from the history and physical, diagnostic workup and management for the diagnosis. Include other peer review resources and and journal articles to support the development of your SOAP note. Complete and attach the evaluation & management score sheet to show how you coded the note for billing in each section.

• Upload a copy of your completed SOAP note.
• Upload a copy of the evaluation & management score sheet.

Case Study: A 45-year-old white man presents to your office complaining of left knee pain that started last night. He says that the pain started suddenly after dinner and was severe within a span of 3 hours. He denies any trauma, fever, systemic symptoms, or prior similar episodes. He has a history of hypertension for which he takes hydrochlorothiazide (HCTZ). He admits to consuming a great amount of wine last night with dinner .On examination, his temperature is 98°F, his pulse is 90 beats/min, his respirations are 22 breaths/min, and his blood pressure is 129/88 mm Hg. Heart and lung examinations are unremarkable. The patient is reluctant to flex the left knee, wincing in pain at touch, and has passive range of motion. The knee is edematous, hot to touch, and has erythema of the overlying skin. No crepitation or deformity is apparent. No other joints are involved. Inguinal lymph nodes are not enlarged. Complete blood count (CBC) reveals a white blood cell count of 10,900 cells/mm3 and is otherwise normal.

needs to be EXACTLY like rubric 

You see a child whose family believes in natural therapy for illnesses (e.g., diet therapy, massage, heat treatments).

How will you incorporate the family’s beliefs into the treatment of a child with an acute upper respiratory infection? With leukemia?