MN553 Unit 4 Assignment Case Study

Your patient is a 23-year-old female. She presents with coughing and wheezing which she stated started about three weeks ago. She is currently 25 weeks pregnant. Her last prenatal visit was one month ago in another state. She has an appointment with the prenatal care provider next week, however her respiratory symptoms brought her to your office today.

History – Chickenpox as a child. Asthma as a child, diagnosed at age 8 for which she used a SABA when needed. She has not had the need to use an inhaler since she was 19. She takes only her prenatal vitamin. No other acute or chronic problems. She advises you that she is up to date on all immunizations except she has not had a flu shot (it is October).
Social – Non-smoker, no drug use. She relocated to your state two weeks ago to get away from an abusive domestic situation. She has no support network in this area and has not yet found employment. She has no medical insurance.

HPA – Non-productive cough x 3 weeks. Wheezing audible from across the room. She states it is like this all day and wakes her from sleep every night. She reports that she is fatigued even in the morning. No other complaints.

PE/ROS – Pt appears disheveled but clean. Wheezing in all lung fields. T 98, P 82 regular, R 28 no stridor. FH 130 regular. The remainder of the exam is WNL.

02 98% and FEV 70%

Directions:

Construct a narrative document of 4-5 pages (not including cover page or reference page)
Diagnose the patient based on the above findings and provide your rationale for how you arrived at the diagnosis.
Develop a treatment plan specifically for this patient, pharmacologic and non-pharmacologic.
Describe community resources (using your own community) currently available in your state/city to support this patient.
Provide a communication plan that you will use to ensure the patient is an active participant in the treatment plan. Refer to therapeutic communication concepts.
Utilize national standards, your pharm and/or patho book, and medical or advanced practice professional sources. Do not use patient-facing sources or general nursing texts.
Use references to support your concepts. Utilize correct APA formatting (7th edition) and mechanics of professional communication.

Rubric Title: MN553 Unit 4 Assignment Rubric

Assignment Criteria	Level III	Level II	Level I	Not Present
Criteria 1	Level III Max Points Points: 10	Level II Max Points Points: 8	Level I Max Points Points: 6	Not Present 0 Points
Diagnosing the patient	An accurate diagnosis with correct staging is providedRationale for arrival at the diagnosis with support from national guidelines is provided	An accurate diagnosis is provided with staging that may not be correctRationale for the diagnosis is provided without support	An accurate diagnosis is provided with staging that may not be correctRationale for the diagnosis is provided without support	Does not meet the criteria
Criteria 2	Level III Max Points Points: 10	Level II Max Points Points: 8	Level I Max Points Points: 6	Not Present 0 Points
Providing pharmacologic intervention	Correct medications are prescribed to treat the diagnosisRational for medications prescribed adheres to national guidelines	50% of correct medications are prescribedRational to support prescribed medications is provided and adheres to national guidelines	Less than 50% of the correct medications are prescribedRational to support the prescribed medications is not present or does not adhere to national guidelines	Does not meet the criteria
Criteria 3	Level III Max Points Points: 5	Level II Max Points Points:	Level I Max Points Points:	Not Present 0 Points
Providing non-pharmacologic interventions	Five or more non-pharmacologic interventions are provided	Three or four non-pharmacologic interventions are noted	One or two non-pharmacologic interventions	Does not meet the criteria
Criteria 4	Level III Max Points Points: 10	Level II Max Points Points: 7	Level I Max Points Points: 0	Not Present 0 Points
Writing a communication plan	A communication plan which includes principles of therapeutic communication is developed	A communication plan that does not include principles of therapeutic communication is developed	Does not meet the criteria	Does not meet the criteria
Criteria 5	Level III Max Points Points: 10	Level II Max Points Points: 7	Level I Max Points Points: 4	Not Present 0 Points
Community Resources	Three or more local community resources are provided	Two local community resources are provided	One local community resource is provided or:Resources are provided but they are not local to the community	Does not meet the criteria
Criteria 6	Level III Max Points Points: 10	Level II Max Points Points: 8	Level I Max Points Points: 6	Not Present 0 Points
College-level academic writing	Professional, peer-reviewed, advanced practice references are usedGrammar and mechanics of writing demonstrate graduate level workAdheres to page number requirements	The majority of references used are professional, peer-reviewed and advanced practiceErrors in grammar or mechanics of writing are present but do not interfere with readabilityAdheres to page number requirements	The majority of references used are professional, peer-reviewed and advanced practiceErrors in grammar or mechanics of writing are present but do not interfere with readabilityDoes not adhere to page number requirements	Does not meet the criteria
Maximum Total Points	55	44	33	0
Minimum Total Points	45 points minimum	34 points minimum	1 point minimum	0

MN5633 Assignment Mild Chronic Asthma Sample Solution

Healthcare providers face various challenges in diagnosing patients who come with different problems in the hospital. Nurses must perform a comprehensive assessment entailing detailed health history and physical examination for a definitive diagnosis. Some conditions have similar characteristics hence the need for careful review and consideration of differential diagnosis. More so, each disease has specific management depending on the cause and severity. Healthcare providers leverage both pharmacologic and non-pharmacologic treatment methods for better patient outcomes. This essay analyzes pharmacological and non-pharmacologic asthma management and community resources.

Wheezing is a persistent coarse whistling sound produced by the narrowed upper airways. It results from inflammation in the trachea or bronchi caused by allergic reactions, infections, or physical obstructions (such as a tumor or foreign body) of the larger upper airways. A diagnosis causing wheezing must thus be from an infectious or allergic cause causing swelling or narrowing of the upper airway. The patient reports a non-productive cough. Other symptoms such as sputum, a runny nose, malaise, and body ache associated with upper respiratory infections are absent. Barnes (2018) state that asthma and chronic obstructive pulmonary disease are the primary cause of recurrent wheezing. However, signs of inflammation are missing, thus ruling out infection.

The patient has a history of asthma diagnosed in childhood. She stopped taking her medications at 19. According to existing evidence, asthma relapses are common even after defeating at around 18. The major risk factors are weakened immunity (pregnancy or missed flu vaccination), traveling, and exposure to precipitating/ causative factors (Trivedi & Denton, 2019). The asthma signs and symptoms have been on and off since childhood, and this incident is a relapse. For this patient, the diagnosis is chronic mild intermittent asthma- an upper respiratory condition that causes narrowing of the airway, wheezing, disturbed sleep due to changes in breathing patterns, and fatigue associated with labored breathing (Stern et al., 2020).

Treatment Plan

Asthma is a chronic illness without a definitive cure. Although individuals, especially children, exhibit symptoms, the disease often relapses later in life. The nursing and medical management of asthma are symptomatic. Eliminating the causative agents can also help in managing asthma. The Global Initiative for Asthma (GINA) is the global strategy responsible for preventing and managing asthma. GINA works with public health officers and other professionals to reduce the global prevalence, morbidity, and mortality. It states that asthma management strategies aim at symptom control and risk reduction in asthma. These strategies also help prevent asthma exacerbation, mortality, and medication side effects (GINA, 2019). Asthma management also entails patient goals and initiatives. Management in pregnancy also entails cushioning the baby against asthma and its medications side effects. Asthma management entails pharmacologic and non-pharmacologic interventions.

Pharmacological treatment is low-dose regular ICS-Formoterol (maintenance and reliever). ICS-budesonide formoterol, SABA, or an inhaler with both ICS and SABA are optional asthma management therapies (GINA, 2019). According to Robijn et al. (2019), ICS-containing drugs have low risks for severe exacerbations such as status asthmaticus. GINA 2019 strategy changes remove SABA as a daily treatment because the drug has a high relapse rate. It will also help reduce reliance that develops when patients take SABA from the early development of the disease. Treatment in pregnancy increases intensity and aggressiveness, and asthma control surpasses any potential drug risk (Robijn et al., 2019). The absence of an ICS-formoterol calls for a SABA inhaler to prevent worsening of the symptoms. According to GINA, a low-dose maintenance therapy (200-500mcg) is integral.

There are various non-pharmacologic modalities for managing asthma. These methods are often underappreciated and include pulmonary rehabilitation, and focused breathing techniques (yoga and breath retraining) are the choice of non-pharmacologic interventions for this patient (Tan et al., 2020). Other interventions include vitamin B and C supplements, determining and avoiding allergens/ asthma triggers, and keeping warm. Pulmonary rehabilitation entails an exercise program that focuses on exercising to train the lung alveoli to open up adequately to support breathing. Exercises force open closed alveoli and promote bronchodilation, improving the integrity of the respiratory effort. It also reduces respiratory effort. It is also important to assess for occupation-related asthma exacerbation and advise on risk reduction.

Communication Plan

Therapeutic patient communication is integral when handling the patient. It begins with understanding relevant patient data and creating a rapport and ends with making mutual goals and objectives. The communication plan will also include retraining in inhaler use. Establishing adherence is integral and entails pointing out the importance of adherence and the consequences of non-adherence to the drugs (GINA, 2019). Teaching about the side effects that are mild and self-limiting such as agitation and muscle and leg cramps, is equally crucial. Keeping warm is integral because cold exposure is a leading cause of asthma attacks. Wearing warm clothes and dressing according to the weather will help reduce exacerbations. GINA requires pregnant women with asthma exacerbation to attend a follow-up clinic after one week; hence booking a clinic after one week with the patient will be integral (GINA, 2019). A review every 3-4 weeks will also be necessary for this pregnant woman. It is vital to make the woman understand that she can come back to the clinic at any time if the symptoms persist.

Community Resources

The Asthma and Allergy Foundation of America (AAFA) Support Community connects patients, families, and caregivers (Cassalia, 2018). The community is an excellent online resource that allows families to interact with their care providers, discuss and consult on asthma problems, and garner support for all individuals. The community resource is available in all states because it is an online platform. The organization also works with local support groups in managing asthma. The community resource majorly works to identify gaps in asthma management and support the passage of laws that positively impact asthma patients and their families. It also focuses on drug availability and costs and new research on better patient management. The resource will help patients access other support groups that meet their specific needs depending on their differences. Other community resources include the asthma community network, online asthma community, Airnow, and Burnwise organizations, which are resources that target asthma risks and help individuals avoid them hence managing asthma.

Conclusion

Patient management requires proper physical assessment and history taking. Asthma is a chronic illness that causes narrowing of the upper airway hence wheezing, fatigue, and disturbed sleep patterns. Asthma is common in childhood, and individuals can acquire remission, but relapse is common, especially with SABA use. The global initiative for asthma is responsible for asthma management and recommends ICS-containing medications as a reliever and maintenance therapy. SABA is avoided due to its risk for relapse. Non-pharmacologic management interventions such as pulmonary rehabilitation are also integral in managing asthma symptoms. Healthcare providers can refer patients to community resources such as AAFA for further management and social support.

References

Barnes, P. J. (2018). Targeting cytokines to treat asthma and chronic obstructive pulmonary disease. Nature Reviews Immunology, 18(7), 454-466. https://doi.org/10.1038/s41577-018-0006-6

Beasley, R., Braithwaite, I., Semprini, A., Kearns, C., Weatherall, M., Harrison, T. W., … & Pavord, I. D. (2020). ICS-formoterol reliever therapy stepwise treatment algorithm for adult asthma. European Respiratory Journal, 55(1). https://doi.org/10.1183/13993003.01407-2019

Cassalia, M. (2018). AAFA and Allergy Standards Host Allergy Summit to Elevate Industry and Consumer Perspectives to Improve Products for Allergy Aware. Retrieved from https://www.globenewswire.com/news-release/2018/11/01/1640881/0/en/AAFA-and-Allergy-Standards-Host-Allergy-Summit-to-Elevate-Industry-and-Consumer-Perspectives-to-Improve-Products-for-Allergy-Aware-Consumers.html

Global Initiative for Asthma (GINA), (2019). A Pocket Guide for Asthma Management and Prevention (for adults and children above five years). Retrieved from https://ginasthma.org/wp-content/uploads/2019/04/GINA-2019-main-Pocket-Guide-wms.pdf

Robijn, A. L., Murphy, V. E., & Gibson, P. G. (2019). Recent developments in asthma in pregnancy. Current Opinion In Pulmonary Medicine, 25(1), 11-17. https://doi.org/10.1097/MCP.0000000000000538

Stern, J., Pier, J., & Litonjua, A. A. (2020, February). Asthma epidemiology and risk factors. In Seminars in Immunopathology (Vol. 42, No. 1, pp. 5-15). Springer Berlin Heidelberg. https://doi.org/10.1007/s00281-020-00785-1

Tan, D. J., Burgess, J. A., Perret, J. L., Bui, D. S., Abramson, M. J., Dharmage, S. C., & Walters, E. H. (2020). Non-pharmacological management of adult asthma in Australia: a cross-sectional analysis of a population-based cohort study. Journal of Asthma, 57(1), 105-112. https://doi.org/10.1080/02770903.2018.1545030

Trivedi, M., & Denton, E. (2019). Asthma in children and adults—what are the differences, and what can they tell us about asthma?. Frontiers in Pediatrics, 7, 256. https://doi.org/10.3389/fped.2019.00256

MN553 Unit 3 Assignment

Part 1

Choose a drug that is used for the GI system. Write a legal prescription for the drug for a fictitious patient. You are the provider. Be sure your prescription includes all legally correct patient information, provider information, medication information as well as any special instructions to the pharmacist. Your writing Assignment should include all the legal elements of a prescription.

Part 2

Write a 250-300 word paper to describe the pharmacokinetics and pharmacodynamics of the drug as well as specific patient education about the chosen drug. Reference your work using correct APA formatting. Utilize correct professional writing including grammar, punctuation, and mechanics. Directions

Rubric Title: MN553 Unit 3 Assignment Rubric

Assignment Criteria	Level III	Level II	Level I	Not Present
Criteria 1	Level III Max Points Points:10	Level II Max Points Points: 8	Level I Max Points Points: 6	Not Present 0 Points
Part 1 –Patient/provider information	All legally required patient and provider information is provided	More than 50% of patient or provider information is provided	Less than 50% of provider or patient information is provided	Does not meet the criteria
Criteria 2	Level III Max Points Points:10	Level II Max Points Points: 8	Level I Max Points Points: 6	Not Present 0 Points
Part 1 – Legal attributes of a written prescription for medication	All required information to prescribe a drug is present	More than 50% of the information necessary to prescribe a drug is present	Less than 50% of the information necessary to prescribe a drug is present	Does not meet the criteria
Criteria 3	Level III Max Points Points: 10	Level II Max Points Points: 8	Level I Max Points Points: 6	Not Present 0 Points
Part 2 –drug kinetics, dynamics and education for a chosen medication	Displays complete understanding of the kinetics, dynamics and education of the chosen drug	More than 50% of the kinetic, dynamics and education information is present	Less than 50% of the kinetic, dynamics and education information is provided	Does not meet the criteria
Criteria 4	Level III Max Points Points: 5	Level II Max Points Points: 4	Level I Max Points Points: 3	Not Present 0 Points
College-level academic writing	Professional, peer-reviewed, advanced practice references are usedGrammar and mechanics of writing demonstrate graduate level work	The majority of references used are professional, peer-reviewed and advanced practice focusedErrors in grammar or mechanics of writing are present but do not interfere with readability	The minority of references are peer-reviewed or advanced practice focusedErrors in grammar or mechanics of writing interfere with readability.	Does not meet the criteria
Criteria 5	Level III Max Points Points: 5	Level II Max Points Points: 4	Level I Max Points Points: 3	Not Present 0 Points
Citations and Formatting	There is a strong attempt to cite all sources using APA style. Minor paper formatting errors may occur. Minor in-text citation errors may occur. All authorship is clear and retrievable.	There is an overall attempt at APA formatting and citation style. Errors in formatting of citation or sources are present. All sources have some form of citation and all citations have a matching source. Citations generally make authorship clear.	There is some attempt to use citation and referencing. There are both in-text citations and reference listings present. Major errors in citations or source formatting are present.Citation or source information may be missing or incorrect. Authorship may be unclear.	Does not meet criteria
Maximum Total Points	40	32	24	0
Minimum Total Points	33 points minimum	25 points minimum	1 point minimum	0

MN553 Unit 6 Assignment Case Study

Mr. Smith brings his 4-year-old son to your primary care office. He states the boy has been ill for three days. Mr. Smith indicates that he would like antibiotics so he can send his son back to pre-school the next day.

History – Child began with sneezing, mild cough, and low grade fever of 100 degrees three days ago. All immunizations UTD. Father reports that the child has had only two incidents of URI and no other illnesses.

Social – non-smoking household. Child attends preschool four mornings a week and is insured through his father’s employment. No other siblings in the household.

PE/ROS -T 99, R 20, P 100. Alert, cooperative, in good spirits, well-hydrated. Mildly erythemic throat, no exudate, tonsils +2. Both ears mild pink tympanic membrane with good movement. Lungs clear bilaterally. All other systems WNL.

Do not consider COVID-19 for this patient diagnosis.

For the assignment, do the following:

Diagnose the child and describe how you arrived at the diagnosis (i.e. how you ruled out other diagnoses).
Provide a specific treatment plan for this patient, pharmacologic and/or nonpharmacologic.
Provide a communication plan for how the family will be involved in the treatment plan.
Provide resources that Mr. Smith could access which would provide information concerning your treatment decisions.
Utilize national standards, your pharm and/or patho book and medical or advanced practice professional sources. Do not use patient-facing sources or general nursing texts to support your diagnosis and treatment.
Use references to support your concepts. Utilize correct APA formatting and mechanics of professional communication.

Rubric Title: MN553 Unit 6 Assignment Rubric

Unit 6 Assignment Criteria	Level III	Level II	Level I	Not Present
Criteria 1	Level III Max Points Points: 8	Level II Max Points Points: 6.4	Level I Max Points Points: 4.8	Not Present 0 Points
Making a correct diagnosis	An accurate diagnosis is providedRationale for arrival at the diagnosis with support from literature	An accurate diagnosis is providedRationale for the diagnosis is provided without support from literature	An accurate diagnosis is provided Rationale for the diagnosis is not provided	Does not meet the criteria
Criteria 2	Level III Max Points Points: 12	Level II Max Points Points: 9.6	Level I Max Points Points: 7.2	Not Present 0 Points
Developing a treatment plan	A correct and specific pharmacologic and non-pharmacologic treatment plan for the case study patient is provided	A specific treatment plan is provided for the case study patient but is missing less than 50% of pharmacologic and non-pharmacologic treatment.	A specific treatment plan is provided for the case study patient but is missing more than 50% of pharmacologic and non-pharmacologic treatment.	Does not meet the criteria
Criteria 3	Level III Max Points Points: 8	Level II Max Points Points: 6.4	Level I Max Points Points: 4.8	Not Present 0 Points
Providing the patient or family with resources	Three or more patient resources to assist with understanding the treatment plan are provided	Two patient resources to assist with understanding the treatment plan are provided	One patient resource to assist with understanding the treatment plan is provided	Does not meet the criteria
Criteria 4	Level III Max Points Points: 7	Level II Max Points Points: 5.6	Level I Max Points Points: 4.2	Not Present 0 Points
Developing a communication plan	A communication plan which includes principles of therapeutic communication is included	A communication plan that does not include principles of therapeutic communication is provided	Does not meet the criteria	Does not meet the criteria
Criteria 5	Level III Max Points Points: 10	Level II Max Points Points: 8	Level I Max Points Points: 6	Not Present 0 Points
College-level academic writing	Professional, peer-reviewed, advanced practice references are usedGrammar and mechanics of writing demonstrate graduate level workAdheres to page number requirements	The majority of references used are professional, peer-reviewed and advanced practiceErrors in grammar or mechanics of writing are present but do not interfere with readabilityAdhere to page number requirements	The minority of references used are professional, peer-reviewed and advanced practiceErrors in grammar or mechanics of writing are present Which interferes with readabilityDoes not adhere to page number requirements	Does not meet the criteria
Criteria 6	Level III Max Points Points: 10	Level II Max Points Points: 8	Level I Max Points Points: 6	Not Present 0 Points
Citations and Formatting	Includes a strong attempt to cite all sources using APA style. Minor paper formatting errors may occur. Minor in-text citation errors may occur. All authorship is clear and retrievable.	Includes an overall attempt at APA formatting and citation style. Errors in formatting of citation or sources are present. All sources have some form of citation and all citations have a matching source. Citations generally make authorship clear.	Major errors in citations or source formatting are present. Citation or source information may be missing or incorrect.Authorship may be unclear.	Does not meet the criteria
Maximum Total Points	55	44	33	0
Minimum Total Points	45 points minimum	34 points minimum	1 point minimum	0

Unit 6 Upper Respiratory Tract Infections Example Solution

Child Diagnosis and Differential Diagnoses

There are various upper respiratory tract infections. They include common cold, influenza, allergic and vasomotor rhinitis, intranasal foreign body, and sinus. Thomas & Bomar (2021) note that influenza is a more acute condition with more severe symptoms, occurring and worsening within twenty hours. The child has had the mild symptoms for three days, ruling out influenza. Allergic and vasomotor rhinitis primarily manifest with inflammation of the nasal mucosal hence nasal drainage, itching, and nasal congestion are absent in Mr. Smith’s son (Meng, Wang, $ Zang, 2019). Intranasal foreign bodies present with rhinorrhea, pain, swelling, and no fever except in severe cases. The child presents with different symptoms ruling out the foreign bodies. Sinusitis is the inflammation of the membrane of the sinuses, and the presentations depend on the affected sinuses. They include nasal congestion, facial pain (sinus inflammation), and nasal congestion absent in this child, ruling out the diagnosis (Leung et al., 2020). Common cold is prevalent in children and is caused by a viral infection of the upper respiratory tract. The symptoms have an acute onset (less critical than influenza), ranging from mild to severe (Thomas & Bomar, 2021). They include nasal congestion, stuffiness, sore throat, cough, and fever.

Management of Common Cold

Common cold is a mild healthcare condition that requires only supportive management. Decongestants and antiviral therapies in children below four years lack clinical trials showing their efficacy, and the FDA advises against their use (Thomas & Bomar, 2021). Symptomatic management using antipyretics and supportive therapy is the mainstay of treatment for Mr. Smith’s son. Ibuprofen 20mg/kg/day oral dosage will help reduce the fever. Nasal irrigation using saline nasal drops is another mainstay management to help dry secretions and congestion. Throat saline spray/irrigation will also help with the sore throat. Zinc sulfate supplement will help reduce the cold’s duration and reduce the severity of the symptoms. Minimizing exposure to a cold environment using warm jackets, gloves, and socks will help prevent severe common cold symptoms (Susan et al., 2022). These interventions will help manage the symptoms and reduce the severity and duration of the cold.

Communication Plan

The family’s involvement in managing this patent is vital. The parent must understand the medications, dosages, importance, routes, and precautions. Nasa drops are instilled twice daily, in the morning and evening, and nasal saline sprays are used similarly (Susaman et al., 2022). Ensure the baby’s nostrils are clear before instilling three drops in each nose. The father also educates on why his child will not receive antibiotics because it is the common cold. Education will also entail follow-up if the cold does not resolve after a week. Common cold resolves independently, and the parent also needs to understand that. Teaching the parent will ensure they participate in care delivery and promote better patient outcomes. Reminding the father to help monitor the child by frequent handwashing and avoiding touching eyes and face will be necessary (Thomas & Bomar, 2020).

Resources on Management of Common Cold

Various resources provide information about common cold, its causes, management, and prevention. Some resources also provide information on the management of common cold. The CDC investigates and releases reports on conditions and their management (CDC, 2021). It provides updated information on current common cold treatments for a common cold. The organization will also give more information to support my choices in managing the child’s cold.

Common cold in adults and children is a mild healthcare condition with mild upper respiratory tract symptoms and fever. It requires only supportive therapy and some medications such as antipyretics, antihistamines, and decongestants. Managing these symptoms hastens the resolution process because a common cold resolves independently. Proactive management of this patient will help prevent exacerbations and will also help him resume his everyday disease-free life.

References

Center for Disease Control and Prevention (CDC), (2021). Common Cold. Disease or Condition of the Week. https://www.cdc.gov/dotw/common-cold/index.html

Leung, A. K., Hon, K. L., & Chu, W. C. (2020). Acute bacterial sinusitis in children: an updated review. Drugs in Context, 9. https://doi.org/10.7573/dic.2020-9-3

Meng, Y., Wang, C., & Zhang, L. (2019). Recent developments and highlights in allergic rhinitis. Allergy, 74(12), 2320-2328. https://doi.org/10.1111/all.14067

Thomas, M., & Bomar, P. A. (2021). Upper Respiratory Tract Infection. In StatPearls [Internet]. StatPearls Publishing.

MN553 Unit 9 Assignment Case Study: Prescribed Drugs with CAMs

Case Study: Prescribed Drugs with CAMs

Mr. X, a 42-year-old male presents to your primary care practice today complaining of low back pain.

History – Mr. X states that he has had chronic low back pain since he had a skiing accident about 10 years ago. Three days ago, he felt a pulling sensation in his lower back after moving some boxes. The pain intensity increased over the subsequent 24 hours and is now steady, aching in nature, at 3-4 out of 10. Mr. X also has Type2 diabetes, which is well controlled on metformin with a HGA1c of 5.6. He has a history of DVT 4 months ago for which he takes Coumadin, INR is WNL. He is followed by a specialist for this problem. He recently started taking two OTC products; kava kava for what he describes as “anxiety” and CoEnzyme Q10 on the advice of a friend.

Social – Mr. X is a smoker, 1 pack per week for 15 years. No alcohol or drug use. He is employed as an accountant and has medical insurance. He is divorced.
PE/ROS – Complains of low back stiffness and pain on movement with occasional spasms related to moving in certain directions. You note he has mild difficulty getting onto the exam table but gait is normal. He denies weakness/numbness/tingling of legs, no radiation, no change in bowel or bladder habits. BMI 27. All range of motion of the back is decreased by 25%. Straight leg lift is negative bilaterally, DTR intact. All other systems WNL.

Medications:

Metformin 1000mg ER one tab daily – Type II Diabetes controlled

Coumadin 5 mg. daily – Hx of DVT – Controlled

Kava Kava 50 mg. tid – Self-medication for anxiety

CoQ10 – 200 mg. daily. – Self-medication for unknown reason

Provide a diagnosis for the patient and your rationale for the diagnosis
Provide a treatment plan specifically for this patient, pharmacologic and non-pharmacologic.
Comment on the use of OTC products in relation to Mr. X’s current chronic and acute disease diagnoses and medications. Include drug-drug interactions and side effect profiles.
Provide an education plan for Mr. X
Present this Assignment as a PowerPoint presentation with between 12 and 16 slides (not including opening slide and resource slide).
You will use the Narrative notes section of the presentation to include the majority of your evidentiary support of your treatment choices and education of family complete with in-text citations using APA formatting,

Your writing Assignment should:

follow the conventions of Standard English (correct grammar, punctuation, etc.);
be well ordered, logical, and unified, as well as original and insightful;
display superior content, organization, style, and mechanics; and
utilize APA 7th edition formatting.

Rubric Title: MN553 Unit 9 Assignment Rubric

Assignment Criteria	Level III	Level II	Level I	Not Present
Criteria 1	Level III Max Points Points: 8	Level II Max Points Points: 6.4	Level I Max Points Points: 4.8	Not Present 0 Points
Correctly diagnosing the patient	A correct diagnosis is provided with supportive rationale from literature	A correct diagnosis is provided without rationale	Does not meet the Criteria	Does not meet the criteria
Criteria 2	Level III Max Points Points: 12	Level II Max Points Points: 9.6	Level I Max Points Points: 7.2	Not Present 0 Points
Prescribing a treatment plan	An appropriate and specific treatment plan for the case study patient is provided with rationale from literature for treatment choices.	A specific treatment plan is provided for the case study patient but is missing less than 50% of pharmacologic and non-pharmacologic treatment with rationale from literature for treatment choices	A specific treatment plan is provided for the case study patient but is missing more than 50% of pharmacologic and non-pharmacologic treatment with rationale from literature for treatment choices; OrRationale for treatment choices from literature are not provided	Does not meet the criteria
Criteria 3	Level III Max Points Points: 11	Level II Max Points Points: 8.8	Level I Max Points Points: 6.6	Not Present 0 Points
Over-the-counter medication use discussion	A thorough discussion of the kinetics and dynamics of OTC products is provided and a rationale for including or excluding them from the treatment plan is provided.	Kinetics and dynamics of OTC products are discussed and are related to the patient’s current meds/conditions but specific direction regarding continued use is not included	Kinetics and dynamics of OTC products are discussed but not related to the patient’s current meds/conditions.	Does not meet the criteria
Criteria 4	Level III Max Points Points: 8	Level II Max Points Points: 6.4	Level I Max Points Points: 4.8	Not Present 0 Points
Education plan	A thorough education plan for the treatment plan is provided which includes principles of therapeutic communication.	An education plan is provided which provides more than 50% of necessary information for the treatment plan and includes principles of therapeutic communication	An education plan is provided but contains less than 50% of necessary information and includes principles or therapeutic communication ORPrinciples of therapeutic communication are not included	Does not meet the criteria
Criteria 5	Level III Max Points Points: 8	Level II Max Points Points: 6.4	Level I Max Points Points: 4.8	Not Present 0 Points
College-level academic writing	Professional, peer-reviewed, advanced practice references are usedGrammar and mechanics of writing demonstrate graduate level workAdheres to page number requirements	The majority of references used are professional, peer-reviewed and advanced practiceErrors in grammar or mechanics of writing are present but do not interfere with readabilityAdheres to page number requirements	The minority of references used are professional, peer-reviewed and advanced practiceErrors in grammar or mechanics of writing are present Which interferes with readabilityDoes not adhere to page number	Does not meet the criteria
Criteria 6	Level III Max Points Points: 8	Level II Max Points Points: 6.4	Level I Max Points Points: 4.8	Not Present 0 Points
Citations and Formatting	There is a strong attempt to cite all sources using APA style. Minor paper formatting errors may occur. Minor in-text citation errors may occur. All authorship is clear and retrievable.	There is an overall attempt at APA formatting and citation style. Errors in formatting of citation or sources are present. All sources have some form of citation and all citations have a matching source. Citations generally make authorship clear.	Major errors in citations or source formatting are present. Citation or source information may be missing or incorrect. Authorship may be unclear.	Does not meet the criteria
Maximum Total Points	55	44	33	0
Minimum Total Points	45 points minimum	34 points minimum	1 point minimum	0

MN553 Unit 4 Assignment Case Study