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Nursing - week 6 discussion, Coursework

Assesment 1: Assessing the Abdomen A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis; however, as a precaution, the doctor ordered a CAT scan. The CAT scan revealed a growth on the pancreas, which turned out to be pancreatic cancer—the real cause of the cramping. Because of a high potential for misdiagnosis, determining the precise cause of abdominal pain can be time-consuming and challenging. By analyzing case studies of abnormal abdominal findings, nurses can prepare themselves to better diagnose conditions in the abdomen. In this assignment, you will analyze a SOAP note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions. Abdominal Assessment SUBJECTIVE: CC: “My stomach hurts, I have diarrhea and nothing seems to help.” HPI: JR, 47 yo WM, complains of having generalized abdominal pain that started 3 days ago. He has not taken any medications because he did not know what to take. He states the pain is a 5/10 today but has been as much as 9/10 when it first started. He has been able to eat, with some nausea afterwards. PMH: HTN, Diabetes, hx of GI bleed 4 years ago Medications: Lisinopril 10mg, Amlodipine 5 mg, Metformin 1000mg, Lantus 10 units qhs Allergies: NKDA FH: No hx of colon cancer, Father hx DMT2, HTN, Mother hx HTN, Hyperlipidemia, GERD Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys) OBJECTIVE: VS: Temp 99.8; BP 160/86; RR 16; P 92; HT 5’10”; WT 248lbs Heart: RRR, no murmurs Lungs: CTA, chest wall symmetrical Skin: Intact without lesions, no urticaria Abd: soft, hyperctive bowel sounds, pos pain in the LLQ Diagnostics: None ASSESSMENT: Left lower quadrant pain Gastroenteritis PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses. To prepare: With regard to the SOAP note case study provided: Review this week’s Learning Resources, and consider the insights they provide about the case study. Consider what history would be necessary to collect from the patient in the case study. Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis? Identify at least five possible conditions that may be considered in a differential diagnosis for the patient. To complete: Analyze the subjective portion of the note. List additional information that should be included in the documentation. Analyze the objective portion of the note. List additional information that should be included in the documentation. Is the assessment supported by the subjective and objective information? Why or Why not? What diagnostic tests would be appropriate for this case and how would the results be used to make a diagnosis? Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least 3 different references from current evidence based literature. Show Descriptions Quality of Work Submitted: The extent of which work meets the assigned criteria and work reflects graduate level critical and analytic thinking.-- Excellent 27 (27%) - 30 (30%) Good 24 (24%) - 26 (26%) Fair 21 (21%) - 23 (23%) Poor 0 (0%) - 20 (20%) Assimilation and Synthesis of Ideas: The extent to which the work reflects the student's ability to: Understand and interpret the assignment's key concepts.-- Excellent 27 (27%) - 30 (30%) Good 24 (24%) - 26 (26%) Fair 21 (21%) - 23 (23%) Poor 0 (0%) - 20 (20%) Assimilation and Synthesis of Ideas: The extent to which the work reflects the student's ability to: Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources.-- Excellent 18 (18%) - 20 (20%) Good 16 (16%) - 17 (17%) Fair 14 (14%) - 15 (15%) Poor 0 (0%) - 13 (13%) Written Expression and Formatting Paragraph/Sentence Structure: Paragraphs make clear points that support well developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and carefully focused--neither long and rambling nor short and lacking substance.-- Excellent 9 (9%) - 10 (10%) Good 8 (8%) - 8 (8%) Fair 7 (7%) - 7 (7%) Poor 0 (0%) - 6 (6%) Written Expression and Formatting English writing standards: Correct grammar, mechanics, and proper punctuation.-- Excellent 5 (5%) - 5 (5%) Good 3 (3%) - 4 (4%) Fair 2 (2%) - 2 (2%) Poor 0 (0%) - 1 (1%) Written Expression and Formatting The assignment follows parenthetical/in-text citations, and at least 3 evidenced based references are listed.-- Excellent 5 (5%) - 5 (5%) Good 3 (3%) - 4 (4%) Fair 2 (2%) - 2 (2%) Poor 0 (0%) - 1 (1%)
Assesment 1: Assessing the Abdomen A woman went to the emergency room for severe abdominal cramping. She was diagnosed with diverticulitis; however, as a precaution, the doctor ordered a CAT scan. The CAT scan revealed a growth on the pancreas, which turned out to be pancreatic cancer—the real cause of the cramping.
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Assignment ID
573755
Discipline
CREATED ON
30 June 2018
COMPLETED ON
2 July 2018
Price
$40
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