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Go to the following website by clicking on the provided link, http://www.countyhealthrankings.org/ , and select a county and a state (this may be the county/state in which you reside, attend school, or plan to live and work as an APRN). After reviewing the website and the health outcomes in the County Health Rankings for the area, answer the following questions in a few short sentences as part of your discussion.

1. Briefly list the general statistics pertaining to a specific health concern that is on the rise in selected the city/county. 
2. How can the creation of a community health center program help to address this public health problem?
3. What can you as a nurse practitioner and/or nurse leader do to influence policy innovation to resolve the problem?

– Students are to write their name and the appropriate discussion number/discussion title in the title bar for each discussion. For example Discussion 1: Micheal Cabrera or Discussion 3: Sheila Smith.This is important in identifying that students are submitting original posts as well as response posts as required.

The Institute of Medicine has stated a goal that 90% of practice be evidence-based by 2020.  According to HealthyPeople.gov, the United States is currently at approximately 15%. Discuss two barriers that might hold nursing practice from achieving this goal and suggest ways in which identified barriers may be addressed.

Subjective Data to Obtain from Patient

            Inquiry of information medications, including current or previous use of over the counter products, vitamins and other herbal supplements. I can inquire about the history of pregnancies, miscarriages, abortions and deliveries, and lactation history in gynecologic and obstetric history. Early menarche, nulliparity or childbirth after 30 years are essential facts to collect from the patient as they prolong exposure to estrogen, which can predispose a person to malignant breast cancer. I can further assess any irradiation history involving the breast region or surrounding tissues (Hsu et al., 2020). Inquiry can be made on any changes in the patient’s skin and hair noted.

            Further systemic information can be obtained in different areas with symptoms such as mood changes and temperature intolerance. Hematologic/ lymphatic system problems such as anemia, easy bruising, fatigue, history of blood transfusion, and family history of anemia are also vital to obtain. I can also inquire on malignancy in other body systems, especially colon cancer, ovarian or endometrial cancer, which predispose the patient to breast cancer. Lifestyle factors like dietary factors and alcohol consumption may alter estrogen metabolism and are crucial data to inquire (Hsu et al., 2020).

Other Objective Findings to Assess

Objective data to obtain include assessing for swollen legs and hands, which may be due to the tumor in the breast’s dermal lymphatics. Check the thyroid for enlargement or, if fair, assess the throat for any mass or any prominent lymphadenopathy, the mouth mucous membranes, and any lesions (Hsu et al., 2020).

Diagnostic Exams to Order

            Mammography can be conducted to reveal the lump’s size and exact location and for early detection and diagnosis. Another test is a biopsy, either a fine needle biopsy or a tissue specimen taken from the lump to confirm whether the tumor is benign or malignant. Ultrasound may also be conducted to measure the lump’s size and check if it has affected the axillary region; it may also be used in guiding biopsy to obtain a section of the lump (Ultrasound-guided procedure). Breast Magnetic Resonance Imaging may also use magnetic and radio waves to create pictures of the breast’s interior (Abu-Naser & Bastami, 2016).

Three Differential Diagnoses

Fibroadenoma

Breast cysts

Breast cancer

The rationale for Differential Diagnosis

            The patient presents with a non-tender, unilateral, firm, painless, located in the upper outer quadrant; however, the lump is non-mobile and 5mm in size, different from the very mobile lump fibroadenoma, which usually is 1-3cm. Breast cysts present with a lump in the breast; however, the lump is very mobile, and the breast is painful or tender. Breast cancer presents with a non-mobile, non-tender, firm lump in the upper outer quadrant of the breast; however, the lump is problematic irregular and poorly delineated, there is also nipple discharge, nipple retraction, dimpling of the skin over the lump, skin ulceration, enlarged nipples and breast pains which are not apparent in the last stages (Aksanh et al., 2020).

Health Education

            Reassuring the patient on their image mainly because of the difference in size between their breasts; encourages them to express fears, feelings and concerns. Advice the patient to report any complications such as fever. Prepare the patient psychologically to accept the diagnosis they will be given and to be ready to follow the measures for treatment and prevention as will be appropriate.

References

Abu-Naser, S. S., & Bastami, B. G. (2016). A proposed rule based system for breasts cancer diagnosis. http://dstore.alazhar.edu.ps/xmlui/handle/123456789/297

Aksan, H., Kundaktepe, B. P., Sayili, U., Velidedeoglu, M., Simsek, G., Koksal, S., … & Uzun, H. (2020). Circulating miR‐155, let‐7c, miR‐21, and PTEN levels in differential diagnosis and prognosis of idiopathic granulomatous mastitis and breast cancer. BioFactors. https://iubmb.onlinelibrary.wiley.com/doi/abs/10.1002/biof.1676

Hsu, Y. H., Chen, V. C. H., Hsieh, C. C., Weng, Y. P., Hsu, Y. T., Hsiao, H. P., … & Gossop, M. (2020). Subjective and objective cognitive functioning among patients with breast cancer: effects of chemotherapy and mood symptoms. Breast Cancer, 1-10. https://link.springer.com/article/10.1007/s12282-020-01168-y

2 replies 

 Describe the characteristics of performance-driven team. Describe the difference between intrinsic and extrinsic motivation and explain why it is important in understanding the types of motivation when it comes to team performance. 

Requirements

1. The Concept Map must visually connect all of the specified objectives  (Program Outcomes, MSN Essentials, and NONPF Competencies) to course work (such as specific discussion board topics, written assignments, exams, lessons, and reading content).    
2. All items should be labeled, for instance, label the objectives and label the course work you select with name of the assignment/reading/discussion board topic and which week it was introduced.
3. Use Microsoft Word or a PowerPoint to create a Concept Map. You can use the features found on the “Insert” tab of a Word doc (in the horizontal ribbon on the top of a Word doc page). For instance, if you click on “insert” you will see shapes and SmartArt. You can use a PowerPoint slide with shapes and lines to create a concept/mind map. This is not a PowerPoint presentation, but a PowerPoint slide can be used to “draw” the Map.

Outcomes/Competencies to be connected with course learning: 

MSN Program Outcome #2:

Create a caring environment for achieving quality health outcomes (Care-Focused).

MSN Essential VIII:

Clinical Prevention and Population Health for Improving Health

National Organization of Nurse Practitioner Competencies #4: Practice Inquiry Competencies

• Recognizes that the master’s-prepared nurse applies and integrates broad, organizational, client-centered, and culturally appropriate concepts in the planning, delivery, management, and evaluation of evidence-based clinical prevention and population care and services to individuals, families, and aggregates/identified populations.

Your Concept Map will visually depict how you see the assignments of the course meeting the outcomes above.

Preparing the Assignment

ViewHow to Create a Concept Map (Links to an external site.)

textbook:  Curley, A.L. & Vitale, P.A. (2016). Population-Based Nursing: Concepts and Competencies for Advanced Practice (2nd ed.). New York, NY: Springer Publishing. 

Description 

MSN Program Outcome #2 

• The Map visually connects the Category to a minimum of two (2) assignments. 
• Each assignment is clearly labeled with week and content topic. 

MSN Essential VIII

• The Map visually connects the Category to a minimum of two (2) assignments. 
• Each assignment is clearly labeled with week and content topic. 

NONPF Competencies #4 

• The Map visually connects the Category to a minimum of two (2) assignments. 
• Each assignment is clearly labeled with week and content topic. 

This assignment will help you understand your personality type. Through this assignment, you will analyze how your specific personality type can enhance or hinder effective leadership in the health care environment.

Using the South University Online Library or the Internet, research about personality types.

Note: You can use the following link to access the online assessment: Jung Typology Test

Based on your research and understanding, write a 3- to 4-page Microsoft Word document that:

• Integrates how your specific personality type can enhance or hinder effective leadership in the health care environment.
• Explains all four aspects of your personality gleaned from the assessment.
• Includes 2- to 3-journal article references.
• *** Humanmetrics Jung Typology Test™Your Type INFJ

On a separate references page, cite all sources using APA 7 format. 

Please note that the title and reference pages should not be included in the total page count of your paper.

Submission Details

• Support your responses with examples.
• On a separate references page, cite all sources using APA 7 format.

Produce a written document defining the injury and setting in the geographical area of their choice

Geographical area: (South Asia)

Injury of Interest: Fire, heat, and hot substances

Direction 

Discuss how this injury varies by age and sex.

No plagiarism

Use APA format 

1 cite sources (internet)

1 1/2 page

Textbook : Global Health 101

4th Edition

Author: Richard Skolnik

Publisher: Jones and Bartlett Learning

Year: 2019

1. Define the apical impulse and describe its normal location, size, and duration.

2. Which abnormal conditions may affect the location of the apical impulse?

3. Explain the mechanism producing normal first and second heart sounds.

4. What is syncope?

5. Define the third heart sound.

6. Define pulmonic stenosis.

7.Define physiologic splitting.

Reply answering the questions above using APA format.

 DESCRIPTION

530: UNIT 4: QUESTION 3: Examine how knowledge of aging can affect all interactions with older adults, including as customers and colleagues

Student: Herbert Porter, Student ID: 57049

Text: Aging Matters: An Introduction to Social Gerontology, Nancy R. Hooyman, Kevin Y. Kawamoto, H. Asuman Kiyak, 2015