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
Rosa, a 29‐year‐old Latina woman, presents for evaluation of wrist pain and swelling. She devel-oped symptoms about 3 months ago and has noted progressive worsening since that time. In addition, she has tenderness across the balls of her feet with any weight bearing. The pain is worse when she is inactive and improves with activity. The symptoms have significantly impacted her ability to perform her job as a receptionist in a busy office. She denies any recent trauma to her hands or feet or other joint pain.
She notes stiffness in the feet and ankles as well as 4 hours of overall morning stiffness that improves only marginally for the rest of the day. She has noted increased fatigue and weakness in the last few months. She often naps when she gets home from work and has curtailed her social activities significantly. Rosa denies fever, chills or other systemic symptoms. Rosa denies dry eyes or dry mouth, changes in her vision, neck or shoulder stiffness, chest pain or difficulty breathing. She denies ever having previous episodes of these symptoms. Rosa denies any rashes, lesions or ulcers, any changes in her hair, skin or nails, any polyuria, polydipsia, or polyphagia. She does not recall being bitten by any insects recently and spends most of her time indoors. Rosa denies any weight loss, history of pregnancy or any memory changes. She is not aware of having any recent infection, nor has she experienced any problems with her bowel or bladder function. She denies numbness or tingling in any part of her body.
Past medical history: None.
Family history: No family history of any inflammatory or autoimmune disease, except for a cousin with systemic lupus erythematosus.
Social history: Rosa is single, but several family members live nearby. She barely supports herself without assistance, but her parents occasionally give her money for extras. She denies a history of smoking or drug use. She drinks with friends on the weekends, consuming 1–2 mixed drinks or beers on Friday and Saturday evenings. She states that she is generally happy but would like to settle down with someone in a monogamous relationship. She verbalizes her fear of having a serious disease during the visit today.
Medications: Rosa takes only birth control pills and a multivitamin daily.
OBJECTIVE
General: Rosa appears to be in no apparent distress.
Vital signs: Rosa weighs 110 lbs, and her height is 63 inches. She has an oral temperature of 100 degrees Fahrenheit. BP is 120/70. HR is 64 and regular. Respiratory rate is 12 and regular.
HEENT: Her head is normocephalic and nontender. There are no scalp lesions or apparent alo-pecia. PERRLA, with EOMs intact. Sclerae are clear without visible scleritis. There is no malar rash or any lesions or ulcers on her face or buccal mucosa.
Neck: There is no cervical or other lymphadenopathy. Her thyroid is nonpalpable. CNs II–XII are grossly intact.
Cardiac: The cardiac exam reveals RRR S1/S2 with no murmurs, clicks, gallops, or rubs.
Respiratory: Lungs are clear bilaterally.
Skin: The skin is clear.
Abdomen: Soft without organomegaly, tenderness, or bruits.
Neuromuscular: There is moderate synovitis (swelling) of the MCP and PIP joints bilaterally and of the MTP joints bilaterally. The patient has limited ROM of the UE and LE digits due to pain. There are no nodules noted on any extremity. The Phalen’s, Finkelstein’s, and Tinel’s tests are negative. There is no warmth or redness of any joint. DTRs are +2 throughout.
CRITICAL THINKING
What is the most likely differential diagnosis and why?
___Osteoarthritis
___Rheumatoid arthritis
___Systemic lupus erythematosus
___Carpal tunnel syndrome
___Sjögren’s syndrome
Which diagnostic studies should be considered to assist with or confirm the diagnosis?
___Rheumatoid factor
___ESR
___CRP
___CCP
___ANA, C3, and C4
___Anti‐DS DNA___CMP
___CBC
___HLA‐B27
___SS‐B
___SS‐A___Imaging studies
What is the plan of treatment?
What is the plan for referrals and follow‐up?
Would the primary diagnosis be different if the patient were 55 years old?
Would there be treatment considerations if the patient had a history of tuberculosis?
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
CLICK ON THE LINK HERE: https://www.perfectacademic.com/orders/ordernow
Do You Have Any Other Essay/Assignment/Class Project/Homework Related to this? Click Here Now [CLICK ME] and Have It Done by Our PhD Qualified Writers!!