Please answer the 3  questions and please provide rationale

case study, references, and in APA 6th ed format.

DERMATOLOGY CASE STUDY

Chief complaint:  “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.

HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief.  She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin  AF cream and it did not help relief her symptoms. She has not tried other remedies. Denies associated symptoms of fever and chills. 

PMH:

Diabetes Mellitus, type 2.

Surgeries: None

Allergies: Augmentin

Medication: Metformin 500mg PO BID.

Vaccination History:  Immunization is up to date and she received her flu shot this year.

Social history:

College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.

Family history:

Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.

ROS:

Constitutional: Negative for fever. Negative for chills.

Respiratory: No Shortness of breath. No Orthopnea

Cardiovascular: Regular rhythm.

Skin: Right great toe swollen, itchy, painful and discolored.

Psychiatric: No anxiety. No depression.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.

NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.

LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.

HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.

MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.

SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.

PSYCH: Normal affect. Cooperative.

Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Proximal subungual onychomycosis

Differential Diagnosis:  Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis

Special Lab: Fungal culture confirms fungal infection.

Please see below:

      Now that you have identified the treatment for onychomycosis and labs for baseline and follow up therapy. please address the following: Specify when to refer the patient after therapy and why? Provide rationale. According to the recommended guidelines, what are the non-pharmacological approaches to Onychomycosis? Provide patient education. Keep in mind the past medical history of this patient.

ppend.

Start by reading and following these instructions:

1. Quickly skim the questions or assignment below and the assignment rubric to help you focus.

2. Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.

3. Consider the discussions and any insights gained from it.

4. Create your Assignment submission and be sure to cite your sources, use APA style as required, check your spelling.

Assignment: This assignment has two parts

Part 1. EBP Research

Locate two research articles on the topic of your choice, but each article needs to use a different research method (quantitative, qualitative, or mixed methods). First, summarize both articles. Then answer the following questions… Which type of research article did you find easier to understand? Explain If you had to complete a research project which style would you choose and why?

This section should include 2 outside references and your book. This section should be at least 1000 words.

Part 2. Political Letter

Identify a current state or national healthcare or nursing issues that impact nurses or healthcare. Possible websites to locate an issue would be…

State Nursing Association

American Nursing Association

Specialized Professional Organizations

Once you have found your issue, write a letter to your governor, senator, or congress person. Your letter should be 500 words, in a block format and addresses should be included. Your first paragraph should state the issue. The second paragraph should state how the issue affects you personally as a nurse (avoid medical jargon). The third paragraph should state how the issue affects the community. Your fourth and final paragraph should restate the importance of the issue and thank the individual for their time and attention to the issue.

Your references for the letter should not be cited in your letter, but should be included on a separate reference page. 

 

Required Resources
Read/review the following resources for this activity: Textbook: Chapter 4 Lesson Minimum of 3 scholarly sources (in addition to the textbook)

Instructions
As part of the discussion this week, you made a brief exploration of a work of art to understand its subject, meaning, and intent. In this assignment, you will explore an artwork in more depth to consider the context in which it was created. Choose any painting, and address the following: Explain the artistic movement associated with the work of art. Describe the style of the artist (How is the artist unique within the movement?) Examine in some depth the influences that shaped the work. Address at least 2 of the following: Stylistic influences Subject/content influences Cross-disciplinary influences such as literature, philosophy, music, science, technology, etc. Historical influences Political influences Reflect on your learning. How did your research enhance your appreciation of the artwork? How does understanding the context of a work help in interpreting it?

Include the following in your paper: Name of the painting Name of the artist Date created Image of the painting

Writing Requirements (APA format) Length: 1.5-2 pages (not including title page, references page, image, or caption for artwork) 1-inch margins Double spaced 12-point Times New Roman font Title page References page (minimum of 3 scholarly sources)

Minimum of 250 word’s  at  least 2 peer review reference in 6th edition apa style.

You are in a place of influence in your professional life where you can help people be successful. Describe the relationship and what actions you have taken or could take to serve others. Based on the textbook, how does your response compare to the views of authority according to servant leadership? How does your response compare to the secular view of authority?

 

Minimum of 250 words with at least 2 peer review reference in 6th edition APA style

  Immunoglobulins are necessary to protect the human physiology from diseases and pathological disorders. Explain the role of IgA, IgG, IgE. IgD, and IgM.