Online Environment

APA format 1 page long 3 references please use one from the reference and 1 from walden university library.  Due 9/14/19 by 9pm EST


Online Environment

A significant challenge for online learning environments is to create a sense of community between peers and instructors. One method to achieve this is for instructors to share their authentic selves and stories with their students (Bristol & Zerwekh, 2011). Discussion forums offer the opportunity for instructors and learners to demonstrate their individuality without face-to-face interaction. Andragogy, or the study of adult learning, says that adults learn best when the content is relevant to their lived experience and when there is the opportunity for interaction between peers (Bradshaw & Hultquist, 2017). Relationship building is also crucial for instructor satisfaction, as well.  Smith and Crowe (2017) found that instructors were more satisfied when they had the opportunity to get to know their students. For the reasons above, utilization of video presentation of the instructor and use of discussion forum will allow a more personal experience of the online learning environment.

Classroom Management

Nursing students are busy people who juggle many demands at once: family, work, and school, among other things. Students generally do not participate in optional ungraded assignments because of their time constraints (Bristol & Zerwekh, 2011). One strategy for classroom management is to decrease the feeling that students are doing busywork. This requires giving credit, in the form of points toward their grade, for their efforts.

In order to head off problems with netiquette, the nurse educator needs to lie out expectations for interacting in the online environment. This can include basic recommendations such as using a professional writing style that does not include short-hand or abbreviations (Bristol & Zerwekh, 2011). In the online environment, incivility is increasingly a problem that interferes with learning. Social media sites are often the forum for incivility between instructor and student. De Gagne, Yamane, Conklin, Chang, and Kang (2018) recommend implementing policies and guidelines in order to avoid unprofessional conduct in the nursing school environment.


Bradshaw, M. J., & Hultquist, B. L.  (2017). Innovative teaching strategies in nursing and

            related health professions (7th ed.). Burlington, MA: Jones and Bartlett.

Bristol, T. J., & Zerwekh, J. (2011). Essentials of e-learning for nurse educators. Philadelphia,

PA: F. A. Davis Company.

De Gagne, J. C., Yamane, S. S., Conklin, J. L., Chang, J., & Kang, H. S. (2018). Social media

use and cybercivility guidelines in US nursing schools: A review of websites. Journal Of Professional Nursing, 34(1), 35–41.

Smith, Y. M., & Crowe, A. R. (2017). Nurse Educator Perceptions of the Importance of

Relationship in Online Teaching and Learning. Journal of Professional Nursing, 33(1), 11–19.

Health History and Medical Information

Case Study: Mr. M.

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the life span.

Evaluate the Health History and Medical Information for Mr. M., presented below.

Based on this information, formulate a conclusion based on your evaluation, and complete the Critical Thinking Essay assignment, as instructed below.

Health History and Medical Information

Health History

Mr. M., a 70-year-old male, has been living at the assisted living facility where you work. He has no know allergies. He is a nonsmoker and does not use alcohol. Limited physical activity related to difficulty ambulating and unsteady gait. Medical history includes hypertension controlled with ACE inhibitors, hypercholesterolemia, status post appendectomy, and tibial fracture status postsurgical repair with no obvious signs of complications. Current medications include Lisinopril 20mg daily, Lipitor 40mg daily, Ambien 10mg PRN, Xanax 0.5 mg PRN, and ibuprofen 400mg PRN.

Case Scenario

Over the past 2 months, Mr. M. seems to be deteriorating quickly. He is having trouble recalling the names of his family members, remembering his room number, and even repeating what he has just read. He is becoming agitated and aggressive quickly. He appears to be afraid and fearful when he gets aggressive. He has been found wandering at night and will frequently become lost, needing help to get back to his room. Mr. M has become dependent with many ADLs, whereas a few months ago he was fully able to dress, bathe, and feed himself. The assisted living facility is concerned with his rapid decline and has decided to order testing.

Objective Data

  1. Temperature: 37.1 degrees C
  2. BP 123/78 HR 93 RR 22 Pox 99%
  3. Denies pain
  4. Height: 69.5 inches; Weight 87 kg

Laboratory Results

  1. WBC: 19.2 (1,000/uL)
  2. Lymphocytes 6700 (cells/uL)
  3. CT Head shows no changes since previous scan
  4. Urinalysis positive for moderate amount of leukocytes and cloudy
  5. Protein: 7.1 g/dL; AST: 32 U/L; ALT 29 U/L

Critical Thinking Essay

In 750-1,000 words, critically evaluate Mr. M.’s situation. Include the following:

  1. Describe the clinical manifestations present in Mr. M.
  2. Based on the information presented in the case scenario, discuss what primary and secondary medical diagnoses should be considered for Mr. M. Explain why these should be considered and what data is provided for support.
  3. When performing your nursing assessment, discuss what abnormalities would you expect to find and why.
  4. Describe the physical, psychological, and emotional effects Mr. M.’s current health status may have on him. Discuss the impact it can have on his family.
  5. Discuss what interventions can be put into place to support Mr. M. and his family.
  6. Given Mr. M.’s current condition, discuss at least four actual or potential problems he faces. Provide rationale for each.

You are required to cite to a minimum of two sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

 my lower abdomen.”

Report Issue




Name:  LP


Time: 1315


Age: 30

Sex: F





“I am having vaginal itching and pain in   my lower abdomen.”



Pt is a   30y/o AA female, who is a new patient that has recently moved to Miami. She seeks treatment today after   unsuccessful self-treatment of vaginal itching, burning upon urination, and   lower abdominal pain. She is concerned   for the presence of a vaginal or bladder infection, or an STD. Pt denies fever. She reports the itching and burning with   urination has been present for 3 weeks, and the abdominal pain has been   intermittent since months ago. Pt has   tried OTC products for the itching, including Monistat and Vagisil. She denies any other urinary symptoms,   including urgency or frequency. She   describes the abdominal pain as either sharp or dull. The pain level goes as high as 8 out of 10   at times. 200mg of PO Advil PRN   reduces the pain to a 7/10. Pt denies   any aggravating factors for the pain. Pt reports that she did start her menstrual cycle this morning, but   denies any other discharge other that light bleeding beginning today. Pt denies douching or the use of any   vaginal irritants. She reports that   she is in a stable sexual relationship, and denies any new sexual partners in   the last 90 days. She denies any   recent or historic known exposure to STDs. She reports the use of condoms with every coital experience, as well   as this being her only form of contraceptive. She reports normal monthly menstrual cycles that last 3-4 days. She reports dysmenorrhea, which she also   takes Advil for. She reports her last   PAP smear was in 7/2016, was normal, and reports never having an abnormal PAP   smear result. Pt denies any hx of   pregnancies. Other medical hx includes   GERD. She reports that she has an Rx   for Protonix, but she does not take it every day. Her family hx includes the presence of DM   and HTN.


Current Medications: 

Protonix   40mg PO Daily for GERD

MTV OTC   PO Daily

Advil   200mg OTC PO PRN for pain





Medication Intolerances: 


Chronic Illnesses/Major traumas





Family History

Father-   DM & HTN; Mother- HTN; Older sister- DM & HTN; Maternal and paternal   grandparents without known medical issues; 1 brother and 3 other sisters   without known medical issues; No children.


Social History

Lives   alone. Currently in a stable sexual   relationship with one man. Works for   DEFACS. Reports occasional alcohol   use, but denies tobacco or illicit drug use.





Denies   weight change, fatigue, fever, night sweats


Denies   chest pain and edema. Reports rare palpitations that are relieved by drinking   water



Denies   any wounds, rashes, bruising, bleeding or skin discolorations, any changes in   lesions


Denies   cough. Reports dyspnea that accompanies the rare palpitations and is also   relieved by drinking water



Denies corrective   lenses, blurring, visual changes of any kind


Abdominal   pain (see HPI) and Hx of GERD. Denies   N/V/D, constipation, appetite changes



Denies   Ear pain, hearing loss, ringing in ears


Reports   burning with urination, but denies frequency or urgency. Contraceptive and STD prevention includes   condoms with every coital event. Current stable sexual relationship with one man. Denies known historic or recent STD   exposure. Last PAP was 7/2016 and normal. Regular monthly menstrual cycle   lasting 3-4 days.



Denies   sinus problems, dysphagia, nose bleeds or discharge


Denies   back pain, joint swelling, stiffness or pain



Denies   SBE


Denies   syncope, seizures, paralysis, weakness



Denies   bruising, night sweats, swollen glands


Denies   depression, anxiety, sleeping difficulties




Weight   140lb

Temp -97.7

BP 123/82


Height 5’4”

Pulse 74

Respiration 18


General Appearance

Healthy   appearing adult female in no acute distress. Alert and oriented; answers   questions appropriately.



Skin is   normal color for ethnicity, warm, dry, clean and intact. No rashes or lesions   noted.



Head is   norm cephalic, hair evenly distributed. Neck: Supple. Full ROM. Teeth are in   good repair.



S1, S2   with regular rate and rhythm. No extra heart sounds.



Symmetric   chest walls. Respirations regular and easy; lungs clear to auscultation   bilaterally.

Family psychiatric history

Prepare A Genogram For The Client You Selected. The Genogram Should Extend Back By At Least Three Generations (Great Grandparents, Grandparents, And Parents)

I will provide a client without violating HIPPA these are the areas need to be addressed in the genogram

  • Demographic information
  • Presenting problem
  • History or present illness
  • Past psychiatric history
  • Medical history
  • Substance use history
  • Developmental history
  • Family psychiatric history
  • Psychosocial history
  • History of abuse/trauma
  • Review of systems
  • Physical assessment
  • Mental status exam
  • Differential diagnosis
  • Case formulation
  • Treatment plan

Pain Today (0-10): Pain is described as 1 out of 10.  Allergies: NKDA  SLEEP ISSUES: Hours of sleep per night: 6-7 Snores: No Sleep latency: 0-15 min Daytime Somnolence: No   Substance History: Caffeine Use: No Cups/Date Equivalent: Tobacco/e-cigs: none Packs/Date Equivalent: Illicit drug use: denied   DEVELOPMENTAL/SOCIAL HISTORY: Patient reports that he grew up in Mississippi. His father died in a motor vehicle accident when he was several months old. Raised by his mother and stepfather. Denies any abuse history. Never married. Has a bachelor’s of arts in communication from Grambling UNIV. reports that he worked at Lowe’s during college and thereafter. Is an AGR Soldier within the United States Army reserves in Mississippi from 2012-2018. States that his religion and spiritual values preference being Christian.  Patient was primarily raised by Biological parents and that childhood was generally Good. Patient denies ever being physically, sexually or emotionally abused. Highest level of education achieved is: 4-year college degree or equivalent. Patient is currently single and currently lives with Other. Housing is currently Off-Post. Patient reports religion, faith or spirituality DO play an important role in life. Social support reported as satisfactory. Patient reports the following history of legal issues: None of the above.  PAST FAMILY/MEDICAL HISTORY: Family Medical Illnesses: None Family Behavioral Health Illnesses: None Family Substance Use History: None  OBJECTIVE MSE Orientation: ☐None ☒Place ☒Object ☒Person ☒Time Attention: ☒Normal ☐Distracted ☒Other: Maintained focus and attention throughout the session. Appearance: ☒Neat ☐Disheveled ☐Inappropriate ☐Bizarre ☒Other: dressed in civilian attire. Behavior: ☒Cooperative ☐Guarded ☐Withdrawn ☐Agitated ☐Stereotyped ☐Aggressive ☒Other: calm Eye Contact: ☒Normal ☐Intense ☐Limited ☒Other: maintained appropriate eye contact during the session. Psychomotor: ☒Normal ☐Restless ☐Tics ☐Slowed ☐Other Speech: ☒Normal rate, volume, and rhythm ☐Tangential ☐Pressured ☐Impoverished ☐Other Mood: “I feel good overall.” Affect: ☒Congruent with mood ☒Euthymic ☐Anxious ☐Angry ☐Depressed ☐Euphoric ☐Irritable ☐Constricted ☐Flat ☐Labile ☐Other Thought Process: ☒WNL ☐Circumstantial ☐Tangential ☐Loose Associations ☐Disorganized ☐Other Thought Content: ☒WNL ☐SI ☐HI ☒ potentially paranoid ☐A/V hallucinations ☐Delusional ☒Other: Denies SI/HI plan or intent Memory Impairment: ☒WNL ☐Short-Term ☐Long-Term ☐Other Insight: ☐Good ☒Fair ☐Poor Comments: Judgment: ☐Good ☒Fair ☐Poor Comments:  BHDP: Behavioral Health Vitals (patient reported): Overall health reported as: Good Pain Level (0-10): 0 Currently treated: N/A Suicidal Ideation Risk – C-SSRS-S score: 0 Past/Prep Behavior last 3 months: N/A # past attempts as of 12/07/2016: 2 Most recent Suicidal Ideation: N/A Suicidal Ideation Duration: N/A Suicidal Ideation Frequency: N/A Protective Elements Stopping Suicidal Actions: Faith/Religion, Family, Hope for future, Friends, Other Harm Others Risk over next week as of 12/18/2018 – None Active Plan: N/A Patient with access to weapons: No  Recent Outcome Measures (last 30 days) BASIS24 – Score: 0.56 – Subclinical to low level of general distress reported (12/18/2018) PHQ9 – Score: 4 – Depressive syndrome unlikely (12/18/2018) GAD7 – Score: 3 – Anxiety syndrome unlikely (12/18/2018) PCL-5 – Score: 3 – None-Low PTSD symptoms reported (12/18/2018) PCL-C: N/A AUDIT: N/A CSI – Score: 8 – Possible relationship distress reported. Evaluation indicated. (11/30/2018) ISI – Score: 9 – Subthreshold insomnia (12/18/2018) BAM: N/A  LABORATORY RESULTS: Reviewed laboratory results  ASSESSMENT Patient Strengths: ☐ None reported ☐ motivated ☐ insightful ☐ committed ☐ Tx compliant ☒ family support ☐ social support ☐desires change ☐ previous positive BH experience ☐ desire to address longstanding issues ☒ good expressive language ☐ good ego strength ☐ Other:  Patient Barriers: ☐ None reported ☐ unmotivated ☐ limited insight ☒ uncommitted ☐ Tx non-compliant ☐ limited family support: ☐resistant ☐co-morbid Dx ☐ previous negative BH experience ☒ limited social support ☐cognitive impairment/TBI ☐low ego strength ☒ Other: Not resistant but questions the validity of his behavioral healthcare  SAFETY RISK ASSESSMENT ☐YES ☒NO History of Suicidal Ideation: ☐YES ☒NO History of Suicidal Planning: ☐YES ☒NO History of Suicidal Gestures: ☐YES ☒NO History of Suicidal Attempts: ☐YES ☒NO Close friends/family who have attempted/completed suicide: ☐YES ☒NO History of intentionally harming others or destroying property: ☐YES ☒NO Current intentions to engage in above behaviors: ☐YES ☒NO History of impulsive-taking:  Risk Factors: ☐None reported ☒Male ☐Impulsive ☒Weapons access ☐Legal Stressors ☐Financial Stressors ☒Occupational conflict ☐Chronic medical problems ☐Substance abuse: ☐Abuse victim: ☐History of suicidal gestures ☐History of family/friend suicide ☐Relationship problems ☐OTHER: insomnia  Protective Factors: ☐None reported ☐Married ☐Children ☒Positive religious coping ☒Future orientation ☒Healthy coping skills ☐Active treatment participation ☒Supportive spouse ☐Supportive family ☐Social support ☒PT wants to continue treatment ☐OTHER:  This provider considered the above risk/protective factors and has determined the following risk level: RISK: Harm to Self – ☒Not Elevated ☐Low ☐Intermediate ☐High Harm to Others – ☒Not Elevated ☐Low ☐Intermediate ☐High SAFETY:☐YES ☒NO Imminent threat to self. ☐YES ☒NO Imminent threat to others. ☐YES ☒NO Imminent threat of harm from other individuals. ☒YES ☐NO Patient is fully able to make informed medical decisions and manage affairs. ☒YES ☐NO Patient is unlikely to withhold information about SI/HI ideation or intent. ☒YES ☐NO Patient is considered to be a reliable source of information.  DIAGNOSTIC FORMULATION: This is a 35-year-old male who was deployed to the Middle East as an individual unit augmentee. He reports that he became an conflict with his leadership over mishandling funds, and other ethical related issues. The unit is making the claim that the patient is misperceiving these incidences, based off of the provider assessment in-theater; paranoia over this situation was identified.  DSM Diagnosis(es) Code: Other occupational structure stressors R/O: Delusional Disorder, psychosis  Estimated Treatment Prognosis: Good .  PLAN Treatment Summary: 1) Patient was provided psychoeducation, assessment of current functioning, risk/safety assessment, development of rapport, development of treatment goals, empathic listening and directed questioning techniques to elicit information and provided supportive environment to facilitate patient insight. Patient was provided active listening, strategic reflection, encouragement and validation. Other therapies discussed include: 1. Diaphragmatic Breathing 2. Progressive Muscle Relaxation 3. Safe Place Imagery 4. Mindful breathing 5. Problem solving techniques 6. Sleep Hygiene 7. Discussed, Virtual Hope box, Tactical Breather, Moving forward and Mindfulness coach apps available on smart phone.  2) Discussed open-access clinic available at BH clinic. Pt agree if symptoms worsen or if new behavioral concerns arise, Pt to call, RTC, or if after duty hours, go to ED and/or call emergency line. Limits to confidentiality were discussed with the patient as appropriate.  3) Attending behavioral health group for deployed service members on Monday, Tuesday, Thursday and/or Friday from 1430-1600.  Medications: None  Risk/Suicide Management Plan: ☒YES ☐N/A The patient will follow-up in therapy to address treatment goals. ☒YES ☐N/A The patient has demonstrated the ability to and has agreed to make use of a crisis response plan. ☐YES ☒N/A The patient was added to the High Interest Program to track continuity of care. ☐YES ☒N/A Persons notified: ☐YES ☒N/A Emergency Contacts: ☒YES ☐N/A Emergency Contacts and Crisis Response Plan: Call friends, family members, or a trusted chaplain. Contact Military One Source at or call 00-800-3429-6477. Call Wounded Soldier and Family Hotline at OCONUS DSN 312-421-3700. Access for online chat support. After duty hours, call 112, call MPs, First Sergeant or primary supervisor if feeling suicidal. During duty hours, walk in to Behavioral Health Clinic. Go to the Emergency Room at Landstuhl Regional Medical Center. They will call the on-call Behavioral Health Provider. ☐YES ☒N/A Safety plan worksheet uploaded into HAIMS.


The candid submission presents the remarkable nursing contributions by Dorothea Orem and Florence Nightingale. Concise comparisons between the SBON versus the ANA and the FDA versus the ANA are included. The purpose of the Pennsylvania Nurse Practice Act is clearly stated. Communication skills, conflict resolution abilities, and focused on optimal outcomes are superior nursing leadership qualities. What could not be located is a description of the influence on the candidate’s practice by the State Board of Nursing and the ANA; a comparison between compact versus non-compact state licensure requirements; explanation of Pennsylvania RN rules of delegation; application of the nursing roles of scientist, detective, and manager of the healing environment to professional practice; two specific ANA Code of Ethics provisions, analysis of the provisions, a clinical practice error, and application of the provisions to the error; and identification of a fourth nursing leadership quality along with how they can be applied to the bedside and within a team. Reviewing and correcting the grammatical, sentence fluency and word choice errors will enhance the clarity of the submission.


















Not Evident

Not EvidentAn explanation of how the State Board of Nursing and the ANA influence the candidate’s nursing practice is not provided.


The ANA and State Board of Nursing are specifically presented in the essay. How both agencies influence the candidate’s practice is not evident.






Not Evident

Not EvidentA comparison of the differences between registered nursing license requirements in a compact state versus a non-compact state is not provided.


The criteria for compact state licensure is clearly stated. Missing is a comparison of the differences between compact versus non-compact state licensure requirements.












Not Evident

Not EvidentA discussion of how the candidate’s state defines delegation for the RN is not provided.


The Pennsylvania Nurse Practice Act is distinctly outlined. Pennsylvania rules for RN delegation are not found.


Not Evident

Not EvidentA discussion of the application of each nursing role to the candidate’s professional practice is not provided.


Serving as a professional nurse is very important, however, the how the roles of scientist, detective and manager of the healing environment are not included.


Not Evident

Not Evident2 provisions from the ANA Code of Ethics are not identified.


Interesting provisions are mentioned in the work. Actual ANA Code of Ethics need to be researched and presented.


Not Evident

Not EvidentAn analysis of how the 2 provisions identified in part G influence the candidate’s professional nursing practice is not provided.


This aspect to be evaluated upon resubmission.


Not Evident

Not EvidentA description of a nursing error in a clinical practice example is not provided.


Nursing professional practice is nicely discussed. A clinical practice error could not be found.


Not Evident

Not EvidentAn explanation of how ANA provisions in part G can be applied to the error from part G2 is not provided.


This aspect to be evaluated when a nursing error has been presented.


Approaching Competence

Approaching Competence4 leadership qualities or traits are identified, but they do not represent excellence in nursing, or they are otherwise inappropriate for a nursing practice.


Communication skills, conflict resolution abilities, and focused on optimal outcomes are powerful nursing leadership qualities. It is unclear what the fourth quality is.


Approaching Competence

Approaching CompetenceThe discussion of how the nurse uses the identified leadership qualities or traits in part H does not include each of the 4 traits, does not include each of the given roles, or it is not relevant.


Communication skills and conflict resolution abilities are validly identified nursing leadership qualities being applied to the bedside and within a team. Being focused on an optimal outcome and a fourth quality are not described at the bedside or within a team.


Not Evident

Not EvidentAn identification of how the work environment impacts each given point is not provided.


Leadership qualities that impact nursing are highlighted in the essay. How the work environment impacts nursing leadership, decision making and professional development is not provided.




Approaching Competence

Approaching CompetenceContent is poorly organized, is difficult to follow, or contains errors in mechanics, usage, or grammar that cause confusion. Terminology is misused or ineffective.


This interesting submission has multiple grammatical , sentence fluency and word choice errors. Reviewing and correcting these errors will enhance the clarity of the submission.

Mr. Newcomb has limited time

Running Head: C304 Task 2 1

C304 Task 2 2

Quite sometimes, in the healthcare field, a relationship developed between patients and nurses and can even extend to the patient family’s member. It is known that on earth, Mr. Newcomb has limited time; on his request. In such situations, people do not want to say a final goodbye to their beloved. Within my nurse’s experiences, the patient often requests not to share their medical information with their next of kin. When patients require for such a thing, then the caregiver must be cooperative. Above all, it is the choice of the patient as to which information must be shared. Mr. Newcomb asked me to provide the wrong information to his wife, which make her uncomfortable. I need to explain to Mr. Newcomb that it would be wrong ethically and morally to do such a thing. More ever, In the medical professional, no nurse with ethical value with go along with his extramarital adultery. As a nurse, my work is to deliver compassionate and outstanding care and do not give false information to his wife.


Beneficence is defined as an act of charity, mercy, and kindness with a strong connotation of doing good to others, including moral obligation. All professionals have the foundational moral imperative of doing right. (J. Humanit, 2009). In the above scenario, the beneficence is shown by providing heart-to-heart empathy with Mr. Newcomb and validate and acknowledge his feeling to say goodbye to his wife.

The opposite of beneficence is Non-maleficence. (Cherry and Jacob,2014) explains that non-maleficence is a principle of ethics in which one does not have to provide harm to another. In the given scenario, as a nurse, I need to use the method of non-maleficence by opting not to lie to Mrs. Newcomb. By doing so, I need to avoid causing any emotional harm to the wife of the patient. The ethical principles of nurses are to uphold information and do not interject it in the personal life of a patient. Autonomy needs independence from controlling or outside influences and the show’s capacity for the actions taken intentionally (Sedig, 2016). Working as a nurse of Mr. Newcomb, there is a need to apply the principle of autonomy by giving respect to his decision. I provide education to all of my patients regarding their decision making. Education is provided to the patients mostly regarding their medications, and improve their lives through medical treatment. Mr. Newcomb can decide and tell his wife to go home or run errands for some hours. As a nurse, I should care for his decision and care about his autonomy as well.

As a nurse, justice is applied when an unconditional and excellent care is continuously provided to Mr. Newcomb even though he has made an unethical request. His recommendations were immoral, but I still need to continue unbiased services and take care of his concerns as I have done with other patients.


Momentarily, some personal conflicts are aroused due to the patient’s request. My heart sank for Mrs. Newcomb, who got married to an adulterer. Ethically I do not want to indulge myself in a situation in which I become an accomplice with Mr. Newcomb by lying to his wife.

I then view the situation from the outside perspective. I do not have information on which boundaries or relationship needs to be set between their marriage. I even choose not to interfere with it. These situations break my heart when a patient says they are counting their breaths. These patients mostly tied to loose ends with their family and ready to say their final goodbyes to their family.


The nurse must provide care to the patients. We are selfless in, day in and day out. Each day at work, we provide knowledge, compassion, and patience to the patients and their families. A nurse can be exhausted because of their duties. Self-care strategies must be implemented and provided by nurses. If I had a day that drains me mentally and physically when I came home, my response explains many things. The saddest and lowest instants that happened during the day keep revolving in my mind. Once, I recalled a scene when a patient has no family around, and he was taking his last breaths, when I was back at home, I cried. All the good things said by the physician, coworker, patient, and family member were revolving in my mind. When the patient mentioned above passed away, then his family come to his body to say a final goodbye. They cried and hugged me. They thanked me and held me for the comfort I provide to their loved one during the last moments of his life. To cover up such unpleasant emotions, I let myself feel raw. Secondly, I do exercise to soothe myself. Sometimes it provides more relaxation when I go to the gym and exhaust my energy. For a healthy lifestyle, it is essential to do exercise. My final strategy is to spend time with my lover. I get myself recharged after spending a carefree time with my lover and our dogs. Watching a movie while sitting on the couch makes me feel good and replenish my soul. I feel that these things not only make me feel happy but also combat burnout and fatigue. I think healthier; a happier nurse can give more care to her patients.


J Chiropr Humanit. 2009 Dec;16(1):44-6. doi: 10.1016/j.echu.2010.02.006. Epub 2010 Apr 1.

PMID: 22693466

 Free PMC Article

Edition. Retrieved from

Sedig, L. (2016, January). What’s the Role of Autonomy in Patient- and Family-Centered Care When Patients and Family Members Don’t Agree? AMA Journal of Ethics, 18(1). Retrieved from

Lab Assignment: Differential Diagnosis for Skin Conditions

Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.In this Lab Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

To Prepare

Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment.

Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?

Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.

Consider which of the conditions is most likely to be the correct diagnosis, and why.

Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.

Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.

Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.

The Lab Assignment

Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style.

Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

Use clinical terminologies to explain the physical characteristics featured in the graphic.

Formulate a differential diagnosis of three to five possible conditions for the skin graphic that you chose.

Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.

book link

Family Issues on Aging

Please, write a response to this discussion in one paragraph by using one reference from peer-reviewed Nursing Journal not older than 5 years. APA required without cover page.


Family Issues on Aging

Mrs. Lo and her daughter seem to be at a critical point in their lives where tough decisions must be made. Mrs. Lo is under the impression that children should take care of their older parents in the latter years of their lives. The need for a comprehensive approach to tackle the needs of elderly Americans have always been an issue in the United States. Cultural, economic and social factors complicate the issue of elderly healthcare (Harvey, 2019).  In Mrs. Lo’s case, I would counsel her and the daughter together and try and find common ground on what is expected of Mrs. Lo’s care. A compromise would have to be reached in order for all parties to be happy. Communication and transparency are vital in situations like this. If there is still an unwillingness on the daughters end to move the mother in I think it would be best for Mrs. Lo to relocate close to the daughter so that at least she will be in close proximity with the daughter. It seems that Mrs. Lo had always been fairly independent so if she lived close to the daughter she would be able to help with the small tasks like grocery shopping and the like. There are millions of nursing home residents in the US and many of these nursing homes are understaffed and in need of better regulation and financing (Tabloski, 2014). An option that I’m familiar with for Mrs. Lo would include having a caregiver visit her during the day to aid her with the tasks that she needs help with. Ultimately communicating with her loved ones would b


Write a 5 paragraph essay with the following components:


a.       Hook/Grabber:




Background info on the topic

Thesis Statement: inform the reader about what your essay will be about; last sentence of the intro para.

Body Paragraphs:

2 paragraphs containing the pros of the use of cellphones

1 paragraph containing the cons of the use of cellphones

Building Main Points:

Organize with the use of topic sentences that illustrate the main idea of each paragraph.Offering a brief explanation of the history or recent developments of topic within the early body paragraphs can help the audience to become familiarized with your topic and the complexity of the issue.

Paragraphs may be ordered in several ways, depending upon the topic and purpose of your argument:•General to specific information• Most important point to least important point . Weakest claim to strongest claim

  • Countering the Opposition:
  • Addressing the claims of the opposition is an important component in building a convincing argument.
  • It demonstrates your credibility as a writer –
  • you have researched multiple sides of the argument and have come to an informed decision.
  • It shows you have considered other points of view – that other points of view are valid and reasonable
  • Effective Counter Arguments:
  • Consider your audience when you address the counterargument.
  • Conceding to some of your opposition’s concerns can demonstrate respect for their opinions.
  • Remain tactful yet firm:   Using rude or deprecating language can cause your audience to reject your position  without carefully considering your claims.
  • Counterarguments may be located at various locations within your body paragraphs.You may choose to:•build each of your main points as a contrast to oppositional claims.•offer a counterargument after you have articulated your main claims.


  • Your conclusion should reemphasize the main points made in your paper.
  • You may choose to reiterate a call to action or speculate on the future of your topic, when appropriate.
  • Avoid raising new claims in your conclusion.

Gynecologic Health

Gynecologic Health




Select a patient that you examined as a nurse practitioner student during the last three weeks of clinical on OB/GYN Issue. With this patient in mind, address the following in a SOAP Note 1 OR 2 PAGES :


Subjective: What details did the patient provide regarding her personal and medical history?


Objective: What observations did you make during the physical assessment?


Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?


Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters for this patient , as well as a rationale for this treatment and management plan.


Very Important:  Reflection notes: What would you do differently in a similar patient evaluation?