nsg 6020 Health assessment week 1 discussion

May 30, | nursing, med, NURS, Paper

nsg 6020 Health assessment week 1 discussion
nsg 6020 Health assessment week 1 discussion
Discussion Question 1
Asking Racheal about breast lumps or discharge is a question I missed. Although she did not have nipple discharge, it is important to ask because most nipple discharge is caused by a benign medical condition. However, discharge can sometime be symptoms of some forms of breast cancer. Nipple discharge along with a lump or mass in the breast can be a sign of cancer (Goolsby, Grubbs, 2014).
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Discussion Question 2
I learned that completing a head to toe physical exam is not always warranted and can be frustrating for the patient. Research shows that most diagnoses are made from history alone than physical examination. For example, palpating and examining the legs or feet of a patient with complaints of breast lumps can be frustrating to the patient. Another error was not obtaining a complete set of vital signs on the patient. I was not able to read the blood pressure accurately or get a pulse due to lack of knowledge of using the virtual blood pressure cuff. Vital signs show how well our body is functioning and is a key indicator during a physical exam. I will review the tutorial to improve my skills on maneuvering on Ihuman. nsg 6020 Health assessment week 1 discussion.
Discussion Question 3
One key finding was the two palpable right breast lumps that was found during a breast examination. Performing a proper breast exam is important due to the patient’s self and family history. This is done by using the pads of the middle 3 fingers of one hand, press downward using a circular motion. During the breast exam it is important to apply steady pressure. This will allow palpation of three levels which include: superficial, medium, and chest wall (Bickley, 2016). Clinical breast exams and breast self-awareness are important methods of early breast cancer detection and should be performed along with mammography (Goolsby, Grubbs, 2014). All three of these methods provide complete breast cancer screening.
Discussion Question 4
I had a hard time fully understanding how to work this program. However, once the summary review occurred at the end and I was able to see it all together and it made sense. One category I missed was her history of atypical ductal hyperplasia.  Having this indication is imperative since it has been almost 3 years since follow up and she did not have a recheck post biopsy which was specified in her past medical history.  Although atypical ductal hyperplasia is benign, it increases the chance of breast cancer (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017). With a first degree relative with a history of breast cancer the patient is at a higher risk of developing breast cancer.
Discussion Question 5
I did not identify fibroadenoma as a differential diagnosis. Occurring mostly in women between the age of 15 and 35, fibroadenoma are solid, noncancerous breast lumps (Buttaro et al., 2017). A fibroadenoma is painless, moves easily when touched and can feel firm, rubbery, or hard. Fibroadenoma are usually well-defined shape. Healthcare providers should stress the importance of patients communicating new lump or change in breast tissue to their healthcare provider.
 
Reference
Bickley, L.S. (2016). Bates’ Pocket Guide to Physical Examination and History Taking (8th
Ed.). Philadephia, PA: Lippincott, Williams & Wilkins. ISBN: 9781496338488
Buttaro, T., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. 2017. Primary nsg 6020 Health assessment week 1 discussion
Care: A Collaborative Practice, 5th Edition. [South University]. Retrieved fromhttps://digitalbookshelf.southuniversity.edu/#/books/9780323355018/cfi/6/8!/4/2/6/4@0:0
Goolsby, M., Grubbs, L. (2015). Advanced Assessment: Interpreting Findings and
Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company. ISBN: 9780803643635
 
 
E,
You did an excellent job on your discussion post. I missed Fibroadenomas as a differential diagnosis too! Cyst are most common in women aged 35 to 50 years old, however fibroadenomas are seen more often in adolescents and young women (Buttaro, Trybulski, Polgar-Bailey, Sandberg-Cook, 2017). Fibroadenomas are the most common benign solid lesion of the female breast and are usually painless, well defined, and freely movable. In fact, ninety percent of breast masses are caused by benign lesions such as cyst, fibroadenomas, and fibrocystic changes (Buttaro et. al, 2017). Diagnostic mammography and ultrasonography are usually the initial tests for a palpable mass in women older than thirty-five years old. Management of a patient with breast masses is administered by the patient’s clinical history, findings, and the patients age. (Buttaro et. al, 2017).
Reference
Buttaro, T., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. 2017. Primary
Care: A Collaborative Practice, 5th Edition. [South University]. Retrieved fromhttps://digitalbookshelf.southuniversity.edu/#/books/9780323355018/cfi/6/8!/4/2/6/4@0:0
S,
Good job on your discussion post. I missed the swollen lymph nodes during Rachel’s physical examination. The lymph nodes are essential to the lymphatic drainage system and provide filtration of foreign substances through the action of lymphocytes, monocytes, and macrophages. There are over six hundred lymph nodes exist in the human body. Lymph nodes enlarge due to many factors such as but are not limited to an allergy or hypersensitivity to drug or environmental pollutants, tissue injury, and autoimmune diseases. Lymph nodes should be characterized by size, firmness, tenderness, and mobility. It should be note that breast changes especially with axillary adenopathy can be threatening and needs further investigation.
Reference
Buttaro, T., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. 2017. Primary
Care: A Collaborative Practice, 5th Edition. [South University]. Retrieved fromhttps://digitalbookshelf.southuniversity.edu/#/books/9780323355018/cfi/6/8!/4/2/6/4@0:0
 
 
RH is a 42-year-old female who presents with two self-detected breast lumps.  She had a breast biopsy three years ago that identified atypical ductal hyperplasia.  Her mother was diagnosed with breast cancer at 48.  Other pertinent information includes weight loss of 11 pounds over the last three months.
Discussion Question 1
One of the questions I miss was Do you have any breast lump or discharge? It is important to ask because most nipple discharge is either normal or caused by a benign medical condition. There are instances, though, when discharge from the breast may be a symptom of some forms of breast cancer. This likelihood is greater if your nipple discharge is accompanied by a lump or mass within the breast or if you have had an abnormal mammogram (Goolsby, Grubbs, 2014). Another question I miss is Have you had any trauma to your breast? This is important because we can differentiate any problems related to breast trauma. A breast injury can result in breast contusion (bruises), pain, and tenderness.
Discussion Question 2
One of my errors was not to do a complete physical exam. It is said that over 80% of diagnoses are made on history alone, a further 5-10% on examination and the remainder on investigation. Whether this adage is true or not may be open to debate but it is clear that history and examination skills remain at the very core of clinical practice. Another error was not to palpate all lymph nodes. Lymph nodes can increase in size in a number of conditions. Infections, cancer, and many immune diseases can affect lymph cells and cause an enlargement of lymph nodes (Goolsby, Grubbs, 2014). Enlarged lymph nodes are often the first sign of lymphoma, a cancer of lymph cells. But all enlarged nodes are not lymphoma.
Discussion Question 3
One key finding was the two palpable right breast lumps. An specific physical exam I can do is a breast examination. Breast exams are best performed soon after your menstrual period ends, because your breasts will not be as tender and swollen as during your period. This makes it easier to detect any unusual changes. Clinical exams and breast self-awareness are important methods of early breast cancer detection and should be performed along with mammography (Goolsby, Grubbs, 2014). All three of these methods provide complete breast cancer screening.
Discussion Question 4
None missed.
Discussion Question 5
Based on your performance and the expert feedback in your ASSESSMENT of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client.
I miss breast lipoma. Breast lipomas have many features that RH was experiencing.  Unilateral, painless, mobile mass were symptoms that were consistent with lipomas.  Her history of weight loss with axillary lymphadenopathy ruled out this diagnosis.  Breast cancer was my leading diagnosis because of the presence of a first-degree relative with breast cancer, prior diagnosis of atypical ductal hyperplasia, recent weight loss and axillary lymphadenopathy.
Reference
Goolsby, M., Grubbs, L. (2014). Advanced Assessment: Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company. VitalBook file. nsg 6020 Health assessment week 1 discussion
 
 
I miss breast lipoma. Breast lipomas have many features that RH was experiencing.
Unilateral, painless, mobile mass were symptoms that were consistent with lipomas.
Her
history of weight loss with axillary lymphadenopathy ruled out this diagnosis.
Breast cancer
was my leading diagnosis because of the presence of a first-degree relative with breast cancer,
prior diagnosis of atypical ductal hyperplasia, recent weight loss and axillary
lymphadenopathy.
Reference
Goolsby, M., Grubbs, L. (2014). Advanced Assessment: Interpreting Findings and
Formulating Differential Diagnoses, 3rd Edition. F.A. Davis Company. VitalBook file nsg 6020 Health assessment week 1 discussion

Discussion Question 1
Based on your performance and the expert feedback in your HISTORY collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain.
Two questions that I did not ask specifically were: Do you now or have you had cancer, and do you drink alcohol? If so, what do you drink and how many drinks per day? I found in the textbook that these questions are important due to modifiable and non-modifiable risk factors of breast cancer. One non-modifiable risk factor of breast cancer is a personal history of breast cancer or lobular carcinoma in situ. A modifiable risk factor of breast cancer alcohol ingestion (Bickley, 2017, p.425).
Discussion Question 2
Based on your performance and the expert feedback in your PHYSICAL EXAM collection, describe two errors in your exam performance or documentation. Use specific references from your text to explain the importance of these findings in correct assessment of this client nsg 6020 Health assessment week 1 discussion.
I did not percuss or palpate the patient’s abdomen. Dull areas of percussion suggest an underlying mass or enlarged organ. This assessment could have revealed an enlarged liver if malignancy were an issue. Deep palpitation can also identify any masses (Brickley, 2017, p.473).
Discussion Question 3
Based on your performance on the PHYSICAL EXAM collection, describe one key finding that you included in your list and describe a specific physical exam that you can perform at the point-of-care to further evaluate the finding. Use specific references from your text.
The key finding included in my list was the two lumps in the patient’s right breast. One specific physical exam that can be performed at the point of care to further evaluate the finding is a clinical breast exam. During this exam you inspect skin changes, symmetry, contours, and retraction in four different views. These views are with arms at sides, arms over head, arms pressed against hips, and leaning forward. nsg 6020 Health assessment week 1 discussion. You also palpate the breasts during the exam. Palpation should be done in the rectangular area extending from the clavicle to the bra line, and from the midsternal line to the posterior axillary line and well into the axilla ensuring the tail of the breast is examined. The patient should be in the supine position for this portion of the exam. During the exam, any nipple discharge present is noted (Brickley, 2017).
Discussion Question 4
Based on your performance and the expert feedback in your ASSESSMENT identification of problem categories, choose one missed/incorrect category and use specific references from your text to explain the importance of this category in arriving at correct differential diagnoses for this client.
I didn’t identify the patient’s decreased appetite and unintentional weight loss of 11 pounds. On looking at the patient’s last visit three years ago, her weight is stated as 148 pounds and, on her visit today, her weight is 149 pounds, so this was not on my mind. It has been three years since her last visit, so she may have had some fluctuations in between. Many conditions, including cancer, can make you feel less hungry. Cancer can have this effect by changing your metabolism, the way your body turns food into energy (WebMD Medical Reference, 2017). This would make the missed category important in reaching the correct differential diagnosis. nsg 6020 Health assessment week 1 discussion.
Discussion Question 5
Based on your performance and the expert feedback in your ASSESSMENT of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client.
I did not specifically include fibroadenoma as a differential diagnosis. This should have been included because fibroadenomas are usually smooth, mobile, and nontender (Brickley, 2017, p. 423). This is very similar to the description given by the patient.
 
Bickley, L. (2017). Bates’ guide to physical examination and history taking. (12th ed.) [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9781496354709/
WebMD Medical Reference. (2017). How to spot early warning signs of cancer. Retrieved from https://www.webmd.com/cancer/cancer-early-warning-signs#1
Amanda,
I didn’t notice that I missed auscultating the abdominal arteries, but I did as well. This is something that I will have to practice. I understand the importance of this step, but it is not something that I have done often in practice. Auscultation for abdominal bruits is a phase of the abdominal examination. Bruits are swishing sounds heard over major arteries most often during systole. The area over the aorta, both renal arteries. and the iliac arteries should be examined carefully for bruits (Goldberg, n.d.). We will continue to improve our assessment skills! Good job!
Goldberg, C. (n.d.). Abdominal exam. Retrieved from https://meded.ucsd.edu/clinicalmed/pe_abdominalexam.pdf
Mary,
I had a hard time navigating ihuman and almost missed the atypical ductal hyperplasia also. I did find it in the PMH section eventually. Atypical ductal hyperplasia (ADH) is a high-risk benign lesion found in approximately 1–10% of breast biopsies and associated with a variable incidence of carcinoma after surgical excision (Latronico et al., 2018). This information makes me think the patient was not educated properly on the severity of this finding. She states it has been six months since she first found these two lumps and just kept missing appointments. I feel that if she had known that ADH was associated with incidence of carcinoma she might not have waited so long to have it seen about. What are your thoughts?
Latronico, A., Nicosia, L., Faggian, A., Abbate, F., Penco, S., Bozzini, A., & … Cassano, E. (2018). Atypical ductal hyperplasia: Our experience in the management and long term clinical follow-up in 71 patients. The Breast, 371-5. doi:10.1016/j.breast.2017.10.003 nsg 6020 Health assessment week 1 discussion

 
NSG 6020 Week 1 Discussion Assignment Latest SU
Assignment 2: Discussion Questions
The discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered .
For this assignment, go to the Discussion Area and post a response to one question in the Discussion Area . You may respond to your classmates’ postings for either question .
To support your work, use your course and text readings and also use the South University Online Library .As in all assignments, cite your sources in your work and provide references for the citations in APA format.
Start reviewing and responding to the postings of your classmates as early in the week as possible .Respond to at least two of your classmates’ initial postings .Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion .Cite sources in your responses to other classmates
Discussion Question 1
Evidence-based practice will be the cornerstone of your advanced practice career .Choose a health disease process that is common in the adult population and post your choice to the discussion question area with the title “Health Disease Choice .” If a health disease is posted, pick another one so that there will be a discussion on a variety of health disease processes . nsg 6020 Health assessment week 1 discussion
Once you have decided on your topic, research two evidence-based articles .Cite your references in APA format .Do not look for less common and seldom-seen diseases; instead, look for the typical problems that you anticipate seeing in your practice as an advanced practice nurse .On the basis of the literature search and adult disease process, also discuss what parts of the complete health history would be essential in understanding a patient’s current health state and work-up completed to date .
Discussion Question 2
Differential diagnoses must be considered before choosing a final diagnosis .What criteria must be met before a final diagnosis can be made? Give an example of three differential diagnoses for a patient who complains of a sore throat .Support your differential diagnoses with a brief statement of reason .You do not have to have a final diagnosis for this patient; just work up the differential diagnoses .This is a common complaint for many patients nsg 6020 Health assessment week 1 discussion .

Kohlberg Moral Dilemmas Example Essay

May 30, | nursing, med, NURS, Paper

Kohlberg Moral Dilemmas Example Essay
Kohlberg Moral Dilemmas
Kohlberg moral dilemmas were presented to him during his study. He wanted to discover how people decide what is wrong and right. Kohlberg developed a theory of moral development and suggested that moral reasoning goes through six stages from childhood to adulthood. This Kohlberg Moral Dilemmas Example Essay explains Kohlberg’s moral development, moral dilemma, types, and examples.
What is Kohlberg’s moral dilemma? How would you describe Kohlberg’s theory of moral development?
Lawrence Kohlberg was interested to know how people decide what is right and what is wrong. To investigate, he read a story of a man who is trying to get an expensive drug that his wife needs to treat her cancer. He begs the pharmacist to reduce the price, but the pharmacist refuses.
The man has no money and decides to steal the medicine. Kohlberg was interested in finding out how the man came to that decision. He suggested that people improve in moral reasoning according to their ethical behavior. Kohlberg’s theory focuses on how children develop moral reasoning. He suggests that moral logic focuses on seeking and maintaining justice.
What is Kohlberg’s theory of moral development essay?
Moral development is the development of the distinction between right and wrong and reasoning. Lawrence Kohlberg, an American psychologist, developed a theory addressing some questions. He focused on how children built moral reasoning by extending Piaget’s theory and suggested that moral development is continuous.
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Kohlberg’s theory of moral development can help parents guide their children as they build their characters. Parents with little children can use rule abeyance and teach older children about social expectations. A teacher can apply Kohlberg’s theory in the classroom by providing moral guidance.
A kindergarten teacher can enhance moral development by setting rules for the school and consequences for violating rules which helps kids develop stage one or morals. A high school teacher can focus on developing interpersonal relationships and maintaining social order. The teacher can accomplish moral development by setting rules in the classroom and giving the students better ideas.
What are Kohlberg’s stages of moral development?
Kohlberg developed a theory of moral development and suggested that moral reasoning goes through six stages from childhood to adulthood. The stages are distinguished into three levels; pre-conventional, convectional, and post-convectional. Each stage includes a more advanced level that advances with life experience.
The following are stages of moral development in this Kohlberg Moral Dilemmas Example Essay;

Obedience and punishment attitude

Morality is controlled at the pre-convectional level, and rules are followed to avoid punishment. This level contains the idea that what is right is personally satisfying or one can get away. Children are shaped by adults’ expectations and obey rules to avoid consequences.
Stage one claims that consequences determine behavior. At this stage, children obey the rules to avoid punishment. According to Kohlberg, people see rules as absolute and fixed, and obeying rules is a way to avoid punishment.

Instrumental attitude

The instrumental stage claims that consequences determine behavior. Children obey rules to satisfy personal needs or receive rewards.

The good girl/ good boy attitude

At the conventional level, rules remain essential to a person. A person supports rules set by others, such as peers, parents, and the government, to maintain social order. Adults analyze the moral standards they have learned from society. The focus changes from self-interest to relationships with social systems and other people.
At this stage, behavior is influenced by social approval and developing excellent interpersonal relationships. A person wants to win or maintain expectations of others of being a good person.

Law and order attitude

At this stage, behavior is determined by social laws. A person considers a larger perspective than that of societal laws. You may assume that laws maintain social order and decision-making becomes more of a close tie. The aim is to maintain laws by respecting authority, doing your duty, and following rules.

Social contract attitude

At post-convectional level, an individual focus beyond their society. Morality is based on principles and values that apply to all societies and situations.
At this stage, behavior is determined by individual rights. A person’s rules and laws improve human purpose. There are exceptions to rules given the right situation. When laws are inconsistent with the majority’s interests and rights, they do not bring good to people, and the alternatives must be considered.

Universal ethical principle

According to Kohlberg, the universal ethical principle stage is the highest functioning stage; some people do not reach this level. At this stage, action is determined by ethical principles of conscience, which are universal in application. The reasoning includes taking every person’s perspectives that the decision could impact.
What is meant by a moral dilemma?
A moral dilemma is deciding on two or more ethical values and taking action you will violate other moral principles. It involves a choice, action, or decision that may involve an uncomfortable situation in which it is hard to decide what to do. A moral dilemma is a situation where you have two or more actions from which you can perform, or there is a moral reason for choosing each action.
In a moral dilemma, you cannot perform all of the actions, and you have to choose one. No matter your choice, you will fail to follow your morals. There are moral reasons for choosing an action and moral reasons for not.
What are the three types of morals?
Below are three types of morals;

Metaethics

Metaethics help an individual determine what is moral. To make an informed decision, you should answer these questions; What are moral values? Do moral facts exist, is morality universal, and what does it mean with good or right?

Normative ethics

Normative ethics involves the appropriate standards for wrong and right behavior. The normative ethical approach includes virtue ethics, deontological, and consequentialist theories.

Applied ethics

Applied ethics includes morals that arise in private or public life. Applied ethics issues include stem cell research, abortion, animal treatment, etc.
What is an example of individual moral dilemma?
You are on a sinking ship with your mother and daughter. You have a lifeboat, but it can only hold two of you. The person who does not get on the lifeboat will drown. Who will you put on the lifeboat?
You can find a case of fight or bullying in which you can intervene in various ways. You can also encounter a homeless person and be in a dilemma of whether to help them. Professionally, a judge may be faced with the dilemma of whether to send someone to prison or not. A doctor can be in the dilemma of whether to lengthen someone’s life artificially. Kohlberg Moral Dilemmas Example Essay.
What are the types of moral dilemmas?
You may find yourself in different types of ethical dilemmas, which may vary in their level of specialty. The following are types of dilemmas;

Ontological moral dilemma

The options of the ontological moral dilemma are equal to their moral consequences. The options and consequences are on the same ethical level, and a person cannot choose between the two.

Epistemic moral dilemma

The dilemma involves two conflicting choices, and you don’t know which is moral or ethical. You will need more knowledge about the two to make a decision.

Self-imposed moral dilemma

A self-imposed dilemma is a situation caused by an individual’s mistakes or actions. The dilemma can cause problems when making a decision.

World-imposed moral dilemma

World-imposed dilemmas are situations that you can’t control, creating moral conflict. You have to resolve the dilemma even if the cause is beyond your control, for example, in times of war.

Obligation moral dilemma

In an obligation dilemma, you feel responsible for carrying more than one choice. You feel you are supposed to do an action from a legal standpoint.

Prohibition moral dilemmas

Prohibition is the opposite of obligatory. The dilemma is you must choose between prohibited options. Your choices are illegal or immoral, but you have to choose one.
What are the 4 types of moral dilemmas?
Below are four types of moral dilemmas;

Hypothetical dilemma

A hypothetical dilemma puts a person in a situation that is unlikely to happen in real life.

Open dilemma

An open dilemma is where all situations related to a dilemma are presented. The person in that dilemma is supposed to choose how to proceed.

Closed dilemma

In a closed dilemma, the person involved should evaluate the protagonist’s performance and not decide what to do.

Complete dilemma

The person involved in a complete dilemma is informed of the consequences of each option that can be taken.
What are some examples of moral dilemmas?
The following are examples of moral dilemmas;

Tram dilemma

A train runs out of control on a track. Five people are tied on the road and will die if the train reaches them. You have a chance to deviate the vehicle to another road, but there is a person tied. So it’s either you divert the train and kill one person or not and let five people die. What would you do?
You can easily complicate choices in this dilemma. For example, you can stop the tram, but there is a risk that all people will die. If you divert the train, there is one person who will die. But what if this person is your child, mother, or brother?

Prisoners dilemma

Two alleged criminals are arrested and locked together, claiming to be involved in a bank robbery. There is no evidence of any of them in the involvement, but they have a penalty of 10 years. The possibility of going free is exposing the other. If they confess both, they will have six years in prison.
If one provides evidence, he will be free, and the other who dies will be sentenced to 10 years. If both deny it, they will remain in prison for a year. In this case, the result depends on the performance of others.

The noble thief

You witness a man robbing a bank but giving money to an orphanage that lacks resources to support children who live there. You can report the thief, but the orphanage will have to return the money which they were to use to feed the kids. The thief has committed a crime, but on the other hand, he has done it for a good purpose. What do you do? The dilemma can be more complicated if a person dies during the robbery.
What are the 3 levels of ethical decision-making?
The following are levels of ethical decision-making;

Consequential

At the consequential level, focus on the consequences of an action and the people who will be affected. While deciding, consider the activities that will have the best results.

Duty

Consider the duties and obligations that you have in a situation and ethical obligations. Ethical duties are doing the right thing and performing the correct action. If an action is ethically correct, it will apply to every person in the situation. You should act ethically even if the result is bad.

Virtue

At the virtue level, identify the character traits that can motivate you in a certain situation. Think about the kind of a person you should be and what a virtuous person would do in a similar situation. While making decisions develop similar virtues and good character to make a good decision.
Wrap up
During his research on moral reasoning, Lawrence Kohlberg presented Kohlberg moral dilemmas to determine how people decide what is wrong and right. He focused on how children built moral reasoning by extending Piaget’s theory and suggested that moral development is continuous and changes as we grow. You may find yourself in different types of ethical dilemmas, which may vary in their level of specialty. This blog will help you make ethical decisions when in a dilemma.