DQ 1: Chronic back pain
DQ 1: Chronic back pain
DQ 1: Chronic back pain
NR 601 Week 2 DQ 1
Discussion Part One (graded)
B.J., a 70-year-old Caucasian female has been seen in the clinic several times over the last 3 years. However, she missed her last annual appointment-last appointment was 18 months ago and today you are the nurse practitioner seeing her. She arrived to the clinic alone and states she is “here for my check-up”.
The patient reports that “my feet just burn and tingle all the time and it is so much worse at night that I can hardly sleep at all”. She also indicates that “I need some new pillows; I use 3 of them now to just get comfortable at night to sleep. Those pillows help me catch my breath so I can sleep better”. She also reports dyspnea just walking to the bathroom, but it only happens when her legs are “swole up” and also states, “the coughing also keeps me up at night”. To be honest, “I’m just tired in general whether my feet are “swole” or not”. She also indicates that she cannot see well, especially at night. She also reported that at her last visit to the clinic, she was told that she had a “heart beat problem” and that she is supposed to be taking aspirin every day. She said she thinks all of her “heart pains” went away after she started taking the aspirin and “putting that pill under the tongue”. One of her concerns she has today is that since her husband died last year, she tells you, “I just don’t like doing things that I liked to do before my husband died. We used to like to do all sorts of stuff, but anymore….I just feel blue all the time”.
Chronic back pain
Previous history of MI in 2010
Congestive Heart Failure?
Coreg 6.25 mg PO BID
Colace 100 mg PO BID
Glucotrol XL 10 mg PO daily
Lantus insulin 20 units at HS
K-dur 20 mEq PO QD
Furosemide 40 mg PO QD
L-Thyroxine 112 mcg PO QD
2010-Left Anterior Descending (LAD) cardiac stent placement
She receives an annual flu shot. Last flu shot was this year
Has never had a Pneumovax
Has not had a Td in over 20 years
Has not had the herpes zoster vaccine
Has not seen a dentist in over 15 years, the time she got her dentures
Last colorectal screening was 11 years ago
Last mammogram was 5 years ago
Has never had a DEXA/Bone Density Test
Last dilated eye exam was 4 years ago
Labs from last year’s visit: Hgb 12.2, Hct 37%, Hgb A1C 8.2%, K+ 4.2,
Na+140,Cholesterol 186, Triglycerides 188, HDL 37, LDL 98, TSH 3.7,
She graduated from high school, and thought about college, but got married right away and then had kids a short time later. Her two sons and their wives live with her, take her to church and to the local senior center; they do all the cleaning, run errands, and do grocery shopping.
Both parents are deceased. Father died of a heart attack; mother died of natural causes. She had one brother who died of a heart attack 20 years ago at the age of 52.
Patient is a current tobacco user and has smoked 1 pack of cigarettes daily for the last 50 years and reports having no desire to quit. She uses occasional chew. She drinks one 4 ounce glass of red wine daily.
Discussion Part One:
Provide differential diagnoses (DD) with rationale.
Further ROS questions needed to develop DD.
Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.
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APA Writing Checklist
Use this document as a checklist for each paper you will write throughout your GCU graduate program. Follow specific instructions indicated in the assignment and use this checklist to help ensure correct grammar and APA formatting. Refer to the APA resources available in the GCU Library and Student Success Center.
☐ APA paper template (located in the Student Success Center/Writing Center) is utilized for the
correct format of the paper. APA style is applied, and format is correct throughout.
☐ The title page is present. APA format is applied correctly. There are no errors.
☐ The introduction is present. APA format is applied correctly. There are no errors.
☐ Topic is well defined.
☐ Strong thesis statement is included in the introduction of the paper.
☐ The thesis statement is consistently threaded throughout the paper and included in the
☐ Paragraph development: Each paragraph has an introductory statement, two or three sentences as the body of the paragraph, and a transition sentence to facilitate the flow of information. The sections of the main body are organized to reflect the main points of the author. APA format is applied correctly. There are no errors.
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Examples of Scholarly Resources include: Academic journals, books written by experts in a field, and formally published encyclopedias and dictionaries.
Peer-Reviewed Journals: Peer-reviewed journals are evaluated prior to publication by experts in the journal’s subject discipline. This process ensures that the articles published within the journal are academically rigorous and meet the required expectations of an article in that subject discipline.
Empirical Journal Article: This type of scholarly resource is a subset of scholarly articles that reports the original finding of an observational or experimental research study. Common aspects found within an empirical article include: literature review, methodology, results, and discussion.
Adapted from “Evaluating Resources: Defining Scholarly Resources,” located in Research Guides in the GCU Library.
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Participation for MSN
Threaded Discussion Guiding Principles
The ideas and beliefs underpinning the threaded discussions (TDs) guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The use of TDs provides students with opportunities to contribute level-appropriate knowledge and experience to the topic in a safe, caring, and fluid environment that models professional and social interaction. The TD’s ebb and flow is based upon the composition of student and faculty interaction in the quest for relevant scholarship. Participation in the TDs generates opportunities for students to actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty. TDs foster the development of members into a community of learners as they share ideas and inquiries, consider perspectives that may be different from their own, and integrate knowledge from other disciplines.
Each weekly threaded discussion is worth up to 25 points. Students must post a minimum of two times in each graded thread. The two posts in each individual thread must be on separate days. The student must provide an answer to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week. If the student does not provide an answer to each graded thread topic (not a response to a student peer) before the Wednesday deadline, 5 points are deducted for each discussion thread in which late entry occurs (up to a 10-point deduction for that week). Subsequent posts, including essential responses to peers, must occur by the Sunday deadline, 11:59 p.m. MT of each week.
Good writing calls for the limited use of direct quotes. Direct quotes in Threaded Discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the Grammar, Syntax, APA category.
Grading Rubric Guidelines
NOTE: To receive credit for a week’s discussion, students may begin posting no earlier than the Sunday immediately before each week opens. Unless otherwise specified, access to most weeks begins on Sunday at 12:01 a.m. MT, and that week’s assignments are due by the next Sunday by 11:59 p.m. MT. Week 8 opens at 12:01 a.m. MT Sunday and closes at 11:59 p.m. MT Wednesday. Any assignments and all discussion requirements must be completed by 11:59 p.m. MT Wednesday of the eighth week.