Question #1:
Emmi has been under a lot of stress and is concerned about her overall health. She works nights at a local restaurant and takes a full course load during the day at a local community college. At lunch today, her friend Jessi suggested that she take Nutrimega supplements to help prevent colds, flu, and other illnesses and reduce her stress. Jessi said that she has been taking Nutrimega for several months and feels great.
Emmi was a little surprised to learn that a month’s supply of Nutrimega cost about $50.00, but she decided to buy the supplements, anyway. The Nutrimega label recommends taking 2 or 3 tablets daily for health maintenance and 2-3 tablets every 3 hours at the first sign of illness. When Emmi read the label on the bottle, she noted that each tablet contained the following nutrients (listed as % daily value): 33% Vitamin A (75% as preformed Vitamin A), 700% Vitamin C, 50% Zinc, and 10% Selenium.
If you were Emmi’s dietitian, health clinician, or nutritionist, would you recommend that Emmi use this product?
Are there any health risks associated with its use, considering the dosed recommended on the label for maintenance and illness and if so, what are they?
What alternative suggestions would give Emmi to help her maintain her overall health?
Question #2:
Report on an article that investigates the relationship between food and cancer. It must come from a peer reviewed journal and not a social media site. Give a brief summary of the research and its findings. Also, what was your opinion of the research?
Please write a response to the article below using the guidelines-(Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years. There should be a mix between research and your reflections. Add critical thinking in the posts along with research. Apply the material in a substantial way.)
Note: Please do not use material from Course Hero as my instructor checks it. Original material needed please.
Article:
According to Warwick-Booth et al. (2018), health education passes health information to people. On the other hand, health promotion is empowering people to have increased control over their health to improve it. Therefore, one can define health promotion education as a combination of different learning experiences by influencing a change of attitude and increasing knowledge to communities to promote their health (Warwick-Booth et al., 2018). Therefore, health education is part of the broader health promotion strategy. Health education plays various roles in health promotion. One of the roles of education health is that it helps build a capacity for behavior change in a community. In addition, health education helps deliver health information to a specific population concerning various health issues they face, e.g., health threats or benefits that they may face (Rural Health Information Hub, 2022).
According to Semachew (2018), the nursing process is a logical problem-solving technique used in identifying, averting, and treating various health problems. The nursing process has five steps: assessment, diagnosis, planning, implementation, and evaluation. The role of the nursing process in health education is that it helps develop critical thinking skills and knowledge to patients about their conditions so that they can reclaim their independence. For example, a patient having a diabetic condition will learn how to administer their injections and how to test their urine.
There are various contemporary issues that families experience globally. These issues involve society killer diseases or untreatable diseases. One of the contemporary issues is diabetes type two. There are various steps that a nurse would take to address diabetes type two in her education plan. The first step is assessing the learning needs of the patient. This step is important because it helps a nurse identify the knowledge gap that their patient has. The second step is to develop learning objectives. A nurse has to set goals that they intend to accomplish after educating diabetes type two patients. The next step is the implementation of patient teaching. This step involves passing knowledge to patients about diabetes type two. For example, a nurse can pass information about the patient’s diet. The next step involves evaluating the patient’s learning to determine whether it was successful. The final step is documenting the patient teaching and learning.
References
Rural Health Information Hub. (2022). Health Education Strategies – Rural Health Promotion and Disease Prevention Toolkit. Rural Health Information Hub. Retrieved 5 February 2022, from https://www.ruralhealthinfo.org/toolkits/health-promotion/2/strategies/health-education#:~:text=Health%20education%20presents%20information%20to,change%20in%20an%20appropriate%20setting.
Semachew, A. (2018). Implementation of Nursing Process in Clinical Settings: The Case of Three Governmental Hospitals In Ethiopia, 2017. BMC Research Notes, 11(1). https://doi.org/10.1186/s13104-018-3275-z
Warwick-Booth, L., Cross, R., Woodall, J., Bagnall, A., & South, J. (2018). Health Promotion Education In Changing And Challenging Times: Reflections From England. Health Education Journal, 78(6), 692-704. https://doi.org/10.1177/0017896918784072
You are to search for quantitative article critique, the article should be a primary source quantitative research article on health issues or problem in in the US or world as a whole. Note, the article will be used for your incoming project. The article should not be a review one
In the Attachment Soap note to rewrite with zero turnit in
SOAP Note – Migraine
University
Common Illness Across The Lifespan-Clinical Practicum
Professor
SOAP Note – Migraine
SUBJECTIVE DATA
Patients ID: Mrs. Olivia Roberts, Age: 68 years old, Race: Caucasian, Gender: Female,
Date of Birth: November 12, 1954, Marital Status: Windowed. The patient seems apprehensive but in good shape. She is a reliable historian.
CC: “I have been experiencing severe headaches that have persisted for four days. The headaches are so strong since they have raised a feeling of nausea and (seeing stars)”
History of Present Illness: Mrs. Roberts is a 68-year-old Caucasian female who visits the clinic with complaints of severe headaches. She explained that the headache was excruciating, having persisted for several days. She explained that headaches cause her a state of restlessness; therefore, she felt the essence of getting a medical examination. The patient explained that since her college days, she had not experienced such headaches. She described the pain from the headaches to be severe, rating it at 9/10 on a pain rating scale where it posits a throbbing sensation in her temporal region. She added that the pain began a few months ago, and it has been gradually worsening over time. The patient described the headache to be serious since, the past few days. She verbalized that she has been using ibuprofen to reduce the difficulty of the pain, but the drugs seem not to work anymore. The patient reports that the pain eases when she is in cool, silent, and mostly dark places while the pain aggravates in the presence of noise and light. This has been denying her the opportunity to catch up with her favorite television program and the NBA league since she is a great fan.
Review of Systems
Constitutional: The patient is friendly and seems a reliable historian on account of her extant and past medical histories. She is in good shape with no significant medical issues bothering her. She reverts unaccounted weight loss or gain, fever, nausea, chills, vomiting, or increased weakness.
HEENT: Head; reports severe headaches that causes a throbbing sensation on her right temporal region. The condition incites dizziness while standing and sensitivities to light and loud music. Eyes; experiences double vision at times with spots. Ears; reverts epistaxis and tinnitus. Nose; denies running nose or nasal congestion. Mouth and throat; Denies sore throat, nodes, swollen glands, or cold sores. Denies bleeding gums or dental deformities.
Skin: Reverts skin rashes, bruises, itching, lesions, or skin colour changes.
Pulmonary: Denies challenges with breathing, wheezing, coughs, or congestion.
Cardiovascular: Denies irregular heartbeats, chest tightness, pain, laboured breathing, or heart murmurs.
Gastrointestinal: Denies changes in bowel patterns, abdominal pain or discomforts, vomiting, constipation, diarrhoea, loss of appetite, but reports that she has been experiencing nausea due to the headaches.
Genitourinary: Denies changes in urinary frequency, pain upon urination or a burning sensation, smelly urine, irregular menses or vaginal discharge.
Musculoskeletal: Reverts injuries or trauma, joints weakness or stiffness, muscle cramps, swellings, or pain in the extremities. Also denies back pain or discomforts.
Lymph/Hematologic: She denies excessive bleeding, bruising, and petechia. Denies lymph nodes that are swollen, enlarged, or painful.
Neuro/Psych: She denies numbness or paraesthesia. Reverts sadness, depression, suicidal ideation, However, she said that the persistent headaches had affected her sleeping habits.
Past Medical History: The patient reported that she has no significant health conditions bothering her in the present, and neither did she have one in her young life. She also added that she has never been hospitalized.
Surgical: Underwent a C-section at age 28 and 31 in the delivery room.
Allergies: Reports no known allergies.
Medications: Been using ibuprofen 400mg 2 tablets a day to relent the headaches.
Immunization: Up to date with her immunizations where she received flu and yellow fever jabs in October. Also indicates that she is tolerant to vaccines.
Family History: Maternal grandparents deceased due to old age-related complications, but they were free of comorbidities. Paternal grandparents were also deceased. The grandfather was subject to Alzheimer’s, but the grandmother was healthy. The mother is alive, aged 92, and she suffers from hypertension and Type II diabetes. Her father died at the age of 90 due to complications attributed to Alzheimer’s. Her husband is alive, aged 72, and he is healthy not affected by any medical condition. Their two sons are alive, aged 37 and 40 years, and they are not affected by any health issues.
Social History: The patient lives with her husband, two grandsons, and two house helps in their own home in Seattle. She is retired from her work duties, where she served as a marine in the United States forces till the age of 65. The husband was an engineer, but he is also retired. They are financially stable. She denies the use of tobacco or recreational drugs. The patient drinks wine at social occasions and special events, but otherwise, she is sober. In her leisure time, she likes swimming, jogging, and yoga, but the headaches have limited her from her routine of exercise. She maintains a healthy dietary plan and abides by her nutritionist’s diet recommendations. She is sexually active. The patient is a Christian and goes for services every Sunday in her local church.
OBJECTIVE DATA
Vital Signs: Temperature: 98.0 ℉, Pulse: 84, Respiratory Rate: 18, Blood pressure 124/82, Oxygen saturation: R.A 96%, Height 5’.7’, Weight 130 lbs, BMI 20.4.
General: The patient seems to be well-behaved, alert, and oriented X4. She is anxious and distressed, but she sits upright. Her responses to queries were brief and logical, though she avoided eye contact throughout the conversation. She complained of headaches and sensitivity to light where she termed the conditions to be nagging.
HEENT: Head; normocephalic with an even and normal distribution of hairs on her head. She had a strong headache with a throbbing sensation in the right temporal region. Eyes; no sinus tenderness, conjunctivas and are PERRLA clear and sees an optician every four months. Ears; no pinna or tragus abnormalities, no tenderness or ear canal inflammation, bilateral cerumen, intact and pearly grey. Throat and Mouth; normal dental formation with milk-white teeth, gums are pink and free of sores or lesions and sees a dentist every four months.
Neck: Trachea midline, with no lymphadenopathy or carotid bruits noted. Mild Pain that radiates down her neck
Pulmonary: Lungs clear to auscultation with no rales or wheezes. upon breathing, chest walls rise and fall symmetrically. Negative for cardiac heave or lifts, and no distress was noted.
Cardiovascular: S1 and S2 are audible with a regular heart rate and rhythm when auscultated. No frictional rubs or gallops were noted.
Gastrointestinal: Nausea without vomiting, soft and round, no guarding or rebound tenderness was noted, normal bowel sounds present in all the four quadrants. No masses or tenderness upon palpation of the CVA region.
Genitourinary: Bladder is non distended. Negative for infections at the labia majora or at the perennial area. Moist perineal area with no lesions. Impalpable lymph nodes, and her vagina assumed a normal shape and size with regular pubic hairs.
Musculoskeletal: Full range of motion in all the extremities, negative for joint stiffness, enlarged joints, deformities or muscle cramps. warm to touch.
Neurologic/Psych: Patient is alert and oriented. Negative for sensory deformities. Speech was clear and logical backed by normal tone of an aging woman. negative for abnormal reflexes, intact cranial nerves.
· Eyes exam would also be significant to ascertain whether the patient has conditions that may lead to severe headaches such as eye strain or sensitivities to white light (Cash et al., 2017).
· Blood chemistry and urinalysis may be done to rule out other conditions that may lead to headaches such as diabetes, infections and thyroid complications (Cash et al., 2017).
ASSESSMENT
Differential Diagnoses
Differential Dx: Migraines (ICD-10-CM-G43.909) – Migraines are often described as severe headaches that trigger a throbbing pain or a pulsing sensation on one side of the head. The headaches are accompanied by nausea, vomiting, and aggravated sensitivities to light and sound, though the condition manifests in stages that include prodrome, aura, attack, and post-drome (Becker, 2017). Migraine attacks are severe since they may last for hours or days; hence they are a bother since they may impact a person’s daily routine of activities. The condition has no age discrimination since it affects patients of all ages (Becker, 2017). The patient presents with a throbbing headache that affects her temporal area of the head, and the headache rose in the past few days. The patient also portrays some signs and symptoms of the condition since she also stated having sensitivities to light and sound, as well as seizures.
Differential Dx: Cluster Headaches (ICD-10-CM-G44.009) – Cluster or cyclical headaches are severe since they occur in cyclical patterns. Cluster headaches wake a patient during the night with intense pain around one eye or one side of the head (Goadsby et al., 2018). The attacks may last between weeks and months, with remission periods when the headaches cease. In the remission sessions, the headaches tend to last between months and years. The headaches are rare, and they are not life-threatening. They manifest in the form of restlessness, pain in one side of the head or one eye, excessive tearing, redness of the eye on the affected side, pale skin, and runny nose (Goadsby et al., 2018). People with cluster headaches may also be affected by gazing. The differential will not be considered since the patient did not report a runny nose, swelling in the eye or redness in one eye, or dropping of an eyelid (Goadsby et al., 2018).
Differential Dx: Viral Meningitis (ICD-10-CM-A87.9) – Viral meningitis is a type of meningitis caused by viruses’ infections, and it is the most common. Non-polio enteroviruses primarily cause the condition though it can also be caused by mumps virus, measles virus, influenza virus, and herpes virus (Brouwer & Van de Beek, 2017). The condition manifests in irritations, poor appetite, lethargy, fever, headache, nausea, vomiting, sleeping troubles, photophobia, and stiff neck (Brouwer & Van de Beek, 2017). The differential will be disregarded since the patient did not report neck stiffness, vomiting, lethargy, fever, or a history of sexually transmitted infections such as herpes virus.
Final Differential: Migraines (ICD-10-CM-G43.909) – The patient is affected by migraine since the signs and symptoms she presented most correlate to signs and symptoms of migraines (Becker, 2017). She presented with a severe headache that was accompanied by throbbing pain in her temporal section of the head (Becker, 2017). The lab tests affirmed the diagnoses of migraines since the blood chemistry and urinalyses reflected no infections or the presence of other comorbidities such as diabetes and thyroid challenges. Imaging studies reflected that the patient was not suffering from head injuries or brain infections.
PLAN
DIAGNOSTIC LAB: The use of neuroimaging, CT, and MRI is depending on the patient’s medical history and physical examination.
Neuroimaging: If a patient has a severe headache, is over 40 years old, has start of headache with exertion, cough, or sexual activities, or has neurological impairment, neuroimaging should be considered (Cash et al., 2017). For an adult with a stable headache, no abnormal findings on examination, and no indication of seizure, neuroimaging will not be required (Cash et al., 2017).
Emergent CT- scan: When a patient complains of “the worst headache ever” and when focal neurological abnormalities, nuchal rigidity, or changed mental state are evident, an urgent CT scan without contrast should be obtained (Cash et al., 2017).
Laboratory test: Most patients with typical symptoms and a negative physical examination do not require a lab test. To rule out opioid and illicit substance abuse, a urine drug test may be recommended. CMP, CBC, TSH, and ESR are also recommended (Cash et al., 2017).
TREATMENT PLAN AND EDUCATION
The patient should be administered with Sumatriptan 50mg when the symptoms of migraines start, such as headaches, nausea, or vomiting (UpToDate, 2020). If the condition’s symptoms persist, the patient should take a second tablet of the dosage after two hours. When taking another dose, the patient should consult with a physician. In 24 hours, one should not take more than 200mg of Sumatriptan medication since it is an overdose that would result in adverse conditions (UpToDate, 2020). Sumatriptan drug belongs to the class of selective serotonin receptor agonists drugs, which is effective in the control of migraines in mild to severe states (UpToDate, 2020). NSAIDs and Acetaminophens may be used to control migraines in mild to moderate states. The drug should not be taken with other medics of the selective serotonin receptor agonists class.
Encourage the patient to keep a headache diary that is accurate and current at all times. This diary will assist the patient in identifying migraine headache triggers. (Cash et al., 2017). The patient should be counselled to monitor her sleeping patterns since they may have resulted in the rise of migraines. She should exercise ample rest time. The patient should also embark on decreased caffeine use and go back to her exercise practice (McLaren, 2021). The patient should also be counselled to reduce stress in her life and embark on a healthy diet plan which will enable her maximum nutritional value from her meals (McLaren, 2021). The patient should also stick by her medications for an effective therapeutic effect.
FOLLOW-UP: Schedule a follow-up in two weeks to evaluate treatment effectiveness and to revise with her headache diary.
Referral: Refer her to neurology if the meds don’t help her headache or send her to the emergency room if she has any neurological or life-threatening signs and symptoms. (Cash et at., 2017).
References
Becker, W. J. (2017). The diagnosis and management of chronic migraine in primary care. Headache: The Journal of Head and Face Pain, 57(9), 1471-1481. https://doi.org/10.1111/head.13089
Brouwer, M. C., & Van de Beek, D. (2017). Viral Meningitis: Epidemiology, diagnosis, and treatment of brain abscesses. Current Opinion in Infectious Diseases, 30(1), 129-134. https://doi.org/10.1097/qco.0000000000000334
Cash, J. C., Glass, C. A., & Mullen, J. (2017). Family practice guidelines (4th ed.). Springer Publishing Company.
Goadsby, P., Wei, D., & Yuan Ong, J. (2018). Cluster headache: Epidemiology, pathophysiology, clinical features, and diagnosis. Annals of Indian Academy of Neurology, 21(5), 3. https://doi.org/10.4103/aian.aian_349_17
McLaren, D. (2021). Headaches and migraines: Medication overuse headache-a difficult pill not to swallow. AJP: The Australian Journal of Pharmacy, 102(1206).
UpToDate. (2020). UpToDate. Retrieved December 3, 2021, from https://www.uptodate.com/contents/acute-treatment-of-migraine-in-adults
We introduced this assignment in Week 1. Part 2 of 3 parts is due this week. This project should be an integrated description and analysis of the business model of a Fortune 500 company of the group’s choosing. Groups will complete a strategic analysis of the organization, and a brief description of the recommendations developed by your team for helping the organization achieve continued success.
· Part 2 – Present a strategic analysis of the organization. Conduct a SWOT analysis of the organization. Identify the organization’s strengths and weaknesses, its unique capabilities, the significant threats it faces and opportunities it has. Make sure you look at and analyze the organization from both an internal and external (industry analysis and macro-environmental) perspective. You should include attention to both business and functional-level issues and factors.
Topic 9 DQ 2
Evidence-based practice (EBP) is an approach to healthcare that utilizes the most current research available in order to improve the health and safety of patients while reducing overall costs and variation in health outcomes (Black, et al., 2015). Introducing change, even evidence-based practice, is not always readily accepted by everyone and may require time for adjusting. Additionally, there may be barriers that may prevent successful implementation of evidence-based practice. Two main barriers to breastfeeding support provided by nurses to new mothers while in the hospital setting are organizational support and lack of motivation from staff members.
Support for the implementation of evidence-based practice is the primary barrier. Nurses need more than to just be given the information, shown how to implement and told to do it. The Knowledge, attitude towards implementing evidence-based practice, lack of resources and training, time mismanagement and lack of motivation are barriers to the implementation of evidence-based practice (Dagne & Beshah, 2021). Organizational support is vital; this can be done by assigning a lighter workload so that nurse can have sufficient time to help these mothers or an extra staff member. Having resource information at hand can also be useful so that nurse can provide this to mothers. Providing nurses with the tools they need to accomplish this practice will motivate nurses to partake in the practice.
Although breastfeeding is natural it may not come natural to all mothers. These mothers may come across challenges such as trouble latching, pain when latching, sore nipples, etc. The goal is to provide nurses with all the resources needed to help and provided these mothers with support they desperately need. But if the nurses are not provided support themselves, they will not be motivated to follow through and this change proposal will fail. Being short staffed, heavy workloads, lack of resources, insufficient time and unclear or unattainable high expectations can discourage nurses from implementing evidence-based practice.
Sustaining change can be difficult, as there are many variables that can affect implementation. One critical component of EBP is to ensure that practice change is part of an organization’s culture so it will continue to impact outcomes over time. Name two potential barriers that may prevent your EBP change proposal from continuing to obtain the same desired results 6 months to a year from now, and your strategies for overcoming these barriers.
Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years. There should be a mix between research and your reflections. Add critical thinking in the posts along with research. Apply the material in a substantial way.
Critical reflection on your growth and development during your practicum experience in a clinical setting helps you identify opportunities for improvement in your clinical skills, while also recognizing your strengths and successes.
Use this Journal to reflect on your clinical strengths and opportunities for improvement, the progress you made, and what insights you will carry forward into your next practicum.
Assignment: Journal Entry
Critical reflection on your growth and development during your practicum experience in a clinical setting helps you identify opportunities for improvement in your clinical skills, while also recognizing your strengths and successes.
Use this Journal to reflect on your clinical strengths and opportunities for improvement, the progress you made, and what insights you will carry forward into your next practicum.
To Prepare
· Refer to the “Population-Focused Nurse Practitioner Competencies” found in the Week 1 Learning Resources and consider the quality measures or indicators advanced nursing practice nurses must possess in your specialty of interest.
· Refer to your “Clinical Skills Self-Assessment Form” you submitted in Week 1 and consider your strengths and opportunities for improvement.
· Refer to your Patient Log in Meditrek and consider the patient activities you have experienced in your practicum experience and reflect on your observations and experiences.
·In 450–500 words, address the following:
Learning From Experiences
· Revisit the goals and objectives from your Practicum Experience Plan. Explain the degree to which you achieved each during the practicum experience.
· Reflect on the three most challenging patients you encountered during the practicum experience. What was most challenging about each?
· What did you learn from this experience?
· What resources were available?
· What evidence-based practice did you use for the patients?
· What would you do differently?
· How are you managing patient flow and volume?
Communicating and Feedback
· Reflect on how you might improve your skills and knowledge and how to communicate those efforts to your Preceptor.
· Answer the questions: How am I doing? What is missing?
· Reflect on the formal and informal feedback you received from your Preceptor.
Discuss the Nursing care of age-related Physiologic or Psychologic Disorder.
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