ERM -PHD

Please review Chapter 35 and answer the following questions.

Explain the best approach to ensure successful implementation of ERM? Please provide a few different elements. 

APA format in a SOAP Note format.  1 page long with questions as to which diagnosis would be accurate and why.  I have included the references I need 3 peer review articles to be included

 

Patient Information:

Initials: JS  Age: 11   Sex: M  Race: Caucasian

SJ

CC: Patient complaining of a mild right earache for the last two days and trouble hearing from that ear.

HPI: James Jones is an 11 year old Caucasian male who presents to the clinic with complaints of a right earache for the last two days. The patient reports worsening pain at night when trying to fall asleep and difficulty hearing out of that ear.  The patient rates is earache pain 5/10 and describes it as sharp and constant. The patient has taken 600mg ibuprofen with minimal relief of pain. The patient reports that he has been spending a lot of time swimming in the pool this summer.

Current Medications:

1.  Ibuprofen 600mg PRN for earache pain

Allergies: NKA

PMHx: Up to date on all immunizations. No significant PMH.

Soc Hx: Patient lives with two siblings and supportive parents in a safe neighborhood in Boston. The patient is currently in middle school and enjoys playing soccer, fishing with his dad and swimming in his pool during the summer. 

Fam Hx: Maternal grandmother died of a stroke at the age of 70. No other significant family history.

ROS: 

GENERAL: No fever, fatigue or chills. No weight loss. 

HEENT: Eyes:  No visual loss, blurred vision, double vision or yellow sclerae. Ears: Patient reporting pain in right ear and hearing loss. Nose, Throat:  No sneezing, congestion, runny nose or sore throat. 

SKIN: No rashes or itching.

RESPIRATORY:  No shortness of breath, cough or sputum.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

LYMPHATICS:  No enlarged nodes. No history of splenectomy.

ALLERGIES:  No history of asthma, hives, eczema or rhinitis.

O.

GENERAL: Patient comes to the clinic with his grandmother, patient appears uncomfortable, is rubbing his right ear and having difficulty hearing. 

HEENT: PEERLA. Ears: Right ear canal is erythematous and edematous with pus present, tympanic membrane is difficult to visualize. Hearing difficulty with right ear. Left ear canal is intact without erythema or edema, tympanic membrane is clear and intact. Nose: Nose is patent without any rhinorrhea. Throat: Oropharynx is clear, without erythema or exudates, mucous membranes are moist, pink and intact. (Sullivan, 2012).

SKIN: Skin color is normal for patient, intact, without rashes or lesions. Skin turgor is good. 

RESPIRATORY: LS CTA bilaterally, no sternal retractions noted.

GASTROINTESTINAL: Abdomen is soft, nontender, nondistended. + BS in all quadrants. No bruits noted. No splenomegaly or masses present. 

NEUROLOGICAL: Cranial nerves II to XII are grossly intact w/out focal neurological defecits (Sullivan, 2012).

LYMPHATICS: No enlarged nodes. 

ALLERGIES: No known allergies. No history of asthma, hives, eczema or rhinitis.

Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines)

Otoscopy: Otoscopy of the ear canal demonstrated erythema, swelling and there was difficulty visualizing the tympanic membrane as there was watery discharge present. According to Lieberthal (2013), otoscopy is usually sufficient enough to reach the diagnosis of  otitis externa in children, however, certain cases require additional diagnostics, especially when occurring in infants presenting with fever. 

Labs: N/A

A.

Differential Diagnoses:

1.  Otitis externa – I chose this as the primary diagnosis because of the patient’s presenting symptoms and the context in which the patient experienced the symptoms. The patient complained of worsening ear pain and hearing loss in the right ear. The patient also reported that he had been swimming in the pool a lot recently. According to Wald (2018), otitis externa often occurs in children after swimming, causes pain and conductive hearing loss if pus or discharge is present and clinical findings include an erythematous, edematous ear canal and difficulty visualizing the tympanic membrane. Acute otitis media- Acute otitis media is another possible diagnosis for this patient because of his presenting symptoms. According to Thomas (2014), acute otitis media generally occurs in patients after a respiratory tract infection and symptoms can include fever, fatigue or malaise. Additionally, Thomas (2014) discusses how purulent discharge is usually present with a bulging tympanic membrane. However, the patient did not report respiratory tract infection related symptoms and was not febrile.    Otitis media with effusion- Otitis media with effusion cannot be ruled out because there is often discomfort in the affected ear with conductive hearing loss, however, there is not usually any purulent fluid in the canal, nor is it associated with swimming (Thomas, 2014). Upper respiratory infection- upper respiratory infection is another possible diagnosis for this patient as it can cause blocking or painfulness in the ear as well as an erythematous tympanic membrane (Pettigrew, 2011). Additionally, upper respiratory infections often times precede otitis externa or other ear infections. Furunculosis- Furunculosis is another possible diagnosis for this patient. Furunculosis is

usually an infected hair follicle in the ear canal that leads to otalgia and tenderness of the

ear which this patient presented with. However it is not too likely as it usually affects the

cartilage of the year and does not lead to conductive hearing loss (Ibler, 2014).

                                                            References

Ibler, K., & Kromann, C. (2014). Recurrent furunculosis – challenges and management:

a review. Clinical, Cosmetic and Investigational Dermatology, 7, 59-64.

            doi:10.2147/ccid.s35302

Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson,

M. A.,  . . Tunkel, D. E. (2013). The diagnosis and management of acute otitis      

            media. Pediatrics, 131(3), 964-999. Retrieved September 25, 2018, from 

            http://pediatrics.aappublications.org/content/pediatrics/131/3/e964.full.pdf

Pettigrew, M. M., Gent, J. F., Pyles, R. B., Miller, A. L., Nokso-Koivisto, J., &     

            Chonmaitree, T. (2011). Viral-bacterial interactions and risk of acute otitis

            media complicating upper respiratory tract infection. Journal of Clinical     

            Microbiology, 49(11), 3750-3755. doi:10.1128/jcm.01186-11

Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F.

            A. Davis.

Thomas, J. P., Berner, R., Zahnert, T., & Dazert, S. (2014). Acute Otitis Media—a

            Structured Approach. Deutsches Ärzteblatt International, 111(9), 151-160.

            Retrieved September 25, 2018, from

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965963/pdf/Dtsch_Arztebl_Int-                           

            111-0151.pdf.

Wald, E. R. (2018). Acute otitis media in children: diagnosis. UpToDate. Retrieved         

            September 25, 2018, from https://www.uptodate.com/contents/acute-otitis-media-

Ms. G., a 23-year-old Hispanic female, came to the clinic for an annual Pap Smear and complains of having a thick, cheesy, white vaginal discharge with itching that has been present for one week. She denies burning during urination. Ms. G. is sexually active in a monogamous relationship with her boyfriend of three years. She states that she and her boyfriend have no other sexual partners. She denies fever, chills, abdominal pain, or pelvic pain. Her last menstrual period was three weeks ago. She does not have any children and is currently attending a local community college and does not have any health insurance. She states “I don’t know how this could happen to me; I am only seeing my boyfriend”. She indicates she is satisfied sexually and she uses oral contraceptives. Based on her presenting signs, what other questions would you elicit? How would you demonstrate knowledge of cultural sensitivity/humility in approach to this patient? What would you assess? What could be the problem?

at least 200 words

apa format 

Instructions

You will design a patient education tool that can be used by nurses for teaching patients using computer applications. You will then present your tool to the class and explain the purpose, how you created it, reasoning for your choice of applications, and provide current evidence of the effectiveness of this patient education. This presentation is 5-10 minutes. Assignment File(s) Patient Education Project and Presentation???? [Word Document] Rubric

NM 208 Patient Education Project ToolNM 208 Patient Education Project ToolCriteriaRatingsPtsThis criterion is linked to a Learning OutcomeUse of Computer Applications20.0 to >17.0 ptsHigh ProficiencyCreative, innovative, effective use of computer applications17.0 to >14.0 ptsModerately High ProficiencyEffective use of computer applications14.0 to >10.0 ptsProficient PointsIneffective use of computer use of applications10.0 to >0 ptsLow-Level Proficiency/Non-ProficientLacking use of computer applications20.0 pts This criterion is linked to a Learning OutcomeOrganization20.0 to >17.0 ptsHigh ProficiencyExtremely well organized; logical format that was easy to follow; flowed smoothly from one idea to another and cleverly conveyed; the organization enhanced the effectiveness of the project17.0 to >14.0 ptsModerately High ProficiencyWell organized; logical format that was easy to follow; flowed smoothly from one idea to another and conveyed; the organization enhanced the effectiveness of the project14.0 to >10.0 ptsProficient PointsSomewhat organized; ideas were not presented coherently and transitions were not always smooth, which at times distracted the audience10.0 to >0 ptsLow-Level Proficiency/Non-ProficientChoppy and confusing; format was difficult to follow transitions of ideas were abrupt and seriously distracted the audience20.0 pts This criterion is linked to a Learning OutcomeContent Accuracy20.0 to >17.0 ptsHigh Proficiency100 % of the facts are accurate17.0 to >14.0 ptsModerately High Proficiency99-90% of the facts are accurate14.0 to >10.0 ptsProficient Points89-80% of the facts are accurate10.0 to >0 ptsLow-Level Proficiency/Non-ProficientFewer than 80% of facts are accurate20.0 pts This criterion is linked to a Learning OutcomeResearch20.0 to >17.0 ptsHigh ProficiencyWent above and beyond to research information; solicited material in addition to what was provided; brought in personal ideas and information to enhance project; and utilized variety of resources to make project effective17.0 to >14.0 ptsModerately High ProficiencyDid a very good job of researching; utilized materials provided to their full potential; solicited adequate resources to enhance project; at time took the initiative to find information outside of school.14.0 to >10.0 ptsProficient PointsUsed the material provided in an acceptable manner, but did not consult any additional resources10.0 to >0 ptsLow-Level Proficiency/Non-ProficientDid not utilize resources effectively; did little or no fact gathering on the topic20.0 pts This criterion is linked to a Learning OutcomeCreativity20.0 to >17.0 ptsHigh ProficiencyWas extremely clever and presented with originality; a unique approach that truly enhanced the project17.0 to >14.0 ptsModerately High ProficiencyWas clever at times; thoughtfully and uniquely presented14.0 to >10.0 ptsProficient PointsAdded a few original touches to enhance the project but did not incorporate them throughout10.0 to >0 ptsLow-Level Proficiency/Non-ProficientLittle creative energy used during this project; was bland, predictable, and lacked “zip”20.0 pts Total Points: 100.0PreviousNext 

COMPETENCIES

726.10.2 : Manager of the Healing Environment

The graduate responds to unpredictable situations and events common in the healthcare environment with appropriate flexibility and creativity.

726.10.3 : The Nurse as Scientist

The graduate correctly interprets and applies scientific evidence when planning and providing safe, quality, and culturally sensitive care for patients and families.

726.10.4 : The Nurse as Detective

The graduate detects subtle changes and deviations from expected health patterns while managing the care of patients.

740.2.8 : Interprofessional Practices

The graduate analyzes the impact of new and diverse advanced nursing and care provider roles on interprofessional practice.

INTRODUCTION

Nursing is a practice discipline that includes direct and indirect care activities that affect health outcomes. As a baccalaureate nursing student, you are developing new competencies in leadership, and in order to achieve mastery, you must apply those competencies to live practice experiences and situations. This Leadership Learning Experience (LLE) is designed to allow you to choose a clinical focus (e.g., practice, policy, education, population) in which you apply your leadership problem–solving skills. The LLE requires engagement with other people within the setting to complete. 
 

You will develop a project within a practice setting that allows you to develop these leadership skills. You will identify a problem area in a practice setting that you specifically want to address (e.g., practice, policy, population, education) that aligns with organizational priorities. Example sources for the problem area may include the following:

             •  Practice: joint commission standards, core measures as quality indicators, other data

             •  Policy: legislation, staffing ratio, regulations from state boards

             •  Population: children with diabetes, adult obesity

             •  Education: future of nursing, Benner’s recommendations about nursing education

You will focus on a real-life solution for the problem. You should choose a topic that is timely, manageable, and realistic to the current healthcare environment. An external resource person (i.e., manager, clinical leader, clinical educator, policy expert, or population expert) must confirm the relevance of the selected project and your engagement in the setting as part of project completion. As with all projects, you should think how you, as a nurse, function in the following roles: detective, scientist, and manager of the healing environment.

REQUIREMENTS

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

Note: Any information that would be considered confidential, proprietary, or personal in nature should not be included. Do not include the actual names of people, stakeholders, or other personally identifiable information. Fictional names should be used. Also, agency-specific data, including financial information, should not be included but should be addressed in a general fashion as appropriate.

Note: Your submission may be in a variety of formats (e.g., report, multimedia presentation).

A.    Develop a written proposal by doing the following:

1.    Identify a problem or issue related to practice, policy, population, or education that aligns with the organizational priorities you seek to solve.

Note: You may need to meet with your organization or practice setting, your manager, or your supervisor to help choose a current problem or issue.

a.    Explain the problem or issue, including why it is applicable to the area of practice you chose and the healthcare environment.

2.    Discuss your investigation of the problem or issue.

a.    Provide evidence to substantiate the problem or issue (e.g., organizational assessment, national source documents, evidence from a stakeholder).

3.    Analyze the state of the situation using current data.

a.    Analyze areas that might be contributing to the problem or issue.

4.    Propose a solution or innovation for the problem or issue.

a.    Justify your proposed solution or innovation based on the results of your investigation and analysis.

5.    Recommend resources to implement your proposed solution or innovation. Include a cost-benefit analysis of your proposed solution or innovation.

6.    Provide a timeline for implementation based on your proposal.

7.    Discuss why each key stakeholder or partner is important for the implementation of the solution or innovation.

a.    Summarize your engagement with the key stakeholders or partners, including the input and feedback you received.

b.    Discuss how you intend to work with those key stakeholders or partners in order to achieve success.

8.    Discuss how your proposed solution or innovation could be implemented, including how the implementation could be evaluated for success.

B.    Explain how you fulfilled the following roles during your process of investigation and proposal development:

1.    scientist

2.    detective

3.    manager of the healing environment

C.    Submit the completed attached “Professional Verification Form” from the organizational leader advising you in your leadership experience.

D.    Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.

E.    Demonstrate professional communication in the content and presentation of your submission.