Category: Nursing

No set page limit but I would like to have at least 3. Outside references other than movie can be used but are not required. If used please include a works cited APA format page at the end.

Use the supplied template to conduct a root cause analysis. Use the specific concern identified in the previous assignment (included in files: safety quality issue).

In assessing patients with anxiety, obsessive-compulsive, and trauma and stressor-related disorders, you will continue the practice of looking to understand chief symptomology in order to develop a diagnosis. With a differential diagnosis in mind, you can then move to a treatment and follow-up plan that may involve both psychopharmacologic and psychotherapeutic approaches.

In this Assignment, you use a case study to develop a focused SOAP note based on evidence-based approaches.

Walden University. (2021). Case study: Dev Cordoba . Walden University Canvas. https://waldenu.instructure.com

• Review this weeks Learning Resources. Consider the insights they provide about assessing and diagnosing anxiety, obsessive compulsive, and trauma-related disorders.
• Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
• Review the video, Case Study: Dev Cordoba . You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
• Consider what history would be necessary to collect from this patient.
• Consider what interview questions you would need to ask this patient.

Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

• Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
• Objective: What observations did you make during the psychiatric assessment?
• Assessment: Discuss the patients mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5 -TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
• Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
• Reflection notes: What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you could follow up with this patient. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion, and disease prevention, taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
• Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).

peer#1

Urinary tract infections are one of the most prevalent types of bacterial infections in the adolescent female population, which in large part can be attributed to the influence of the anatomy, which allows easier ascension by bacteria colonization. As a family nurse practitioner (FNP), a high level of knowledge of the overall clinical assessment, evidence-based differentiation diagnosis, and the ability to plan the treatment according to guidelines is required. To demonstrate systematic clinical reasoning, this discussion considers a 15-year-old girl who complains about dysuria, urgency and frequency of urine, lower abdominal pain, fever, and vomiting.

Pertinent Positives and Negatives

The subjective pertinent positives are dysuria, a higher than usual frequency (4 to six to eight voids/day) of urine, lower abdominal pain of 6/10 that increases with the presence of urgency, fever, chills, and one episode of vomiting. The patient remembers having a previous UTI at the age of five years and having similar symptoms. On examination, costovertebral angle (CVA) and suprapubic tenderness were observed objectively, which are typical signs of upper and lower urinary tract involvement, respectively (Crane et al., 2021). Relevant negativity encompasses refusal to have sex, lack of vaginal discharge, no history of frequent UTI, and no peritoneal examination. These results minimize the chances of sexually transmitted diseases, vaginitis, or appendicitis, but do not completely rule out the gynecological etiologies.

Additional Information Needed

A urinalysis with microscopy and urine culture with sensitivity analysis is indispensable before concluding diagnosis and starting treatment because the patient has reported allergic reactions to penicillin ((Kuroda et al., 2023). Systemic inflammatory response and renal performance would be measured with a complete blood count and extensive metabolic analysis. Clinical indication of a serum or urine pregnancy test should be used irrespective of abstinence reported, because adolescents might not tell the truth about sexual activity. In case of abnormality of structure or abscess, renal ultrasound is recommended.

Differential Diagnoses

There are three diagnoses that may be possible in this case. The most important diagnosis is acute pyelonephritis. This is due to the range of systemic symptomsfever, chills, vomitingas well as having CVA tenderness and lower urinary tract symptoms, distinguishing it from uncomplicated cystitis (Bryant et al., 2025). The second possible diagnosis is an uncomplicated cystitis. The presence of dysuria with increased frequency; however, having a systemic inflammatory response is against an isolated lower tract infection, as well as supports the diagnosis of acute pyelonephritis. The third possible diagnosis is to consider an ovarian torsion or a cyst due to any adolescent female have acute lower abdominal pain, since processes related to gynecology mimic urinary tract conditions and would require imaging studies to rule this out (Eisenberg et al., 2024).

Acute Pyelonephritis Management Plan

The guidelines of the Infectious Diseases Society of America recommend outpatient treatment of adolescents who can receive the oral form without any signs of sepsis (Alsaywid et al., 2023). Beta-lactams should be avoided because of an allergy to penicillin. A Trimethoprim-sulfamethoxazole DS 160/800 mg PO BID is the regimen of choice before culture sensitivity. Alternative is 500 mg Ciprofloxacin PO BID 7-14 days, though considerate use of fluoroquinolone in the adolescent group should be prudent because of the risk of tendinopathy. The supportive care includes acetaminophen to treat fever, oral hydration, and phenazopyridine 200 mg TID up to 48 hours to treat symptomatic dysuria. Follow-up (48-72 hours) is mandatory, and clinical aggravation and insufficiency of oral medications are the causes of hospitalization. The patient must be educated on antibiotic compliance, hydration precautions, and hygiene as a preventive measure.

Conclusion

The case highlights the importance of the FNP in distinguishing between upper and lower UTI and providing personalized and allergy-sensitive treatment. The systematic clinical assessment, evidence-based guideline incorporation, and effective patient education are all benefits that can maximize the outcome of adolescent patients with urogenital complaints.

peer#2

After reviewing this case, several findings stand out to me. The patient is a 15-year-old female with burning during urination, urinary frequency, and lower abdominal pain that has been getting worse over the past three days. She normally urinates about four times a day but now feels the urge six to eight times daily, sometimes without producing urine. She also reports fever, chills, nausea, and one episode of vomiting. On exam, the provider noted both suprapubic tenderness and costovertebral angle (CVA) tenderness. Those findings are important because they suggest the infection may be affecting the kidneys rather than just the bladder. Pertinent negatives include the patient denying sexual activity, vaginal bleeding, or discharge.

There are still a few things I would want to clarify. I would want to see a urinalysis and urine culture to confirm infection and identify the organism. Even though the patient denies sexual activity, I would still consider a pregnancy test because that is standard practice in adolescents with urinary symptoms. I would also ask more questions about hydration, recent antibiotic use, and whether she has had recurrent UTIs since childhood. I remember seeing a similar situation during clinical, and the provider emphasized how important urine cultures are before starting treatment.

My differential diagnoses would include acute pyelonephritis, acute uncomplicated cystitis, and nephrolithiasis. Based on the systemic symptoms and CVA tenderness, acute pyelonephritis is the most likely priority diagnosis.

Management should follow current guidelines. A urinalysis and urine culture should be obtained before antibiotics are started. Empiric therapy often includes trimethoprim-sulfamethoxazole or a cephalosporin depending on resistance patterns and allergies (Schmiemann et al., 2024). The patient should also be encouraged to stay well hydrated and use antipyretics for fever or discomfort. Close follow-up is important because symptoms should improve within 4872 hours of treatment (Schmiemann et al., 2024).

This case study sounds very similar to a patient I had last week!

Assignment Overview

In this assignment, you will be asked to watch The American Nurse documentary by Carolyn Jones. This documentary is one of the four from the American Nurse Project. To learn more about this effort, click the link: .

After watching the documentary, you will complete the reflection worksheet below.

Instructions

1. Watch The American Nurse Documentary using this link –
2. Complete the following attached reflection document –

I need one title page.

3 pages for the body.

1 page for list of references.

Please follow instructions and grading rubric. You can rename the title page for what is best. The pediatric psychiatric diagnosis that I chose was “Disruptive Behavioral Disorders”- This diagnosis looks like it is a group of conditions in children and adolescents. You can research this diagnosis to your findings to match what the instructions are requiring. If this is too complicated, I am fine with you choosing another pediatric psychiatric diagnosis- just let me know. If you have any other questions, please let me know.

1. Review the Week 3 Risk Management Case Study scenario in the Course Announcements. Using the provided case study is required. If the required case study is not used, a 10% deduction will be applied. See the rubric. (Template is attached to this file)
2. Use the . Use of this template is required. If the template is not used, a 10% deduction will be applied. See the rubric. Save the template and include your name in the file name.
3. Complete the Risk Management Case Study Template using the provided scenario.
4. Follow APA grammar, spelling, word usage, and punctuation rules consistent with formal, scholarly writing.
5. Provide an in-text citation from three scholarly sources to support your writing.

Case study:

In an outpatient care setting, a healthcare risk management case arises due to the inappropriate delegation of duties by a nurse practitioner (NP) to a medical assistant (MA). The NP, overwhelmed by patient volume and time constraints, delegates tasks beyond the MA’s scope of practice, leading to potential risks to patient safety.

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