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
Aliyah is a 22‐year‐old African American female who presents with profound fatigue, sore hands and wrists, and frequent episodes of oral and nasal ulcers. She has been told by others that she has a rash across her cheeks when she is exposed to the sun; and she has just begun to notice this herself. Aliyah describes the fatigue as debilitating, and she finds it difficult to work as a legal assistant. When she is home, she frequently naps; but this never fully relieves her fatigue. Her hands and wrists ache, and this further complicates her ability to do her job, as she is expected to type most of the day.
She reports occasional cold sores since she was a teen, but recently these sores have become worse and harder to heal. She has also developed intermittent sores in the nose. Aliyah reports intermit-tent episodes of fever, and she has been using acetaminophen to control these episodes. She states, “I just don’t have any energy, and I really don’t feel well.”
Aliyah’s menses have always been heavy and accompanied by significant dysmenorrhea. The periods started out regular (at age 12) but have gradually become less predictable. Aliyah is a smoker. She has been coughing but denies chest pain, palpitations, dyspnea, swelling of her extremities, seizures, headaches, changes in sensation, weakness, changes in bowel or bladder function, dry eyes or dry mouth, eye pain, or changes in vision.
Past medical surgical history: None.
Family history: No connective tissue or inflammatory diseases, heart disease, diabetes mellitus, or respiratory illness.
Medications: Acetaminophen and a birth control pill.
OBJECTIVE
Vital signs: Temperature: 100.6°F orally; HR: 68 and regular; RR: 12 and regular; BP: 110/64;
weight: 110 lbs (down from 120 lbs 4 months ago); height: 5 ft 4 inches.
HEENT: Mild alopecia is noted. TMs are clear and intact. PERRLA; EOMs are intact; sclera and conjunctiva are clear. Aphthous ulcers are noted in the mouth and nose. Dentition is grossly intact. There is mild bilateral anterior cervical lymphadenopathy.
Cardiac: RRR S1/S2; without murmurs, clicks, gallops, or rubs.
Respiratory: CTA bilaterally.
Skin: An erythematous rash is noted across the cheeks, sparing the nasolabial folds. Livedo is noted on the lower extremities. Nailfold capillaries are positive for loops.
Musculoskeletal: No synovitis or swelling is noted. There is no TTP. There is LROM of wrists fingers bilaterally due to pain.
Neurologic: Mentation is grossly intact. CNs II–XII are grossly intact. Sensation and propriocep-tion are grossly intact. DTRs are +2. Romberg is negative. Heel‐toe is negative. RAMs are negative.
CRITICAL THINKING
What is the most likely differential diagnosis and why?
__Rheumatoid arthritis
__Systemic lupus erythematosus
__Vasculitis
__Discoid lupus
__Fibromyalgia
__Osteoarthritis
__Influenza
Which diagnostic studies should be considered to assist with or confirm the diagnosis? __Urinalysis
__Metabolic panel__CBC with differential
__Lipids
__TSH
__CK
__ESR or CRP
__U1 ribonucleoprotein (RNP)
__Rheumatoid factor
__CCP
__ANA with reflex
__Anti‐DS DNA
__Anti‐SM
__Anti‐RO/SSA
__Anti‐LA/SSB__Homocysteine
__C3, C4
__HIV
__Hepatitis B
__Hepatitis C
__X‐rays (if so, what type?)__Antiphospholipid antibodies (lupus anticoagulant [LA], IgG and IgM anticardiolipin [aCL] antibodies; and IgG and IgM anti‐beta2‐glycoprotein [GP] I) __Urine protein‐to‐creatinine ratio
What is the plan of treatment?
What is the plan for referrals and follow‐up?
Are there other manifestations of this disease?
Would it change the diagnosis or impact the prognosis or treatment if the patient were taking minocycline? What if the patient had a parvovirus?
What are the potential complications of this disease?
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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