SOAP Note

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Diagnostic Impression: You must begin to narrow your differential diagnosis to your diagnostic impression.  You must explain how and why (your rationale) you ruled out any of your differential diagnoses. You must explain how and why (your rationale) you concluded to your diagnostic impression.  You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection a discussion related to legal/ethical considerations (demonstrating critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

References 

References (move to begin on next page)

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

Week 8 Discussion

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  Resources

To Prepare:

  • Revisit the Congress.gov website provided in the Resources and consider the role of RNs and APRNs in policy-making.
  • Reflect on potential opportunities that may exist for RNs and APRNs to participate in the policy-making process.

Post an explanation of at least two opportunities that exist for RNs and APRNs to actively participate in policy-making. Explain some of the challenges that these opportunities may present and describe how you might overcome these challenges. Finally, recommend two strategies you might make to better advocate for or communicate the existence of these opportunities to participate in policy-making. Be specific and provide examples.

please read

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 Decubitus ulcers: origin, classification, and how to avoid them.

 a minimum of 1 pages.  include at least 2 academic sources, formatted and cited in APA.

 Submission Instructions: 

  • Your assignment will be run through TurnItIn to check for plagiarism. 

see below

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see below 

EVIDENCE-BASED PRACTICE AND THE QUADRUPLE AIM

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EVIDENCE-BASED PRACTICE AND THE QUADRUPLE AIM

Healthcare organizations continually seek to optimize healthcare performance. For years, this approach was a three-pronged one known as the Triple Aim, with efforts focused on improved population health, enhanced patient experience, and lower healthcare costs.

More recently, this approach has evolved to a Quadruple Aim by including a focus on improving the work life of healthcare providers. Each of these measures are impacted by decisions made at the organizational level, and organizations have increasingly turned to EBP to inform and justify these decisions.

To Prepare:

· Read the articles by Sikka, Morath, & Leape (2015); Crabtree, Brennan, Davis, & Coyle (2016); and Kim et al. (2016) provided in the Resources.

· Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.

· Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.

To Complete:

Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim.

Your analysis should address how EBP might (or might not) help reach the Quadruple Aim, including each of the four measures of:

· Patient experience

· Population health

· Costs

· Work life of healthcare providers

Wk4DP

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Week 4 Discussion Forum

There are many possible sources of literature available (e.g., the West Coast University
library electronic databases, such as Medline, Cinahl, and PubMed). Which specific
scholarly articles did you use and why did you choose them for your topic?

More than 300 words other than references. Can wait 4 days.

  • Week 4 Discussion Forum

Nursing Assignment

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Week 6 Organizational Ethics Presentation

This week, you will submit a video presentation. (I will doing the video presenting the power point you will be doing for me ) Your presentation must include both audio and visual components and be professional in nature.

1. Choose a topic below. – same topic you have to select from Discussion Board 1.

· Taken from the assigned reading in Butts chapter 12, page 401, “EthicalReflection: Typical Unethical or Illegal Behaviors in Organizations” ( list bellow and also attached in instructions on discussion Board 1)

2. Create a presentation (Power Point ) of 12-15 slides or screens 
excluding the title and references. ( Total about 17 slides with title and references )

· Your slides/screen should include titles, main ideas, bullet points, and relevant images, charts, graphs, etc.  

3. In your presentation:

· Describe an ethical situation, based on the chosen topic, that can get in the nurse's way of practicing ethically. Describe the situation clearly and concisely.

· Identify how this situation relates to one provision within the Code of Ethics for Nurses.

· Identify two ethical principles that may arise when facing this situation.

· Discuss how a nurse might lessen the impact of the situation on the nurse's practice.

· In addition to the course texts, cite and reference a minimum of two (2) additional scholarly sources to support your work.( same references you have to mention on discussion Board 1)

· Close with a summary of your topic, and APA formatted reference slide(s).

Review the rubric for further information on how your assignment will be graded.

A list of words on a white background Description automatically generated

URS_521_DE – Presentation Rubric NURS 512

NURS_521_DE – Presentation Rubric NURS 512

Criteria

Ratings

Pts

This criterion is linked to a Learning OutcomeContent

105 to >91.35 pts

Meets Expectations

The introduction is attention getting and lays out the topic well. It establishes a strong framework for the rest of the presentation. The conclusion is comprehensive and compelling. Presentation contains accurate and complete information. Ideas, facts, and information provided demonstrate a strong, confident, understanding of the material.

91.35 to >78.75 pts

Approaches Expectations

The introduction lays out the topic. It establishes some framework for the rest of the presentation. The conclusion is clear. Presentation contains accurate and complete information. Ideas, facts, and information provided demonstrate an understanding of the material.

78.75 to >61.95 pts

Below Expectations

There is minimal introduction establishing a vague framework for the rest of the presentation. The conclusion is abrupt or unclear. Presentation contains some inaccurate and incomplete information. Ideas, facts, and information provided demonstrate little understanding of the material.

61.95 to >0 pts

Not Meeting Expectations

Introduction is missing No framework is established for the presentation. The conclusion is missing. There may be multiple instances of inaccurate or incomplete information. No understanding is demonstrated.

105 pts

This criterion is linked to a Learning OutcomeOrganization

105 to >91.35 pts

Meets Expectations

Information is presented in a clear, logical order with an apparent beginning, middle, and end. The speaker introduces the topic, identifies the topic skillfully.

91.35 to >78.75 pts

Approaches Expectations

Information is generally presented in a clear, logical order with an apparent beginning, middle, and end. The speaker introduces the topic.

78.75 to >61.95 pts

Below Expectations

Information is presented in a way that shows little organization or order. The speaker fails to introduce the topic or does so in a way that is confusing.

61.95 to >0 pts

Not Meeting Expectations

Information is not presented in a logical, cohesive order. Topic is unclear.

105 pts

This criterion is linked to a Learning OutcomeSlide Presentation

60 to >52.2 pts

Meets Expectations

Use of visual aids/ images is appropriate. Slides are easy to read, interesting, and relevant to the content. All main ideas are presented succinctly. Contains the required number of slides.

52.2 to >45.0 pts

Approaches Expectations

Use of visual aids/images generally appropriate. Slides generally easy to read, somewhat interesting and relevant to the content. Some main ideas are presented succinctly. May be missing some of the required number of slides.

45 to >35.4 pts

Below Expectations

Use of visual aids/images not fully appropriate. Slides generally not easy to read. Main ideas missing or difficult to find quickly. May have irrelevant visual aids or images. Missing several of the required number of slides.

35.4 to >0 pts

Not Meeting Expectations

Use of visual aids /images not appropriate. Slides not easy to read. Missing most required slides. Slides missing main ideas.

60 pts

This criterion is linked to a Learning OutcomeMechanics and APA

30 to >26.1 pts

Meets Expectations

The assignment consistently follows current APA format and is free from errors in formatting, citation, and references. No grammatical, spelling, or punctuation errors. All sources are cited and referenced correctly.

26.1 to >22.5 pts

Approaches Expectations

The assignment consistently follows current APA format with only isolated and inconsistent mistakes and/or has a few grammatical, spelling, or punctuation errors. Most sources are cited and referenced correctly.

22.5 to >17.7 pts

Below Expectations

The assignment generally follows current APA format with several mistakes and grammatical, spelling, or punctuation errors. Most sources are cited and referenced incorrectly.

17.7 to >0 pts

Not Meeting Expectations

The assignment does not follow current APA format and/or has many grammatical, spelling, or punctuation errors. Sources are missing.

30 pts

Total Points: 300


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assist week 4

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Week 4 – Assignment: Analyze Quality Performance

Improvement requires the ability to effectively analyze data. While extensive knowledge in using statistical analysis tools is desirable, health administrators adept at constructing charts and analyzing the organizational data as compared to established benchmarks yields valuable information.

For your assignment this week, you will prepare an Analysis Report paper. Begin your assignment with the following steps:

1.Read the case study published by the Agency for Healthcare Research and Quality (AHRQ) featuring Tampa General Hospital's use of the AHRQ tools to improve quality measures. The link to the Tampa General Hospital's case study is found in your Weekly Resources.

 After reading the Tampa General Hospital case study, you will access the
Hospital Compare website link found in your Weekly Resources. At this site, you will insert Tampa, Florida into the location box, select Hospital as the type of facility, and insert Tampa General Hospital into the name box. Once the webpage for Tampa General Hospital is accessed, click on
Patient Survey Ratings. Here you will find the hospital's patient satisfaction ratings along with the state and national ratings in each category.

 With these data, you will use an Excel spreadsheet to insert the type of indicator (i.e.,
Patients who reports their nurses always communicated well and the observed score for Tampa General Hospital as well as the average Florida and National scores provided). Repeat this process to include all 10 statements of patient satisfaction.

Once your spreadsheet data is complete, create a bar graph by clicking on Insert in the top header and selecting the bar graph to visually display the comparison of Tampa General Hospital's scores to the state and national average scores. Instead of using Excel, you may alternately create a Table in Microsoft Word using the same data as described above placed in a table. Once the table is complete, click Insert from the ribbon at the top of the page, and then click Chart. From here, select Bar chart and use the Clustered Bar Chart style. For either method, make sure all three data sources are depicted in the chart. An example of how to set up your table and the resulting bar graph that is both required in your paper are shown. Keep in mind the information you retrieve is a single data set and does not represent performance over time, but rather represents a snapshot of organizational performance as compared to external standards.

 Next, you will click on
Quality in the Tampa General Hospital's website header and scroll down to
Complications and Deaths. Once the section expands, scroll down to
Infections. In the
Infection's section, you will find the quality score for the topic in the case study regarding catheter-associated urinary catheter infections (CAUTI). Record the score for Tampa General Hospital for this measure and note the national benchmark score of 1. You will analyze this score as it compares to the national score and its relevance to the case study.

 Lastly, you will prepare your Analysis Report paper that contains an introductory section, the body of your report containing your analysis of Tamps General Hospital's patient satisfaction ratings and the comparison of the ratings to the state and national scores, and your analysis of the CAUTI infection rate compared to the national rate. You will also include a summary section in your paper. You will insert your Clustered Bar graph (see example) with the 10 statements and scores as a Figure into your discussion and analysis of the scores. The table you created (see example) to display the 10 statements and the hospital, state, and national scores will be in an appendix to your report. Be sure to check APA guidelines for using an appendix in a report, how to label figures and tables.

Table example: 

Patient satisfaction survey statements

Tampa General Hospital rating

Florida rating

National rating

Patients who reports their nurses always communicated well

81%

81%

77%

Clustered Bar graph example from data in table example:

A graph of a patient survey Description automatically generated

length: A minimum of 5 pages, not including the title page, reference page, and the appendix

image1.png

Wk3soap668B

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Week 3: Problem-Focused SOAP Note

Criteria Ratings Pts

This criterion is linked to a
Learning Outcomes
(Subjective)

2.5 pts

Accomplished

Symptom analysis is well organized, with C/C,

OLD CART, pertinent negatives, and pertinent

positives. All data needed to support the

diagnosis & differential are present. Is

complete, concise, and relevant with no

extraneous data.

2.5 pts

This criterion is linked to a
Learning Outcome
(Objective)

2.5 pts

Accomplished

Complete, concise, well organized, well

written, and includes pertinent positive and

pertinent negative physical findings. Organized

by body system in list format. No extraneous

data.

2.5 pts

This criterion is linked to a
Learning Outcome A
(Assessment)

2.5 pts

Accomplished

Diagnosis and differential dx are correct,

include ICD code, and are supported by

subjective and objective data.

2.5 pts

This criterion is linked to a
Learning Outcome (Plan)

2.5 pts

Accomplished

The plan is organized, complete and supported

with 2 evidence-based references. Addresses

each diagnosis and is individualized to the

specific patient and includes medication

teaching and all 5 components: (Dx plan, Tx

plan, patient education, referral/follow-up,

health maintenance).

2.5 pts

Total Points: 10

Use the template that I gave you before. The first page needs blank for cover sheet.

Diagnoses is R300; Dysuria. Needs ICD 10 codes for differential dx,

CPT codes for labs and procedures such as UA, Urine culture and sensitivity, physical

examination etc Do not paste and copy all (it needs paraphrasing). Research a lot for

patient education, pertinent positive and pertinent negative, non-pharmacologic

treatment etc. APA 7 format. I can give you five days to complete it.

Patient initial: J. V.

Patient DOB: 1963 Sex: F

SUBJECTIVE:

Chief Complaint:

History Of Present Illness:

-Patient is seen today for flank pain and dysuria

Medical History:

COVID pos 5/7/22

anemia

UTI, pyelonephritis s/p hospitalization w/sepsis

Mx kidney stones

Varicose Veis

Scoliosis

Surgical History:

Lithotripsy 2020

Gynecological History:

G5P5A0

denies h/o abnormal pap or mammo

Family History:

M: dementia, lupus, hypothyroid

F: varicose veins

Social History:

-single

-lives with children

-works as food service worker HMH

-denies tobacco

-denies ETOH

-denies recreational drugs

Smoking Status: Never Smoked

Allergies:

Macrobid; ; Dizziness

Morphine; ;

Current Medications:

Currently not taking medications

Review of System:

Constitutional: #fatigue#

Patients deny weight change, fever, chills, weakness, sleep changes, appetite changes.

Head: Patient denies headache.

Neck: Patient denies abnormal masses, neck stiffness.

Eyes: Patient denies vision loss, blurring, discharge, excessive tearing, dryness.

Ears: Patient denies hearing loss, tinnitus, vertigo, discharge, pain

Nose: Patient denies rhinorrhea, stuffiness, sneezing, itching.

Mouth: Patient denies ulcers, bleeding gums, taste problems.

Throat: Patient denies throat pain, difficulty swallowing,

Cardiovascular: Patient denies chest pain, chest pressure, palpitations, DOE,

orthopnea.

Respiratory: Patient denies shortness of breath, cough, increased sputum, hemoptysis.

Gastrointestinal: Patient denies nausea, vomiting, heartburn, dysphagia, diarrhea,

constipation, melena, abdominal pain, jaundice, hemorrhoids.

Genitourinary: #R flank pain, dysuria, increased frequency#

Patient denies abnormal urgency, hesitancy, incontinence, hematuria, nocturia, stones.

Musculoskeletal: Patient denies arthralgias, joint stiffness, myalgias, muscle weakness,

instability and abnormal range of motion

Integumentary (Skin and/or Breast): Patient denies rash, changes in hair, changes in

nail, pruritus

Neurological: Patient denies headache, syncope, seizures, vertigo, ataxia, diplopia,

tremor, numbness, tingling.

Psychiatric: #insomnia#

Patient denies depression, mood abnormalities, anxiety, memory loss, appetite

changes

Endocrine: Patient denies sensitivity to cold or heat, polyuria, polydipsia.

Hematologic/Lymphatic: Patient denies bleeding, bruising, lymphadenopathy.

GYN: Patient denies abnormal bleeding, changes in menstrual cycle, hot flashes.

OBJECTIVE:

Vital Signs:

Height: 64.50 in

Weight: 139.40 lbs

BMI: 23.56

Blood Pressure: 135/78 mmHg

Temperature: 98.60 F

Pulse: 86 beats/min

Physical Exam:

Constitutional:

WD, WN, Alert, Oriented X3 in NAD. Affect appropriate. Gait normal.

Eye: PERRLA, EOMI, nl conjunctiva

Ear: No pinnea/tragal tenderness. Drums are visualized, no wax in canals

Nose: N1 mucosa. N1 Nasal septal walls and turbinates.

Mouth: N1 bucal mucosa, no lesions noted.

Throat: Clear, no erythema or exudates.

Neck: supple, no masses. No thyromegaly. Trachea is midline. N1 carotid auscultation.

No JVD

Cardiovascular: RRR, N1 S1 and S2, No cardiac murmurs, rubs or gallops.

Lungs: ctab, no wheezes, rhonchi or crackles

Chest/Breasts: 4/12/22: #L breast 3 o clock lumpiness, ttp#

Gastrointestinal (Abdomen): soft, nt, nd, bs(+). No palpable masses.

Genitourinary: #R flank CVAT#

Lymphatic: -No LAN noted

Musculoskeletal: #ttp over medial aspect of L knee with preserved ROM with small

healed 1 x1 cm scar from abrasion#

strength symmetrical and wnl. No muscle weakness or stiffness. No joint effusion

Skin: #callus noted between 4th and 5th metatarsal on L foot#

Normal color and texture.

Extremities: #varicose veins R greater than L#

Warm, no clubbing, cyanosis or edema. N1 DP/PT pulses bilaterally

Neurological/Psychiatric: CN I-XII intact, neurosensory wnl, strength (5/5), (2+) DTR

UE/LE bilaterally

-Judgment and insight intact

Imaging: 9/21/22 arterial u/s neg

ASSESSMENT:

Diagnosis:

ICD-10 Codes:

1)M545; Low back pain

2)R300; Dysuria

3)R946; THYROID ABNORMAL RESULT

4)D649; Anemia, unspecified

5)R5383; Fatigue

PLAN:

Procedures:

1) 99215; Comprehensive

2) 99401; 15 min

3) 99000; Handling of specimen from doctor to lab

4) 81002; Urinalysis/Dip

Orders:

1) 5463; UA complete (lab order)

2) 395; UCX (lab order)

Medications:

Augmentin 500-125 MG Oral Tablet; Take 1 tablet orally every 12 hours; Qty: 14;

Refills: 0

Care Plan:

.

***recurrent UTI, h/o pyelo and sepsis- last UCx 4/12/22 showed 100K E coli resistant to

cipro and levaquin. Pt reports 2 day h/o R flank pain, dysuria, frequency and fatigue.

Tried Macrobid in the past which caused severe dizziness.

-UA 12/23/22 pos for leukocytes

-send out Ucx 12/23/22

-Rx Augmentin 500/125mg bid x7 days, r/b d/w pt

-ER precautions over holiday weekend

-referred to uro given recurrent UTI and high-risk history

***abnormal TSH- noted on labs 4/19/22. TSH 0.266 unsure if ever discuss

-reordered TSH 12/23/22

**fatigue- h/o anemia. pt reports hgb dropped to 9 once, donates blood occasionally. per

pt took iron in the past. no overt bleeding 4/19/22 cbc and irons normal. Pt requesting

again to check

-ordered iron panel, ferritin 12/23/22 per pt request

***elevated B12- 4/19/22 B12 level over 1500

-discuss nv, but will need to stop any supplementation

***L knee pain- fell and landed on L knee. worsen with prolonged standing. Reports she

had same pain on R knee and had steriod injection, which resolved it. On PEX, ttp over

medial aspect of L knee with preserved ROM with small healed 1 x1 cm scar.

-on 8/8/22 spoke to pt regrading her L knee x ray. MRI is recommended given that she

sustained a trauma to her knee and has radiologic findings of possible soft tissue injury.

She is in significant pain, takes Ibuprofen, reports difficulty with ambulation. Pt states

that she tried to make appt with ortho and radiology, but no slots were available anytime

soon.

-Needs MRI. Can either order or she can see ortho and do it with them. I was able to

arrange an appt for her to see Dr Panosyan tomorrow at 1:30.

***varicose veins, bil leg pain- to b/l LEX, R greater than L, chronic. c/o occasional

aching. prolonged standing and walking at work. 9/21/22 arterial duplex neg

-Ordered venous u/s 8/3/22

-referred to vein specialist 4/12/22 and 8/3/23

Plan Notes Continued: .

***Tinea cruris bilaterally – noted on PEX on 10/26/22

-Rx ketoconazole 2% cream top bid x 2wks, r/b, d/w pt

***Callus- Pt reports painful, itchy lesion in between 4th and 5th metatarsal. Works long

hours on her feet. Pt reports she has new shoes and tried OTC counter products with

no relief. Admits to trying her son's salicylic acid acne med on lesion. On PEX, small,

hardened callus is noted.

-Referred to podiatry on 10/26/22

***insomnia- chronic. has failed melatonin and hydroxyzine 50 mg. also took Ambien

5mg prn in past

-cont w/caution

Patient Instructions: .

-Pt has been instructed to take medications as prescribed

-Pt received education on compliance with medications and recommendations

-Pt received counseling regarding Medication Side Effects

-Pt received counseling on following a well-balanced healthy diet with veg, fruit and

fiber.

-Pt was instructed to do CV exercise at least 3-4 times every week for 30 minutes.

-Pt received counseling regarding stress management

PHCM: .

58 yo F:

-annual PEX: done 4/12/22–next due 4/12/23

-annual labs: done 4/19/22 unsure if ever discussed

-cervical CA screening: referred to gyn 4/12/22

-breast CA screening: dx mammo L breast u/s ordered 4/12/22

-colon CA screening: referred to GI 4/12/22

-skin CA screening: referred to derm 4/12/22

Immunizations:

-influenza: fall 2021

-tetanus: unsure, rec 4/12/22

-shingrix: rec 4/12/22

-COVID: Pfizer 5/2021, 6/2021, booster 3/2022

  • Week 3: Problem-Focused SOAP Note

Capstone final draft

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Please see the attachment for the instructions