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Epidemiology of Mononucleosis Sample PaperIntroductionEpstein-Barr virus is the ...

Epidemiology of Mononucleosis Sample Paper

Introduction

Epstein-Barr virus is the pathogen that causes mononucleosis. Mononucleosis is also referred to as “the kissing disease” or mono and the virus is transmitted via contact with bodily fluids of an infected person, particularly saliva. The spread through saliva is responsible for the name “kissing disease”, as the virus is spread via kissing, sharing silverware such as cups, spoons or forks, drinks, or food with the infected individual. It is also spread when an infected person sneezes or coughs near a healthy person. The symptoms of infection include fatigue, fever, sore throat, sore muscles, swollen lymph nodes, vomiting and loss of appetite (Naughton et al., 2021).

Additional symptoms include palatal petechiae, rash and periorbital and eyelid edema. Some infected individuals may present with no symptoms or extremely mild symptoms that they go unnoticed. The majority of persons with mono recover within 2 to 4 weeks, but fatigue may last for several weeks more. Other individuals take as much as 6 months or longer to clear the symptoms. The diagnosis of mononucleosis is based on a high index of suspicion by the doctor, focusing on the symptoms. The doctor may assess the patient for swollen lymph nodes, tonsils or enlarged liver or spleen (Naughton et al., 2021). A complete blood count determines whether white blood cells are elevated and presence of atypical leukocytes. Antibody tests check for presence of specific antibodies within the circulation produced by the body’s immune system in response to Epstein Barr Virus, which is the gold standard test.

Complications of mononucleosis include swollen tonsils, enlarged spleen, enlarged liver, blood disorders, heart disease and nervous system pathology. Swollen tonsils result from increased immune response to the infection, causing enlargement of lymph nodes due to hyper-active reticulo-endothelial system (Naughton et al., 2021). Swollen tonsils result in difficulty in swallowing or breathing through the oral cavity. An enlarged spleen results from a hyper-active reticulo-endothelial system in response to active infection. Also, since the body destroys infected red blood cells at an alarming rate, the spleen engages in hematopoiesis to replace lysed red blood cells, in a process referred to as extramedullary hematopoiesis. An enlarged spleen presents as a sharp pain of sudden onset on the left hypochondriac region of the abdomen.

Since damaged red blood cells pass through the liver to conjugate and metabolize the hemoglobin, the patient may present with jaundice or hepatitis following infection of liver cells. The body’s immune system may actively destroy large numbers of erythrocytes, resulting in a hemolytic anemia. Platelet destruction results in thrombocytopenia (Naughton et al., 2021). The infection may also result in inflammation of the heart. i.e. myocarditis, presenting with an irregular heart beat and murmur. Infection of the nervous system may present with symptoms such as seizures, inflammation of the brain (encephalitis) or inflammation of the meninges covering the brain (meningitis). More severe complications from mononucleosis ensue in a host with a weakened immune system, for instance, in HIV/AIDS patients and persons taking immunosuppressive medications such as corticosteroids and cancer chemotherapy.

No definitive treatment exists to cure mononucleosis. As such, the disease is managed by placing the patient on bed rest, administering intravenous fluids for rehydration and managing the pain and fever using pain relievers such as acetaminophen or NSAIDS. The enlarged tonsils are managed by corticosteroids (Naughton et al., 2021). Also, there is no vaccine to prevent infection and the virus may stay in the host’s saliva for several months without physical symptoms of disease. Thus the best way of prevention includes washing hands often and avoiding sharing drinks, foods, toothbrushes and silverware.

Studies reveal that 75 % of adults of ages 18 to 22 years develop infectious mononucleosis following EBV infection. Among infected persons, 10 % are asymptomatic while 15 % exhibit atypical symptoms (Dunmire, Hogquist & Balfour, 2015). The incidence within the United States is 500 cases per 100 000 per year, with an annual incidence rate of 200 to 800 cases per 100 000 for young adults between 15 and 19 years. The prevalence of EBV worldwide is 95 %. The mortality rate is 17 % globally and morbidity is undetermined.

Social Determinants of Health

Infectious mononucleosis has higher incidence among individuals from upper socioeconomic groups compared to lower socioeconomic groups, as revealed by a study conducted in London (Dunmire, Hogquist & Balfour, 2015). This observation is attributable to the fact that individuals from high socioeconomic groups escape subclinical infection with Epstein Bar Virus during childhood to later develop the infection in adulthood. Moreover, individuals from lower socioeconomic groups may have under-diagnosis of the infection owing to inability to access medical care. This proposition is further supported by the presence of antibodies to Epstein-Barr virus among persons of lower socioeconomic groups, such as military recruits and pediatric patients in poor neighborhoods (Dunmire, Hogquist & Balfour, 2015). The higher prevalence of the antibody is also observed among students in universities and colleges. These findings are attributable to overcrowded living conditions since the disease is spread mainly via salivary contact. In overcrowding, an infectious person coughs salivary droplets containing the infectious virus, which are inhaled by healthy occupants of the room who acquire the infection. The prevalence of antibodies to EBV is lower in persons from middle-class environments, owing to adequate spacing and less risks for overcrowding. Among occupations, the incidence of mononucleosis is higher among nurses, doctors and other medical personnel and lower among manual workers. In addition to higher exposure risk to infected patients, medical workers may access diagnostic facilities with ease, resulting to high rates of detected illnesses.

A study by Cambridge University assessed the social determinants of mononucleosis as household socioeconomic position using mother’s educational level (Higher, degree, A, As, S level, GCSE), equivalised income rank with the partner’s joint income and the employment status (managerial, intermediate, small employers, own account workers, lower supervisory/technical occupations and semi-routine/routine occupations) (Black & Black, 2018). The area environment was determined as Large urban, Town or rural while the home environment was described by variables assessing for overcrowding (less than 1.5 rooms per person), collective child care (using nannies) and temperature in the child’s room. The housing tenure was described as owner, rent privately, social housing and other. The likelihood for EBV infection was significantly lower in children from higher social class, higher equivalised income and with mother having higher educational level (Black & Black, 2018). The likelihood for infection was higher among children sleeping in cold rooms, overcrowded homes, rented accommodation, and larger towns/cities. Urban dwelling exposes individuals to higher risks of contacting the virus via reduced personal space such as in public transport and living within small shared spaces. The low socioeconomic status (education, income and occupation) leads to inadequate living conditions within households, especially overcrowding and social renting, that increases the chances of spreading or acquiring the virus.

Epidemiologic Triangle

Host factors favoring infection with Epstein-Barr virus include genetic susceptibility, immunodeficiency, immunosuppression, intimate salivary contact with a carrier and airborne virus. Genetic susceptibility was identified in a study investigating individuals with inborn immune system errors, who exhibited higher susceptibility to and increased frequency of disease induced by the virus infection (Barros et al.,2019). Infants also have higher risks of developing EBV infection as maternal antibody (IgG) disappears from their bloodstream.

The children infected with Epstein Barr virus are often asymptomatic, and the infection could be confused for other differential diagnoses of common pediatric illnesses. But infection in adolescence and young adulthood results in characteristic features of infectious mononucleosis. Adolescents and young adults have increased risk of acquiring the infection, particularly in crowded living conditions such as in hostels, and intimate salivary contact involved in sexually active individuals. Sharing of silverware including cups, knives, forks and spoons is also common within this population, further increasing the likelihood of acquiring an infection (Bar-Or et al.,2020).

The epithelial linings of the oropharynx and uterine cervix are composed of squamous cells that the virus easily infects by bypassing the physiological barriers such as salivary and mucoid secretions. The role of a weakened immune system in developing the disease cannot be ignored. EBV has higher likelihood of developing into infectious mononucleosis in individuals who have immunosuppression secondary to organ transplant, chemotherapy, diabetes mellitus or human immunodeficiency virus.

Factors contributing to the virulence of EBV include increased antigen variation, selective infection of B lymphocytes, presence of a glycoprotein for attachment to cells and a latent phase. During the latent phase, the virus resides within the host without detection by the host’s immune system, enabling sustained viral replication and infection of more cells and tissues (Bar-Or et al.,2020). The replication cycle is also enhanced by the promoter of the viral gene ZEBRA that halts the latent phase and initiates the replication. Infecting B lymphocytes of hosts enables the virus to go undetected by the immune system, since B lymphocytes are involved in processing pathogen antigens, regulating immune responses and producing antibodies against infection. As a result, autoreactive infected B cells circulate, reaching specific target organs and initiate tissue damage, B cell damage, and release of the virus to infect new cells (Barros et al.,2019). The viral glycoprotein present on the lipid envelope enables the virus to attach to uninfected cells and commence the infection process.

Environmental factors contributing to spread of the virus include cold temperatures, poorly ventilated accommodations, humid environments and overcrowding. Exposure to cold triggers the human body to release cortisol into the circulation, which leads to reduced numbers of circulatory lymphocytes (Dunmire, Hogquist & Balfour, 2015). Since lymphocytes are the immune cells involved in combating virus infection, their reduced numbers makes it easier for the virus to cause infection in the host. Poorly ventilated rooms translate to air being stationary within confined spaces. In such cases, the airborne virus stays in the room air for longer periods, increasing the chances of its inhalation by an occupant. Likewise, overcrowding translates to less personal space between individuals, leading to higher chances of transmitting the virus via aerosol droplets incase an infected person coughs.

Role of a Community Health Nurse

The role of a community health nurse in dealing with infectious mononucleosis cannot be ignored. Since the disease is airborne, the community health nurse works with other health professionals to formulate appropriate strategies regarding sanitation, public practices, business interactions and personal interactions that would prevent the spread of the Epstein-Barr Virus (Naughton et al., 2021). For instance, the community health nurse may discourage kissing a person presenting with fever, malaise and other symptoms of infection.

The nurse may also encourage construction of buildings with adequate ventilation to prevent virion aerosols from being confined to rooms with stationary air that would favor transmission. The nurse also educates the caregivers interacting with the infected on the best practices to avoid acquiring the infection. Additional roles of a community health nurse involve holding educational campaigns to increase awareness of mononucleosis among the population, especially in crowded places like churches and schools.

In case finding, the nurse should have a high index of suspicion. A patient presenting with fever, muscle pain, lymphadenopathy and a sore throat should be highly suspected of Epstein-Barr virus infection (Naughton et al., 2021). In assessment, the nurse should check the temperature, respiratory rate, blood pressure and pulse rate to rule out life-threatening complications from the illness. Also, the health worker should order for laboratory workups to confirm the presence of antibodies to the virus within the circulation to provide a definitive diagnosis.

Every case should be documented in the facility’s medical records. The nurse then calculates the incidence of the disease and compares with other reported incidences from the records. A figure that is higher than expected is characteristic of an outbreak, which the nurse ought to report to the Centers for Disease Control and Prevention (Naughton et al., 2021). The department of health may then formulate strategic preventive measures to curb the outbreak before transformation into a pandemic. The nurse is directly involved in providing care to persons infected with Epstein Barr Virus, including administering the appropriate medication for symptoms relief and educating the individual on how to prevent spreading the pathogen to other persons.

The Centers for Disease Control and Prevention

The Centers for Disease Control and Prevention keeps track of infectious mononucleosis. The CDC is the national agency that develops and applies disease control and prevention, promotes environmental health and holds health education activities for improved health of U.S. citizens (Black & Black, 2018). To achieve its objectives, the CDC carries out epidemiologic studies and laboratory analyses to keep relevant surveillance of diseases, enabling the body to identify, define and prevent health problems. The organization actively engages in collection, analysis and distribution of data pertaining to disease and acts as the leading agency in formulating and implementing solutions to environmental health challenges.

The agency also operates series of studies focused on developing and testing effective disease prevention, control and health promotion programs (Black & Black, 2018). At the national level, CDC formulates and assesses the occupational health and safety standards recommended by professionals, and provides training, research and technical aid to provide healthy and safe working environments for professionals across various disciplines. An additional responsibility involves conducting a nationwide program to improve hospital laboratories’ performance.

Worth-noting, the CDC controls both introduction and spread of an infectious disease, besides providing consultation and aid to international agencies and other nations seeking to promote health, preserve environmental health or improve disease prevention and control (Levinson, 2017). An intriguing finding is that the organization provides the Preventive Health and Health Services Block Grant to applicants, in addition to program expertise and assistance to State, Federal, local or private organizations dealing with disease control and prevention.

In the case of infectious mononucleosis, since no vaccine for EBV has completed successful clinical trial to date, the appropriate prevention strategy taken by CDC is to enhance awareness of the spread of the virus among U.S. citizens. CDC educates the community on the importance of proper hygiene practices, appropriate ventilation of buildings and avoiding overcrowding in public and private places (Levinson, 2017). Also, members of the population are cautioned against engaging in close salivary contact with suspected infected persons, including acts of kissing or sharing silverware such as forks, spoons and cups.

Global Implication of Infectious Mononucleosis

While the global incidence of infectious mononucleosis remains undetermined, an incidence of 90% is noted among children in developing nations (Dunmire, Hogquist & Balfour, 2015). The children experience asymptomatic EBV infection before they attain five years and are insusceptible to mononucleosis at later stages in their lives. Also, infectious mononucleosis has no specific racial or ethnic predilections, but its incidence is higher among persons of high socioeconomic class in developed countries.

Whereas the disease shows no preference for either sex, splenic rupture as a complication is more common in males, with only 10 % of splenic ruptures being among women(Dunmire, Hogquist & Balfour, 2015). In Central Africa, Epstein Barr-virus is associated with an increased risk of developing Burkitt Lymphoma, particularly in children. The virus is closely linked to nasopharyngeal carcinoma among Alaskan Eskimos and Cantonese Chinese.

Conclusion

Curtly, infectious mononucleosis is an infectious disease that poses a significant public health problem, primarily owing to ignorance of the public on existence of the Epstein-Barr virus and its mode of transmission. The role of the community nurse in identifying the cases, diagnosing, providing appropriate relief of symptoms and educating the public on prevention measures cannot be overemphasized. The mentioned facts have been adequately discussed in this paper.

References

Bar-Or, A., Pender, M. P., Khanna, R., Steinman, L., Hartung, H. P., Maniar, T., … & Joshi, M. A. (2020). Epstein–Barr virus in multiple sclerosis: theory and emerging immunotherapies. Trends in molecular medicine, 26(3), 296-310. https://www.sciencedirect.com/science/article/pii/S1471491419302941
Barros, M. H. M., Vera-Lozada, G., Segges, P., Hassan, R., & Niedobitek, G. (2019). Revisiting the tissue microenvironment of infectious mononucleosis: identification of EBV infection in T cells and deep characterization of immune profiles. Frontiers in immunology, 10, 146. https://www.frontiersin.org/articles/10.3389/fimmu.2019.00146/full
Black, J. G., & Black, L. J. (2018). Microbiology: principles and explorations. John Wiley & Sons.
Dunmire, S. K., Hogquist, K. A., & Balfour, H. H. (2015). Infectious Mononucleosis. Current topics in microbiology and immunology, 390(Pt 1), 211–240. https://doi.org/10.1007/978-3-319-22822-8_9
Levinson, W. (2017). Review of medical microbiology and immunology.
Naughton, P., Healy, M., Enright, F., & Lucey, B. (2021). Infectious Mononucleosis: diagnosis and clinical interpretation. British Journal of Biomedical Science, 1-10. https://www.tandfonline.com/doi/abs/10.1080/09674845.2021.1903683

Episodic Focused SOAP Note on Back Pain DiscussionPatient Information:A 42-year- ...

Episodic Focused SOAP Note on Back Pain Discussion

Patient Information:

A 42-year-old male.

S.

CC (chief complaint): Lower back pain

HPI: The patient is a 42-year-old male who reports lower back pains for the past month. He reports that the pain occasionally radiates to his left leg.

I would like to know if the onset of the pain was sudden or gradual. I would like to know the character of the pain. Is it sharp, aching, or burning? Is it continuous or intermittent?

I would also like to know if there are any associated symptoms. These symptoms include fecal or urinary incontinence, weakness and numbness of the limbs, weight loss, fever, night sweats etc.

I would like to know if there are any exacerbating or relieving factors to this pain. Is it worse when walking, sitting, or lying flat? Is the pain worsened by coughing or straining? What does he do to relieve the symptoms? Has he taken any medications to try and relieve the symptoms?

I would like to know if the pain is getting better or worse. I would also like to know the severity of the pain by asking the patient to grade the severity on a scale of 1-10

I would ask the patient if he has ever experienced back pain in the past and if it is similar to what he’s experiencing now.

I would ask if the patient has any previous trauma or injuries that might have preceded his symptoms.

Current Medications: I would ask for any medications the patient is taking e.g. steroids or analgesics.

PMHx: I would check if the patient has any musculoskeletal condition such as osteoarthritis.

I would ask the patient if he has had spinal surgery before.

Soc Hx: I would ask about the patient’s occupation. Does it involve carrying around heavy loads?

Does the patient take alcohol or tobacco?

Travel Hx: I would ask about any recent visits to TB endemic areas or areas with a high prevalence of TB. This is important as TB can cause Pott’s disease (Wong et al., 2017).

Fam Hx: I would ask if anyone in his family has had similar symptoms before.

ROS:

GENERAL: I will ask for constitutional symptoms such as weight loss, fatigue, fevers, night sweats and chills.

GENITOURINARY: I will ask for urinary incontinence or retention.

NEUROLOGICAL: I will ask for weakness, numbness, paralysis, or tingling in the extremities. I will ask in changes in bowel or bladder control

MUSCULOSKELETAL: I will ask for muscle pain, joint stiffness.

HEMATOLOGIC: I will ask for signs of anemia, bleeding or bruising.

LYMPHATICS: I will ask for the presence of enlarged lymph nodes.

Physical exam: I will check the vital signs i.e., the temperature, BP, respiratory rate and pulse rate.

MUSCULOSKELETAL:

Inspection: Check for the spinal alignment. Check for muscle wasting. Check for bruising which might suggest recent trauma or surgery. Gait and Posture test to observe the overall posture and how the patient walks. Range of motion. To test for extension of the spine, forward flexion, lateral flexion and lateral rotation of the spine.

Palpation and percussion of the spine. Done to assess the alignment of the spine and note any tenderness and muscle spasms. Palpation of the sciatic notch. Tenderness over this area with radiation of pain to the leg may indicate an irritation of the sciatic nerve.

NEUROLOGICAL (of the lower limb).

Inspection: Check for muscle wasting, fasciculations, and tremors

Palpation: this includes assessing the tone and power of the muscle groups

Reflexes. Testing the ankle and knee reflexes can help with determining the level of spinal cord compromise.

Motor testing and sensory testing to assess for muscle weakness and sensation. The nerve roots that are most likely affected are L4, L5, and S1.

L5: The sensory component is tested on the dorsum and medial aspect of the big toe. The motor component is tested by asking the patient to dorsiflex the great toes (Stecco et al., 2019)

L4: The sensory component is tested on the medial aspect of the lower leg and ankle. Dorsiflexion of the great toe can be used to check for some L4 root dysfunction of the motor component.

S1: The sensory component is tested on the dorsum and lateral aspect of the little toe. The motor component is assessed by asking the patient to flex their knee so that the foot lies flat on the bed. This test assesses the hamstrings. Testing for these nerves can help to detect nerve root dysfunction.

Diagnostic tests:

A complete blood count (CBC) is necessary. By studying the blood parameters, we can rule out an infection or a malignancy. A raised white cell count can suggest an infection. Iron deficiency anemia can be a sign of malignancy.
Erythrocyte sedimentation rate should be tested. A raised ESR can point towards ankylosing spondylitis (Ranganathan et al., 2017).
Liver function tests. An elevated ALP may be a sign of bony
Bone profile. Hypercalcemia may be a sign of malignancy.
Plain X-rays of the spine. Done to screen for possible fractures or other bony deformities.

A.

Differential Diagnoses

Nerve tumors such as neurofibroma of the cauda equina. This can present with sciatica. The pain is usually continuous (Solomon & Wakeley, 2017).
Intervertebral disc prolapse. This is caused by physical stress. Herniation of the nucleus can cause compression of the cauda equina which may present with pain in the lower limb (Solomon & Wakeley, 2017).
TB of the spine. This can also lead to degeneration of the spinal and compression of the surrounding structures. Pain is a common presentation (Solomon & Wakeley, 2017).
Vertebral fracture. Pain is a common symptom of fractures. Fractures can also lead to compression of the nerve roots which may present with pain and weakness of the lower limbs (Solomon & Wakeley, 2017).
Muscular strain and spasms. These can result in pain in the lower back and difficulty in forward flexion (Solomon & Wakeley, 2017).

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

References

Ranganathan, V., Gracey, E., Brown, M. A., Inman, R. D., & Haroon, N. (2017). Pathogenesis of ankylosing spondylitis—recent advances and future directions. Nature Reviews Rheumatology, 13(6), 359-367. https://doi.org/10.1038/nrrheum.2017.56
Solomon, L., & Wakeley, C. (2017). Diagnosis in orthopaedics. In Apley and Solomon’s System of Orthopaedics and Trauma (pp. 450-500). CRC Press.
Stecco, C., Pirri, C., Fede, C., Fan, C., Giordani, F., Stecco, L., & De Caro, R. (2019). Dermatome and fasciatome. Clinical Anatomy, 32(7), 896-902. https://doi.org/10.1002/ca.23408
Wong, Y. W., Samartzis, D., Cheung, K. M. C., & Luk, K. (2017). Tuberculosis of the spine with severe angular kyphosis: mean 34-year post-operative follow-up shows that prevention is better than salvage. The Bone & Joint Journal, 99(10), 1381-1388. https://doi.org/10.1302/0301-620x.99b10.bjj-2017-0148.r1

Episodic/Focused SOAP Note Template Assignment PaperEpisodic/Focused SOAP Note T ...

Episodic/Focused SOAP Note Template Assignment Paper

APA format 3 peer references needs to review case study and document on differential diagnosis as to agreeing or disagreeing Due October 20.2018 at 5pm

Episodic/Focused SOAP Note Template

Patient Information:

A.S., 46 F, Caucasain

Episodic/Focused SOAP Note Template Assignment Paper

CC “ankle pain in both ankles; worse in right ankle, after hearing ‘pop’ while playing soccer.”

HPI: A.S. is a 46 year old Caucasian female who presents with bilateral ankle pain which she describes as chronic for the last 3 months. Episodic/Focused SOAP Note Template Assignment Paper. She acutely injured her right ankle 3 days ago while playing soccer. The pain is described as aching with intermittent sharp characteristics. Associated symptoms include limited ROM. The pain is worse with weight bearing and OTC pain medications have included alternating doses of Tylenol and Motrin with moderate relief.

Current Medications:

Motrin 200 mg by mouth every 4-6 hours as needed for pain
Hydrochlorothiazide 12.5mg by mouth daily for 6 months for HTN

Allergies: PCN- rash, no known food/environmental allergies

PMHx: HTN; immunizations are up to date- last tetanus 12/2017; flu shot 10/2018 cholecystectomy 2015

Soc Hx: A.S. is employed as a Registered Nurse and remains active by playing soccer three times a week. She is married with two teenage daughters. She denies tobacco and alcohol use.

Fam Hx: Maternal grandmother deceased at age 56 from MI. Maternal father deceased at age 75 from complications of COPD. Paternal grandparents unknown. Episodic/Focused SOAP Note Template Assignment Paper. Father history is unknown. Mother is alive with type 2 diabetes that is well controlled with oral agents. Sibling age 43 alive and well. Children are alive and well with no medical hx.

ROS:.

GENERAL: No weight loss, fever, chills, weakness or fatigue.

HEENT: Eyes: No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat.

SKIN: No rash or itching.

CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema,

RESPIRATORY: No shortness of breath, cough or sputum.

GASTROINTESTINAL: No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY: No burning on urination.

NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL: pain and swelling to right ankle, limited weight bearing and ROM in b/l ankles, worse in the right ankle. Episodic/Focused SOAP Note Template Assignment Paper. No muscle cramping. No back pain.

HEMATOLOGIC: No anemia, bleeding or bruising.

LYMPHATICS: No enlarged nodes. No history of splenectomy.

PSYCHIATRIC: No history of depression or anxiety.

ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES: No history of asthma, hives, eczema or rhinitis.

GENERAL: AAOx 3, limping gait, no distress. No fever. Skin is warm, dry, and intact. Skin of the lower extremities is warm and pink in color.

CARDIOVASCULAR: chest is symmetric with symmetrical expansion, PMI noted at fifth intercostal space at the midclavicular line, normal S1 and S2, no m/r/g, no edema in legs, dorsalis pedis 2/4 bilaterally, normal hair distribution in legs and no pigmentation of b/l legs.

MUSCULOSKELETAL: limited ROM and weight bearing in b/l ankles, worse in right ankle. No clubbing, cyanosis, or edema.

NEUROLOGICAL: mood and affect appropriate, CN II-XII intact. Motor: 5/5 in upper and lower extremities, DTRs 2+ bilaterally.

Diagnostic results:

Ankle x-ray– If the Ottawa ankle rule is positive (bone tenderness at posterior malleolus, bone tenderness at posterior medial malleolus, or inability to bear weigh > 4 steps) ankle radiographs are indicated (Polzer, Kanz, Prall, Haasters, Ockert, Mutschler, & Grote, 2012) Episodic/Focused SOAP Note Template Assignment Paper.

If ankle radiographs negative- assess ligament in affected extremity as compared to un-injured extremity by doing the crossed leg test, squeeze test, external rotation test, anterior drawer test, and talar tilt test. These tests will assist in determining the need for an MRI and also grading the sprain (Polzer, Kanz, Prall, Haasters, Ockert, Mutschler, & Grote, 2012).

Labs may include a uric acid level which is elevated with gout and a WBC which would be elevated with osteomyelitis. MRI imaging may also be indicted.

Sprain- because the patient heard the “pop” sound, her injury is likely related to an ankle sprain in which the ligaments and tissue that surround the bones of the ankle are injured causing swelling, pain, and limited ROM (PubMed Health, 2018).

Fracture– a fracture would be unlikely if the patient was able to bear weight after the injury. The area would also become ecchymotic with limited to no ROM (PubMed Health, 2018).

Osteomyelitis– the extremity would be warm, erythematous, not usually associated with an acute injury, potential fever present, usually associated with a systemic infection or a wound (Ball, Dains, Flynn, Solomon, & Stewart, 2015) Episodic/Focused SOAP Note Template Assignment Paper.

Gout– associated with hot, swollen joints, pain and limited ROM (Ball, Dains, Flynn, Solomon, & Stewart, 2015)

Bursitis– limited ROM, swelling, pain, warmth, and point tenderness (Ball, Dains, Flynn, Solomon, & Stewart, 2015)

References for Episodic/Focused SOAP Note Template Assignment Paper

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby Episodic/Focused SOAP Note Template Assignment Paper.
Polzer, H., Kanz, K. G., Prall, W. C., Haasters, F., Ockert, B., Mutschler, W., & Grote, S. (2012).
Diagnosis and treatment of acute ankle injuries: development of an evidence-based algorithm. Orthopedic Reviews, 4(1), e5. http://doi.org/10.4081/or.2012.e5
PubMed Health. (2018). Ankle sprains: overview. Retrieved from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072736/

Episodic/Focused SOAP Template Health AssessmentEpisodic/Focused SOAP Template H ...

Episodic/Focused SOAP Template Health Assessment

A 47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools.

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each

ORDER THROUGH BOUTESSAY

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.

Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc.

Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.

As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources.

Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it.

This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Essay 6: The Spirit Catches You, and You Fall DownEssay 6: The Spirit Catches Yo ...

Essay 6: The Spirit Catches You, and You Fall Down

According to chapter 4 in the book, what perceptions of American physicians may have affected Hmong refugees’ ability to feel that they could trust the American health care system?
How did Dwight Conquergood make some headway in working to promote public health among Hmong refugees at Ban Vanai camp?
How may some of the negative perceptions of Foua and Nao Kao by staff affect how they cared for Lia and her family?
How did you feel about Foua and Nao Kao’s continual “noncompliance” with Lia’s medication regimen?
Describe how Merced’s public health department effectively handled a public health situation regarding a Hmong family raising rats in the home and how this communication could have easily broken down.

ORDER THROUGH BOUTESSAY

Essay 6: The Spirit Catches You and You Fall Down Instructions

Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Also Read:

Assignment 8: Operations-based Company
NRS 493 Topic 1 Professional Capstone and Practicum Reflective Journal Assignment
NRS 493 Topic 1 Capstone Change Project Paper
NRS 493 Topic 1 Individual Success Plan Essay Paper
NRS 493 Topic 10 Discussion Essays

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the
Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Episodic Soap Note Headaches PaperPatient: A-KSex: MaleAge: 20Race:CC: Headach ...

Episodic Soap Note Headaches Paper

Patient: A-K

Sex: Male

Age: 20

Race:

CC: Headache

History of Presenting Illness:

The 20-year-old male patient presents with headaches that are intermittent. The headache is diffuse and occurs all over. The patient reports that the pain has the greatest intensity above the eyes, nose jaw and around the cheekbones.

The timing of the headache. I would want to know for how long the patient has had the headache. Primary headaches usually exist for a longer time compared to secondary headaches. Acute headaches can be associated with subarachnoid hemorrhage or an acute hypertensive crisis. I would also want to ascertain the duration of each attack

It is important to know whether there are any associated symptoms, such as nausea, photophobia, phonophobia, visual auras, and vomiting. Vomiting can be a feature of a migraine. The character of the headache is also a useful pointer. Migraines can present as a throbbing and pulsatile headache (Lakhan, 2018). Tension headaches are dull. Exacerbating and relieving factors can give pointers as to whether there are any triggers. Headaches can be worsened by posture and relieved by lying down

Another thing to find out is the severity of the headache. The patient should score the headache on a verbal rating scale of 1-10 with 10 being the most severe. Migraines tend to be severe compared to tension headaches. It is however important to note that the pain from a primary headache can be as disabling as that due to a secondary headache.

Current medications:

I would want to know any medications the patient takes. This includes the medications that the patient takes to relieve the headache, the number of tablets taken and the duration. This is relevant as certain medications have headaches as a side effect. An example is sildenafil which is vasodilator. Coronary vasodilators can also cause hypotension which may present as headache. Also, overuse of analgesics can result in chronic headaches (Vandembussche et al, 2018).

Allergies:

I would want to know if the patient has any allergies. Allergies may cause rhinorrhea and sinusitis.

Past Medical Hx:

For past medical history, it is relevant to know if the patient has any chronic illnesses. These include hypertension and diabetes. Diabetes can present with headaches such as in episodes of hypoglycemia. An acute hypertensive crisis can also present as a headache. I would also want to know if the patient has a history of recent trauma as this may present as headaches especially if the patient has a raised intracranial pressure.

Social Hx:

I would also want to know about the patient’s personal habits such as alcohol and tobacco use. Alcohol can aggravate cluster headaches. Heavy caffeine use is also associated with headaches

Family hx:

It is important to know if the patient has a history of similar headaches to his or any headache at all in the family (Sufrinko et al., 2018)

ROS:

On the review of systems, I would ask for;

GENERAL: Any recent illness, fever, chills, night sweats, weight loss or gain.

HEENT: Any visual loss, blurred vision, double vision, light sensitivity during headaches or yellow sclerae. Ears: pain, hearing loss. Nose: seasonal rhinorrhea sneezing, congestion, pain in sinus area during headaches, or runny nose. Throat: Sore throat, difficulty speaking or swallowing.

SKIN: Rash, or itching.

CARDIOVASCULAR: Chest pain, chest discomfort, palpitations and edema.

RESPIRATORY: Cough or shortness of breath,

GASTROINTESTINAL: Anorexia with headaches, nausea, and vomiting.

GENITOURINARY: Burning on urination

NEUROLOGICAL: Dizziness, syncope, numbness or tingling in the extremities, paralysis, changes in bowel or bladder control.

MUSCULOSKELETAL: Muscle pain, joint pain, or back pain

HEMATOLOGIC: Anemia.

LYMPHATICS: Enlarged nodes.

PSYCHIATRIC: History of depression and anxiety.

ENDOCRINOLOGIC: Excessive thirst, polyphagia, or polyuria.

ALLERGIES: History of asthma, rhinitis, or seasonal allergies

Physical exam:

General: The vital signs should be measured. This includes the heart rate, the blood pressure, the respiratory rate and the temperature. The temperature is useful in detecting whether there is a fever which can be an indication of an infection. The SpO2 on room air should also be checked.

Head and Neck: Check for the full range of motion. Meningitis can present with neck stiffness and headache (Young & Thomas, 2018). Also, check for head symmetry and any signs of trauma. Examine the scalp for areas of swelling and tenderness.

HEENT: Inspect the eyes and periorbital areas for any signs of lacrimation and flushing. Check the pupillary size and light responses. Check the nares for purulence, bleeding, rhinorrhea. Check for swallowing difficulties or hearing loss

Cardiovascular: Check for heart rate, heart rhythm, heart sounds, and any added sounds

Respiratory: Auscultate the lung fields for breath sounds and for respiratory rate.

Gastrointestinal: Palpate for abdominal tenderness or pain. Auscultate all 4 quadrants for bowel sounds.

Neurological: Assess whether the patient is well oriented to place time and situation. Assess the memory, Both short-term and long-term. Check the muscle tone.

Diagnostic results:

The necessary diagnostic tests include a CT scan of the head is done to rule out secondary causes of headache

A Complete Blood Count (CBC). headache is one of the symptoms of anemia therefore this should be ruled out.

Erythrocyte Sedimentation Rate (ESR). This is done to determine whether there is an inflammation such as temporal arteritis which can present as headache.

Nasal smear to look for eosinophils. This would confirm the presence of allergic rhinitis (Farrer, 2018).

Differential Diagnoses

Acute Sinusitis: Acute Rhinosinusitis causes symptomatic inflammation inside the nasal cavities lasting less than four weeks. It is a common complaint of frontal headaches, with pressure or fullness feeling. This disorder is usually worse during winter (Farrer, 2018).

Medication rebound headache: This is a chronic daily headache associated with medication or caffeine use. Pain with this headache is often described as diffuse. It is associated with person’s using headache medication or caffeine intake on a daily basis. This type of headache starts a few hours after the last dose of medication or caffeine (Vandembussche et al, 2018).

Migraine without aura: This is one of the most common complaints that patients present with. It is a very common disorder (Yeh et al., 2018). Headache is usually unilateral and described as throbbing. Migraines often are accompanied by photophobia, phonophobia, nausea, and vomiting.

Tension Headache: This type of headache is very common in adults. It presents as a mild to moderate headache that is band-like and develops gradually. It is usually associated with stress and can last from a few hours to a day (Dwyer, 2018).

Bacterial Meningitis. The patient’s chief complaint is headache and therefore this is a possible diagnosis. Meningitis usually presents with headache as one of its major symptoms (Young & Thomas, 2018).

References

Dwyer, B. (2018, December). Posttraumatic headache. In Seminars in neurology (Vol. 38, No. 06, pp. 619-626). Thieme Medical Publishers.
Farrer, F. (2018). Is it an allergy or is it sinusitis?. SA Pharmacist’s Assistant, 18(3), 25-26.
Lakhan, K. J. (2018). “Sinus” Headaches: Sinusitis Versus Migraine. Physician Assistant Clinics, 3(2), 181-192.
Sufrinko, A., McAllister-Deitrick, J., Elbin, R. J., Collins, M. W., & Kontos, A. P. (2018). Family history of migraine is associated with posttraumatic migraine symptoms following sport-related concussion. The Journal of head trauma rehabilitation, 33(1), 7.
Vandenbussche, N., Laterza, D., Lisicki, M., Lloyd, J., Lupi, C., Tischler, H., … & Katsarava, Z. (2018). Medication-overuse headache: a widely recognized entity amidst ongoing debate. The journal of headache and pain, 19(1), 1-14.
Yeh, W. Z., Blizzard, L., & Taylor, B. V. (2018). What is the actual prevalence of migraine?. Brain and behavior, 8(6), e00950.
Young, N., & Thomas, M. (2018). Meningitis in adults: diagnosis and management. Internal medicine journal, 48(11), 1294-1307.

Essay 5: Models of Abnormal Psychology Through Case Study.Essay 5: Models of Abn ...

Essay 5: Models of Abnormal Psychology Through Case Study.

Comparing Models of Abnormal Psychology Through Case Study.

The goal of this assignment is to explore two models of abnormal psychology beyond the textbook and apply these perspectives to one case study depicting a major mental illness.
I will email you the the APA citation style word document and the case study article.

Essay 5: Models of Abnormal Psychology Through Case Study Instructions:

Require APA format word document
Please red chapter 1 and 2 of textbook: Fundamentals of Abnormal Psychology by Ronald J. Comer and Jonathan S. Comer
Use two models
a) Biological model
b) Cognitive-behavioral model
Use the APA citation style word document that I email you. Replace all highlighted text as noted on the document. This document is set up in APA citation style so do not change anything that is not highlighted.
Complete one introductory paragraph that includes the following:

Make sure this section of the semester paper is labeled “Introduction”

A brief introduction with a thesis statement including the following:

A definition of abnormal psychology
A brief description of the “Obsessive – Compulsive Disorder”
A brief description of the Biological Model and Cognitive-behavioral Model.
The goal of evidence-based treatment specific to Obsessive-Compulsive Disorder.

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Essay 5: Strengths and Opportunities for GrowthEssay 5: Strengths and Opportunit ...

Essay 5: Strengths and Opportunities for Growth

(1st-grade class. include literacy for first grade ) it is based on a literacy lesson plan for a first grade.

Write a 400-word reflection based on the feedback you received from your classroom teacher and personal observations about the experience; explain the following:

Strengths and opportunities for growth. Provide specific evidence from your activity.
How did you meet the needs of students with different learning styles in your lesson? What were the students’ responses?
What opportunities did you give students to learn, practice, and master content? What is the proof that students learned the content?
What changes will you implement in your next lesson? Be sure to provide specific examples.

ORDER THROUGH BOUTESSAY

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort, and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized.

Read over your paper – in silence and then aloud – before handing it in, and make corrections as necessary. Often, having a friend proofread your paper for obvious errors is advantageous. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12-point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. Letting your essay run over the recommended number of pages is better than compressing it into fewer pages.

The paper must be neatly formatted and double-spaced with a one-inch margin on each page’s top, bottom, and sides. When submitting a hard copy, use white paper and print it out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument. GCU Journal Of Health Care Organization Provision And Financing

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words.

Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.

One or two-sentence responses, simple statements of agreement or “good post,” and off-topic responses will not count as substantive. Substantive responses should be at least 150 words.

I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ are graded separately and do not count toward participation.

In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days for three replies.

Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).

Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything due during the week.

APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the resources tab in LoudCloud, for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).

Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage the overutilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly.

As Master’s level students, you must be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding or critical analysis of the content.

It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report, and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper more of someone else’s thoughts than yours?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud, for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

Per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask questions or send messages. This will be checked at least once every 24 hours.

Essay 6: System of health care deliveryEssay 6: System of health care deliveryMa ...

Essay 6: System of health care delivery

Managed care is a system of health care delivery that aims to provide a generalized structure and focus when managing the use, access, cost, quality, and effectiveness of health care services. There are various ways in which the managed care organization reimburses hospitals for their services. Examples of Managed Care Reimbursement Methods include the following:

Percent-of-charge payment
Per diem payment
Case rate payment (DRGs and MS-DRGs)
Ambulatory Patient Grouper (APG)
Ambulatory Payment Classification (APCs)
Other types of reimbursement (carve-out, stop-loss, and withhold pools)

Instructions

Create a Venn Diagram (with a minimum of 4 points) to compare and contrast two of the Managed Care Reimbursement methods listed above.
Review the video “How to Create a Venn Diagram in Word and PowerPoint” in Supplemental Resources prior to completing this part of the assessment.
Summarize your findings in a one-page paper. In your summary, explain how each method is different and provide an example of when it is appropriate for an organization to use each method.
Submit both parts of this assessment in the same document.

(Please be advised that this is a two part assignment Venn Diagram and one page Paper)

ORDER THROUGH BOUTESSAY

Essay 6: System of health care delivery Instructions

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the
Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Ethical And Spiritual Decision Making In Healthcare 9Ethical And Spiritual Decis ...

Ethical And Spiritual Decision Making In Healthcare 9

What do the four parts of the Christian biblical narrative (i.e., creation, fall, redemption, and restoration) say about the nature of God and of reality in relation to the reality of sickness and disease? From where would one find comfort and hope in the light of illness according to this narrative? Explain in detail each part of the narrative above and analyze the implications.

ORDER THROUGH BOUTESSAY

Principlism

“Principlism,” by Childress, in the Encyclopedia of Ethics (2001).

https://lopes.idm.oclc.org/login?qurl=http://search.credoreference.com.lopes.idm.oclc.org/content/entry/routethics/principlism/0

Ethics

“Ethics,” by Hobden, from Key Concepts in Nursing (2008).

https://lopes.idm.oclc.org/login?qurl=http://search.credoreference.com.lopes.idm.oclc.org/content/entry/sageuknurs/ethics/0

American Journal of Bioethics

American Journal of Bioethics website.

http://www.bioethics.net/

Presidential Commission for the Study of Bioethical Issues

Presidential Commission for the Study of Bioethical Issues website.

https://bioethicsarchive.georgetown.edu/pcsbi/studies.html

Bioethics

“Bioethics” from the Internet Encyclopedia of Philosophy website.

http://www.iep.utm.edu/bioethic/

Bioethics

“Bioethics,” by Waters, from Cambridge Dictionary of Christian Theology (2011).

https://lopes.idm.oclc.org/login?url=https://search.credoreference.com/content/entry/cupdct/bioethics/0?institutionId=5865

The Five-Box Method: The “Four-Box Method” for the Catholic Physician

“The Five-Box Method: The ‘Four-Box Method’ for the Catholic Physician,” by Marugg, Atkinson, and Fernandes, from The Linacre Quarterly (2014).

https://www-ncbi-nlm-nih-gov.lopes.idm.oclc.org/pmc/articles/PMC4240053/

The Four Quadrant Approach to Ethical Issues in Burn Care

The Four Quadrant Approach to Ethical Issues in Burn Care,” by Teven and Gottlieb, from AMA Journal of Ethics (2018).

https://journalofethics.ama-assn.org/article/four-quadrant-approach-ethical-issues-burn-care/2018-06

Navigating Ethics in a Health-Care Setting

“Navigating Ethics in a Health-Care Setting,” by Sego, from Clinical Advisor (2011).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=108243948&site=ehost-live&scope=site

The Four Principles of Biomedical Ethics: A Foundation for Current Bioethical Debate

“The Four Principles of Biomedical Ethics: A Foundation for Current Bioethical Debate,” by Lawrence, from Journal of Chiropractic Humanities (2007).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105887311&site=ehost-live&scope=site

The “Four Quadrants” Approach to Clinical Ethics Case Analysis; An Application and Review

“The ‘Four Quadrants’ Approach to Clinical Ethics Case Analysis; An Application and Review,” by Sokol, from Journal of Medical Ethics (2008).

https://search-proquest-com.lopes.idm.oclc.org/docview/1781073684?accountid=7374

Teaching Clinical Ethics Using the Four Topic Method

“Teaching Clinical Ethics Using the Four Topic Method,” by Ediger, from International Journal of Athletic Therapy & Training (2015).

https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edsbl&AN=RN603857263&site=eds-live&scope=site

Autonomy in Applied Medical Ethics

“Autonomy in Applied Medical Ethics,” by Freer, from Ethics & Medicine (2017).

https://search-proquest-com.lopes.idm.oclc.org/docview/1861785878/fulltextPDF/91A6E593DF9F4C28PQ/6?accountid=7374

Ethical And Spiritual Decision Making In Healthcare 9 Instructions

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the
Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.