Homework Help - Blog Posts

It has been almost two hours since i have started my homework and i would just like to ask how I'm meant to "explain sentence structure" can someone help?

This is late homework by the way and it's due today so i need help fast

THIS IS EXTREMELY URGENT SOMEONE HELP PLEASE

I think i figured it out but i probably did it wrong

Oh well, at least i don't all my homework even though it did take over 3 hours

NR 601 Week 1 Case Study Discussions Physical Examination (Part 1) NEW

Discussion Part One (graded)

 You meet your first patient of the morning. A.K. is a 65-year-old Caucasian male who you are seeing for the first time. Both wife and daughter are present.

Background

He reports that he has had an 18-pound unintentional weight loss in the last 2 months “I am just not hungry anymore, and when I do eat, I get full so fast. In fact, it is really hard to eat, and I don’t eat nearly as much as usual, even though I eat 3 times every day”. He also reports feeling more tired than usual. “I am not sleeping very well. My wife wakes me up when I am snoring, or when she thinks I am not breathing. I used to have sleep apnea, but I don’t think I have it anymore. Besides, that mask is so horrible to wear.” He reports day time somnolence. He reports that he is at the clinic today because of his wife and daughter’s concern about his weight loss and loss of appetite.

PMH

Mr. A.K. has a history of hypertension, cataracts, and osteoarthritis. Current medications:

Ibuprofen 600 mg po TID

Lisinopril 20 mg po QD

Hydrochlorothiazide 25 mg PO QD

Simvastatin 20 mg po QD

Vitamin D3 50,000 units po weekly

Omeprazole 40 mg po QD

Sudafed 50 mg po TID prn

Surgeries      

 April 2010-Right cataract extraction with Intraocular Lens Placement  June 2010- Left cataract extraction with Intraocular Lens Placement  November 2011-Left total knee arthroplasty

Allergies: No known drug or food allergies. Allergies to latex causing difficulty breathing and to bee stings, causing widespread edema and airway obstruction.

Vaccination History

He receives annual flu shots “most of the time”. His last one was 18 months ago.

Received a Pneumovax “the day I turned 65”.

His last TD was greater than 10 years ago.

Has not had the herpes zoster vaccine.

Social history

He has an 8th grade education and is a retired concrete finisher. He lives with his wife of 45 years and his daughter lives next door. He enjoys working in his back yard garden and recently tripped over the garden hose last week where his neighbor had to come and help him up.

Family history

Both parents are deceased. Father died of a heart attack at the age of 80; mother died of breast cancer at the age of 76. He has one daughter who is 45 years old and has hypertension. Hypertension, coronary artery disease, and cancer runs in the family.

Habits

He drinks one 4 ounce glass of red wine nightly; previous smoker of 30 years; he quit for 10 years, and is now smoking ¼ pack per day for the last 6 months.

  Discussion Part One:

Provide the differential diagnoses (DD) with rationale

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NR 601 Week 1 Case Study Discussions Physical Examination (Part 2) NEW

Discussion Part Two (graded)

  Physical examination

Vital Signs:

Height:  5 feet 7 inches   Weight: 170 pounds Waist Circumference – 32 inches BP 130/84 T 98.0 po P 92 regular R 22, non-labored

HEENT: normocephalic, symmetric. Evidence of prior cataract surgery in both eyes. PERRLA, EOMI, cerumen impaction bilateral ears. Several broken teeth, loose partial plate.

NECK: Neck supple; non-palpable lymph nodes; no carotid bruits.

LUNGS: Decreased breath sounds bases bilaterally, clear to auscultation HEART: RRR with regular without S3, S4, murmurs or rubs.

ABDOMEN: Bloated appearance, active bowel sounds, LLQ tenderness and 6 cm x 7 cm mass.

PV: Pulses are 2+ BL in upper and lower extremities; no edema NEUROLOGIC: Negative

GENITOURINARY: no CVA tenderness

MUSCULOSKELETAL: gait fluid and steady. No muscle atrophy or asymmetry. Full ROM all joints. Strength 5/5 and equal bilaterally. Hips: Discomfort on flexion in both hips; extensor and flexor strength symmetrical.

Knees: Left knee discomfort with weight bearing. No redness, warmth or edema. Full ROM in both knees with symmetrical extensor and flexor strength. Crepitus on extension of left knee.

Hands: No redness or swelling. Bilateral joint tenderness of the distal interphalangeal and proximal interphalangeal joints of the 2nd and 3rd digits.

Calf circumference-31 cm; Mid-arm circumference- 22 cm

PSYCH: normal affect

SKIN: Pale. Areas of healing ecchymosis: Left knee- 3 cm x 2 cm x 0 cm. Right knee -2 cm x 2.5 cm x 0 cm.

 Discussion Part Two:

Summarize the history and results of the physical exam. Discuss the differential diagnosis and rationale for choosing the primary diagnosis. Include one evidence-based journal article that supports your rationale and include a complete treatment plan that includes medications, possible referrals, patient education, ICD 10 Codes, and plan for follow-up.

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NR 601 Week 2 Case Study Discussions Physical Examination (Part-1) NEW

Discussion Part One (graded)

B.J., a 70-year-old Caucasian female has been seen in the clinic several times over the last 3 years. However, she missed her last annual appointment-last appointment was 18 months ago and today you are the nurse practitioner seeing her. She arrived to the clinic alone and states she is “here for my check-up”.  

Background:

The patient reports that “my feet just burn and tingle all the time and it is so much worse at night that I can hardly sleep at all”. She also indicates that “I need some new pillows; I use 3 of them now to just get comfortable at night to sleep. Those pillows help me catch my breath so I can sleep better”.  She also reports dyspnea just walking to the bathroom, but it only happens when her legs are “swole up” and also states, “the coughing also keeps me up at night”.  To be honest, “I’m just tired in general whether my feet are “swole” or not”. She also indicates that she cannot see well, especially at night. She also reported that at her last visit to the clinic, she was told that she had a “heart beat problem” and that she is supposed to be taking aspirin every day. She said she thinks all of her “heart pains” went away after she started taking the aspirin and “putting that pill under the tongue”.  One of her concerns she has today is that since her husband died last year, she tells you, “I just don’t like doing things that I liked to do before my husband died. We used to like to do all sorts of stuff, but anymore….I just feel blue all the time”.

PMH:

Chronic back pain

Hypertension

Previous history of MI in 2010

Diabetes?

Hypothyroidism?

Constipation?

Congestive Heart Failure?

Current medications: 

            Coreg 6.25 mg PO BID

            Colace 100 mg PO BID

            Glucotrol XL 10 mg PO daily

            Lantus insulin 20 units at HS

            K-dur 20 mEq PO QD

            Furosemide 40 mg PO QD

            L-Thyroxine 112 mcg PO QD

Aspirin?

Nitroglycerine?

Surgeries:

2010-Left Anterior Descending (LAD) cardiac stent placement Allergies: Amoxicillin

Vaccination History:

She receives an annual flu shot. Last flu shot was this year Has never had a Pneumovax

Has not had a Td in over 20 years

Has not had the herpes zoster vaccine

Other:

Has not seen a dentist in over 15 years, the time she got her dentures

Last colorectal screening was 11 years ago

Last mammogram was 5 years ago

Has never had a DEXA/Bone Density Test

Last dilated eye exam was 4 years ago

Labs from last year’s visit: Hgb 12.2, Hct 37%, Hgb A1C 8.2%, K+ 4.2, Na+140,Cholesterol 186, Triglycerides 188, HDL 37, LDL 98, TSH 3.7, ALT/AST WNL.

Social history:

She graduated from high school, and thought about college, but got married right away and then had kids a short time later. Her two sons and their wives live with her, take her to church and to the local senior center; they do all the cleaning, run errands, and do grocery shopping. Family history:

Both parents are deceased. Father died of a heart attack; mother died of natural causes.  She had one brother who died of a heart attack 20 years ago at the age of 52.

Habits:

Patient is a current tobacco user and has smoked 1 pack of cigarettes daily for the last 50 years and reports having no desire to quit. She uses occasional chew.  She drinks one 4 ounce glass of red wine daily.

  Discussion Part One:

 Provide differential diagnoses (DD) with rationale.

Further ROS questions needed to develop DD.

Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.

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NR 601 Week 2 Case Study Discussions Physical Examination (Part-2) NEW

Discussion Part Two (graded)

Physical examination:

Vital Signs

Height: 5 feet 2 inches Weight: 163 pounds BMI: 29.8   BP 110/70 T 98.0 po P 100 R 22, non-labored; Urinalysis: Protein 2+, Glucose: 4+ HEENT: normocephalic, symmetric. Bilateral cataracts; PERRLA, EOMI; Upper and lower dentures in place a fitting well. No tinnitus NECK: Neck supple; non-palpable lymph nodes; no carotid bruits. Thyroid non-palpable

LUNGS: Decreased breath sounds in bases bilaterally with rales, expiratory wheezing with prolonged expiratory phase noted throughout all lung fields. No costovertebral angle tenderness (CVAT) noted. Increase in AP diameter noted.

HEART: Irregularly irregular rhythm; Unable to detect S3 or murmur ABDOMEN: Normal contour; active bowel sounds all four quadrants; no palpable masses.

PV: Pulses are 2+ in upper extremities and 1+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally;

NEUROLOGIC: Achilles reflexes are hypoactive bilaterally. Vibratory perception to the 128 Hz tuning fork placed at the MTP of her great toe is absent bilaterally; She is unable to discern monofilament placement in 3 locations on her left foot and 2 places on her right foot.

GENITOURINARY: no CVA tenderness; not examined

MUSCULOSKELETAL: Heberden’s nodes at the DIP joints of all fingers and crepitus of the bilateral knees on flexion and extension with tenderness to palpation medially at both knees. Kyphosis and gait slow, but steady.

PSYCH: normal affect; her Mini-Cog Score is 3. Her PHQ-9 score is 22. SKIN: Sparse hair noted on lower legs and feet bilaterally with dry skin on her ankles and feet.

 Discussion Part Two:

Summarize the history and results of the physical exam. Discuss the differential diagnosis and rationale for choosing the primary diagnosis. Include one evidence-based journal article that supports your rationale and include a complete treatment plan that includes medications, possible referrals, patient education, ICD 10 Codes, and plan for follow up.

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NR 601 Week 3 Case Study Discussions Physical Examination  (Part-1) NEW

Discussion Part One (graded)

Katie Smith, a 65 year-old female of Irish descent, is being seen in your office for an annual physical exam. You are concerned since she has rescheduled her appointment three times after forgetting about it. She and her husband John are currently living with their daughter Mary, son-in-law Patrick, and their four children. She confesses that while she loves her family and appreciates her daughter’s hospitality, she misses having her own home.  As she is telling you this, you notice that she develops tears in her eyes and does not make eye contact with you. 

Background:

Although Mrs. Smith is scheduled for an annual physical exam and reports no particular chief complaint, you will need to complete a detailed geriatric assessment. Katie reports a lack of appetite. She tells you that she nibbles most of the time rather than eating full meals. She also reports having insomnia on a regular basis.

PMH:

Katie reports a recent bout of pneumonia approximately 3 months ago, but did not require hospitalization.  She also has a history of HTN and high cholesterol.

Current medications: 

HCTZ 25mg daily

Evista 60mg daily

Multivitamin daily

Surgeries:      

Appendectomy as a child in Ireland (date unknown)

1968- Cesarean section

Allergies: Denies food, drug, or environmental allergies Vaccination History:

Cannot remember when she had her last influenza vaccine

Does not recall having received a Pneumovax

Her last TD was greater than 10 years ago

Has not had the herpes zoster vaccine

 Screening History:

Last Colonoscopy was 12 years ago

Last mammogram was 4 years ago

Has never had a DEXA/Bone Density Test

 Social history:

Emigrated with her husband from Ireland in her 20s and has always lived in the same house until recently. She retired a year and a half ago from 30 years of teaching elementary school; has never smoked but drinks alcohol socially. She states that she does not have an advanced directive, but her daughter Mary keeps asking her about setting one up.   Family history:

Both parents are deceased but lived disease-free up into their late 90s.  She has one daughter who is 44 years old with no chronic illness and two sons, ages 42 and 40, both in good health.  

Discussion Day 1:

Differential Diagnoses with rationale

Further ROS questions needed to develop DD

Based on the patient data provided, choose geriatric assessment tools  that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.

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NR 601 Week 3 Case Study Discussions Physical Examination (Part-2) NEW

Discussion Part Two (graded)

 Physical examination:

Vital Signs:

Height:  5’0”   Weight: 150 pounds BMI: 29.3   BP: 120/64    T: 98.0 oral  P: 68 regular    R: 16, non-labored

HEENT: Normocephalic, symmetric. Evidence of prior cataract surgery 

in both eyes. PERRLA, EOMI, cerumen impaction bilateral ears.

NECK: Neck supple; non-palpable lymph nodes; no carotid bruits.

LUNGS: Clear to auscultation

HEART: RRR with regular without S3, S4, murmurs or rubs. 

ABDOMEN: Normal contour; active bowel sounds, LLQ tenderness.

PV: Pulses are 2+ BL in upper and lower extremities; no edema. No 

evidence of peripheral neuropathy.

NEUROLOGIC: Negative

GENITOURINARY: No CVA tenderness

MUSCULOSKELETAL: Gait fluid and steady. No muscle atrophy or 

asymmetry. Full ROM all joints. Strength 5/5 and equal bilaterally. Joint swelling in fingers both hands.

PSYCH: Flat affect; patient declined to answer PHQ-9 and GDS

SKIN: Grossly intact without rashes or ecchymosis.

 Discussion Part Two:

Summarize the history and results of the physical exam. Discuss the differential diagnosis and rationale for choosing the primary diagnosis. Include one evidence-based journal article that supports your rationale and include a complete treatment plan that includes medications, possible referrals, patient education, ICD 10 Codes, and plan for follow up.

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NR 601 Week 4 Case Study Discussions Physical Examination  (Part-1) NEW

Discussion Part One (graded)

 You are seeing S.F., a 74-year-old. Hispanic male in the office this morning for difficulty breathing.

Background:

S.F. presents with increased dyspnea on exertion that has become progressively worse over the last 3 days. You observe that he is using pursed lip breathing as he explains his chief complaint. He reports that he has been coughing up a moderate amount of thick, green sputum for approximately one week that was accompanied by a fever of 100.6 and chills. He took Ibuprofen 400 mg every 4 hours and increased his fluid intake for the last week. Two days ago he noticed that the sputum is now yellow rather than green and that he has not experienced any more fever. Overall, he feels like he is getting better. However, the dyspnea on exertion developed three days ago without relief despite the use of his Spiriva HandiHaler. He reports that he lost his rescue inhaler and has not had it to use in over 2 months. 

PMH:

COPD

Hypertension

Osteoarthritis 

Current medications: 

Asprin-81 daily

Cyclobenzaprine 10 mg prn

Meloxicam 15 mg daily

Metoprolol 25 mg daily

Spiriva HandiHaler daily as directed

Tramadol 50 mg daily prn

Surgeries:      

Appendectomy as a child (date unknown)

2004-Left cataract extraction with intraocular lens placement

2008-Right cataract extraction with intraocular lens placement 

Allergies: NKA

Vaccination History:

Influenza vaccine- October 2013

Pneumovax-2010

His last TD-can’t remember

Has not a TDAP/TD in 20 years 

Screening History:

Last Colonoscopy was 2012-normal

Last dilated retinal and glaucoma exam was 2013 

Social history:

Retired roofer-stopped working in 2004 due to arthritis and pain in his rotator cuff. Is married and lives with spouse. They have 4 grown children who live within a 10 mile radius of them. Currently smokes-is down to ½ pack cigarettes daily. Has smoked for 45 years total. Family history:

Father is deceased and had a history of hypertension and diabetes; Mother is deceased and had a history of CAD/MI; Sister-history of colon cancer. 

 Discussion  Part One:

Provide differential diagnoses  (DD)with rationale. 

Further ROS questions needed to develop DD. 

Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.

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NR 601 Week 4 Case Study Discussions Physical Examination  (Part-2) NEW

Discussion Part Two (graded)

 Physical examination:

Vital Signs:

Height:  5’8” Weight: 188 pounds BMI: 28.58    BP: 130/70    T: 99.0 oral    P: 72 regular    R: 24, pursed-lip breathing; Pain level-7-right shoulder HEENT: Normocephalic, symmetric. PERRLA, EOMI, cerumen impaction bilateral ears.

NECK: Neck supple; non-palpable lymph nodes; no carotid bruits. LUNGS: Labored respirations; posterior RLL, LLL, RML, LML diminished breath sounds. Rhonchi right and left anterior chest.

HEART: RRR with regular without S3, S4, murmurs or rubs.     ABDOMEN: Normal contour; active bowel sounds, LLQ tenderness.

PV: Diminished pedal pulses; hair loss noted over extremities.

NEUROLOGIC: Negative

GENITOURINARY:  Urinary dribbling, urgency, gets up 4 times during the night, distended bladder.

MUSCULOSKELETAL: Limited ROM in right shoulder. Crepitus in knees bilaterally. 

PSYCH: Negative 

SKIN: Negative

 Discussion Part Two:

Summarize the history and results of the physical exam. Discuss the differential diagnosis and rationale for choosing the primary diagnosis. Include one evidence-based journal article that supports your rationale and include a complete treatment plan that includes medications, possible referrals, patient education, ICD 10 Codes, and plan for follow up.

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NR 601 Week 5 Case Study Discussions Physical Examination  (Part-1) NEW

Discussion Part One (graded)

 C.W. is a tall, thin 78-year-old African American male brought into the office by his son who states that the patient is restless, angry, and has been unable to sleep for the last week. The son indicates that he is very concerned about his father because he lives alone. Also, he is concerned about the “strange” symptoms that his father has presented with recently.

 Background: 

C.W. presents as restless, hyperverbal, obnoxious and angry. He expresses himself by periodic yelling. He is unkempt and smells strongly of urine, alcohol and body odor. ………… has an unsteady gait and sways while standing. As you converse with the son, you determine that C.W. was medically separated from military service due to mental health issues after 2 years of active duty that ended in 1947. He has been married and divorced three times over the years. He typically seeks no acute or preventative medical care. ___ was treated by a psychiatrist previously, but he did not like taking the prescribed medications so he stopped taking them and did not keep any further psychiatric appointments.  

 PMH:

Patient denies any previous diagnoses. However, when asked why he saw a psychiatrist in the past, he tells you that the psychiatrist diagnosed paranoid schizophrenia, but that he does not have any psychiatric diagnoses or problems. He states: “It was just a way for him to make money off me coming in and seeing him and paying the drug companies for me to take all those meds!” 

Current medications: 

Denies prescription medications, over the counter medication, herbal therapies or vitamins.  

Surgeries:

Denies surgeries 

Allergies: NKA

Vaccination History:

Flu vaccine: never given

Pneumovax: never given

Tetanus: never given

Herpes zoster: never given 

Screening History:

 Last Colonoscopy was 2012-normal

Last dilated retinal and glaucoma exam was 2013 

 Social history and Risk Factors:

 Patient admits to smoking cigarettes and cigars. …… estimates that he smokes about 1 pack of cigarettes daily for the last 40 years, and 2 cigars each week for the last 30 years.

He states that he drinks a 24 ounce bottle of beer 4-6 times a week. … denies drinking wine or hard liquor. …….. does admit to smoking marijuana on occasion but does not use other recreational drugs. Patient denies falling. You notice some scrapes on his forearms, and when asked, he tells you that he fell yesterday: “I got pretty drunk out fishin’ with friends and fell off my bike trying to ride home”. He does not use any assistive devices for ambulation or balance.

Significant ROS:

Productive cough with white sputum. Denies hemoptysis.

He answers “No” to the PHQ-2 screening questions. 

Family history:

Reports no significant family history

  Discussion Part One:

Provide differential diagnoses (DD) with rationale. Further ROS questions needed to develop DD. Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.

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NR 601 Week 5 Case Study Discussions Physical Examination  (Part-2) NEW

Discussion Part Two (graded)

 Physical examination:

Vital Signs:

Height:  5’8”   Weight: 154 pounds BMI: 23.4   BP: 132/76    P: 76  regular    R: 16

HEENT: Normocephalic, symmetric. PERRLA, EOMI, no cataracts noted; poor dentition.

NECK: Neck supple; non-palpable lymph nodes; no carotid bruits. LUNGS: Respirations are unlabored, decreased breath sounds and crackles at the bases bilaterally. Prolonged expiratory phase throughout lung fields, inspiratory wheezes and a productive cough of cloudy white sputum.

HEART: RRR with regular without S3, S4, murmurs or rubs. 

ABDOMEN: Round, firm abdomen; active bowel sounds;  non-tender. NEUROLOGIC: Unsteady gait, swaying while standing during periods of agitation. Achilles reflexes are present bilaterally. Strength is equal but decreased in the upper and lower extremities bilaterally.

GENITOURINARY:  Urinary incontinence with strong odor of urine. NO CVA tenderness.

MUSCULOSKELETAL: Mild kyphosis. Heberden’s nodes at the distal interphalangeal joints (DIP) of all fingers, and marked crepitus of the bilateral knees on flexion and extension. Pedal pulses palpable. No edema noted in lower extremities.

 PSYCH: Manic, restless, angry and hyperverbal

SKIN: Right forearm with 3 cm x 5 cm x 0 cm dry, scabbed abrasion. Left forearm with 4 cm x 5 cm x 0 cm dry, scabbed abrasion.

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NR 601 Week 6 Case Study Discussions Health Promotion, Health Protection, Disease Prevention, and Treatment Considerations in Long-Term Care (Part-1) NEW

Discussion Part One (graded)

 Ms. S. is a 62-year-old black female who has returned to the clinic to discuss her concerns that her lifestyle modifications to lose weight have not worked. At the last visit 3 months ago, she was advised to change her eating habits and increase activity to promote weight loss. She reports walking at least 30 minutes a day but has lost very little weight. ……….. indicates that the walking only made her extremely thirsty and hungry and attributes her increased thirst and hunger to increased exercise and her increased urination due to drinking more water since “it’s been hot lately” and exercise makes me thirsty”…… has returned to the clinic to discuss if there is anything else that can be done to lose weight and to determine why she is so tired, thirsty and hungry all the time. She also thinks she may have an overactive bladder since she has to urinate frequently during the day, which has influenced her not to go on outings with her friends.

  Discussion Questions Part One

 Conduct a ROS on this patient.

Indicate which symptoms are most concerning to you.

List your differential diagnoses.

What types of screenings would be appropriate to use based on the chief complaint?

What primary diagnosis are you choosing at this point?

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NR 601 Week 6 Case Study Discussions Health Promotion, Health Protection, Disease Prevention, and Treatment Considerations in Long-Term Care (Part-2) NEW

Discussion Part Two (graded)

 Physical Exam:

Discussion Part Two (graded)

Vital signs: blood pressure 145/90, heart rate 100, respirations 20 height 5’1”; weight 210 pounds

Labwork:

CBC: normal

UA: 2+ glucose; 1+ protein; negative for ketones

CMP: BUN/Creat. elevated; Glucose is 300 mg/dL

Hemoglobin A1c: 12%

Thyroid panel: normal

LFTs: normal

Cholesterol: total cholesterol (206), LDL elevated; HDL is low EKG: normal

General: obese female in not acute distress HEENT: unremarkable

CV: S1 and S2 RRR without murmurs or rubs

Lungs: Clear to auscultation

Abdomen– soft, round, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits

Discussion Questions Part Two

 For the primary diagnosis, what non-pharmacological and pharmacological strategies would be appropriate?

Include the following: lab work and screenings to be completed. Describe patient education strategies.

Describe follow-up and any referrals that may be necessary.

Discussion Part One (graded)

C.G. is a 69-year-old male with a history of right head and neck cancer that you have been following for one year. The carcinoma was initially localized to the head and neck-specifically at the left lingual tonsil region and went on to complete a total of 6 weeks of radiation and chemotherapy. Recently, the last PET scan indicated some metabolic activity in the left lymph node area along with other regions of abnormal metabolic activity in the body-particularly the liver and the lungs indicating metastasis. C.G. indicates that he is tired of the effects of chemotherapy and radiation and does not want to pursue any more treatment for cancer.

Background:

Right head and neck cancer with metastasis to liver and lungs; patient is refusing further treatment.

PMH:

Hypertension

Hyperlipidemia

Stomatitis

Anemia

Neutropenia 

Current medications: 

Carvedilol 12.5 mg po 1 daily

Furosemide 40 mg po daily

Surgeries:      

2012: right radical neck dissection 

Allergies:

None 

Vaccination History:

Influenza vaccine last received 1 year ago

Received pneumovax at age 65

Received Tdap 5 years ago

Has not had the herpes zoster vaccine 

Social history and Risk Factors:

Former smoker-stopped smoking at the time his cancer was diagnosed-2 years ago

Negative for alcohol intake or drug use

Patient does not have an advanced directive or living will. He is refusing further treatment for his cancer and his wife and children are in disagreement with him. The patient wants to know what his options are for the remainder of his life.  

Family history:

Negative 

 Discussion Part One:

 Provide differential diagnoses (DD) with rationale.

Further ROS questions needed to develop DD.

Identify the legal/ethical issues involved with the patient and describe your approach to addressing end-of-life care for this patient.

Discussion Part Two (graded)

 Physical examination:

Vital Signs: Height:  6’0   Weight: 140 pounds; BMI: 19.0   BP: 156/84  P: 84 regular R: 20

HEENT: normocephalic, symmetric PERRLA, EOMI; poor dentition NECK: left neck supple; non-palpable lymph nodes; no carotid bruits. Limited ROM

LUNGS: rhonchi in anterior chest bilaterally.

HEART: S1 and S2 audible; regular rate and rhythm

ABDOMEN: active bowel sounds all 4 quadrants; Normal contour; RUQ tenderness; liver palpable

NEUROLOGIC: negative

GENITOURINARY: negative

MUSCULOSKELETAL: negative

PSYCH: PHQ-9 is 15

SKIN: oral mucosa irritated-stomatitis

 Discussion Part Two:

Summarize the history and results of the physical exam. Discuss the differential diagnosis and rationale for choosing the primary diagnosis. Include one evidence-based journal article that supports your rationale and include a complete treatment plan that includes medications, possible referrals, patient education, ICD 10 Codes, and plan for follow up.

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PSY 330 Week 5 DQ 2 Sociobiology

View the interview with E.O. Wilson (http://www.charlierose.com/view/interview/4989), a pioneer in the field of sociobiology.  In the video, Dr. Wilson makes some very strong statements regarding the biological nature of human behavior.  Many of these statements are in direct opposition to other models and theories that you have been exposed to throughout this course.  You will be divided by last names for this discussion.  Your initial post should formulate an argument either to support or refute E.O. Wilson’s claims from the interview.    

Last names beginning with letters A-M:  Provide a reasoned argument that supports the statements that E.O. Wilson makes regarding the biological nature of human behavior in the interview video clip.  Your initial post should be a minimum of 250 words and utilize at least one peer-reviewed source that was published within the last five years, cited according to APA guidelines as outlined in the Ashford Writing Center.

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PSY 330 Week 5 DQ 1 Triadic Theory

Select a mental illness that you are interested in learning more about.  Provide a brief overview of this mental illness.  Discuss how Triadic Theory would likely describe the cause of this illness.  What would a therapist, employing this approach in his or her practice, suggest as a possible treatment for this disorder?  Do you think that this theory is more appropriate for the diagnosis and treatment of some disorders, more than others?

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PSY 330 Week 5 Assignment Final Project

Final Project

Select one of the following options for your Final Project: Option 1: Models of Personality Critique

Focus of the Final Project

Using the model of personality you selected in Week One, write an eight- to ten- page, double-spaced (not including title and reference pages) critique of the model.  Your discussion should incorporate a minimum of six to eight scholarly, peer-reviewed sources that were published within the last five years.  Your critique should provide an evaluation of the selected model rather than a simple summary.  Your Final Project critique must contain the following:

Introduction Provide a general introduction to the selected model, as well as, the focus of this critique and the overall direction your paper will take.

Discussion Present a detailed critique and/or evaluation of the model of personality you have selected.  Be sure that your opinions about the model are substantiated by citations from scholarly research.  As the majority of your Final Project, this section must contain an evaluation of: 1. The theories present within your selected model 2. The major contributors in the field of your selected model 3. The methods of inquiry used by your selected model 4. An overview of the strengths and weaknesses of this model of personality     Conclusion Provide a summary of your critique of the selected model of personality.  Address the current relevance of this model in explaining theories of personality.  Additionally, discuss the possible future research directions that could be taken to further elucidate the role of this model in explaining personality.  

Writing the Final Project

The Final Project:

1. Must be eight to ten double-spaced pages in length, and formatted according to APA style as outlined in the Ashford Writing Center. 2. Must include a title page with the following: a. Title of paper b. Student’s name c. Course name and number d. Instructor’s name e. Date submitted 3. Must begin with an introductory paragraph that has a succinct thesis statement. 4. Must address the topic of the paper with critical thought. 5. Must end with a conclusion that reaffirms your thesis. 6. Must use at least six to eight scholarly, peer-reviewed sources that were published within the last five years.  Visit the Ashford University Online Library to locate these resources. 7. Must document all sources in APA style, as outlined in the Ashford Writing Center. 8. Must include a separate reference page, formatted according to APA style as outlined in the Ashford Writing Center.

Option 2: Models of Personality Lecture

Focus of the Final Project

Imagine you are interviewing for an instructor position at a college to teach a theories of personality course.  The hiring committee has asked you to prepare a PowerPoint presentation on one of the theoretical models of personality.  Using the model of personality you selected in Week One, create a 15-to 20-slide PowerPoint presentation (not including title or reference slides) that critiques the model.  Your discussion should incorporate a minimum of six to eight scholarly, peer-reviewed sources that were published within the last five years.  Your presentation should provide an evaluation of the selected model, rather than a simple summary.  Your Final Project lecture must contain the following:

Introduction Provide a general introduction to the selected model, as well as, the focus of this critique and the overall direction your paper will take.

Discussion Present a detailed critique and/or evaluation of the model of personality you have selected.  Be sure that your opinions about the model are substantiated by citations from scholarly research.  As the majority of your Final Project, this section must contain an evaluation of: 1. The theories present within your selected model 2. The major contributors in the field of your selected model 3. The methods of inquiry used by your selected model 4. An overview of the strengths and weaknesses of this model of personality     Conclusion Provide a summary of your critique of the selected model of personality.  Address the current relevance of this model in explaining theories of personality.  Additionally, discuss the possible future research directions that could be taken to further elucidate the role of this model in explaining personality.  

It is critical that this project is developed as a presentation.  The slides should contain relevant graphics, images, tables, and utilize some of the functions of PowerPoint, where appropriate.  Simple slides that only feature text are not adequate for this assignment.  For tips on creating an excellent presentation, read the following overview.   

Remember to submit a Word document that contains the same information as your title slide, so your instructor can provide you with feedback on your presentation.  This document should be submitted in the dropbox in addition to the presentation file.  

Writing the Final Project

The Final Project: 1. Must be at least 15-20 PowerPoint slides (not including title and reference slides).  2. Must include a title slide with the following: a. Title of presentation b. Student’s name c. Course name and number d. Instructor’s name e. Date submitted 3. Must begin with an introduction containing a thesis statement, address the topic with critical thought, and end with a conclusion that reaffirms the thesis. 4. Must use at least six to eight scholarly, peer-reviewed sources that were published within the last five years.  Visit the Ashford University Online Library to locate these resources. 5. Must document all sources in APA style, as outlined in the Ashford Writing Center. 6. Must include a separate reference slide, formatted according to APA style as outlined in the Ashford Writing Center. 7. Must include detailed speaker’s notes in the notes section of the PowerPoint presentation. 8. In addition to the presentation, please submit a Word document containing the same information as the title slide.  This document will be used for your instructor to provide you with feedback regarding your work.  Submit this file along with the presentation in the assignment dropbox.   

Carefully review the Grading Rubric for the criteria that will be used to evaluate your assignment.  

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PSY 330 Week 4 DQ 1 Cognitive Theory

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Review the week’s reading on cognitive and cognitive-behavioral theories of personality, which have significant application in the treatment of abnormal behavior.  Select one of the options below and develop a case study that could use one of the therapy techniques listed to treat a patient exhibiting an abnormal behavior.  Indicate in your post which option you selected.       Option A:  Discuss the theory underlying Rational Emotive Therapy.  Why does this approach lend itself so well as a therapy?  Develop a short, fictional case study of a client with an abnormal behavior.  Describe how you would approach the treatment of this disorder with cognitive therapy and why cognitive therapy would be appropriate for the treatment of this disorder.  Your initial post should be a minimum of 250 words and utilize at least one peer-reviewed source that was published within the last five years, cited according to APA guidelines as outlined in the Ashford Writing Center.      Option B: Discuss the theory underlying Beck’s Cognitive Therapy.  Why does this approach lend itself so well as a therapy?  Develop a short, fictional case study of a client with an abnormal behavior.  Describe how you would approach the treatment of this disorder with cognitive therapy and why cognitive therapy would be appropriate for the treatment of this disorder.  Your initial post should be a minimum of 250 words and utilize at least one peer-reviewed source that was published within the last five years, cited according to APA guidelines as outlined in the Ashford Writing Center.

 PSY 330 Week 4 DQ 2 Interpersonal Style

Review this week’s reading and describe your interpersonal style.  What factors have affected the interpersonal style that you exhibit?  Do you think the source(s) of your interpersonal style are consistent with the theories underlying the models described in the course text?  Your initial post should be a minimum of 250 words and utilize at least one peer-reviewed source that was published within the last five years, cited according to APA guidelines as outlined in the Ashford Writing Center.

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PSY 330 Week 2 DQ 2 Heritability

One of the goals of behavioral genetics is to identify the heritability of a particular behavior.  Heritability is the amount of variance in observed behaviors among people that can be explained by genetics.  Review this week’s reading and discuss the strengths and weaknesses of some of the methods used to determine heritability in humans.  Address the use of adoption studies and twin studies, as well as shared environmental factors and unique environmental factors.  

PSY 330 Week 3 Assignment Final Project Outline

Final Project Outline

Review the Final Project guidelines and, using the approved topic that was identified in Week One, construct an outline of your Final Project.  Your outline should be a minimum of one to two pages (excluding title and reference pages) and include each of the required headings/sub-headings listed for your Final Project as well as a two-to three-sentence description of each.  Additionally, a reference page must be included with at least six peer-reviewed sources that were published within the last 5 years, cited according to APA guidelines as outlined in the Ashford Writing Center.  These sources will also be used for the Final Project.  Each section of the outline should specify which sources will apply to that area.

This outline is a tool to ensure you are on the right track for your Final Project.  The more detail and information you provide in this assignment, the more feedback you will receive from your instructor.  

Carefully review the Grading Rubric for the criteria that will be used to evaluate your assignment.

PSY 330 Week 3 DQ 1 Behaviorism

Imagine you have completed the certification process and you are now a practicing therapist who specializes in behavior modification.  A new client calls you to make an appointment and discloses that she has a severe phobia of dogs.  She has been terrified of them since childhood.  Her fiancé has a dog and will not part with it, which requires her to get treatment before they are married.  Take one of the following approaches to develop a strategy for her behavior change:

Option A: Utilize classical conditioning techniques to develop a strategy for changing the behavior of the client. Be specific in identifying the unconditioned stimulus, the unconditioned response, the conditioned stimulus, and the conditioned response. Your response should also indicate the most likely cause of this disorder from a behaviorist perspective. Your initial post should be a minimum of 250 words and utilize one peer-reviewed source which was published within the last five years, cited according to APA guidelines as outlined in the Ashford Writing Center.  Indicate in your post which option you are responding to.    

Option B: Utilize operant conditioning techniques to develop a strategy for changing the behavior of the client. Be specific in identifying the reinforcement for the unwanted behavior and the method(s) of reinforcement you will use. Your response should also indicate the most likely cause of this disorder from a behaviorist perspective. Your initial post should be a minimum of 250 words and utilize one peer-reviewed source which was published within the last five years, cited according to APA guidelines as outlined in the Ashford Writing Center.  Indicate in your post which option you are responding to.

PSY 330 Week 3 DQ 2 Psychodynamic Theory

The psychodynamic model provides a general guideline for the development of normal and abnormal behavior.  Overall, the model is comprised of numerous theories and approaches that follow a general trend for behavior formation.  Evaluate each of the theories contained in the psychodynamic approach as they are presented in your course text.  Explain what normal and abnormal behavior would be within the perspective of each theory.  Provide a reasoned interpretation of what unifies the various theories within the psychodynamic model.

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PSY 330 Week 2 DQ 1 Neurobiology

Select one of the following options for this discussion.  Indicate in your post which option you are responding to. Option A:  Review this week’s reading, which introduced the role of neurotransmitters in human behavior and personality.  Use the Ashford University Online Library to locate one peer-reviewed research study which was published in the last five years and that implicates a neurotransmitter as the cause of an abnormal behavior (psychological disorder).  Clearly indicate in your discussion:

a.   The abnormal behavior being studied. b.   The neurotransmitter that is implicated. c.   The role of the neurotransmitter in the expression of the abnormal behavior.  

Your initial post should be a minimum of 250 words and utilize at least one peer-reviewed source that was published within the last five years, cited according to APA guidelines as outlined in the Ashford Writing Center. Guided Response: Review several of your classmates’ posts.  Respond substantively to two peers who chose a different neurotransmitter or abnormal behavior than you did.  Address the role of the neurotransmitter in the expression of the abnormal behavior that they each selected.  Are there other possible explanations for the cause of this abnormal behavior?  Which explanation do you think makes the most sense?  Why?    Option B: Review this week’s reading, which introduced the impact of early trauma on function and personality development.  Use the Ashford University Online Library to locate a peer-reviewed research study which was published within the last five years and that examines the impact of brain trauma on the function and development of personality.  Clearly indicate in your discussion:

a.   The trauma that occurred. b.   The duration between the time of the trauma and the research study. c.   The impact of the trauma on overall function. d.   The impact of the trauma on personality and behavior.

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PSY 330 Week 2 Assignment Nature Versus Nurture

The nature versus nurture debate, as it relates to human development, has perplexed mankind for centuries.

In the field of human behavior, the question frequently arises as to how much of human behavior is due to environment and how much is due to genetic influence.  Review the Nature and Nurture Predispose to Violent Behavior article (http://www.nervenklinik.uk-wuerzburg.de/fileadmin/uk/psychiatrie/Dokumente/Forschung/Psychiatric_Neurobiology_and_Bipolar_Disorder_Program/MAO-A_and_violent_crime.pdf)

from this week’s reading and write a two-to three-page analysis (excluding title and reference pages) of this study.  Utilize a minimum of two peer-reviewed sources that were published within the last five years, cited according to APA guidelines as outlined in the Ashford Writing Center.  

Your paper should examine the various methods used to determine if violent behavior is a function of nature or nurture.  Additionally, analyze the following:

a. What is the researcher’s hypothesis and conclusion?

b. Do you agree with their results?  Why or why not?

c. Do the results clearly indicate if violent behavior is a function of nature versus nurture?

d. Did the results of this study change your opinion on nature versus nurture as it relates to behavior?   

Carefully review the Grading Rubric for the criteria that will be used to evaluate your assignment. 

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PSY 330 ASH

PSY 330 Week 1 DQ 1 Methods PSY 330 Week 1 DQ 2 Psychoanalytic Theory PSY 330 Week 2 Assignment Nature Versus Nurture PSY 330 Week 2 DQ 1 Neurobiology PSY 330 Week 2 DQ 2 Heritability PSY 330 Week 3 Assignment Final Project Outline PSY 330 Week 3 DQ 1 Behaviorism PSY 330 Week 3 DQ 2 Psychodynamic Theory PSY 330 Week 4 DQ 1 Cognitive Theory PSY 330 Week 4 DQ 2 Interpersonal Style PSY 330 Week 5 Assignment Final Project PSY 330 Week 5 DQ 1 Triadic Theory PSY 330 Week 5 DQ 2 Sociobiology

  PSY 330 Week 1 DQ 1 Methods

Which of the methods and statistics presented in Chapter 2 of your course text do you think are the most effective for the study of personality? Why?  Identify and discuss at least one experimental method and one statistical approach. Explain their specific uses as outlined in your course text.  

PSY 330 Week 1 DQ 2 Psychoanalytic Theory

Select one of the following options for this discussion.  Indicate in your post which option you are responding to. 

Option A: Psychoanalytic theory presents explanations for abnormal behavior as well as a variety of methods for treatment of that behavior.  Select one of the methods or techniques used in psychoanalysis and discuss the strengths and weaknesses of this approach as it applies to the treatment of psychological disorders.  Your initial post should be a minimum of 250 words.  It must include at least 1 peer-reviewed source that was published within the last five years, cited according to APA guidelines as outlined in the Ashford Writing Center. 

Guided Response:  Review several of your classmates’ posts.  Respond substantively to two of your peers who identified different methods and techniques than what you chose.  In your response, compare the strengths and weaknesses of their selection to yours.  Do you think one of the selected methods or techniques is superior?  Why?  

Option B: Select one of the following early theorists that were instrumental in developing the psychoanalytic theoretical approach.  Examine and describe the theorist’s contribution(s) to psychoanalytic theory. Your initial post should be a minimum of 250 words.  It must include at least 1 peer-reviewed source that was published within the last five years, cited according to APA guidelines as outlined in the Ashford Writing Center. a.   Sigmund Freud b.   Carl Jung c.   Alfred Adler d.   Wilhelm Reich e.   Karen Horney f.   Anna Freud g.   Melanie Klein h.   Helen Deutsch

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PSY 490 Week 3 Individual Ethics Awareness Inventory

Complete the Ethics Awareness Inventory

Prepare a 700- to 1,050-word summary of your findings from the Ethics Awareness Inventory.

Discuss the role and importance of personal ethics in psychology, principles, and the Code of Conduct.

Discuss how ethics can affect how you will apply psychological principles to personal, spiritual, social, and organizational issues.

Assess how ethics affect psychological knowledge and principles related to personal growth, health, and development.

Analyze advantages of psychology as a degree choice. How do ethics play a role in your decision to pursue a degree in psychology?

PSY 490 Week 3 Summary

Write and present a summary of how this week’s readings and activities have affected your thought process regarding any aspect of this week’s Capstone course. (300 – 500 Words)

PSY 490 Week 4 DQ 1

This topic is a hot topic in the field of psychology today. In my on campus classes I show a DVD called "The Medicated Child" (PBS Home Video: WGBH Educational Foundation).  It goes into the excellent detail of the diagnosis of bipolar in children. It is a very controversial area, especially in the area of medication. May I ask your opinion...and if you would , feel free to debate the topic (debate meaning, back up and cite your opinion with reference support materials).  Do you think psychologists should (or can) accurately diagnose Bipolar in children (under the age of eighteen)??  I challenge you to watch this video before you pass an opinion.  You can access the full video in segments (online viewing ) for free at http://www.pbs.org/wgbh/pages/frontline/medicatedchild/

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PSY 490 Week 1 Summary

PSY 490 Week 1 Summary

Write and present a summary of how this week’s readings and activities have affected your thought process regarding any aspect of this week’s Capstone course. (350 – 500 Words)

PSY 490 Week 2 Summary

Write and present a summary of how this week’s readings and activities have affected your thought process regarding any aspect of this week’s Capstone course. (300 – 500 Words)

PSY 490 Week 3 DQ 1

The Ethics Awareness Inventory CORE concepts do not include Kohlberg’s stages of moral development. Why do you think that is? Do you think they concur? Explain your responses.

PSY 490 Week 3 DQ 2

What are the advantages or disadvantages of a psychology degree? What are the advantages or disadvantages of a bachelor’s, master’s, and doctorate degree in psychology?

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PSY 490 Week 1 Individual The Diverse Nature of Psychology Paper

Write a 700- to 1,050-word paper in which you analyze the diverse nature of psychology as a discipline.

Address the following items as a part of your analysis:

 ·      Evaluate the influence of diversity on psychology’s major concepts.

·      Identify two examples of subdisciplines and two examples of subtopics within psychology. Examples of major concepts and their subtopics include the following:

 o  Motivation: theory of emotion, and approach and avoidance

o  Behaviorism: aggression, cheating, and binge drinking

o  Cognition: cognitive dissonance and false memories

 ·      How can the subdisciplines and subtopics you identified be applied to other disciplines and venues in contemporary society?

·      Relate the subdisciplines and subtopics to your theoretical perspective.

·      Include your psychological contribution to society in the areas of work, education

PSY 490 Week 1 Individual The Diverse Nature of Psychology Paper

Write a 700- to 1,050-word paper in which you analyze the diverse nature of psychology as a discipline.

Address the following items as a part of your analysis:

 ·      Evaluate the influence of diversity on psychology’s major concepts.

·      Identify two examples of subdisciplines and two examples of subtopics within psychology. Examples of major concepts and their subtopics include the following:

 o  Motivation: theory of emotion, and approach and avoidance

o  Behaviorism: aggression, cheating, and binge drinking

o  Cognition: cognitive dissonance and false memories

 ·      How can the subdisciplines and subtopics you identified be applied to other disciplines and venues in contemporary society?

·      Relate the subdisciplines and subtopics to your theoretical perspective.

·      Include your psychological contribution to society in the areas of work, education, health, and leisure.

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PSY 490 Week 1 DQ 2

How is the field of psychology similar to other sciences? How is it different? Do you believe that psychology should be classified as a science? Why or why not?  

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Hey y’all, I know I try to keep non-fandom stuff off of here, but I would really appreciate it if you took the time to do this survey! It’s just for the final in my data analysis class, so none of the information will be used outside of my groups slides. Thank you so much!!