Parts 1 and 2   have the same questions. However, you must answer with references and different writing, always addressing them objectively, as if you were different students. Similar responses in wording or references will not be accepted. 

APA format

1) Minimum 13 pages  (No word count per page)-   Follow the 3 x 3 rule: minimum of three paragraphs per page 

You must strictly comply with the number of paragraphs requested per page.  

The number of words in each paragraph should be similar

         Part 1: minimum 2 pages (24 hours)

         Part 2: minimum 2 pages (24 hours)

         Part 3: minimum 2 pages (24 hours)

         Part 4: minimum 7 pages (48 hours)

Submit 1 document per part

2)¨******APA norms

        The number of words in each paragraph should be similar

        Must be written in the 3 person

         All paragraphs must be narrative and cited in the text- each paragraph

         The writing must be coherent, using connectors or conjunctive to extend, add information, or contrast information. 

         Bulleted responses are not accepted

         Don’t write in the first person 

         Do not use subtitles or titles      

         Don’t copy and paste the questions.

         Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

Submit 1 document per part

3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks) 

********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)

4) Minimum 6 references (APA format) per part not older than 5 years  (Journals, books) (No websites)

All references must be consistent with the topic-purpose-focus of the parts. Different references are not allowed 

5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next

 Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

Q3. Research is…………………………………………………. (a) The relationship between……… (b) EBI has to

6) You must name the files according to the part you are answering: 

Example:

Part 1.doc 

Part 2.doc

__________________________________________________________________________________

Parts 1 and 2  have the same questions. However, you must answer with references and different writing, always addressing them objectively, as if you were different students. Similar responses in wording or references will not be accepted. 

The number of words in each paragraph should be similar

Part 1:  Advanced Primary Care of Family

Topic: Respiratory case

SUBJECTIVE:

Janis, a 59 – year – old female, presents with tachypnea, dyspnea on exertion, and mild chest discomfort. She was diagnosed with emphysema four years ago and was placed on bronchodilator therapy. She has an 80-pack-year history of smoking. “ I feel short of breath when I walk, and my chest is sore. ” She describes her chest soreness as mild pressure, rated as two on a 1 – 10 scale. The pain is over the anterior thorax, more pronounced in the ribs, which she believes has developed from coughing hard. She states that she has had a nonproductive cough for four days and feels more fatigued than usual.

Past medical history

She has osteoarthritis in the hands and knees. She has a surgical history of appendectomy and cholecystectomy. In the past year, she has had two exacerbations of her COPD and has attempted to stop smoking, using nicotine gum replacement unsuccessfully.

Family history

Noncontributory.

Social history

She lives with her husband, who also smokes two packs of cigarettes per day and cares for her elderly mother, who lives with them and is frail but ambulatory.

Medications

Albuterol MDI, 90 mcg/inhalation, two puffs as needed every 4 – 6 hours; ipratropium bromide MDI, 18 mcg/inhalation, two puffs four times/day; ibuprofen as needed for arthritic pain.

Allergies

Janis is allergic to Keflex and penicillin.

OBJECTIVE:

General: Janis is dyspneic at rest, sitting. The use of accessory muscles is evident. Pursed lip breathing noted.

Vital signs: BP: 122/64; P: 92; R: 26; T: 100.2; SpO2: 88. AP to transverse ratio is 1:1.

Skin: Warm and dry.

HEENT: Negative.

Cardiovascular: RRR: S1/S2; no murmurs, clips, rubs, or gallops. No evidence of peripheral edema. Posterior tibial and dorsalis pedis pulses 2 + /4 + .

Respiratory: Lungs have diffused wheezing and crackles in the right upper lobe. Tenderness to palpation along intercostal spaces on the right and left anterior and lateral thorax from the 2nd to 5th intercostal spaces. PFT conducted two months prior to the visit showed obstructive flow patterns and reduced FEV1/FVC.

Abdomen: Soft, with bowel sounds; tympanic to percussion.

Neurologic: Negative.

Based on the described case scenario, please answer two of the following questions:

1. Which diagnostic or imaging studies should be considered to assist with or confirm the diagnosis? (one paragraph)

a. Explain  (one paragraph) 

2. What is the most likely differential diagnosis, and why? (one paragraph)

a. Explain

3. What is your plan of treatment? (one paragraph)

a. Pharmacology

b. Nonpharmacology

4. What is your plan for follow-up care? also, include (one paragraph)

a. Are any referrals needed?

a. Explain and justify

5. What are additional risk factors evident for this patient? (one paragraph)

6. Explain two standardized guidelines that you should use to treat this patient (one paragraph)

Part 2:  Advanced Primary Care of Family

Topic: Respiratory case

SUBJECTIVE:

Janis, a 59 – year – old female, presents with tachypnea, dyspnea on exertion, and mild chest discomfort. She was diagnosed with emphysema four years ago and was placed on bronchodilator therapy. She has an 80-pack-year history of smoking. “ I feel short of breath when I walk, and my chest is sore. ” She describes her chest soreness as mild pressure, rated as two on a 1 – 10 scale. The pain is over the anterior thorax, more pronounced in the ribs, which she believes has developed from coughing hard. She states that she has had a nonproductive cough for four days and feels more fatigued than usual.

Past medical history

She has osteoarthritis in the hands and knees. She has a surgical history of appendectomy and cholecystectomy. In the past year, she has had two exacerbations of her COPD and has attempted to stop smoking, using nicotine gum replacement unsuccessfully.

Family history

Noncontributory.

Social history

She lives with her husband, who also smokes two packs of cigarettes per day and cares for her elderly mother, who lives with them and is frail but ambulatory.

Medications

Albuterol MDI, 90 mcg/inhalation, two puffs as needed every 4 – 6 hours; ipratropium bromide MDI, 18 mcg/inhalation, two puffs four times/day; ibuprofen as needed for arthritic pain.

Allergies

Janis is allergic to Keflex and penicillin.

OBJECTIVE:

General: Janis is dyspneic at rest, sitting. The use of accessory muscles is evident. Pursed lip breathing noted.

Vital signs: BP: 122/64; P: 92; R: 26; T: 100.2; SpO2: 88. AP to transverse ratio is 1:1.

Skin: Warm and dry.

HEENT: Negative.

Cardiovascular: RRR: S1/S2; no murmurs, clips, rubs, or gallops. No evidence of peripheral edema. Posterior tibial and dorsalis pedis pulses 2 + /4 + .

Respiratory: Lungs have diffused wheezing and crackles in the right upper lobe. Tenderness to palpation along intercostal spaces on the right and left anterior and lateral thorax from the 2nd to 5th intercostal spaces. PFT conducted two months prior to the visit showed obstructive flow patterns and reduced FEV1/FVC.

Abdomen: Soft, with bowel sounds; tympanic to percussion.

Neurologic: Negative.

Based on the described case scenario, please answer two of the following questions:

1. Which diagnostic or imaging studies should be considered to assist with or confirm the diagnosis? (one paragraph)

a. Explain  (one paragraph) 

2. What is the most likely differential diagnosis, and why? (one paragraph)

a. Explain

3. What is your plan of treatment? (one paragraph)

a. Pharmacology

b. Nonpharmacology

4. What is your plan for follow-up care? also, include (one paragraph)

a. Are any referrals needed?

b. Explain

5. What are additional risk factors evident for this patient? (one paragraph)

6. Explain two standardized guidelines that you should use to treat this patient (one paragraph)

 

 Part 3: Complementary and Alternative Health Care

1. What is Complementary and alternative medicine (CAM) (One paragraph)

2. How  Complementary and alternative medicine (CAM) and nursing links (One paragraph)

3. How nurses can incorporate alternative medicine into a holistic approach to patient care (One paragraph)

4. Explain the benefits for the patient when nurses incorporate alternative medicine into a holistic approach to patient care (One paragraph)

5. Explain how holism and humanism improve the nurse’s patient care (One paragraph)

6. Explain the benefits for the patient when they get holism and humanism care from nurses (One paragraph)

 Part 4: Crisis Intervention

Topic: Posttraumatic Stress Disorder

1. Introduction (One paragraph)

2. What is PTSD ? (One paragraph)

3. Explain the statistics data in the last 5 years of PTSD (Three paragraphs)

a. Global (One paragraph)

b. The USA (One paragraph)

c. Florida (One paragraph)

4. According to (ONLY) to DSM5 explain PTSD  (Two paragraphs)

a. Diagnostic criteria (One paragraph)

b. Categorization (One paragraph)

5. Explain the physiological responses of PTSD   (Two paragraphs)

6. Explain the maladaptive patterns of PTSD  (Two paragraphs)

7. Interventions / Treatments  (Two paragraphs)

a. Pharmacological (One paragraph)

b. Non-pharmacological (One paragraph)

8. Explain other considerations in the management of PTSD  (Three paragraphs)

a. Management of behaviors (One paragraph)

b. Family considerations (One paragraph)

c. Challenges in the care of patients with this disorder (One paragraph)

9. Explain one evidence-based practice guidelines/research for nurses for the management of PTSD patient (One paragraph)

10. Explain one nursing theory that support the identification of clinical problems of PTSD patient (One paragraph)

11. Explain the important of implementation and imporve of nursing skills in the care of adults with this disorder.  (Two paragraphs)

a. Which nursing skills are vitals (One paragraph)

b. Which nursing skills are secundaries (One paragraph)

12. Conclusion for nurses (One paragraph)