Discussion

Purpose

The purpose of the graded collaborative discussions is to engage faculty and students in an interactive dialogue to assist the student in organizing, integrating, applying, and critically appraising knowledge regarding advanced health assessment. Meaningful dialogue among faculty and students fosters the development of a learning community as ideas, perspectives, and knowledge are shared.

Course Outcomes

This discussion enables the student to meet the following course outcomes:

• CO 1: Apply advanced practice nursing knowledge to collecting health history information and physical examination findings for various patient populations. (POs 1, 2)
• CO 4: Adapt health history and physical examination skills to the developmental, gender-related, age-specific, and special population needs of the individual patient. (POs 1, 2)
• CO 5: Conduct focused and comprehensive health histories and examinations for various patient populations. (POs 1, 2)

Due Dates

Initial posts are due to the discussion board by Wednesday at 11:59 p.m. MT. Instructor and peer responses are due by Sunday at 11:59 p.m. MT. Students must post on a minimum of two separate days. A 10% late penalty will be imposed for discussions posted after the deadline Wednesday at 11:59 p.m. MT, regardless of the number of days late. NOTHING will be accepted after 11:59 p.m. MT on Sunday (i.e., the student will receive an automatic 0).

Total Points Possible

The total points possible for this assignment is 75.

Preparing the Discussion

Follow these guidelines when completing each component of the discussion. Contact your course faculty if you have questions.

This week, you will consider assessment questions and appropriate interventions related to social determinants of health. Healthy physical, social, and economic environments strengthen the potential to achieve health and well-being. The nurse practitioner (NP) must assess all facets of clients’ health during a comprehensive health history. Identify the assigned topics listed by the first letter of your first name. For example, if your first name is Gilda then your assigned topic is education access and quality. Select an objective related to your assigned social determinant from the Healthy People website.

First Letter of Your First NameTopicA – EEconomic stabilityF – JEducation access and qualityK – OHealth care access and qualityP – SNeighborhood and built environmentT – ZSocial and community context

Complete the following requirements:

1. Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
   1. Correctly identify your assigned social determinant. Briefly define the determinant and describe how it impacts healthcare outcomes.
   2. Select an objective related to your assigned social determinant from the Healthy People website linked above. Identify the status of the objective and the population to whom the objective applies.
   3. Provide at least three appropriate questions related to the chosen objective that the NP could incorporate into the health history and interview to assess the client and family.
   4. Identify at least two online, national, or local resources and explain how the resources could help meet the chosen objective for at-risk clients or families.
2. Integration of Evidence: Integrate relevant scholarly sources as defined by program expectations.
   1. Cite a scholarly source in the initial post.
   2. Cite a scholarly source in one faculty response post.
   3. Cite a scholarly source in one peer post.
   4. Accurately analyze, synthesize, and/or apply principles from evidence with no more than one short quote (15 words or less) for the week.
   5. Include a minimum of two different scholarly sources per week. Cite all references and provide references for all citations.
3. Engagement in Meaningful Dialogue:Engage peers and faculty by asking questions, and offering new insights, applications, perspectives, information, or implications for practice:
   1. Peer Response: Respond to at least one peer on a topic other than the initially assigned topic.
   2. Faculty Response: Respond to at least one faculty post.
   3. Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice.
4. Professionalism in Communication:Communicate with minimal errors in English grammar, spelling, syntax, and punctuation.
5. Reference Citation: Use current APA format to format citations and references and is free of errors.
6. Wednesday Participation Requirement:Provide a substantive response to the graded discussion topic (not a response to a peer or faculty), by Wednesday, 11:59 p.m. MT of each week.
7. Total Participation Requirement: Provide at least three substantive posts (one to the initial question or topic, one to a student peer, and one to a faculty question) on two different days during the week.

Please see the attachment for instructions

NUR2092 WRITE-UP—HEALTH HISTORY
Classroom Assignment Week Two

Date __________________________ Examiner ______________________

1. Biographic Data Name _______________________________________________ Phone________________________ Address____________________________________________________________________________ Birthdate ________________________________ Birthplace _________________________________ Age __________ Gender __________ Marital Status ______________ Occupation _______________ Race/ethnic origin __________________________________ Employer ________________________

2

. Source and Reliability

3. Reason for Seeking Care

4.
Present Health or History of Present Illness

Past Health History

Describe general health ______________________________________________________________ Childhood illnesses __________________________________________________________________ Accidents or injuries (include age) ______________________________________________________ Serious or chronic illnesses (include age) ________________________________________________ Hospitalizations (what for? location?) ____________________________________________________ Operations (name procedure, age) ______________________________________________________
Obstetric history: Gravida ____________ Term ____________ Preterm ____________ (# Pregnancies)
(# Term pregnancies) (# Preterm pregnancies)
Ab/incomplete _____________________ Children living _____________________ (# Abortions or miscarriages) _____

Course of pregnancy__________________________________________________________________ (Date delivery, length of pregnancy, length of labor, baby’s weight and sex, vaginal delivery or cesarean section, complications, baby’s condition)
Immunizations_____________________________________________________________________

Last examination date: Physical ________________

Dental ________________ Vision ________________
Allergies _________________________________ Reaction __________________________________

Current medications _________________________________________________________________ _

6. Family History—Specify Which Relative(s)

Heart disease___________________________ High blood pressure______________________ Stroke_________________________________ Diabetes_______________________________

Blood disorders_________________________ Breast or ovarian cancer___________________

Cancer (other)__________________________ Sickle cell______________________________ Arthritis_______________________________
Allergies_______________________________ Asthma _______________________________ Obesity________________________________ Alcoholism or drug addiction ______________

Mental illness ___________________________ Suicide ________________________________

Seizure disorder ________________________ Kidney disease __________________________ Tuberculosis _____

Review of Systems (Circle/highlight both past health problems that have been resolved and current problems, including date of onset.)

General Overall Health State: Present weight (gain or loss, period of time, by diet or other factors), fatigue, weakness or malaise, fever, chills, sweats or night sweats

Skin: History of skin disease (eczema, psoriasis, hives), pigment or color change, change in mole, excessive dryness or moisture, pruritus, excessive bruising, rash or lesion

Hair: Recent loss, change in texture

Nails: Change in shape, color, or brittleness

Health Promotion: Amount of sun exposure, method of self-care for skin and hair

Head: Any unusually frequent or severe headache, any head injury, dizziness (syncope), or vertigo

Eyes: Difficulty with vision (decreased acuity, blurring, blind spots), eye pain, diplopia (double vision), redness or swelling, watering or discharge, glaucoma or cataracts

Health Promotion Eyes: Wears glasses or contacts, last vision check or glaucoma test, how coping with loss of vision, if any

Ears: Earaches, infections, discharge and its characteristics, tinnitus, or vertigo

Health Promotion Ears: Hearing loss, hearing aid use, how loss affects daily life, any exposure to environmental noise, method of cleaning ears

Nose and Sinuses: Discharge and its characteristics, any unusually frequent or severe colds, sinus pain, nasal obstruction, nosebleeds, allergies or hay fever, or change in sense of smell

Mouth and Throat: Mouth pain, frequent sore throat, bleeding gums, toothache, lesion in mouth or tongue, dysphagia, hoarseness or voice change, tonsillectomy, altered taste

Health Promotion/Mouth & Throat: Pattern of daily dental care, use of prostheses (dentures, bridge), and last dental checkup

Neck: Pain, limitation of motion, lumps or swelling, enlarged or tender nodes, goiter

Breast: Pain, lump, nipple discharge, rash, history of breast disease, any surgery on breasts Axilla: Tenderness, lump or swelling, rash

Health Promotion Breast: Performs breast self-examination, including frequency and method used, last mammogram and results

Respiratory System: History of lung disease (asthma, emphysema, bronchitis, pneumonia, tuberculosis), chest pain with breathing, wheezing or noisy breathing, shortness of breath, how much activity produces shortness of breath, cough, sputum (color, amount), hemoptysis, toxin or pollution exposure
Health Promotion Respiratory: Last chest x-ray examination

Cardiovascular System: Precordial or retrosternal pain, palpitation, cyanosis, dyspnea on exertion (specify amount of exertion it takes to produce dyspnea), orthopnea, paroxysmal nocturnal dyspnea, nocturia, edema, history of heart murmur, hypertension, coronary artery disease, anemia

Health Promotion Cardiovascular: Date of last ECG or other heart tests and results

Peripheral Vascular System: Coldness, numbness and tingling, swelling of legs (time of day, activity), discoloration in hands or feet (bluish red, pallor, mottling, associated with position, especially around feet and ankles), varicose veins or complications, intermittent claudication, thrombophlebitis, ulcers
Health Promotion Peripheral Vascular: If work involves long-term sitting or standing, avoid crossing legs at the knees; wear support hose.

Gastrointestinal System: Appetite, food intolerance, dysphagia, heartburn, indigestion, pain (associated with eating), other abdominal pain, pyrosis (esophageal and stomach burning sensation with sour eructation), nausea and vomiting (character), vomiting blood, history of abdominal disease (ulcer, liver or gallbladder, jaundice, appendicitis, colitis), flatulence, frequency of bowel movement, any recent change, stool characteristics, constipation or diarrhea, black stools, rectal bleeding, rectal conditions, hemorrhoids, fistula)

Health Promotion Gastrointestinal: Use of antacids or laxatives

Urinary System: Frequency, urgency, nocturia (the number of times awakens at night to urinate, recent change), dysuria, polyuria or oliguria, hesitancy or straining, narrowed stream, urine color (cloudy or presence of hematuria), incontinence, history of urinary disease (kidney disease, kidney stones, urinary tract infections, prostate); pain in flank, groin, suprapubic region, or low back

Health Promotion Urinary: Measures to avoid or treat urinary tract infections, use of Kegel exercises

Male Genital System: Penis or testicular pain, sores or lesions, penile discharge, lumps, hernia

Health Promotion Male Genital: Perform testicular self-examination? How frequently?

Female Genital System: Menstrual history (age at menarche, last menstrual period, cycle and duration, any amenorrhea or menorrhagia, premenstrual pain or dysmenorrhea, intermenstrual spotting), vaginal itching, discharge and its characteristics, age at menopause, menopausal signs or symptoms, postmenopausal bleeding.

Health Promotion Female Genital: Last gynecologic checkup, last Pap test and results

Sexual Health: Presently in a relationship involving intercourse? Are aspects of sex satisfactory to you and partner, any dyspareunia (for female), any changes in erection or ejaculation (for male), use of contraceptive, is contraceptive method satisfactory? Use of condoms, how frequently? Aware of any contact with partner who has sexually transmitted infection (gonorrhea, herpes, chlamydia, venereal warts, HIV/AIDS, syphilis)?

Musculoskeletal System: History of arthritis or gout. In the joints: pain, stiff-ness, swelling (location, migratory nature), deformity, limitation of motion, noise with joint motion. In the muscles: any pain, cramps, weakness, gait prob-lems or problems with coordinated activities. In the back: any pain (location and radiation to extremities), stiffness, limitation of motion, or history of back pain or disk disease.

Health Promotion Musculoskeletal: How much walking per day? What is the effect of limited range of motion on daily activities, such as on grooming, feeding, toileting, dressing? Any mobility aids used?

Neurologic System: History of seizure disorder, stroke, fainting, blackouts. In motor function: weakness, tic or tremor, paralysis, coordination problems. In sensory function: numbness and tingling (paresthesia). In cognitive function: memory disorder (recent or distant, disorientation). In mental status: any nervousness, mood change, depression, or any history of mental health dysfunction or hallucinations.

Hematologic System: Bleeding tendency of skin or mucous membranes, excessive bruising, lymph node swelling, exposure to toxic agents or radiation, blood transfusion and reactions.

Endocrine System: History of diabetes or diabetic symptoms (polyuria, polydipsia, polyphagia), history of thyroid disease, intolerance to heat or cold, change in skin pigmentation or texture, excessive sweating, relationship between appetite and weight, abnormal hair distribution, nervousness, tremors, need for hormone therapy.

Functional Assessment (Including Activities of Daily Living)

Self-Esteem, Self-Concept: Education (last grade completed, other significant training) ______________

Financial status (income adequate for lifestyle and/or health concerns) __________

Value-belief system (religious practices and perception of personal strengths) ___________

Self-care behaviors ______________________

Activity and Exercise: Daily profile, usual pattern of a typical day ________________________________

Independent or needs assistance with ADLs, feeding, bathing, hygiene, dressing, toileting, bed-to-chair transfer, walking, standing, climbing stairs _________________________________

Leisure activities ________________________________________

Exercise pattern (type, amount per day or week, method of warm-up session, method of monitoring

Sleep and Rest: Sleep patterns, daytime naps, any sleep aids used ___________________

Nutrition and Elimination: Record 24-hour diet recall. _______________________________________ _____________________________________________________________________________________

Is this menu pattern typical of most days? ___________________________________________________

Who buys food? ____________________________

Who prepares food? __________________________

Finances adequate for food? __________________________________

Who is present at mealtimes? __________________________________

Interpersonal Relationships and Resources: Describe own role in family _________________________

How getting along with family, friends, co-workers, classmates ______________________

Get support with a problem from? ______________________________________________

How much daily time spent alone? _______________________________________________________
Is this pleasurable or isolating? ___________________________________________________________

Coping and Stress Management: Describe stresses in life now __________________________________ _____________________________________________________________________________________
Change(s) in past year ______________________________________________

Methods used to relieve stress _______________________

Are these methods helpful? ___________________________

Personal Habits:

Daily intake caffeine (coffee, tea, colas) ______________________________________

Smoke cigarettes? ____________________________
Number packs per day ______________

Daily use for how many years __________________
Age started ___________

Ever tried to quit? ____________________________
How did it go? _____________________________

Drink alcohol? ____________________ Date of last alcohol use _______

Amount of alcohol
that episode __________________________________________________________

Out of last 30 days, on how many days had alcohol? ____________________________________

Ever told had a drinking problem? ________________________________________________________
Any use of street drugs? ___________
Marijuana? _________________________________

Cocaine? __________________________________
Crack cocaine? ______________________________
Amphetamines? _____________________________
Heroin? __________________

Prescription painkillers? _____________________
Barbiturates? _______________________________
LSD? _____________________________________

Ever been in treatment for drugs or alcohol? ________________________________________________

Environment and Hazards: Housing and neighborhood (type of structure, live alone, know neighbors) _____________________________________________________________________________________

Safety of area _________________________________________________________________________
Adequate heat and utilities ____________________________________________________________

Access to transportation ____________________________________________________________

Involvement in community services _______________________________________________________
Hazards at workplace or home ___________________________________________________________
Use of seatbelts ____________________________________________________________________

Travel to or residence in other countries ___________________________________________________
Military service in other countries ________________________________________________________
Self-care behaviors _____________________________________________________________________
Intimate Partner Violence: How are things at home? Do you feel safe? __________________

Ever been emotionally or physically abused by your partner or someone important to you___-

Ever been hit, slapped, kicked, pushed, or shoved or otherwise physically hurt by your partner or ex-partner? _____________________________________________________________________________________
Partner ever force you into having sex? ____________________________________________________
Are you afraid of your partner or ex-partner? ________________________________

Occupational Health:

Please describe your job. ______________________________________________

Work with any health hazards (e.g., asbestos, inhalants, chemicals, repetitive motion)? ___________________________________________________________________________________

Any equipment at work designed to reduce your exposure?

Any work programs designed to monitor your exposure? _________________________________

Any health problems that you think are related to your job? _____________________________

What do you like or dislike about your job? _________________________________________________

Perception of Own Health:

How do you define health? ________________________________________

View of own health now ________________________________________________________________

What are your concerns? ________________________________________________________________

What do you expect will happen to your health in future? _______________________

Your health goals ______________________________________________________________________

Your expectations of nurses, physicians ___________________________________________________

Feedback for learner

Overall, you showed that research shows that a traditional sepsis education program may not be as effective in nurses identifying early sepsis. Which article shows which training program you plan to implement? It was not clear what you will implementing, especially since you did not have a closing paragraph.

You used “timely” multiple times, however you did not discuss what this means in terms of minutes, hours or days. What is “timely” identification?

You also lacked solid research on gaps and opportunities for future research. 

You continue to show the same APA errors as in your previous assignments despite my comments and feedback. Please correct these for the final Capstone to avoid a zero in APA format. I highly recommend you use FNU's writing center or refer to APA 7th Edition book.

 Due 9/24/23    4 pm EST 

• For this assignment, you must complete a matrix table for three research articles (see template provided below).
• You will be identifying the following to complete the table:
  • Articles/reference (in APA format)
  • Purpose of the article/Study question
  • Variables (i.e. independent vs dependent)
  • Study design: Quantitative/Qualitative/Mixed
  • Sampling
  • Methods
  • Instruments
  • Findings/Result
• You will be identifying the concepts being explored in the study: the “what” of the study, the methods or the “how” of the study, participants in the study or the “who,” along with the instruments/tools used in the study to collect data, i.e., surveys, interviews, etc.
• Lastly, you will state the findings of the study.
• Remember, the studies should support your ideas and should be less than five (5) years old.
• They should not be from the Web, but from the library databases. Use the resources found in the library.
• In addition, you must follow APA 7th edition guidelines when documenting the reference in the first column.
• Please use, at minimum three scholarly references for this assignment.

USE THIS TOPIC AND ARTICLES

Topic and 3 articles that were used previously TOPIC:  Healthcare Equity among the Elderly in Europe · Article 1: “ Equity in healthcare access and service coverage for older people: a scoping review of the conceptual literature. “The article evaluates the various interventions on health equity, impact on health outcomes, healthcare access, and reductions in health disparities.· Article 2: “Evaluating Policy Reforms for Healthcare Equity Among the Elderly in Europe”It investigates the impact of policy reforms on health disparities and access to healthcare services.· Article 3: “Socioeconomic Factors and Health Outcomes Among European Elderly: A Critical Analysis of Healthcare Equity Policies”It critically examines the role of socioeconomic factors in healthcare equity and disparities.