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
George is a 62‐year‐old gentleman presenting to primary care with complaints of newly developed right great toe pain with redness, swelling, and discharge. One week ago, while George was performing his routine foot care, he decided to remove a callus on the bottom of his right great toe. The callus had a lifted edge and the patient thought it would be better removed so as to not catch the skin and have it tear away. After gently pulling away the callus using tweezers George noted the skin underneath to be pink and intact. He reports the region where the callus had been removed was visibly indented slightly below the surrounding dermis.
Five days ago George began to develop tenderness and pain (6/10) on the underside of his right great toe with weightbearing and walking activity. George wrapped the toe with a gauze dressing in an effort to pad the great toe, thinking this would help him with pain management while he went about his daily activities. Three days ago, George noted increasing pain and redness in the right great toe and he now had a scant amount of blood‐tinged discharge on the dressing when he took the dressing off that evening.
George continued with self‐care, washing the affected great toe with antibacterial soap daily, applying a clean, dry gauze dressing during daytime hours and open to air at bedtime. The pain and redness continued and discharge was becoming more abundant. Now, George reports that within the past 24 hours his pain has increased to a 8/10, redness is extending to lateral regions of the great toe with swelling, and he notes the discharge during the evening dressing removal has changed to yellow and blood tinged. George, concerned about worsening symptoms, presents today for evaluation of the right great toe wound.
Family history: Heart disease: PGM, PGF, MGM, MGF, mother, father, and brother; peripheral
vascular disease (PVD): mother, brother; hypertension: mother, brother; stroke and TIAs: mother;
colon cancer: PGM; colitis: mother; ovarian cancer: mother; diabetes mellitus Type 2: MGM,
mother; brain aneurysm: PGF.
Past medical history: Idiopathic thrombocytopenic purpura (ITP) (chronic type), diagnosed at age 33; low back pain (three herniated discs auto accident rear‐ended) age 35; duodenal ulcer (resolved), diagnosed at age 40; diaphragmatic hernia, diagnosed at age 40; mixed hyperlipidemia, diagnosed
at age 48; diabetes mellitus Type 2, diagnosed at age 50; peripheral vascular disease, diagnosed at age 53; sleep apnea, diagnosed at age 53; heart disease (peripheral arterial disease and mild aortic stenosis), diagnosed at age 60.
Social history: George is 62 years old, married for 42 years, father of 4 adult children and grandfather of 4 grandchildren. He is a college graduate and has been employed 49 years in a professional, white‐collar position. He has spent most of those years in an executive managerial position, working 40‐plus hours weekly. There have been no known occupational hazards or chemical exposures. George is active in his community and a practicing Catholic who attends weekly services. His hobbies include fine woodworking and professional cooking. He says his interpersonal relationships are satisfying and supportive. George reports that his finances are very good; he lives an upper‐middle‐class lifestyle. George lives in a single‐family home in a safe to moderately safe suburban neighborhood. He has never smoked. He rarely drinks alcohol and when he does, he drinks wine.
Medications:
• Atorvastatin, 80 mg one tablet PO at bedtime
• Irbesartan, 150 mg one tablet daily
• Lantus (insulin pen), 12 units SQ daily
• Metformin HCL, 1,000 mg one tablet PO twice a day with meals
• Torsemide, 20 mg one tablet daily every morning
• Potassium chloride ER, 20 MEQ two tablets daily every morning
• Epipen, as directed PRN for bee sting allergy/anaphylaxis
• Senna (stool softener), one tablet daily as directed
• Multivitamin (Centrum Silver), one tablet daily every morning
• Vitamin D3, 2,000 IU one tablet every morning with a meal
• Osteo Bi‐Flex (glucosamine chondroitin), 750 mg two tablets daily
• Ultra CoQ10 (Qunol brand), 100 mg one soft gel daily
• Tylenol Extra Strength, 500 mg two tabs daily as needed for pain
• Kaprex (selective kinase response modulator), 350 mg one soft gel daily for low back pain
Allergies:
Prednisone/steroids (high doses cause significant muscle weakness).
Bee sting – Anaphylaxis – carries Epipen and has allergy notification in wallet.
No known food allergies.
Immunizations: Up to date.
OBJECTIVE
George is a well‐developed, well‐nourished adult male in no acute distress. He is dressed appro-priately for the season with excellent hygiene. He is alert and oriented times three. George is engaging and interactive; his speech is clear and articulate. George’s gait is steady, but he walks bearing weight on the outer edge of the right foot; his posture is upright.
Vital Signs:
Height: 6 ft 5 inches; weight: 298 lbs (BMI = 35.3); temperature: 98.9°F (temporal); pulse: 84/minute
(apical) RRR; respirations: 16 BPM (breaths per minute); blood pressure: 118/72; pulse xx: 99% on
room air; pain: 6/10 (foot pain/right great toe).
Integumentary: Intact without rashes or lesions; warm and dry. There are scattered varicosities on the legs bilaterally. There is brownish discoloration to the skin of the lower legs bilaterally, predominantly over the shins and dorsum aspects of the feet. There is no edema.
Right great toe: Plantar aspect of right great toe reveals broken skin integrity with a wound of 2.0 cm × 1.5 cm (length × width), a depth of 2–3 mm. There is a small amount of serosanguinous dis-charge, some yellow crusting on the edges of the wound; mild redness and swelling are noted on the lateral regions of the right great toe. The toe is warm and tender to palpation. The patient reports pain at 6/10 with passive and active ROM.
HEENT:
Eyes: PERRLA, EOMs intact, visual acuity grossly intact.
Ears: External canals patent, TMs pearly gray, intact. Hearing is intact to whispered voice 3 feet bilaterally.
Nares: Patent, pink mucosa intact; inferior turbinates visible, no discharge.
Throat: Oral mucosa pink, tongue well papulated, no lesions; no swelling or exudate in pharynx; teeth in good repair.
Respiratory/Thorax: Easy breathing, no use of accessory muscles, no retractions. Lungs clear throughout all fields, no crackles, no wheezes.
Cardiac: No lifts or heaves visible; S1, S2 RRR, without murmurs, clicks, gallops, or rubs.
PV: Pulses 2+ bilaterally (brachial, radial, dorsalis pedis, and posterior tibial).
Abdomen: Moderately protuberant, soft nontender throughout, tympany predominant, normoac-tive bowel sounds all 4 quadrants, no tenderness, Blumberg’s negative, no guarding.
Musculoskeletal: Tenderness to palpation and moderate pain with ROM of right great toe joint. Full ROM of all major joints, upper and lower extremities
Neurological: Cranial nerves I–XII grossly intact, alert and oriented ×3, gait steady and balanced, alternating arm swings.
CRITICAL THINKING
Which diagnostic or imaging studies should be considered to assist with or confirm the diagnosis?
___CBC with differential
___HBA1c
___CMP
___Blood cultures
___X‐ray (right foot)___MRI (right foot)
Identify and explain three differential diagnoses.
___Diabetic foot ulcer
___Nonhealing skin wound with secondary bacterial infection
___MRSA infection
___Cellulitis with or without osteomyelitis
What is the plan of treatment?
Are there any standardized guidelines to consider?
What health education should be provided to the patient?
What complicating factors specific to this case should be considered?
What collaborative assessment and care might the patient require? Include your rationale.
___Referral to a wound specialist
___Referral to Podiatry
___Visiting nurse with a wound specialist nurse for follow‐up with home care___Orthopedic or physical therapy consult
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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