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  What characteristics would lead a provider to suspect domestic violence, child abuse, or elder abuse is taking place within a family? Discuss your facility's procedure for reporting these types of abuse. Violence and abuse is described as any intentional physical, mental, or psychological harm inflicted on a vulnerable person. This includes punching, berating, screaming, and other types of intentional cruelty. Domestic violence also involves threats or mild verbal or physical attacks, and victims seek to comply with the abuser's demands. Victims feel trapped, reliant, helpless, and powerless. They can experience depression as a result of being stuck in the abuser's power and control loop. As a victim's self-esteem deteriorates as a result of prolonged abuse, he or she will blame themselves for the violence and be unable to see a way out of the situation. Neglect is described as any deliberate or unintentional lack of concern for someone's well-being, such as failing to meet a dependent's basic needs. Child abuse, child neglect, dependent adult abuse, dependent adult neglect, and domestic violence are all examples of abuse and neglect If a family member shows apparent signs of bruising, malnutrition, depression, extreme fear, extortion, or other similar factors, a mandatory leader can suspect violence or neglect. However, this list is little and not an exhaustive, and other elements which exist. There is no one-size-fits-all solution, but mandatory reporters are expected to search for trends of concern and various indicators of problems; they are expected to ask questions if required and to report anything they believe, even if they are not 100 percent certain. A instructor, for example, can suspect child abuse if a student is chronically underweight and seems desperate to eat all they can while at school. If a woman arrives at the emergency room with severe bruises and physical injuries that do not seem to match her reasons for the medical problems, a nurse may suspect domestic abuse. A mental health professional may suspect elder abuse if a senior citizen pays large sums of money to a single person or if a family member micromanages their finances. A required reporter must be aware of the appropriate authority to which the alleged violence and neglect should be reported. In the case of child violence, each state has a department of child services (also known as social services) that should be contacted through the appropriate channels, such as hot lines. Domestic abuse should be reported to local law enforcement. Adult services agencies in each state deal with elder abuse and other forms of maltreatment of dependent adult. References Child abuse - reporting procedures. (2019). Better Health Channel. https://www.betterhealth.vic.gov.au/health/healthyliving/child-abuse-reporting-procedures Elder abuse: Types, signs, and reporting. (2020, June 11). Find Assisted Living, Memory Care and Senior Living | A Place for Mom. https://www.aplaceformom.com/caregiver-resources/articles/elder-abuse Respond to the post in discussion using 200-300 words in APA format with reference to support the post.

 Population health promotion involves the improvement of the quality of life of the community through the provision of primary, secondary and tertiary healthcare services. The community health nurse should, therefore, play a supervisory role of the community member to control and regulate their health behavior. The primary function of the nurse in the partnership with the community stakeholders is to guide and advise them on the healthy practice that can promote a healthy living of the community (Eldredge et al., 2015). For instance, the community health nurse can decide to encourage the community stakeholders to champion the construction of toilets by each household in the community. That way, the nurse will be providing primary care through the community stakeholders who can prevent the development of disease in the community. The nurse can also take advantage of the community stakeholders to organize a community meeting whereby the nurse can advise and educate the community on health-seeking behavior and health promotion activities. Appraising community resources like religious and nonprofit making organizations in the community is vital in enhancing community participation in health promotion. For instance, religious institutions are against some social acts that can encourage the spread of diseases like premarital sex. Appraising such values in such institutions helps to improve the community's understanding and participation in disease prevention and health promotion. Using 200-300 words APA format with references in support of the discussion   Explain the role of the community health nurse in partnership with community stakeholders for population health promotion. Explain why it is important to appraise community resources (nonprofit, spiritual/religious, etc.) as part of a community assessment and why these resources are important in population health promotion. 

Geopolitical and phenomenological place influence the context of a population or community assessment and intervention in various ways. A community could be defined by one of two designations, phenomenological (relational) or geological (spatial). A geographic community is a community within defined jurisdictional boundaries. These communities could include city communities, rural municipalities or towns. Phenomenological communities, on the other hand, define a group of people with shared or similar-minded relationships, beliefs, goals, and interests (Leipert, 1996). They might not necessarily share the same geographical boundaries as geographical communities. These communities could include social groups or religious groups. These people mostly come together to achieve the feeling of belonging in their relational designations. These people may have a group perspective that differentiates them from other groups on matters including culture, values, beliefs, characteristics, and goals. Everyone lives in a geographic community and many people are also part of a phenomenological group. These groupings present various challenges for public health nurses. The main challenge is the issue of cultural and language barriers. Some of the practices that can help overcome these challenges include reflective practice and obtaining knowledge of different cultures and practices. Nurses should also self-evaluate and ensure that their personal beliefs do not interfere with the nursing process. The nursing process is utilized to assist in identifying health issues because it involves the appropriate application of a systematic series of actions that aim at ensuring that individuals achieve their optimal level of health. The main steps in the nursing processes include assessment, diagnosis, planning, implementation, and evaluation. Assessment refers to the collection and evaluation of information regarding the status of health in the community (Rector, 2013). It aids in discovering potential or existing needs and assets as a basis for any future action plans or interventions. Using 200-300 words APA format with references to support the discussion.   Discuss how geopolitical and phenomenological place influence the context of a population or community assessment and intervention. Describe how the nursing process is utilized to assist in identifying health issues (local or global in nature) and in creating an appropriate intervention, including screenings and referrals, for the community or population. 

  Topic 3 DQ 1 In the nineteenth century, health was described as the absence of disease.Because of the lack of sanitary conditions, diseases spread more widely.Sanitary conditions were better known in the late 19th and early 20th centuries, and steps were taken to adequately control them, resulting in diseases that were more manageable. Vaccines were invented in the twentieth century, and the concept of health changed from cure to prevention. As the field of health promotion expanded, the term "health" came to mean a combination of factors such as physical, emotional, and spiritual well-being (Falkner, 2018). Today’s goals is to create a community of wellness in which health promotion and disease prevention take precedence over seeking careonce an illness has developed.We now realize that fitness and wellbeing go hand in hand with disease prevention. We may not always have control over our health, but we can make decisions to improve our well-being. Promoting good health has existed for as long as there have been efforts to improve the public's health. “The method of encouraging people to gain control over and improve their health is known as health promotion” (World Health Organization, 2019, para. 1).It shifts the emphasis away from human actions and toward a variety of social and environmental interventions.The nurse's position in health promotion is critical, and it includes being an advocate, a provider of care/services, a care manager, an educator, and a researcher. The nurse is pushing reform to strengthen procedures in order to improve patient safety by using EBP to do so. Falkner, A. (2018) Health promotion in nursing care. In Grand Canyon University (Eds.), Health promotion: Health and wellness across the continuum. Retrieved from World Health Organization. (2019). What is health promotion. Retrieved from https://www.who.int/healthpromotion/fact-sheet/e Respond using 200-300 words APA format with references supporting in discussion 

  Soap Note 1 Acute Conditions (15 Points) Pick any Acute Disease Vital signs need to be present. Height and Weight should be included where appropriate. a) Appropriate systems are examined, listed in the note and consistent with those identified in 2b.(10pts). b) Pertinent positives and negatives must be documented for each relevant system. c) Any abnormalities must be fully described. Measure and record sizes of things (likes moles, scars). Avoid using “ok”, “clear”, “within normal limits”, positive/ negative, and normal/abnormal to describe things. (5pts). 4) Assessment (___10pts.): Diagnoses should be clearly listed and worded appropriately. 5) Plan (___15pts.): Be sure to include any teaching, health maintenance and counseling along with the pharmacological and non-pharmacological measures. If you have more than one diagnosis, it is helpful to have this section divided into separate numbered sections. 6) Subjective/ Objective, Assessment and Management and Consistent (___10pts.): Does the note support the appropriate differential diagnosis process? Is there evidence that you know what systems and what symptoms go with which complaints? The assessment/diagnoses should be consistent with the subjective section and then the assessment and plan. The management should be consistent with the assessment/ diagnoses identified. 7) Clarity of the Write-up(___5pts.): Is it literate, organized and complete?   Name:  LP Date:  Time: 1315   Age: 30 Sex: F   SUBJECTIVE   CC:   “I am having vaginal itching and pain in   my lower abdomen.”   HPI:   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   PMHx: Allergies:   NKA & NKDA Medication Intolerances:  Denies Chronic Illnesses/Major traumas GERD Hospitalizations/Surgeries Denies   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.   ROS   General  Denies   weight change, fatigue, fever, night sweats Cardiovascular Denies   chest pain and edema. Reports rare palpitations that are relieved by drinking   water   Skin Denies   any wounds, rashes, bruising, bleeding or skin discolorations, any changes in   lesions Respiratory Denies   cough. Reports dyspnea that accompanies the rare palpitations and is also   relieved by drinking water   Eyes Denies corrective   lenses, blurring, visual changes of any kind Gastrointestinal Abdominal   pain (see HPI) and Hx of GERD. Denies   N/V/D, constipation, appetite changes   Ears Denies   Ear pain, hearing loss, ringing in ears Genitourinary/Gynecological 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.    Nose/Mouth/Throat Denies   sinus problems, dysphagia, nose bleeds or discharge Musculoskeletal Denies   back pain, joint swelling, stiffness or pain   Breast Denies   SBE Neurological Denies syncope,   seizures, paralysis, weakness   Heme/Lymph/Endo Denies   bruising, night sweats, swollen glands Psychiatric Denies   depression, anxiety, sleeping difficulties   OBJECTIVE   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 Skin is   normal color for ethnicity, warm, dry, clean and intact. No rashes or lesions   noted.   HEENT Head is   norm cephalic, hair evenly distributed. Neck: Supple. Full ROM. Teeth are in   good repair.   Cardiovascular S1, S2   with regular rate and rhythm. No extra heart sounds.    Respiratory Symmetric   chest walls. Respirations regular and easy; lungs clear to auscultation   bilaterally.   Gastrointestinal Abdomen   flat; BS active in all 4 quadrants. Abdomen soft, suprapubic   tender. No hepatosplenomegaly.        Genitourinary Suprapubic   tenderness noted. Skin color normal   for ethnicity. Irritation noted at   labia majora, minora, and perineum. No ulcerated lesions noted. Lymph nodes   not palpable. Vagina pink and moist   without lesions. Discharge minimal,   thick, dark red, no odor. Cervix pink   without lesions. No CMT. Uterus normal size, shape, and consistency.     Musculoskeletal Full   ROM seen in all 4 extremities as patient moved about the exam room.   Neurological  Speech   clear. Good tone. Posture erect. Balance stable; gait normal.   Psychiatric Alert   and oriented. Dressed in clean clothes. Maintains eye contact. Answers   questions appropriately.   Lab Tests Urinalysis   – blood noted (pt. on menstrual period), but results negative for infection Urine   culture testing unavailable Wet   prep - inconclusive  STD   testing pending for gonorrhea, chlamydia, syphilis, HIV, HSV 1 & 2, Hep B   & C    Special Tests- No ordered at this   time.   Diagnosis    Differential Diagnoses 1-Bacterial Vaginosis (N76.0) 2- Malignant neoplasm of female genital organ,         unspecified. (C57.9) 3-Gonococcal infection, unspecified. (A54.9) Diagnosis o Urinary   tract infection, site not specified. (N39.0) Candidiasis of vulva and vagina.   (B37.3) secondary to presenting symptoms (Colgan & Williams, 2011) & (Hainer   & Gibson, 2011).    Plan/Therapeutics   Plan:   Medication –  § Terconazole cream 1 vaginal application QHS for 7 days for   Vulvovaginal Candidiasis;  § Sulfamethoxazole/TMP DS 1 tablet PO twice daily for 3 days   for UTI (Woo & Wynne, 2012) Education –  § Medications prescribed.  § UTI and Candidiasis symptoms, causes, risks, treatment,   prevention. Reasons to seek emergent care, including N/V, fever, or back   pain.  § STD risks and preventions.  § Ulcer prevention, including taking Protonix as prescribed,   not exceeding the recommended dose limit of NSAIDs, and not taking NSAIDs on   an empty stomach.  Follow-up         –  § Pt will be contacted with results of STD studies.  § Return to clinic when finished the period for perform   pap-smear or if symptoms do not resolve with prescribed TX.              References Colgan, R. & Williams, M. (2011). Diagnosis and Treatment of Acute Uncomplicated Cystitis. American Family Physician, 84(7), 771-776. Hainer, B. & Gibson, M. (2011). Vaginitis: Diagnosis and Treatment. American Family Physician, 83(7), 807-815.  Woo, T. M., & Wynne, A. L. (2012). Pharmacotherapeutics for Nurse Practitioner Prescribers (3rd ed.). Philadelphia, PA: F.A. Davis Company. 2 sample Sample Regular Soap Note Template.docx PATIENT INFORMATION Name: Mr. W.S. Age: 65-year-old Sex: Male Source: Patient Allergies: None Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime PMH: Hypercholesterolemia Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago. Surgical History: Appendectomy 47 years ago. Family History: Father- died 81 does not report information  Mother-alive, 88 years old, Diabetes Mellitus, HTN Daughter-alive, 34 years old, healthy Social Hx: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone. SUBJECTIVE: Chief complain: “headaches” that started two weeks ago Symptom analysis/HPI: The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness. He states that he has been under stress in his workplace for the last month. Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting. ROS: CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizzeness as describe above. Denies changes in LOC. Denies history of tremors or seizures.  HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing. Respiratory: Patient denies shortness of breath, cough or hemoptysis. Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal dyspnea. Gastrointestinal: Denies abdominal pain or discomfort. Denies flatulence, nausea, vomiting or diarrhea. Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence. MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound. Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus. Objective Data CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 0/10. General appearance: The patient is alert and oriented x 3. No acute distress noted. NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5. HEENT: Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,.Lids non-remarkable and appropriate for race. Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses. Cardiovascular: S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec. Respiratory: No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation. Gastrointestinal: No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no rebound no distention or organomegaly noted on palpation Musculoskeletal: No pain to palpation. Active and passive ROM within normal limits, no stiffness. Integumentary: intact, no lesions or rashes, no cyanosis or jaundice. Assessment  Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed. Differential diagnosis: Ø Renal artery stenosis (ICD10 I70.1) Ø Chronic kidney disease (ICD10 I12.9) Ø Hyperthyroidism (ICD10 E05.90) Plan Diagnosis is based on the clinical evaluation through history, physical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease. These basic laboratory tests are: · CMP · Complete blood count · Lipid profile · Thyroid-stimulating hormone · Urinalysis · Electrocardiogram Ø Pharmacological treatment:  The treatment of choice in this case would be: Thiazide-like diuretic and/or a CCB · Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily.  Ø Non-Pharmacologic treatment:  · Weight loss · Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat · Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults · Enhanced intake of dietary potassium · Regular physical activity (Aerobic): 90–150 min/wk · Tobacco cessation · Measures to release stress and effective coping mechanisms. Education · Provide with nutrition/dietary information. · Daily blood pressure monitoring at home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP · Instruction about medication intake compliance.  · Education of possible complications such as stroke, heart attack, and other problems. · Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all Follow-ups/Referrals · Evaluation with PCP in 1 weeks for managing blood pressure and to evaluate current hypotensive therapy. Urgent Care visit prn. · No referrals needed at this time. References Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017 (25th ed.). Print (The 5-Minute Consult Series). Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.). ISBN 978-0-8261-3424-0

Patient education is a significant responsibility for all nurses. A patient should be educated from the moment of admission to the date of discharge. There are always opportunities for nurses to teach patients and enforce teaching. According to Whitney, the first process of being health educator and teaching is patient assessment (2018). Patient assessment is necessary because each patient has different learning style, education level, values, and belief system. Nurses are also responsible to assess for any barriers in learning. Some of these barriers include culture, health disparities, environment, language, literary, and physiological barriers (Whitney, 2018). Patients need to be educated to make informed decisions, manage their health, prevent illness, and promote health. Nurses collaborate with an interdisciplinary team to develop a teaching plan tailored to a patient. Nurse educator may collaborate with an interdisciplinary team to develop a tailored individual care plan. It is important for nurses to find out what is important to their patient and what motivated them to make the teaching more effective (Smith & Zsohar, 2013). This will be different for every patient because each patient has a different motivator and readiness to learn. Nurses should utilize the teach back method to demonstrate effective teaching. When developing educational programs in health promotion it is important for nurses to focus on a specific target group that share the same values and goals. It is important to determine the literacy level and any other barriers to learning. Providing various resources such as video, written, and audio material is essential for teaching and evaluating the patient’s knowledge in teaching. Behavioral objectives should be utilized in a patient’s care plan when the patient is willing to learn and change. Before a nurse can utilize the behavioral objective, they need to determine the patient’s readiness to change and create on objective for the patient’s stage (Whitney, 2018). There are six stages of change. Nurses play a crucial role in patient education and are key players in improving patient health and wellness. References Smith, J. A., & Zsohar, H. (2013). Patient-education tips for new nurses. Nursing, 43(10), 1-3. doi:10.1097/01.nurse.0000434224.51627.8a Whitney, S. (2018). Teaching and Learning Styles. In Health Promotion: Health & Wellness Across the Continuum. Grand Canyon University. Respond to the above student's posting using 200 to 250 words APA format supporting with one or two references in discussions.

  This week, you will develop a PowerPoint presentation reviewing the theories from each module.  Please select one theory from each module (1-8) and answer the following questions. You should have two slides per theory: Describe the theory Provide 3 examples of how the theory applies to current practice Provide 3 positive patient outcomes resulting from utilizing the theory Explain 3 benefits to nursing satisfaction when utilizing the theory Describe two barriers to using the theory in practice and at least one method for overcoming each barrier (support methods with sources) Support from literature clearly noted throughout The PowerPoint presentation should include at least two outside references and the textbook. The presentation should contain 2 to 4 slides per theory, for a total of 16 to 32 slides. Total Point Value of Assignment: 500 points

Familial Health Traditions Instructions:  Conduct an interview with an older family member. Summarize your findings regarding familial and social changes, and your ethnocultural and religiousheritage. (Include one example) Your paper should be: One (1) page Typed according to APA style for margins, formating and spacing standards 

Example: PATIENT INFORMATION Name: Mr. W.S. Age: 65-year-old Sex: Male Source: Patient Allergies: None Current Medications: Atorvastatin tab 20 mg, 1-tab PO at bedtime PMH: Hypercholesterolemia Immunizations: Influenza last 2018-year, tetanus, and hepatitis A and B 4 years ago. Surgical History: Appendectomy 47 years ago. Family History: Father- died 81 does not report information   Mother-alive, 88 years old, Diabetes Mellitus, HTN  Daughter-alive, 34 years old, healthy Social Hx: No smoking history or illicit drug use, occasional alcoholic beverage consumption on social celebrations. Retired, widow, he lives alone. SUBJECTIVE: Chief complain: “headaches” that started two weeks ago Symptom analysis/HPI: The patient is 65 years old male who complaining of episodes of headaches and on 3 different occasions blood pressure was measured, which was high (159/100, 158/98 and 160/100 respectively). Patient noticed the problem started two weeks ago and sometimes it is accompanied by dizziness.He states that he has been under stress in his workplace for the last month. Patient denies chest pain, palpitation, shortness of breath, nausea or vomiting. ROS: CONSTITUTIONAL: Denies fever or chills. Denies weakness or weight loss. NEUROLOGIC: Headache and dizzeness as describe above. Denies changes in LOC. Denies history of tremors or seizures.  HEENT: HEAD: Denies any head injury, or change in LOC. Eyes: Denies any changes in vision, diplopia or blurred vision. Ear: Denies pain in the ears. Denies loss of hearing or drainage. Nose: Denies nasal drainage, congestion. THROAT: Denies throat or neck pain, hoarseness, difficulty swallowing. Respiratory:Patient denies shortness of breath, cough or hemoptysis. Cardiovascular: No chest pain, tachycardia. No orthopnea or paroxysmal nocturnal dyspnea. Gastrointestinal:Denies abdominal pain or discomfort.Denies flatulence, nausea, vomiting or diarrhea. Genitourinary: Denies hematuria, dysuria or change in urinary frequency. Denies difficulty starting/stopping stream of urine or incontinence. MUSCULOSKELETAL: Denies falls or pain. Denies hearing a clicking or snapping sound. Skin: No change of coloration such as cyanosis or jaundice, no rashes or pruritus. Objective Data CONSTITUTIONAL: Vital signs: Temperature: 98.5 °F, Pulse: 87, BP: 159/92 mmhg, RR 20, PO2-98% on room air, Ht- 6’4”, Wt 200 lb, BMI 25. Report pain 0/10. General appearance: The patient is alert and oriented x 3. No acute distress noted.NEUROLOGIC: Alert, CNII-XII grossly intact, oriented to person, place, and time. Sensation intact to bilateral upper and lower extremities. Bilateral UE/LE strength 5/5. HEENT:Head: Normocephalic, atraumatic, symmetric, non-tender. Maxillary sinuses no tenderness. Eyes: No conjunctival injection, no icterus, visual acuity and extraocular eye movements intact. No nystagmus noted. Ears: Bilateral canals patent without erythema, edema, or exudate. Bilateral tympanic membranes intact, pearly gray with sharp cone of light. Maxillary sinuses no tenderness. Nasal mucosa moist without bleeding. Oral mucosa moist without lesions,.Lids non-remarkable and appropriate for race. Neck: supple without cervical lymphadenopathy, no jugular vein distention, no thyroid swelling or masses. Cardiovascular:S1S2, regular rate and rhythm, no murmur or gallop noted. Capillary refill < 2 sec. Respiratory:No dyspnea or use of accessory muscles observed. No egophony, whispered pectoriloquy or tactile fremitus on palpation. Breath sounds presents and clear bilaterally on auscultation. Gastrointestinal:No mass or hernia observed. Upon auscultation, bowel sounds present in all four quadrants, no bruits over renal and aorta arteries. Abdomen soft non-tender, no guarding, no reboundno distention or organomegaly noted on palpation Musculoskeletal:No pain to palpation. Active and passive ROM within normal limits, no stiffness. Integumentary:intact, no lesions or rashes, no cyanosis or jaundice. Assessment Essential (Primary) Hypertension (ICD10 I10): Given the symptoms and high blood pressure (156/92 mmhg), classified as stage 2. Once the organic cause of hypertension has been ruled out, such as renal, adrenal or thyroid, this diagnosis is confirmed. Differential diagnosis: Ø Renal artery stenosis(ICD10 I70.1) Ø Chronic kidney disease(ICD10 I12.9) Ø Hyperthyroidism (ICD10 E05.90) Plan Diagnosis is based on the clinical evaluation through history, physical examination, and routine laboratory tests to assess risk factors, reveal identifiable causes and detect target-organ damage, including evidence of cardiovascular disease. These basic laboratory tests are: · CMP · Complete blood count · Lipid profile · Thyroid-stimulating hormone · Urinalysis · Electrocardiogram Ø Pharmacological treatment:  The treatment of choice in this case would be: Thiazide-like diuretic and/or a CCB · Hydrochlorothiazide tab 25 mg, Initial dose: 25 mg orally once daily.    Ø Non-Pharmacologic treatment:   · Weight loss · Healthy diet (DASH dietary pattern): Diet rich in fruits, vegetables, whole grains, and low-fat dairy products with reduced content of saturated and trans l fat · Reduced intake of dietary sodium: <1,500 mg/d is optimal goal but at least 1,000 mg/d reduction in most adults · Enhanced intake of dietary potassium · Regular physical activity (Aerobic): 90–150 min/wk · Tobacco cessation · Measures to release stress and effective coping mechanisms. Education · Provide with nutrition/dietary information. · Daily blood pressure monitoring at home twice a day for 7 days, keep a record, bring the record on the next visit with her PCP · Instruction about medication intake compliance.  · Education of possible complications such as stroke, heart attack, and other problems. · Patient was educated on course of hypertension, as well as warning signs and symptoms, which could indicate the need to attend the E.R/U.C. Answered all pt. questions/concerns. Pt verbalizes understanding to all Follow-ups/Referrals · Evaluation with PCP in 1 weeks for managing blood pressure and to evaluate current hypotensive therapy. Urgent Care visit prn. · No referrals needed at this time. References Domino, F., Baldor, R., Golding, J., Stephens, M. (2017). The 5-Minute Clinical Consult 2017 (25th ed.). Print (The 5-Minute Consult Series). Codina Leik, M. T. (2014). Family Nurse Practitioner Certification Intensive Review (2nd ed.). ISBN 978-0-8261-3424-0

Primary Response: Within the Discussion Board area, write 300–500 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas. For this Discussion Board, please complete the following: The SWOT analysis is often used to help managers understand the competitive advantage of their organization. It can also help them to make decisions to support the organization’s mission and vision in an ethical manner and help with strategic planning. Watch the video: Putting Your SWOT to Use which will provide you with what you need to know about SWOT and making it work for your organization’s strategic planning. Review the abbreviated version of the Starbucks 2020 SWOT Analysis. Considering the video and the Starbucks 2020 SWOT Analysis, answer the following questions: Opportunities are to be prioritized in your strategic plan. How would you recommend that Starbucks prioritize Ready to Drink (RTD) coffee products in the U.S.? Weaknesses are important and need to be acted on quickly. What would be your first step to act on Starbucks expanding outside the U.S.? Why do you think this would work? Threats need to be watched and monitored. Explain how you would plan to monitor weather disasters that could drive up the price of coffee beans?