FNP592 WEEK 1 TO 8 DISCUSSIONS AND ASSIGNMENTS SOAP NOTES | GET INSTANT WRITING HELP

Week 1: Discussion Question – Clinical Practice

 

Discuss your plan for completing your clinical hours. What specific skills or goals would you like to accomplish during this clinical rotation? How do you plan to use evidence to support your clinical decisions?

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: A minimum of 300 words, not including references
  • Citations: At least 4-5 high-level scholarly reference in APA from within the last 5 years

Week 2: Discussion Question – Evidence-Based Practice

Diabetes is a common illness seen in primary care.  Using evidence-based practice, what screening would you need to make to ensure these patients are getting adequate care and health promotion.

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: A minimum of 300 words, not including references
  • Citations: At least 4-5 high-level scholarly reference in APA from within the last 5 years

Week 3: Discussion Question – Diagnosis Presentation

For discussion this week, students will post a presentation for review and discussion among other students. Please post your presentation by Thursday. You may use feedback from your peers to help improve the presentation, which will be then submitted to the assignment dropbox on Monday night. There will be two grades associated with this project; the weekly discussion grade and also the instructor’s grade of the presentation itself, in the assignment dropbox Please see the presentation assignment prompt for more details.

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: 10-12 slides in length (excluding title and reference slides, with a maximum recording length of 20 minutes)
  • Format: PPT titled as follows:
  • Last name_DiagnosisPresentation1_mmddyyyy
  • Example: Billingsley_CholecystitisPresentation1_01172020
  • Citations: At least 6-7 high-level scholarly references in APA from within the last 5 years

Week 4: Discussion Question – Population Based Health

Pick a specific population within your clinical environment or community and discuss the overall health of that population – morbidity, mortality, health behaviors, risk factors, barriers to access, etc. Identify a targeted health issue or health promotion service/program that is needed or being utilized and discuss the benefits/downfalls or pros/cons. Reference and citations required.

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: A minimum of 300 words, not including references
  • Citations: At least 4-5 high-level scholarly reference in APA from within the last 5 years

Week 5: Discussion Question – Clinical Resources

Resources are an important part of daily practice.  Identify and describe two resources you have seen being used in clinic that are helpful in determining diagnosis, assessment or treatment plans.  Citation and reference required.

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: A minimum of 300 words, not including references
  • Citations: At least 4-5 high-level scholarly reference in APA from within the last 5 years

Week 6: Discussion Question – Diagnosis Presentation

For discussion this week, students will post a presentation for review and discussion among other students. Please post your presentation by Thursday. You may use feedback from your peers to help improve the presentation, which will be then submitted to the assignment dropbox on Monday night. There will be two grades associated with this project; the weekly discussion grade and also the instructor’s grade of the presentation itself, in the assignment dropbox Please see the presentation assignment prompt for more details.

 

 

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: 10-12 slides in length (excluding title and reference slides, with a maximum recording length of 20 minutes)
  • Format: PPT titled as follows:
  • Last name_DiagnosisPresentation1_mmddyyyy
  • Example: Billingsley_CholecystitisPresentation1_01172020
  • Citations: At least 6-7 high-level scholarly references in APA from within the last 5 years

Week 7: Discussion Question – Health Promotion & Wellness or Clinical Goals & Evidence-Based Practice

Evaluate the Healthy People 2030 goals and summarize two guidelines for health screenings or modifiable risk factors that can be recommended by the advanced practice nurse. Reference and citations required.

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: A minimum of 300 words, not including references
  • Citations: At least 4-5 high-level scholarly reference in APA from within the last 5 years

 

Week 8: Discussion Question – Reflection

 

Week 8: Discussion Question – Reflection

Of the 6 SOAP notes you submitted for this course and uploaded in Project Concert, which categories within the template below did you complete? For your personal use and tracking, please place dates in the boxes as you complete the SOAP notes (Do not include this information in your response to this prompt, this is for personal tracking only). This will help you visualize your progress, however, this is a supportive reflective activity and is not intended to replace or augment documentation of hours. The notes in Project Concert will be used to determine whether the program criteria are met.  Please continue to use this form in subsequent clinical courses.

Consider: Which categories (body systems) and which ages should you prioritize for program completion? Which areas have you finished? Of the minimum required pediatric categories (infant, child, teen), and maternal health, how many more do you still need to capture in your total clinical requirements (list each category)?

Response Instructions:

  • Complete the activity outlined in this prompt (Do not upload the template in your response)
  • Reflect on your completion of this activity and the considerations above. Template
  • Summarize a reflection that includes a de-identified description of a patient encounter you found memorable for this course.
  • What made it memorable and what might you do differently if you were to see that patient again?

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: A minimum of 300 words, not including references
  • Citations: At least 4-5 high-level scholarly reference in APA from within the last 5 years

 

Summary Week 7 Clinical FNP 592 Evaluate the Healthy People 2030 goals and summarize two guidelines

Evaluate the Healthy People 2030 goals and summarize two guidelines for health screenings or modifiable risk factors that can be recommended by the advanced practice nurse. Reference and citations required.

Expectations Initial Post: Length: A minimum of 250 words, not including references Citations: At least one high-level scholarly reference in APA from within the last 5 years

SOAP Note Week Two

 

United States University

FNP592: Common Illnesses Across the Lifespan

Dr. Theresa Gress

October 1, 2020

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SOAP Note Week Three

ID: Mickey Mouse, DOB 1/1/2000, age 20, white Hispanic male presents to the clinic unaccompanied and appears to be a reliable historian.

S:

CC: “Cough, runny nose, and sore throat x 7 days”

 

HPI: New Asian male patient 28 yo presents to the clinic unaccompanied, complaining of non-productive cough, runny nose and sore throat x 7 days (1/7/2020). Currently somewhat controlling symptoms with Dayquil and Nyquil. Cough mild, worsened when laying flat. Highest temp at home 99 degrees. Patient wondering if he needs antibiotics. Rates pain in throat as 4/10, described as “aching, swallowing makes it worse”, relieved by Dayquil/nyquil. Denies headache, denies sick contacts or recent travel. Denies feeling worse outdoors or seasonally. He is a reliable historian

PMH:

Allergies: No known drug allergies. Strawberries (rash), seasonal allergies Childhood: Asthma until high school, chickenpox at age 2

Surgical: Tonsillectomy (1998), Wisdom Teeth Removal (2005)

Medications: None

Vaccinations: received childhood vaccines, Last flu shot given Oct 2019.

Denies psychiatric history.

Social History:

Denies tobacco/e-cigarette use. Admits to occasional once every 2-3 months alcohol use – last drink

2 months ago, Engaged, works in IT, Hobbies include archery.

Family History:

Mother died age 60-Diabetes II Sister 42yo living -HTN Maternal Grandma died age 67- Dementia

ROS:

General: No weight change, weakness, fatigue, fevers..

Eyes: no vision change, corrective lenses, pain redness, excessive tearing, double vision, blurred vision, or blindness. EarsNose/Throat/mouth: no hearing change, tinnitus, earaches, infection, discharge. POSITIVE FOR RHINORRHEA. No sinus pain or epistaxis. POSITIVE FOR SORE THROAT, HOARSE VOICE. No bleeding gums, dentures, sore tongue, dry mouth. Last dental exam was 4 months ago.

C/V: Denies chest pain, palpitations. Pulmonary: POSITIVE FOR NON-PRODUCTIVE COUGH, negative hemoptysis, dyspnea, wheezing, pleuritic pain Neuro: No headache, dizziness, focal numbness/weakness, nausea, vomiting.

Lymph: Denies swollen lymph nodes in neck.

Allergy/immunology: Denies seasonal allergies or allergy to pets, pollen or other. Denies frequent illness.

O:

VS: T – 98 P – 80 R – 16 BP – 128/72 O2 sat – 99% – 4/10 pain in throat. Wt: 205 Ht: 72 in BMI: 27.8

Skin: Natural in color, warm, smooth and dry. Good skin turgor, no lesions, rashes, ecchymosis or moles. Nails without clubbing or cyanosis.

HEENT: Ears: pinna clean, no exudate noted. TM intact and pearly gray with cone of light bilat. Nose: nasal mucosa pink and moist. Inferior turbinates slightly reddened bilat. Nares patent bilat. No sinus pain upon palpation. Septum midline. Throat: oral mucosa pink and moist, tongue mobile without lesions, tonsils absent. Posterior pharynx with erythema but no cobblestone appearance. Neck: non-tender cervical area, no lymph nodes palpable. Non-enlarged thyroid palpated. Trachea midline. Neuro: Alert and oriented x 4. Cardio: RRR. Crisp S1 S2 without clicks or murmurs.

Thorax and lungs: Thorax is symmetric with good expansion. Respirations are even and unlabored. No use of accessory muscles, stridor, grunting, or nasal flaring. Lungs CTA Bilaterally.

(***notice not all systems are in the PE when doing a focused exam on a problem)

 

A:

Differential DDX: INCLUDE AT LEAST 3 DIFFERENTIALS

1. Viral pharyngitis – most likely as evidenced by sore throat, cough, no fever (Stead, 2019). (←←←←←that is a practice treatment guideline)

2. Strep Throat – not as likely; no fever and 7 days duration, age not as consistent with this dx

3. Allergic rhinitis – no report of sx increasing with outdoor activity or exposure to allergens, sx with sore throat are less likely for allergies.

 

DX: Viral pharyngitis

 

P:

In house throat swab for rapid strep – negative.

Continue to rest and drink lots of fluids (Cash & Glass, 2017; Stead, 2019).

Continue OTC Dayquil/Nyquil PRN per directions on the box – Safe dosing discussed, sedation may occur with Nyquil, avoid driving or operating heavy machinery after taking.

Encourage tea with honey and lemon to help with cough and sore throat.

Gargle with warm salt water 2-3 times a day for 30 sec, swish and spit.

Do not drink alcohol while taking these medications.

Cover mouth when coughing, do not drink after other people (Cash & Glass, 2017).

Return to office in 3-4 days if symptoms do not improve, worsen, or get better and then again get worse (Cash & Glass, 2017). Call 911 or go to ER for trouble breathing or any other emergent concern (Stead, 2019).

 

 

 

References:

 

Cash, J. & Glass, C. (2017). Family practice guidelines. New York, NY. Springer.

 

Stead, W. (2019). Symptomatic treatment of acute pharyngitis in adults. In L. Kunnis

(Ed.). UpToDate Retrieved February 12, 2020 from:

https://www.uptodate.com/contents/symptomatic-treatment-of-acute-pharyngitis-

in-adults

SOAP Note Week Eight – Pediatric UTI

Carla J. Aldaz, RN, BSN

United States University

FNP592: Common Illness Across the Lifespan

Professor Gryan Garcia

June 28, 2021

 

 

SOAP Note Week Eight – Pediatric UTI

ID: S.U., DOB: 11/16/2007, 14-year-old Caucasian Female present to the clinic with her Mother. The Patient and Mother appear to be reliable historians.

S: CC: “Cloudy, foul-smelling pee, and is burning and painful x 3 days.” HPI: S.U. is a 14-year-old Caucasian Female that presents to the clinic with her Mother. The Mother states that the child has frequently been urinating, and the urine is cloudy and foul- smelling. The child expresses that it is uncomfortable to urinate as it has a burning sensation. The child states that it started 3 days ago after she got home from swim camp. She denies blood in the urine, vaginal discharge, or irritations along with SOB, flank pain, or fever. The patient rates pain 7/10 when urinating.

PMH: Gestational age 40 weeks delivery was vaginal, Met growth and developmental milestones, no phycological or social concerns. The Patient is with optimal physical, social, and mental health. Allergies: No known drug allergies, No food allergies, No seasonal allergies Surgical: Wisdom Teeth 2020 Medication: None Vaccinations: Up to date on childhood vaccines, Flu shot November 2020 Social History: The Patient lives with her Mother: Father, and older brother in a single-level home. The Patient is just completed 8th grade and will be starting her freshman year. The Patient is a single heterosexual that is not sexually active. The Patient babysits 2x a week and plays soccer. Father is a Dentist, and Mother is a Hairstylist. Menstrual cycle started at age 12 and is regular. Her last menstrual period was two weeks ago. The patient eats a well-balanced diet; No guns are in the home, and Patient feels safe.

Family History: Maternal Grandparents-Grandmother-68 Hx: Glaucoma Grandfather-60 diseased- Lung Cancer Paternal Grandparents- Grandmother- 65 No medical history healthy Grandfather-66 Hx: Hypertension, DMII Father- 39 Hx: Hypertension Mother-38 Hx: Hypothyroid Brother- 16 Healthy no medical history

ROS:

Constitution: Denies weakness, fatigue, weight loss, or fever at this time HEENT: Denies dizziness, vision impairment, or headache, Denies hearing loss ear pain or discharge, Denies loss of smell, congestion or sinus pain, Denies sore throat, sores, lesions, or bleeding gums Pulmonary: Denies SOB, dyspnea on exertion, cough, wheezing, and no history of Asthma or seasonal allergies Cardiovascular: Denies Chest pain, palpations, no murmurs, syncope, or swelling Skin: Denies itching, dryness, loss of hair, rashes, or changes in nail texture Gastrointestinal: Denies nausea, vomiting, change in appetite, or bowel

 

 

movements Genitourinary: Complaints of frequent urination, burning and 7 out of 10 pain during urination, Report cloudy, foul-smelling urine, Denies blood in the urine or vaginal discharge Musculoskeletal: Denies muscle pain or aches, No joint deformities or issues with gait Neurologic: Denies paresthesia, numbness or tingling Psychiatric: Denies depression or suicidal ideation Hematologic: Denies bruising, bleeding history of anemia or fatigue

Allergy/immunologic: Denies allergies or immunologic compromise

O: Vital Signs: Temp: 98.4 HR: 80 RR:17 BP:117/68 O2: RA 100% Wt: 125 Ht: 63in. BMI:22.1 Pain Scale: 7/10- During urination

Physical Exam: Appearance: Happy pleasant, and cooperative teenage female in no acute distress. Alert and oriented x4. Patient and Mother engaged in conversation; Patient maintains eye contact and answers each interview and examination question. HEENT: Normocephalic Normal hair distribution, No visual or hearing impairment, PERRLA, TM intact and pearly gray, Nasal mucosa pink and moist, oral mucosa pin and moist neck non- tender trachea midline, no lymph node swelling or tenderness, good dentition, no lesions or sores noted. Pulmonary: Lungs symmetric with equal rise and fall clear to auscultation bilaterally, no rales, rhonchi, or wheezing noted Cardiovascular: Regular Heart Rate S1 and S2 upon auscultation, no murmurs, gallops, rubs, heaves, or lifts noted Skin: Natural in color, warm to touch, smooth and dry, good skin turgor, no rashes, lesions, bruising, or cyanosis noted. Abdomen: Nontender, soft, normoactive bowel sound in all 4 quadrants Genital-Urinary: Bladder not distend on palpation, denied vaginal discharge, frequent, painful burning sensation with urination No vaginal exam was performed. Musculoskeletal: Full ROM w/ 5/5 strength bilaterally in upper and lower extremities. No joint or muscle pain or tenderness noted, steady gait Neurological: Motor function intact, no weakness or tremors Psychiatric: Affect and mood stable

A: Differential DDX:

• Urinary Tract Infection N39.0: Patient complains of frequent urination with burning sensation while urinating for 3 days after returning home from swimming camp. The Patient states 7 out of 10 pain during urination. In addition, the Patient reports cloudy, foul-smelling urine, Denies blood in urine, vaginal discharge, or fever.

• Vaginitis N77.1: Patient has painful urination, and foul-smelling odor in urine R/O patient is not sexually active and does not have any vaginal bleeding, itching, or discharge (Dains & Ciofu Bauman, 2020).

• Urethritis N34.1: Patient has painful, frequent urination R/O patient is not sexually active and does not have any vaginal itching, irritation, or discharge (Dains & Ciofu Bauman, 2020).

FINAL DX: Urinary Tract Infection

 

 

P: Diagnostic:

U/A: Urine dipstick specimen (Hollier, 2021).

Tested Sample Showed: Urine dipstick specimen yielded a small amount of cloudy urine, positive for leukocyte esterase, and nitrite test.

Pharmacological Treatment: • Current treatment recommendations for UTI therapy for young women without

comorbidities is a short course of 3-7 days of antibiotics (Hollier, 2021). • Sulfamethoxazole/ Trimethoprim (Bactrim) 160mg PO BID for 3 days (Hollier, 2021).

Non-Pharmacologic Treatment Plan:

• Education: Good hydration to prevent further health complications like kidney stones while taking Bactrim (Dains & Ciofu Bauman, 2020).

• Education on medication compliance: Instruct patient to take medication as prescribed and not take extra medication for a missed dose. Avoid exposure to sunlight and tanning beds as Bactrim can cause sensitivity to sunlight (Dains & Ciofu Bauman, 2020).

• Education to avoid hygiene sprays and douches (Dains & Ciofu Bauman, 2020). • Education on proper wiping from front to back(Dains & Ciofu Bauman, 2020). • Education on the importance to not wear wet or tight underwear to reduce risk of

infection/Instruct patient to change out of wet swimming suit after swimming (Dains & Ciofu Bauman, 2020).

• Education on Cranberry juice to help reduce recurrent infections (Dains & Ciofu Bauman, 2020).

Follow-up: 1 week to monitor signs and symptoms instruct patient and Mother to contact office increased signs and symptoms, shortness of breath, nausea, vomiting, diarrhea, dark urine, dizziness, fever or skin reaction.

 

 

Reference

Dains, J. E., Ciofu Bauman, L., & P. (2020). Advanced Health Assessment and Clinical Diagnosis

in Primary Care (6th ed.). St. Louis, MO: Elsivier.

Hollier, A. (2021). Clinical guidelines in primary care (4th ed.). Advanced Practice Education

Associates. ISBN-978-1

 

  • SOAP Note Week Eight – Pediatric UTI
  • SOAP Note Week Eight – Pediatric UTI
  • PMH:
  • Social History:
  • Family History:
  • ROS:
  • O:
  • Physical Exam:
  • A:
  • Pharmacological Treatment:
  • Non-Pharmacologic Treatment Plan:

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FNP591 WEEK 1-8 DISCUSSION QUESTIONS | GET INSTANT WRITING HELP

 

FNP 591: Common Health Illness Across the Lifespan

Week 1: Discussion Question – Caring Theoretical Model or Evidence-Based Practice

Select one of the following discussion questions:

Describe a caring theoretical model and how it can systematically be applied to the day-to-day practice of advanced nurses.

OR

Explain how the advanced practice nurse can apply research-based evidence to inform clinical practice.

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: A minimum of 250 words, not including references
  • Citations: At least one high-level scholarly reference in APA from within the last 5 years

Week 2: Discussion Question – HEENT or Respiratory System

Select one of the following discussion questions:

A ten-year-old patient presents in the clinic with soft-tissue swelling around the left eye. The parent reports that the child has had a cold with copious amounts of nasal drainage for approximately a week. The parent thought the child was getting better, but this morning the child awoke with a red eye and a fever of 102.1°F. The child has no complaint of headache, vomiting or visual disturbances.

Describe how the FNP would clinically manage and follow up this patient. List the pharmacological and non-pharmacological interventions. Describe how the treatment plan might be different for a 35-year-old patient as well as a 65+ year old patient.

OR

A 52-year-old male presents to the clinic with a productive cough for 5 days. Describe at least 5 more questions the FNP should ask this patient in the health history. Please generate at least 5 differential diagnoses for a cough. Describe how the FNP would clinically manage and follow up this patient based on each differential diagnosis.

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: A minimum of 300 words, not including references
  • Citations: At least 3-4 high-level scholarly reference in APA from within the last 5 years

Week 3: Discussion Question – Cardiology or Cardiovascular

 

Select one of the following discussion questions:

The 42-year-old female patient presents for follow up on lab results from her annual physical exam completed a week ago. The lab results are as follows: Triglycerides 225, LDL 170, HDL 22, HgBA1c 8.3%
Patient history reveals a 20 pack-a-year smoking history and type 2 diabetes. The last labs done 18 months ago were normal. What is this patient’s cardiovascular risk based on these lab results? Describe how the FNP would clinically manage and follow up this patient. List the pharmacological and non-pharmacological interventions.

OR

A 66 year old male presents to your office complaining of shortness of breath for the past five days which has gotten progressively worse.  His shortness of breath is worse when lying down and with exertion. He complains of a cough, especially at night. He also reports increased swelling in both legs bilaterally and mild substernal chest pressure.

The patient has a history of diabetes, hypertension, and a prior myocardial infarction.  His vital signs are: BP 208/102, HR 116, RR 28, T 98.4, 94% oxygen saturation. On exam you note rales in the lung bases bilaterally as well as 1+ pitting edema in the lower extremities bilaterally.  The patient is sitting up and in no acute respiratory distress.

Provide the most likely diagnosis based on the HPI and PE. In addition, provide your interpretation of the cues found in the assessment. List at least 3 possible differential diagnoses and justify your rationale. Develop therapeutic plan options based on quality, evidence-based clinical guidelines.

 

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: A minimum of 300 words, not including references
  • Citations: At least 3-4 high-level scholarly reference in APA from within the last 5 years

 

Week 4: Discussion Question – Dermatology or Gastrointestinal

Select one of the following discussion questions:

A 10-year-old Asian patient presents with an erythematous maculopapular rash, conjunctivitis, a mild fever of 102.1 and a strawberry tongue. The rash started 4 days ago. How are you going to evaluate this patient? What is the differential diagnosis for this patient? Describe your treatment plan based on current guidelines.

OR

46-year-old male complains of chest pain described as pain in his midchest for the past couple of months that has progressively worsened over the last couple of weeks. He states it has worsened when he is going to bed at night or when he eats a large meal. He has been eating out a lot more over the past couple of months because he has been traveling a lot for work. He denies any nausea or vomiting. He has been taking OTC Tums for the past few weeks, but he has to take 10-12 a day and only gets minimal relief. He denies any unusual weight gain or loss. Physical exam reveals an obese, Caucasian male with mild epigastric tenderness. No hepatosplenomegaly. Bowel sounds normoactive in all four quadrants. Provide the most likely diagnosis based on the HPI and PE. In addition, provide your interpretation of the cues found in the assessment. List at least 3 possible differential diagnoses and justify your rationale. Develop therapeutic plan options based on quality, evidence-based clinical guidelines.

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: A minimum of 300 words, not including references
  • Citations: At least 3-4 high-level scholarly reference in APA from within the last 5 years

Week 5: Discussion Question – Women’s Health or GU

 

 

 

Select one of the following discussion questions:

A 21-year-old female patient presents to the office for an annual exam. She has had normal, regular menstrual cycles since she was 14 but she has not had a menstrual cycle in over 6 months. A pregnancy test is negative. The FNP wants to order blood work to determine the cause of her secondary amenorrhea. When the patient hears that if all is normal the treatment will be giving progestins to initiate a menstrual cycle, she tells the FNP that she cannot do that because she does not believe in birth control pills. The FNP tries to advise the patient that it is not birth control pills, but a hormone to assist in regulating her periods and the patient leaves the office crying. What does the FNP do now to help this patient?

OR

65-year-old male presents to your clinic with frequent urination. He complains of painless, frequent urination approximately every 45 minutes to an hour for the past 5 months. He states he hates visiting doctors because they always try to find something wrong with him. His wife made him this appointment, but he thinks his problem is just because he is getting older. He denies any pain on urination or any blood in the urine. He also denies any difficult voiding. No foul odor is in the urine or discharge from the penis. He has tried to reduce his liquid consumption, but it has not made much of a difference. He denies any pelvic pain or rectal pain. He has not had any labs done in the past 5 years. Also, he has not had a physical done in 10 years. Physical exam reveals an African American male in no apparent distress. Abdomen is soft, nontender, no masses or distensions on palp. No hepatosplenomagaly. DRE reveals an enlarged, firm, smooth, symmetrical prostate. Provide the most likely diagnosis based on the HPI and PE. In addition, provide your interpretation of the cues found in the assessment. List at least 3 possible differential diagnoses and justify your rationale. Develop therapeutic plan options based on quality, evidence-based clinical guidelines.

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: A minimum of 300 words, not including references
  • Citations: At least 3-4 high-level scholarly reference in APA from within the last 5 years

Week 6: Discussion Question – Neurology or Mental Health

Select one of the following discussion questions:

A 66-year-old patient presents to your office with jaw pain. She states she has had jaw pain that radiates to her ear for the last week. She thought she had a tooth infection, but her dentist told her nothing appeared to be wrong. He recommended she see her primary care physician. She is requesting pain medication because it hurts so badly.  Provide at least 3 possible differential diagnoses and justify your rationale. Develop therapeutic plan options based on quality, evidence-based clinical guidelines.

OR

The FNP is conducting a routine follow-up on a patient with depression. The patient reports she is feeling like she can’t go on anymore. The FNP learns that this patient discontinued her medication 3 weeks ago because she couldn’t afford it. What should the FNP do in this situation? Support your response.

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: A minimum of 300 words, not including references
  • Citations: At least 3-4 high-level scholarly reference in APA from within the last 5 years

Week 7: Discussion Question – Heme or Endocrine

elect one of the following discussion questions:

55-year-old female presents to your office with fatigue.  She states she has felt tired for many months and thinks “something is wrong” with her.  She denies any rectal bleeding, nausea, vomiting, abdominal pain. What else do you need to ask her about?
PMH- HTN controlled on lisinopril 20mg PO QD
Family Hx- No family history known as she is adopted
VSS and Physical Exam is WNL
Hgb- 10.9g/dL (13-18)
RBC- 3.53 m/mm3 (4.3-6)
MCV- 76 fL (78-100)
MCH- 24 pg (27-34)
RDW 19% (12.1-18.2)
Serum ferritin- 16 ng/mL (18-370)
Serum iron- 23 ug/dL (40-190)
TIBC- 391ug/dL (250-400)
Vitamin B12- 450pg/mL  (>200)
What is your Assessment and Plan? Please include specific instructions on any medication and education.

OR

A 42-year-old woman has noticed dry skin, fatigue, and weight gain over the past 3 months. Her blood pressure is 110/70 mm Hg, pulse 60/min, and heart and lungs are normal. Her skin feels rough and dry, but the rest of her examination is normal. Her biochemistry is normal, but the TSH is 39 mU/L. Provide at least 3 possible differential diagnoses and justify your rationale. Develop therapeutic plan options based on quality, evidence-based clinical guidelines.

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: A minimum of 300 words, not including references
  • Citations: At least 3-4 high-level scholarly reference in APA from within the last 5 years

Week 8: Discussion Question – Pediatrics or OB

Select one of the following discussion questions:

Your patient is an eight-year-old male child who is extremely active and not doing well in school. After several visits and using the Conners CBRS, you diagnosed him with ADHD. His parents are divorced, and the father attends with the mother and is against medication but would like to talk about cognitive-behavioral approaches prior to starting medication. What is your approach with this child and his parents? What options would you present and why? If they agreed on a medication but later wanted to try the cognitive-behavioral approach to wean the child off of medication, what types of linear plan would you form, who would you involve in this plan, and how long would you expect this plan to be in place in order to show long-term improvements?

OR

You have a 17-year-old female that comes in with suspected pregnancy and limited family support. She is accompanied by her 18-year-old boyfriend who is the father of the child. While knowing she needs prenatal care, what resources and education would you try to provide and how would you encourage compliance in this vulnerable patient? What are some of the biggest risk factors that this patient faces and how can you provide quality care while being sensitive to the stigma that comes with teen pregnancy?

Expectations

Initial Post:

  • Due: Thursday, 11:59 pm PT
  • Length: A minimum of 300 words, not including references
  • Citations: At least 3-4 high-level scholarly reference in APA from within the last 5 years

Course Description

This course for advanced practice nursing students concentrates on the levels of prevention and primary care management of common healthcare problems of individuals and their families. Patients across the life spectrum are managed within a culturally, and spiritually diverse environment using the clinical decision making process. Evidence-based research is utilized to develop comprehensive, cost effective, least invasive, quality healthcare guidelines for these common healthcare problems. These guidelines include health promotion counseling, screening, and client education to optimize the client’s health. Emphasis is placed on critical thinking, diagnostic reasoning, implementing appropriate diagnostic tests, prescribing pharmacologic and non-pharmacologic integrative healing therapies, professional interpersonal relationships, the caring professional role and teaching/coaching techniques.

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Course Learning Outcomes

  1. Perform levels of prevention and primary care management of common healthcare problems of diverse clients based on advanced practice nursing theory and evidence based practice with attention to resource allocations, acceptability, simplicity, adherence, efficacy, spirituality, and safety.
  2. Practice the advanced professional roles of clinician, consultant, collaborator, community advocate, educator and leader in the care of common healthcare problems.
  3. Implement appropriate, client-centered, anticipatory guidance and learning for beginning advanced nursing practice primary care management of common healthcare problems using evidence based rationale and appropriate community resources across the lifespan.
  4. Implement critical thinking and diagnostic reasoning to establish a differential diagnosis for common healthcare problems using evidence based rationale and appropriate community resources across the lifespan.
  5. Evaluate appropriateness of non-pharmacologic and pharmacologic interventions for common healthcare problems considering such variables as risk factors, psychosocial environmental factors, spirituality, and cultural competence to achieve maximum level of health.
  6. Implement effective SOAP documentation of common healthcare problems across the lifespan.
  7. Students will demonstrate ability to meet coding requirements with growing emphasis on the plan.

Required Materials

American Psychological Association. (2009). Publication Manual of the American Psychological Association. Washington DC: American Psychological Association. Spiral Bound Edition. ISBN 9781433805622

Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2019). Primary Care, The Art and Science of Advanced Practice Nursing – An Interprofessional Approach. Davis Plus.  ISBN 9780803667181

Bright Futures Guidelines and Pocket Guide- free reference (4th ed). https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_POCKETGUIDE.pdfj

Burns, C, Ardys, M., Brady, M., Starr, N., & Blosser, C. (2016).  Pediatric Primary Care. Elsevier. ISBN 9780323243384

Cash, J. & Glass, C. (2017). Family Practice Guidelines. Springer Publishing. ISBN 9780826153418

Wolf, L., Johnson, R., & Saavedra, A. (2013). Fitzpatrick’s Color Atlas and synopsis of Clinical Dermatology. McGraw-Hill. ISBN: 9780071793025 .

3 Credits

Prerequisite MSN 572; Corequisite FNP 592

Required Textbook and Readings

American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). https://doi.org/10.1037/0000165-000

Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2019). Primary Care, The Art and Science of Advanced Practice Nursing – An Interprofessional Approach. Davis Plus.  ISBN 9780803667181

Bright Futures Guidelines and Pocket Guide- free reference (4th ed).https://brightfutures.aap.org/Bright%20Futures%20Documents/BF4_POCKETGUIDE.pdfj

Burns, C, Ardys, M., Brady, M., Starr, N., & Blosser, C. (2016).  Pediatric Primary Care. Elsevier.  ISBN 9780323243384

Cash, J. & Glass, C. (2017). Family Practice Guidelines. Springer Publishing. ISBN 9780826153418

Wolf, L., Johnson, R., & Saavedra, A. (2013).  Fitzpatrick’s Color Atlas and synopsis of Clinical Dermatology. McGraw-Hill.  ISBN: 9780071793025.

Course Description

This course for advanced practice nursing students concentrates on the levels of prevention and primary care management of common healthcare problems of individuals and their families. Patients across the life spectrum are managed within a culturally, and spiritually diverse environment using the clinical decision making process. Evidence-based research is utilized to develop comprehensive, cost effective, least invasive, quality healthcare guidelines for these common healthcare problems.  These guidelines include health promotion counseling, screening, and client education to optimize the client’s health.  Emphasis is placed on critical thinking, diagnostic reasoning, implementing appropriate diagnostic tests, prescribing pharmacologic and non-pharmacologic integrative healing therapies, professional interpersonal relationships, the caring professional role and teaching/coaching techniques.

Course Learning Outcomes

This course has been developed to meet the essential curriculum element Vlll. Master’s-Level Nursing Practice as defined by the American Association of Colleges of Nursing, Essentials of Master’s Education for Advanced Practice Nursing and the Family Nurse Practitioner Core Competencies defined by the National Association of Nurse Practitioner Faculties.

By the end of this course, students should be able to:

  1. Perform levels of prevention and primary care management of common healthcare problems of diverse clients based on advanced practice nursing theory and evidence based practice with attention to resource allocations, acceptability, simplicity, adherence, efficacy, spirituality, and safety.
  2. Practice the advanced professional roles of clinician, consultant, collaborator, community advocate, educator and leader in the care of common healthcare problems.
  3. Implement appropriate, client-centered, anticipatory guidance and learning for beginning advanced nursing practice primary care management of common healthcare problems using evidence based rationale and appropriate community resources across the lifespan.
  4. Implement critical thinking and diagnostic reasoning to establish a differential diagnosis for common healthcare problems using evidence based rationale and appropriate community resources across the lifespan.
  5. Evaluate appropriateness of non-pharmacologic and pharmacologic interventions for common healthcare problems considering such variables as risk factors, psychosocial environmental factors, spirituality, and cultural competence to achieve maximum level of health.
  6. Implement effective SOAP documentation of common healthcare problems across the lifespan.
  7. Students will demonstrate ability to meet coding requirements with growing emphasis on the plan.

MSN Program Learning Outcomes

Upon completion of the Master of Science in Nursing, the student will be able to:
Goal: Literacy

  1. Evaluate and apply evidence-based findings to advanced nursing roles.
  2. Integrate cultural competence into advanced nursing roles.
  3. Integrate the Master Essential’s and specialty standards into the advanced nursing role.

Goal: Communication

  1. Compose professional written communication for advanced nursing roles.
  2. Speak professionally in advanced nursing roles.
  3. Demonstrate the advanced nursing role through leadership, collaboration, and caring science to improve health outcomes.

Goal: Reasoning

  1. Evaluate and apply quantitative and qualitative data to validate and guide decision making relevant to health outcomes.
  2. Integrate ethical reasoning into advocacy and decision making.
  3. Objectively evaluate and synthesize information in advanced nursing roles.

Course Grades and Assignments Breakdown

Graded Item # of Assignments Points Total Points %
Discussions 8 20 160 16%
Quizzes 7 20 140 14%
Aquifer Case Studies 16 25 400 40%
Benchmark Assignment:Evaluation of Clinical Practice Guideline 1 300 300 30%
Total 1000 100%

Assessment And Measurement: Grading Scale

Points Letter Grade Indicator
95-100 A Superior
90-94 A-
87-89 B+ Above Average
84-86 B MSN Requirement
80-83 B-
77-79 C+
74-76 C BSN Requirement
70-73 C- Failure
0-69 F Failure

Instructional and Evaluation Strategies

This course is organized into 8 weekly modules. The student’s performance will be assessed by the work they do in the course – including participation in the discussions that are a part of each lesson. Students are expected to be able to demonstrate their learning throughout the course.

Categories of evaluation may include:

  • Participation in class discussions, whether online discussion forums or synchronous meetings
  • Exams or quizzes
  • Essays, case studies, research papers, etc.
  • Presentations, including videos, powerpoints, posters, etc.
  • Projects, group or individual
  • Reflections or journals

Students can expect faculty to fairly evaluate this work using the rubrics or other scoring methods provided in the course. This is intended to provide you with feedback and specific guidance that will enable you to take ownership of your learning.

How to be Successful in this Class

  • Be prepared: read the assignments and contribute to our learning community.
  • Plan ahead: create a personal calendar for your course work and life events. Don’t fall behind. But if you do, contact your instructor for their help. Successful students are proactive students.
  • Communicate: if you don’t understand something, ask for clarification from your instructor. Use the class forum. Message your classmates. Email your advisor. Use your USU email account. Communication in a virtual community is key!
  • Explore Resources: Visit the Library Corner for your research needs and information support. Contact helpdesk@usuniversity.edu for technology assistance. Use Brainfuse for online tutoring and homework help.
  • Keep your eye on the goal: GRADUATION!

Course Calendar

Week Readings/Content Assignment/Discussion Due Date 
1 FNP 591: Week 1 Video (Module Overview)
Dunphy, Winland-Brown, Porter, Thomas: Ch. 1, 2, 3, 4, 5, 79, Pages 3-72; 1311-1326Burns: Chapter 9

Resource – Aquifer Info and Login Instructions

Introduction
Syllabus/Plagiarism Acknowledgement
Week 1: Discussion Question – Caring Theoretical Model or Evidence-Based PracticeAquifer High Value Care Modules
Tuesday
WednesdayThursday/Monday

Monday

2 FNP 591: Week 2 Video (Module Overview)
Dunphy, Winland-Brown, Porter, Thomas: Ch. 21, 22, 23, 24, 25, 26, 27 (HEENT), 28, 29, 30, 31,32, 33 (Respiratory) pages 293-449Burns:  Ch. 28 (Neuro/Head), 29 (Eye Disorders), 30 (Ear Disorders, 32 (Resp) (Pages: 660-755; 794-832)
Week 2: Discussion Question – HEENT or Respiratory System
Week 2 Quiz – HEENT & RespiratoryAquifer Case Studies – HEENT & Respiratory
Thursday/Monday

Monday

Monday

3 FNP 591: Week 3 Video (Module Overview)

Dunphy, Winland-Brown, Porter, ThomasCh: 34, 35, 36, 37 (page 451 – 527

Burns:  Ch. 31 (Cardio)

Benetos, A., Petrovic, M., & Strandberg, T. (2019). Hypertension management in older and frail older patients. Circulation Research.

Week 3: Discussion Question – Cardiology or Cardiovascular
Week 3 Quiz – Cardiovascular
Aquifer Case Studies – Cardiovascular
Thursday/Monday

Monday
Monday

4 FNP 591: Week 4 Video (Module Overview)

Dunphy, Winland-Brown, Porter, Thomas: Ch. 11, 12, 13, 14,15, 16, 17 (Derm), 38, 39, 40, 41, 42 (GI)

Burns:
Ch. 33 (GI), 37 (Derm)

Pulzato, I., Boero, E., Shaipi, E., & Cardinale, L. (2019). “Sigmoid diverticulitis mimicking cholecystitis” a clinical challenge. The Ultrasound Journal, 11(14).

Week 4: Discussion Question – Dermatology or Gastrointestinal
Week 4 Quiz – Derm & GI
Aquifer Case Studies – Derm & GI
Thursday/Monday

Monday
Monday

5 FNP 591: Week 5 Video (Module Overview)

Dunphy, Winland-Brown, Porter, Thomas: Ch. 43, 44, 45, (Renal), 46, 47, 48, 49, 50, 51, (Gender-Related), 52, 53, 54, 55 ( MSK) Pages 623 – 873,
Burns:  Ch. 35 (GU), 36 (Gyne), 38 (MSK)Additional ReadingOsteoporosisGout and Pseudogout

Week 5: Discussion Question – Women’s Health or GU
Week 5 Quiz – Renal, Musculoskeletal, Men’s and Women’s HealthAquifer Case Studies – Musculoskeletal and Men’s Health
Thursday/Monday

Monday

Monday

6 FNP 591: Week 6 Video (Module Overview)

Dunphy, Winland-Brown, Porter, Thomas: Ch 6, 7, 8, 9, 10 (Neuro), 64, 65, 66, 67, 68, 69, 70, 71 (Psychosocial), 81 (15 min Psychotherapy)

Burns:  Ch. 28 (Neuro), 19 (Mental Health)
Additional Reading:Alzheimer’s diseasePosition Statement 35: Aging Well: Wellness and Psychosocial Treatment for the Emotional and Cognitive Challenges of Aging

Week 6: Discussion Question – Neurology or Mental Health

Week 6 Quiz – Neuro & Mental Health

Aquifer Case Studies – Neuro & Mental Health

Thursday/Monday

Monday

Monday

7 FNP 591: Week 7 Video (Module Overview)

Dunphy, Winland-Brown, Porter, Thomas: Ch 56, 57, 58, 59 (Endocrine/Metabolic), 60, 61, 62, 63 (Hematology/Immune), Ch 15 Osteoporosis (Pages 808-815)

Burns:  Ch. 25 (Atopic, Rheumatic), 26 (Endocrine and Metabolic dx), 27 (Hematology)
American Diabetes Association. (2018). Older adults: Standards of medical care in Diabetes – 2018. Diabetes Care, 41 (Supplement 1).

Week 7: Discussion Question – Heme or Endocrine

Week 7 Quiz – Endocrine, Metabolic, Hematology, & Immune System
Aquifer Case Studies – Endocrine & Metabolic

Thursday/Monday

Monday

Monday

8 FNP 591: Week 8 Video (Module Overview)

Burns:  Ch. 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 16, 17, 18, 19

Brightspace Pocketguide
McClure, C.C., Cataldi, J.R., & O’Leary, S.T. (2017). Vaccine hesitancy: Where we are and where we are going. Clinical Therapeutics, 39(8), 1550-1562.
Saad, Eh. R., & Diamond, H.S. (2018, Dec. 12). Polymyalgia Rheumatica. Medscape.

Week 8: Discussion Question – Pediatrics or OB

Week 8 Quiz – GYN, Peds, Gerontology, and Review.
Aquifer Case Studies – Peds & GYN

Benchmark Assignment – Evaluation of a Clinical Practice Guideline
End of Course Survey

Thursday/Monday

Monday

Monday

Monday

Monday

Late Assignments: Late work is not accepted for full credit unless prior arrangements are made with the instructor, or a VERIFIABLE emergency (serious illness, accident, or natural disaster). Technological issues are not considered valid grounds for late assignment submission. This policy does not apply to assignments due on the last day of the session. For incomplete grade requests for the course session, please refer to the USU Academic Affairs Policies.

With professor’s approval, late submissions of an assignment due each week will be accepted based on the following grading criteria.

  • 1-3 days late: 5% deduction from the total points
  • 4-7 days late: 10% deduction from the total points

Technical Requirements

To successfully complete this course, you will need access to appropriate technology with reliable internet access and the appropriate system and software to support the D2L learning platform. The technical requirements for users can be found in the D2L course shell.

Course Assignment Descriptions

You will have several opportunities to demonstrate your knowledge and understanding of the principles taught in this course. The primary means of evaluating your work will be through practical application of the material. In the event that you have difficulty completing any of the assignments for this course, please contact your professor immediately. Please refer to the weekly materials section of the lecture for complete details regarding the activities and assignments for this course. The following are the details.

  1. Introduction

Write a short biography to introduce yourself to the class and answer any posted or follow-up questions. The self-introduction should be posted by Midnight (PST) on the first Tuesday of the session. In addition to your bio, you can share your expectation and personal learning goal of the course with your classmate and the professor.

  1. Online Forum Discussion Participation (20 points each, 160 points total)

You will be expected to participate in online discussions regarding the weekly topic.

Initial Substantive Posts: The discussion forum initial posts will be on Thursday midnight of each week. In your substantive post you are encouraged to use references (you may use your textbook); show evidence of critical thinking and your interpretation as it applies to the concepts or prompt and/or use examples of the application of the concepts to work and life.  Proper punctuation, grammar, and correct spelling are expected. Please use the spell-check function. Your original, initial post should not be just copied and pasted off internet sources, even when you supply a reference/citation. Please paraphrase what you are reading and write what you find using your own thoughts and ideas. This will help improve your writing and thinking. Use of any reference material or outside sources require proper APA citations. Copying and pasting information from the internet will result in zero credit for the post.

Required Replies: In addition to making a primary post, you must make at least two additional substantive posts to classmates and/or your instructor. Your responses should build on the concept discussed, offer a question to consider, or add a differing perspective, etc. Rather than responding with, “Good post,” explain why the post is “good” (why it is important, useful, insightful, etc.). If you disagree, respectfully share your alternative perspective. Just saying “I agree” or “Good idea” is not sufficient for credit. Refer to the rubric for the threaded discussions. Your replies are due by Monday midnight of each week.

  1. Quizzes (20 points, 140 points each)

Weeks 2 through 7 you will complete quizzes that are address the content of the weekly readings. The quiz will be comprised of 20 multiple-choice and short written response questions, except for Week 8 which will have 30 questions.

  1. Aquifer Case Studies (25 points each, 400 points total)

This term you will be working through application of the course content through completion of Aquifer case studies. Except for Week 1, which has a non-case study assignment, each week you will have two assigned cases to complete that coordinate with the weekly topics. Each Aquifer case study focuses on a particular patient and health problem. Case presentations use pictures, video and audio files, as well as questions you must respond to. At the end of the case study, you are prompted to create a summary statement(s).

See USU NUR CAT Worksheet Rubric for additional details and point weighting.

  1. Benchmark Assignment – Evaluation of Clinical Practice Guideline (300 points)

The purpose of this assignment is to identify a clinical practice guideline in your specialty area. You will be challenged to evaluate this guideline and discuss its use in clinical practice. This assignment is due at the end of Week 8 but can be completed anytime during this course. This assignment requires a considerable amount of time for completion. Do not wait until week 8 to begin this assignment.

Choose a health problem that you may commonly see in primary care nurse practitioner practice. Describe the health problem and recommended medical management for it. Research published clinical practice guidelines and evaluate the practice guideline you have selected based on the components listed in the Clinical Practice Guideline Template below.

Clinical Practice Guideline Prompts:

HEALTHCARE PROBLEM IDENTIFIED: Briefly describe the health problem you have identified. Include a discussion of morbidity, mortality, epidemiology and pathophysiology related to this health problem

PRACTICE GUIDELINE: Describe the clinical practice guideline used for this problem. Reflect on the questions included. Expand on your answer using support from evidence

  • Does the clinical practice guideline adequately address the health problem? Describe.
  • Is this practice guideline based on current evidence (within 5 years)? What is the strength of this evidence?
  • Does this clinical practice guideline adequately direct the healthcare provider in the management of a patient with this problem?
  • How effective is this clinical guideline in the management of patients with this healthcare problem? Think about how you would assess the effectiveness of patient management.

ANALYSIS: Think about future healthcare needs of patients with this problem, changing demographics, and changes in healthcare policies. Address these questions.

  • Does this clinical practice guideline need revision(s)? Please explain your answer in detail.
  • If you were going to revise this clinical practice guideline, what would you change? What evidence would you use to base your changes on?
  • How might changes in US demographics and healthcare reform affect this clinical practice guideline?
  • What strategies would you use to increase the likelihood that a new or modified clinical practice guideline would be adopted and used in clinical practice?

EVALUATION How would you determine its effectiveness of this revised clinical practice guideline in directing care for patients with the identified health problem? Outline the steps you might employ.

LEARNING POINTS (3-5 bullet points outlining key learning in this case.)

REFERENCES (APA formatting, current within past 5 years.)


Expectations

  • Due: Monday, 11:59 pm PT
  • Length: 8 pages minimum, 12 pages maximum not including the title page, abstract, and reference pages
  • Format: APA formatted paper – you can opt to use the prompts or a version of the prompt for headers, but do not copy the prompts directly into your paper
  • Research: APA formatting, current within past 5 years.

See USU NUR Research Paper Rubric for additional details and point weighting.

Case Analysis Tool Worksheet

Student’s Name:                                 

 

  1. Epidemiology/Patient Profile

 

Marissa Payne is a 12-year-old female patient. Reports of secondary smoking at home. No breathing problem or history of pneumonia or other lung or cardiac illnesses. Denies hospitaliz

 

 

 

 

  1. Prioritized Cues from Hx and PE.(Do not include lab, x-‐ray, or other diagnostic test results here.)
  • Tier 1: The cues (may be positive or negative) that contribute most to the diagnosis of the active problem.
  • Tier 2: These are cues of intermediate importance (list only positive cues).
  • Tier 3: Of least importance (list only positive cues).

 

Tier 1                                                               Tier 2                                                   Tier 3

Fever, headache, and runny nose x 3 days Exposure to other students or classmates who are sick  
Coughs with mucus Obesity  
Throat pain and chest discomfort    
Denies receiving flu vaccine this year    
Temp- 38.3 degree Celsius, HR is 110    
PE. Ill-appearing, inflamed turbinates with clear discharge    
Hyperemic oropharynx without tonsillar exudates and tender bilateral anterior cervical lymphadenopathy    
Ronchi auscultated on inspiration and occasional wheeze that clears with cough.    
Negative crackles, egophony, changes in tactile fremitus, whisper pectroliloquy, or areas of dullness to percussion.    
Secondhand smoking    

 

III. Problem Statement

 

Marissa Payne is a 12-year-old female patient. Reports of secondary smoking at home. No breathing problem or history of pneumonia or other lung or cardiac illnesses. Denies hospitalization. She presented at the clinic with complaints of fever, headache and runny nose for 3 days. Also coughs accompanied by mucus, throat pain and chest discomfort. States that she didn’t receive flu vaccine this year. On physical exam, patient has inflamed turbinates with clear discharges. Hyperemeic oropharynx without tonsillar exudates, and tender bilateral anterior cervical lymphadenopathy. Rhonchi is noted upon inspiration and wheezing that clears with cough. Negative crackles, egophony, changes in tactile fremitus, whisper pectroliloquy, or areas of dullness to percussion

 

 

 

  1. Differential Diagnosis

Based on what you have learned from the history and physical examination, list up to 3 diagnoses that might explain this patient’s complaint(s).

List your most likely diagnosis first, followed by two other reasonable possibilities. For some cases, fewer than 3 diagnoses will be appropriate.

Then, enter the positive or negative findings from the history and the physical examination that support each diagnosis.

 

Leading dx:  

 

Influenza and bronchitis

 

 

History Finding(s)                                                            Physical Exam Finding(s)

Fever, headache, and runny nose x 3 days Temp- 38.3 degree Celsius, HR is 110 and obese
Coughs with mucus PE. Ill-appearing, inflamed turbinates with clear discharge
Throat pain and chest discomfort Hyperemic oropharynx without tonsillar exudates and tender bilateral anterior cervical lymphadenopathy
Denies receiving flu vaccine this year Ronchi auscultated on inspiration and occasional wheeze that clears with cough.
Exposure to other students or classmates who are sick Negative crackles, egophony, changes in tactile fremitus, whisper pectroliloquy, or areas of dullness to percussion.
Secondhand smoking  

 

 

 

Alternative dx: 

 

Bacterial Pneumonia

 

 

History Finding(s)                                                            Physical Exam Finding(s)

Fever, headache, and runny nose x 3 days Temp- 38.3 degree Celsius, HR is 110 and obese  
Coughs with mucus PE. Ill-appearing, inflamed turbinates with clear discharge  
Throat pain and chest discomfort Hyperemic oropharynx without tonsillar exudates and tender bilateral anterior cervical lymphadenopathy  
Denies receiving flu vaccine this year Ronchi auscultated on inspiration and occasional wheeze that clears with cough.  
Exposure to other students or classmates who are sick    
Secondhand smoking    

 

Alternative dx: 

 

Streptococcal Pharyngitis

 

 

 

History Finding(s)                                                            Physical Exam Finding(s)

Fever, headache, and runny nose x 3 days Temp- 38.3 degree Celsius, HR is 110 and obese
Coughs with mucus PE. Ill-appearing, inflamed turbinates with clear discharge
Throat pain and chest discomfort Hyperemic oropharynx without tonsillar exudates and tender bilateral anterior cervical lymphadenopathy
   
   

 

  1. Explanation of Diagnostic Plan (including tests, labs, imaging studies, etc.) and Treatment Plan in prioritized order:

 

Diagnostic Plan                                                                     Rationale

Rapid strep test To determine if the patient is positive for GAHBS
   
   
   
   

 

Treatment Plan                                                                      Rationale

Take Ibuprofen or acetaminophen For fever and muscle aches or acetaminophen if the fever isn’t resolving with ibuprofen.
Take tea with honey It can help with cough and sore throat
Rest and hydrate For better recovery and to prevent the spread of the disease
Patient education Teach the patient on the transmission of the flu and how can her family can prevent the spread of the disease through frequent handwashing. Also, additional precaution for those other family member who are older or young children.
Get immunized once she gets better Receiving flu vaccine is pivotal in prevention of flu.
Education on second hand smoking It is important to educate the family of the exposure of the child from second hand smoking and talk about the risk of being exposed.
Managing obesity Counselling about the risk of staying obese and what are the health problem that may cause due to obesity. Advised for healthy diet and exercise regularly.

 

 

 

I have adhered to the honor system: (Sign your name here)

 

 

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HCS 468 Week 5 Assignment Privacy and Confidentiality Report

Name (Enter your name here)

HCS / 468

Instructor: Taryn Zubich

Date (Enter the date here)

Week 5 Assignment Writing Prompts Worksheet

Privacy and Confidentiality Report

Review the following scenario:

ABC Health Systems (AHS) was founded in 1959 by a group of 10 doctors in a mid-sized city in the southeastern United States. Beginning with a 30-bed hospital, AHS has expanded to its current bed complement of 305 acute care beds, a 110-bed skilled rehab and nursing facility on its campus, a 65-bed assisted living facility, outpatient rehab services, ER, and a cancer treatment clinic. AHS has 1,195 full-time employees’ campus-wide and is accredited by The Joint Commission, Commission on Accreditation of Rehabilitation Facilities, and also has other credentialed or accredited services throughout the campus.

Ben Smithfield was recently hired as the privacy officer for AHS. Previously, he worked for the third-largest faith-based health system, which is in the Midwest. In his new job, he reports to the vice president for risk management, who served as AHS’s privacy officer prior to Ben’s recruitment. AHS felt their privacy and security concerns could be best met with a full-time program manager dedicated to training, compliance, and management of this function.

Ben’s first week on the job proved to be very busy. While eating breakfast at a local fast-food restaurant, he overheard 2 doctors discussing AHS’ first successful robotic surgery on Paul Petersen. The MDs enthusiastically reported on Mr. Petersen’s condition stating that “although the surgery took longer than expected, Mr. Petersen’s vital signs were good. His pain level is high, and we are closely monitoring a post-op infection.” Later that day, Ben was contacted by Mr. Petersen, who was surprised to see his case discussed on the local news. That was not the only time Ben saw AHS in the news that day. He saw a press release from administration that reported that an ER patient, Violet Jones, was arrested after she physically assaulted 2 nurses who were attempting to insert her catheter.

Observations Found on Tour

During Ben’s first day, there was also a tour of the hospital and Ben took note of the following violations:

· A USB drive was unattended in the IT department and was clearly visible from an open door to the department.

· A maintenance worker was throwing old laptops in a dumpster, along with digital printer/copy cartridges.

· A high school student was shadowing a medical resident and observed her charting in an electronic health record (EHR) at the nurses station.

· A resident answered questions for the spouse of Mr. Petersen at the nurses’ station, which was heard by the high school student and Ben.

· The high school student, the medical resident, and Mr. Petersen’s spouse left the nurses station to meet with Mr. Petersen. The medical resident did not log out of the terminal. Ben sat at the terminal and scrolled through the open EHR.

· Charge RN Betsy Brown approached Ben and explained that she was excited to meet the new recruit that the VP spoke so enthusiastically about. When Betsy left, Ben was unable to view the open record due to a timeout provision. He asked an LPN if he would log Ben in and the LPN gladly complied.

· Across from the nurses desk in the hall, Ben noticed a white board that listed all patients on the unit, the name of the attending physician, the purpose of their admission (hip surgery, knee replacement, gall bladder removal, etc.), along with their code status—full code, no code, Do Not Resuscitate (DNR), etc.

· Taking a break from viewing electronic charts, Ben headed to the staff break room on the unit. As he tossed his drink can in the trash can, Ben saw vital signs logs for patients on that unit completed the previous day. The logs contained patient and staff names, along with patient information, including temperatures, blood pressure, pulse rate, and blood sugar test strip results.

· Heading back to his office, Ben decided to stop by the IT department and check further about the unattended USB drive. He found the door unlocked and the area unattended. No one was around and the USB drive was still in plain sight on the desk.

· On his way to his first staff meeting later that day, Ben passed the radiology waiting area. He observed a crew filming what appeared to be a commercial using the full waiting room as a backdrop.

· In the staff meeting, Ben asked when the last HIPAA security assessment was completed. The staff was vague as to an actual date, but the consensus was “about 3 years ago.” The VP of nursing asked if Ben would check to see what follow-up was done about the missing or stolen laptop off West B 18 months ago. Her concern was the missing patient data since this was a common laptop used by numerous people; so many, in fact, that the laptop had a simple password: 12345.

After his first day on the job, Ben felt there was a need for him to summarize 3 major violations he observed and develop a plan of action that could be used to prevent these violations in the future. Each incident on the Observations Found on Tour list is either a legal or regulatory compliance violation.

 

 

 

PLAN OF ACTION:

Select 3 compliance violations from the list to focus on in your plan of action.

Respond to the five writing prompts below to develop a plan of action. Insert your answer beneath the prompt.

Please be sure to research your information and properly cite your sources.

 

1. Compliance Violations

Summarize three compliance violations you selected from the scenario and the regulations or laws that address these violations.

 

2. Regulatory Stakeholders

Analyze the roles and responsibilities of regulatory agencies, accrediting and certifying bodies, and state professionals’ boards and their influence on facility operations and compliance to regulatory standards in the scenario.

 

3. Patient and Provider Rights

Explain the patient and provider rights and responsibilities and what impact regulations have on standards of care and potential liabilities as they relate to the violations.

 

 

 

4. Compliance and Risk Management Factors of the Medical Records

Analyze the potential risk management issues as they relate to the violations selected and the organization’s responsibility to protect the medical records and protected health information.

 

 

 

5. Create a basic plan of action and implementation process that could be used to prevent these violations in the future. Include industry-recognized strategies and best practices in your plan.

 

REFERENCES (minimum of 2 required):

Name (Enter your name here)

HCS 468

Instructor: Taryn Zubich

Date (Enter the date here)

Week 5 Assignment Writing Prompts Worksheet

 

Privacy and Confidentiality Report

Review the following scenario:

ABC Health Systems (AHS) was founded in 1959 by a group of 10 doctors in a mid-sized city in the southeastern United States. Beginning with a 30-bed hospital, AHS has expanded to its current bed complement of 305 acute care beds, a 110-bed skilled rehab and nursing facility on its campus, a 65-bed assisted living facility, outpatient rehab services, ER, and a cancer treatment clinic. AHS has 1,195 full-time employees’ campus-wide and is accredited by The Joint Commission, Commission on Accreditation of Rehabilitation Facilities, and also has other credentialed or accredited services throughout the campus.

Ben Smithfield was recently hired as the privacy officer for AHS. Previously, he worked for the third-largest faith-based health system, which is in the Midwest. In his new job, he reports to the vice president for risk management, who served as AHS’s privacy officer prior to Ben’s recruitment. AHS felt their privacy and security concerns could be best met with a full-time program manager dedicated to training, compliance, and management of this function.

Ben’s first week on the job proved to be very busy. While eating breakfast at a local fast-food restaurant, he overheard 2 doctors discussing AHS’ first successful robotic surgery on Paul Petersen. The MDs enthusiastically reported on Mr. Petersen’s condition stating that “although the surgery took longer than expected, Mr. Petersen’s vital signs were good. His pain level is high, and we are closely monitoring a post-op infection.” Later that day, Ben was contacted by Mr. Petersen, who was surprised to see his case discussed on the local news. That was not the only time Ben saw AHS in the news that day. He saw a press release from administration that reported that an ER patient, Violet Jones, was arrested after she physically assaulted 2 nurses who were attempting to insert her catheter.

Observations Found on Tour

During Ben’s first day, there was also a tour of the hospital and Ben took note of the following violations:

· A USB drive was unattended in the IT department and was clearly visible from an open door to the department.

· A maintenance worker was throwing old laptops in a dumpster, along with digital printer/copy cartridges.

· A high school student was shadowing a medical resident and observed her charting in an electronic health record (EHR) at the nurses station.

· A resident answered questions for the spouse of Mr. Petersen at the nurses’ station, which was heard by the high school student and Ben.

· The high school student, the medical resident, and Mr. Petersen’s spouse left the nurses station to meet with Mr. Petersen. The medical resident did not log out of the terminal. Ben sat at the terminal and scrolled through the open EHR.

· Charge RN Betsy Brown approached Ben and explained that she was excited to meet the new recruit that the VP spoke so enthusiastically about. When Betsy left, Ben was unable to view the open record due to a timeout provision. He asked an LPN if he would log Ben in and the LPN gladly complied.

· Across from the nurses desk in the hall, Ben noticed a white board that listed all patients on the unit, the name of the attending physician, the purpose of their admission (hip surgery, knee replacement, gall bladder removal, etc.), along with their code status—full code, no code, Do Not Resuscitate (DNR), etc.

· Taking a break from viewing electronic charts, Ben headed to the staff break room on the unit. As he tossed his drink can in the trash can, Ben saw vital signs logs for patients on that unit completed the previous day. The logs contained patient and staff names, along with patient information, including temperatures, blood pressure, pulse rate, and blood sugar test strip results.

· Heading back to his office, Ben decided to stop by the IT department and check further about the unattended USB drive. He found the door unlocked and the area unattended. No one was around and the USB drive was still in plain sight on the desk.

· On his way to his first staff meeting later that day, Ben passed the radiology waiting area. He observed a crew filming what appeared to be a commercial using the full waiting room as a backdrop.

· In the staff meeting, Ben asked when the last HIPAA security assessment was completed. The staff was vague as to an actual date, but the consensus was “about 3 years ago.” The VP of nursing asked if Ben would check to see what follow-up was done about the missing or stolen laptop off West B 18 months ago. Her concern was the missing patient data since this was a common laptop used by numerous people; so many, in fact, that the laptop had a simple password: 12345.

After his first day on the job, Ben felt there was a need for him to summarize 3 major violations he observed and develop a plan of action that could be used to prevent these violations in the future. Each incident on the Observations Found on Tour list is either a legal or regulatory compliance violation.

PLAN OF ACTION:

Select 3 compliance violations from the list to focus on in your plan of action.

Respond to the five writing prompts below to develop a plan of action. Insert your answer beneath the prompt.

Please be sure to research your information and properly cite your sources.

1. Compliance Violations

Summarize three compliance violations you selected from the scenario and the regulations or laws that address these violations.

In this section of your paper, you want to identify three compliance violations you selected from the scenario presented in the worksheet. Provide a brief summary of each violation you selected, and please be sure to identify regulations or laws that address these violations. Please be sure to include any citations in your work (i.e. if you reference laws and law descriptions) to give credit to your sources and meet APA requirements (Zubich, 2021).

2. Regulatory Stakeholders

Analyze the roles and responsibilities of regulatory agencies, accrediting and certifying bodies, and state professionals’ boards and their influence on facility operations and compliance to regulatory standards in the scenario.

In this section of your paper, you want to identify any regulatory agencies, accrediting and certifying bodies, and state professional boards which may play a role in the three compliance violation scenarios in which you described above. For example, with a HIPAA violation, a report must be made to the Office of Civil Rights (OCR). What would the OCR do to investigate? How would the report be made? Please provide detail on any state investigation that might occur and identify the potential fines or penalties which the covered entity might face if a violation is verified. Please be sure to include any citations in your work to give credit to your sources and meet APA requirements (HIPAA, 2021).

3. Patient and Provider Rights

Explain the patient and provider rights and responsibilities and what impact regulations have on standards of care and potential liabilities as they relate to the violations.

In this section of your paper, you want to identify the patient and provider rights and responsibilities which relate to the violations. For example, the patient’s right to restrict sharing of their health data would be violated in a HIPAA violation. Expand on any other patient rights which might be violated, or what other provider rights or responsibilities may have also been violated in the three scenarios you discussed. Please be sure to include any citations in your work to give credit to your sources and meet APA requirements (Zubich, 2021).

4. Compliance and Risk Management Factors of the Medical Records

Analyze the potential risk management issues as they relate to the violations selected and the organization’s responsibility to protect the medical records and protected health information.

In this section of your paper, you want to analyze the potential risk management issues as they related to the violations. How do the violations impact medical record management? How does the violation impact the patient protected health information? What type of risk will the healthcare organization face? Please be sure to include any citations in your work to give credit to your sources and meet APA requirements (HIPAA, 2021).

5. Create a basic plan of action and implementation process that could be used to prevent these violations in the future. Include industry-recognized strategies and best practices in your plan.

This section of your paper will detail a plan of action that could be implemented to prevent these violations in the future. Here, you want to detail steps that could be taken to avoid issues from occurring in the future and best practices which could be put in place. Research to identify best practice standards. Please be sure to include any citations in your work to give credit to your sources and meet APA requirements (Zubich, 2021).

REFERENCES (minimum of 2 required):

HIPAA, J. (2021). The Rules of HIPAA. Retrieved from HIPAA.org

Zubich, Taryn (2021). Week 5 Assignment Extra Help. Retrieved from extrahelp.org

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Considering what you know about generational trauma and ACEs, think about issues in the news and other forms of media. Share a story that includes either generational trauma or ACEs. This story can be fiction or non-fiction. Identify the issue of trauma or ACE in the story and provide multiple ways development could be affected.

Directions:

The impact of genetics and our environment on development from a scientific perspective can provide data. This module examines scientific issues like generational trauma and Adverse Childhood Experiences (ACEs). The data is still being collected on these topics, but anecdotally, the impacts of issues of trauma can be seen in individuals’ daily lives.

Initial Post

Considering what you know about generational trauma and ACEs, think about issues in the news and other forms of media. Share a story that includes either generational trauma or ACEs. This story can be fiction or non-fiction. Identify the issue of trauma or ACE in the story and provide multiple ways development could be affected.

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NRNP6645 Week 5 Discussion: Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings

NRNP6645 Week 5 Discussion: Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings

Discussion: Cognitive Behavioral Therapy: Comparing Group, Family, and Individual Settings

Photo Credit: Getty Images

There are significant differences in the applications of cognitive behavior therapy (CBT) for families and individuals. The same is true for CBT in group settings and CBT in family settings. In your role, it is essential to understand these differences to appropriately apply this therapeutic approach across multiple settings. For this Discussion, as you compare the use of CBT in individual, group, and family settings, consider challenges of using this approach with groups you may lead, as well as strategies for overcoming those challenges.

To prepare:

  • Review the videos in this week’s Learning Resources and consider the insights provided on CBT in various settings.
By Day 3

Post an explanation of how the use of CBT in groups compares to its use in family or individual settings. Explain at least two challenges PMHNPs might encounter when using CBT in one of these settings. Support your response with specific examples from this week’s media and at least three peer-reviewed, evidence-based sources. Explain why each of your supporting sources is considered scholarly and attach the PDFs of your sources.

Read a selection of your colleagues’ responses.

By Day 6 of Week 1

Respond to at least two of your colleagues by recommending strategies to overcome the challenges your colleagues have identified. Support your recommendation with evidence-based literature and/or your own experiences with clients.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

 

 

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Justin Baldoni describes the ideas imposed on him during his upbringing. How did those ideas impact his adulthood? Can you relate to his experiences? 

Watch: https://www.ted.com/talks/justin_baldoni_why_i_m_done_trying_to_be_man_enough/transcript?language=en

Address the following:

1. Justin Baldoni describes the ideas imposed on him during his upbringing. How did those ideas impact his adulthood? Can you relate to his experiences?

2. Reflect and address the following:

** How does the way you “perform gender” change according your context? Have you ever experienced “gender policing”?

**Have you engaged in “gender policing” of others? If so, why?

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Leadership 360-Degree Feedback, management homework help

Continuing on the themes
of the Module 1 and 2 Case Assignments, for this module you will also be doing
a self-assessment as well as applying the concepts from the module to your own
organization. Make sure to thoroughly review the required background materials
before starting this assignment, as you need to apply concepts from readings
such as Wilson (2014) or Taylor, et al. (2008) as part of this assignment.

This assignment has five
sections. For each section, the suggested length is one half to one full page,
for a total length of four to five pages not including the title page and
references. You should also make sure to cite Wilson (2014) and Taylor, et al.
(2008) multiple times throughout the paper as well as any additional references
that you find:

1. 
Most 360-degree surveys are not free and in fact are very
expensive if you want to get a license to use them at your organization.
However, there are a few free sample 360-degree surveys out there. Do a search
on Google or other search engines using terms such as “free 360-degree feedback
survey.” Find two or three free surveys and choose one of them that you think
would be most applicable to your organization. Explain the reasoning for your
choice, and try to use criteria from Taylor, et al. (2008) for selecting your
survey.

2. 
Now go ahead and take the survey that you chose in your answer
to Question 2 above. Fill out the survey as a self-evaluation – i.e. use the
survey to evaluate your own leadership skills and other skills. Report the
results of your survey. Do you think the survey was useful? What areas for
improvement in your leadership skills did you find from using the survey?

3. 
As a next step, fill out the survey again but this time evaluate
your current supervisor or a previous supervisor that you worked with. Report
your results. Were the results fair to your supervisor? What are the main areas
for improvement for your supervisor based on your results?

4. 
Now that you have taken the survey twice, what is your overall
evaluation of the survey that you took? Did the survey ask the right questions
necessary for you and your supervisor? Are there different or additional
questions that you think should be added to this survey? Use the “Standardized
Instrument Checklist” on page 37 of Taylor, et al. (2008) as well as your own
experiences filling out the survey to assess the usefulness of the survey that
you took.

5. 
Finally, take a look at page 255 of Wilson (2014) where she
discusses six different pitfalls of a 360-degree survey. Which pitfalls do you
think would apply to your organization and the leaders you work with? How might
you overcome these pitfalls if you were to lead a 360-degree survey process in
your organization?

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Using the Transtheoretical Model of Change, health and medicine homework help

Here’s a CASE this week – to indepedently consider and then to discuss as a team:

Imagine that you are a school nurse working with Amy, 15 years old, and her mother. Amy is 5’2” tall and weighs 185 pounds and is interested in trying out for the drama club at school, which is putting on the play Peter Pan. Amy is worried that she will not be accepted and tells you that she has few friends at school. She has tried many types of diets since she was 12 years old but talks about her failures in the past and how she gets depressed and snacks while watching television each evening with Mom.

Amy’s mother, Marion, is a 35-year-old single woman who works as a paralegal. Marion’s position was recently changed from client services in the main law office to title search services at the off-site office. Marion has moderate hypertension, smokes, is 70 pounds above her ideal weight, and describes extreme fatigue in the evenings after lengthy computer searches.

Using the Transtheoretical Model of Change, apply the stages of change, and propose change processes to assist both Amy and her mother Marion in the difficult and real process.

Use the outline/prompts below to create an initial post to share with your team !

  1. STAGES of CHANGE
    • Identify which stage of change AMY exhibits (Precontemplation/Contemplation/Preparation/Action/ Maintenance
    • Identify which stage of change mother MARION exhibits (Precontemplation/Contemplation/Preparation/Action/ Maintenance)
  2. READINESS for CHANGE
    • Provide an assessment for AMY’s readiness for change.
    • Provide an assessment for mother MARION’s readiness for change.
  3. ACTIVITIES for CHANGE
    • What ACTIVITIES would you recommend for AMY ?
    • What activities would you recommend fo rmother MARION?

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Need help with communications relationship

Choose an individual who has lived part of their adult work-life BEFORE the widespread use of the cell phone.Interview that person about different ways in which COMMUNICATION IN RELATIONSHIPS was different BEFORE they had a cell phone, and how it changed once they got one. Plan your questions carefully to get at his/her perceptions of how the cell phone has affected communication in relationships.

Write a 2-page paper (typed) in which you apply the information you get from your interviewee to some issues and concepts raised in chapter9in the textbook on “Media”.

There are three concepts in the book, you may need it for the assignement

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theory of myth, writing homework help

In Chapter Four of the textbook, Studying Religion, it discusses two case studies of myth: the Mesopotamian epic Enuma Elish, and the story of Moses in the Bible. The textbook then discusses the different types of myth and the different functions of myth. Finally it discusses five most important theories of myth used by scholars of religion. In your writing assignment consider the five different theories of myth discussed in Chapter Four. Which of the five theories of myth do you believe is most helpful in understanding the meaning and function of myths in different religions, and why? Illustrate how the theory of myth you argue is most useful could be used to understand and explain the two case studies of the myths considered in the chapter: the Enuma Elish and the Moses story in the Bible.

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