Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
SUBJECTIVE
Mr. Alfredo Suarez is a right‐handed 68‐year‐old male who presents to the office with tremors to bilateral hands. His daughter, Maria, accompanies him to this visit and is worried he has “Parkinson’s.” Mr. Suarez reports that he first noticed “shaking” to his hands about 2 years ago but was not both-ered by it and attributed it to “getting old.” Over the past 2 months, the hand shaking has started to interfere with his ability to play cards and prepare meals. Maria interjects and states “his hands shake all the time now and he can’t even hold a fork.” Maria goes on to report that her father is an avid woodworker and is no longer working in his shop because he kept “dropping tools.”
Mr. Suarez states the tremors are consistently present all of the time and he most notices them when he tries to hold objects or read his book. He is most annoyed by these symptoms because they are interfering with hobbies. He reports, “people notice it and bring it up and then it gets worse.” He says that his brother has “shaky hands” and that he thinks his paternal grandmother had “Parkinson’s” because “she always shook.” He reports that tremors increase during stress and anxiety. He reports he also feels “more anxious lately” and doesn’t know if his medication is working. He notes increased anxiety about attending social events and worrying about his grand-daughter, who was diagnosed with epilepsy last year. He feels his hands are becoming “very clumsy.” He denies any alleviating factors. He denies any numbness or weakness to extremities. Denies any changes in gait or falls.
Past medical history: Hypertension (HTN), hyperlipidemia (HLD), generalized anxiety disorder, GERD, asthma/COPD overlap syndrome
Family history:
• Mother: HTN, HLD, CAD
• Father: Stroke, HTN, Type 2 DM
• Brother: HTN, Type 2 DM, “shaky” hands
Social history:
• Patient is widowed and lives alone. He lost his wife 2 years ago due to breast cancer. He has 1 daughter, Maria, and 2 grandchildren who he sees regularly and who live nearby.
• He retired at age 65 and worked as a carpenter.
• Hobbies: Woodworking, cooking, spending time with family, and reading.
• Nonsmoker; no illicit drug use.
• Drinks a “shot” of bourbon 3–4 nights per week.
Medications:
• Lisinopril 20 mg po daily
• Rosuvastatin 20 mg po daily
• Fluoxetine 60 mg po daily
• Omeprazole 20 mg po daily
• Albuterol MDI 2 puffs every 4 hours as needed
• Tiotropium inhaler 2 puffs once a day
Allergies: NKDA
OBJECTIVE
General: Pleasant, cooperative, NAD.
Vital signs: BP: 142/88; HR: 72; RR: 20; T: 98.9°F; height: 72 inches; weight: 210 lbs; BMI: 27.
Systems approach listed by system:
Cardiovascular: Apical pulse RRR, no murmurs, rubs, gallops, no S3, S4.
Pulmonary: Lung sounds clear to auscultation bilaterally; respirations unlabored and regular.
Musculoskeletal: FROM to all 4 extremities, normal muscle bulk noted, no edema, redness to joints, strength 5/5 to all 4 extremities.
Neurological: Patient is alert/oriented to person, time, and place; normal affect and mood; normal insight and judgment, speech clear. CN II–XII intact. Normal tone to all 4 extremities; no cogwheel rigidity noted. Reflexes: 2+ bilaterally to biceps, triceps, and brachioradialis, 1+ to bilateral knees and Achilles; no clonus, toes downgoing bilaterally. Coordination: F‐N‐F testing WNL, RAM WNL, Romberg negative. Sensory exam: Normal pinprick, light touch, and vibratory sense to all 4 extrem-ities; proprioception intact. Tremor exam: Bilateral course action and postural tremor noted to both hands that relieves at rest, right is slightly more prominent than left; there is no intention or resting tremors on exam; no other adventitious movements noted. Spiral drawing, done with right hand.
Gait exam: Patient able to arise from a sitting to standing position without using arms; demon-strates normal speed, stride, and turn, arm swing intact bilaterally, slightly stooped posture, no reemergence of hand tremors with ambulation.
CRITICAL THINKING
What are the top three differential diagnoses in this case and why?
Which diagnostic tests are required in this case and why?
What are the concerns at this point?
What is the plan of treatment?
What are the plans for referral and follow‐up care?
What health education should be provided to this patient?
What demographic characteristics might affect this case?
Does the patient’s psychosocial history impact how you might treat him?
What if the patient lived in a rural (or urban) setting?
Are there any standardized guidelines that should be used to treat this case? If so, what are they?
Are there other history questions that are pertinent when assessing a patient with tremors?
If this patient did not have insurance, would that change the management strategy?
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. GET THIS PROJECT NOW BY CLICKING ON THIS LINK TO PLACE THE ORDER
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