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
Marion is an 85‐year‐old woman of European descent who lives alone and comes to the office every 3–6 months for monitoring of hypertension and hyperlipidemia. Today she presents with a concern about vision changes. Marion reports some vision changes including increased sensitivity to glare; increased difficulty with dark adaptation, with colors seeming not as vivid as they used
to; and increased difficulty with reading, but that she does not have any “floaters” as her friend reported to her last week. She states that she needs bright light to read comfortably. She mentions that this has worsened over the past few years and has become increasingly bothersome. She denies any eye pain or discharge, diplopia, or halos. She has no history of eye trauma. She men-tions that her last eye exam was 5 years ago. She denies any history of glaucoma but thinks she may have had some early cataracts on her last exam. Marion states that she maintains an independent lifestyle and requires no assistance in her day to day activities.
Past medical/surgical history: Hypertension; hyperlipidemia; peripheral arterial insufficiency; osteoporosis; generalized anxiety disorder; osteoarthritis; status post hip fracture with repair/ pinning at age 82.
Family history: Mother: died at age 78, lung cancer; had age‐related macular degeneration and
migraines. Father: died at age 65, MI; had coronary artery disease, diabetes, and stroke.Social history: Marion was widowed 10 years ago and lives alone in a 1‐bedroom, first‐floor apartment with 5 steep stairs to enter the building. She is dating socially and attends the senior dances at the local community center about once a week. She maintains the flower gardens in her front yard and states that she walks a half mile most days with her friend. Marion states that she falls asleep without difficulty most nights, but often awakens during the night and has difficulty falling back asleep. She states that she actually sleeps about 5.5 hours per night, but experiences some daytime sleepiness. She states that she has 1–2 drinks after her dance class and occasionally when on a date. She quit smoking 25 years prior (smoked 1 pack of menthol cigarettes per day for 40 years).
Diet: Marion’s typical diet includes toast with butter and jam for breakfast with black coffee; soup and sandwich with a glass of milk for lunch; roast beef, potatoes with gravy, and green beans with butter and salt for dinner; and no snacks. She eats dinner out with friends about 2 or 3 nights per
week at the diner or a restaurant and usually has some type of meat, potato or white rice, and a cooked vegetable. She does not drive, as she uses public transportation.
Medications: She has brought all of her medication bottles with her. Her medications include lisinopril, atorvastatin, citalopram, and alendronate. She has an expired prescription/bottle of hydroxyzine that she states that she uses occasionally for “nerves.” She also takes acetaminophen as needed for arthritis pain.
Allergies: Penicillin (causes rash to chest and arms).
Marion admits to some gradual visual changes; difficulty hearing (mostly in crowded restau-rants); postnasal drip; and occasional arthritis pain in her shoulders, fingers, hips, and knees. She admits to occasional leakage of urine when she has a cold/cough. She denies headache, falls, head trauma, cough, dyspnea, chest discomfort, abdominal pain, and change in appetite or weight, polyuria, polydipsia, polyphagia, weakness, numbness, and dizziness.
OBJECTIVE
Eyes: Visual acuity: 20/40 in both eyes (with corrective eyeglasses). The outer one‐third of her eyebrows is absent. Slight ectropion bilaterally. Conjunctiva/sclera clear. No crescentic shadow. Positive for arcus senilis. PERRLA. EOMs intact with mild decrease in upward gaze; visual fields full. Positive for red reflex bilaterally; suboptimal retinal visualization.
The remainder of the physical examination is unchanged since her last visit.
CRITICAL THINKING
Which diagnostic studies should be considered to assist with or confirm the diagnosis?
___Amsler grid
___MacuFlow
___National Eye Institute Visual Functioning Questionnaire 25
___Ophthalmological referral for testing
Which of the symptoms or signs related to Marion’s eyes or vision represent pathological changes versus normal aging?
Which differential diagnoses should be considered at this point? What are the three most common diagnoses/conditions affecting vision in older adults? Are Marion’s signs and symp-toms similar to the clinical presentations of these conditions? ___Macular degeneration
___Glaucoma
___CVA
___Cataracts
Based on this exam, what is the plan of care? Would you seek any referrals from the interpro-fessional team?
If Marion were under 65 years of age, would the management plan change?
What patient, family, and caregiver education is most important in this case?
A few weeks after the visit described above, you receive a phone call from Marion’s friend, who calls the clinic with news that Marion experienced a brief episode of slurred speech and
right‐sided weakness that lasted a few minutes. These symptoms occurred about 30 minutes ago. What is your priority recommendation? Her friend reports that Marion is feeling fine now but she is frightened. What is your advice?
What diagnostic evaluation should be completed?
What education is needed?
What is the management plan?
What are some of the most important domains of nursing assessment and management (physical, psychological) during these first few hours after symptoms? In the early post‐stroke period?
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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