NR 601 Week 3 Case Study Discussions Physical Examination (Part-1) NEW
NR 601 Week 3 Case Study Discussions Physical Examination (Part-1) NEW
Discussion Part One (graded)
Katie Smith, a 65 year-old female of Irish descent, is being seen in your office for an annual physical exam. You are concerned since she has rescheduled her appointment three times after forgetting about it. She and her husband John are currently living with their daughter Mary, son-in-law Patrick, and their four children. She confesses that while she loves her family and appreciates her daughter’s hospitality, she misses having her own home. As she is telling you this, you notice that she develops tears in her eyes and does not make eye contact with you.
Background:
Although Mrs. Smith is scheduled for an annual physical exam and reports no particular chief complaint, you will need to complete a detailed geriatric assessment. Katie reports a lack of appetite. She tells you that she nibbles most of the time rather than eating full meals. She also reports having insomnia on a regular basis.
PMH:
Katie reports a recent bout of pneumonia approximately 3 months ago, but did not require hospitalization. She also has a history of HTN and high cholesterol.
Current medications:
HCTZ 25mg daily
Evista 60mg daily
Multivitamin daily
Surgeries:
Appendectomy as a child in Ireland (date unknown)
1968- Cesarean section
Allergies: Denies food, drug, or environmental allergies Vaccination History:
Cannot remember when she had her last influenza vaccine
Does not recall having received a Pneumovax
Her last TD was greater than 10 years ago
Has not had the herpes zoster vaccine
Screening History:
Last Colonoscopy was 12 years ago
Last mammogram was 4 years ago
Has never had a DEXA/Bone Density Test
Social history:
Emigrated with her husband from Ireland in her 20s and has always lived in the same house until recently. She retired a year and a half ago from 30 years of teaching elementary school; has never smoked but drinks alcohol socially. She states that she does not have an advanced directive, but her daughter Mary keeps asking her about setting one up. Family history:
Both parents are deceased but lived disease-free up into their late 90s. She has one daughter who is 44 years old with no chronic illness and two sons, ages 42 and 40, both in good health.
Discussion Day 1:
Differential Diagnoses with rationale
Further ROS questions needed to develop DD
Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.
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PSY 205 Week 5 Assignment 1 Parental Responsiveness NEW
Assignment 1: Parental Responsiveness
Due Week 5 and worth 160 points Story Before my first child was born, I studied child development. I learned the importance of responsive caregiving. I learned that I would soon be able to read my baby’s cries. I would know what was wrong and what I could do by the sound of the cry. After my baby was born, I responded quickly when he cried. To my surprise, I had difficulty calming him. I realized I did not always know what was wrong by the sound of his cry. I became very frustrated and decided that if my baby was dry, fed, and not tired. I would just let him cry it out. I didn’t know what else to do. Write a two to three (2-3) page paper in which you: Explain how Behaviorism, Psychoanalytic Theory, and Attachment Theory suggest handling this situation and predict what would be each likely outcome. Identify the characteristics that a baby could have that may disrupt the attachment process. Suggest a solution that is supported by research and theory. Explain what the research says regarding how parents should react to the cries of a child. Assess the behavior of the mother in supporting secure attachment. Use at least four (4) quality resources in this assignment. Note: Wikipedia and similar Websites do not qualify as quality resources. Your assignment must follow these formatting requirements: Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions. Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length. The specific course learning outcomes associated with this assignment are: Assess the biological, cognitive, cultural, environmental, and social factors that influence development throughout the lifespan. Use technology and information resources to research issues in lifespan development. Write clearly and concisely about lifespan development using proper writing mechanics
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NR 601 Week 5 Case Study Discussions Physical Examination (Part-2) NEW
Discussion Part Two (graded)
Physical examination:
Vital Signs:
Height: 5’8” Weight: 154 pounds BMI: 23.4 BP: 132/76 P: 76 regular R: 16
HEENT: Normocephalic, symmetric. PERRLA, EOMI, no cataracts noted; poor dentition.
NECK: Neck supple; non-palpable lymph nodes; no carotid bruits. LUNGS: Respirations are unlabored, decreased breath sounds and crackles at the bases bilaterally. Prolonged expiratory phase throughout lung fields, inspiratory wheezes and a productive cough of cloudy white sputum.
HEART: RRR with regular without S3, S4, murmurs or rubs.
ABDOMEN: Round, firm abdomen; active bowel sounds; non-tender. NEUROLOGIC: Unsteady gait, swaying while standing during periods of agitation. Achilles reflexes are present bilaterally. Strength is equal but decreased in the upper and lower extremities bilaterally.
GENITOURINARY: Urinary incontinence with strong odor of urine. NO CVA tenderness.
MUSCULOSKELETAL: Mild kyphosis. Heberden’s nodes at the distal interphalangeal joints (DIP) of all fingers, and marked crepitus of the bilateral knees on flexion and extension. Pedal pulses palpable. No edema noted in lower extremities.
PSYCH: Manic, restless, angry and hyperverbal
SKIN: Right forearm with 3 cm x 5 cm x 0 cm dry, scabbed abrasion. Left forearm with 4 cm x 5 cm x 0 cm dry, scabbed abrasion.
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