Past Medical History (PMH):
Patient is Diabetic, controlled with Metformin 500 mg by mouth twice a day, Lantus 15 units SC bedtime. Hypertensive, controlled with Olmesartan 20 mg by mouth once a day. Atrial Fibrillation, controlled with Rivaroxaban 15 mg by mouth once a day and bisoprolol 10 mg by mouth once a day.

Labs:
Hb 12.7 g/dl; Hct 38.8% WBC 8.2; Glycemia 74mg/dl; Creatinine 0.8 mg/dl; BUN 9.8 mg/dl; AST 21 U/L ALT 17 U/L; Bil T 1.90 mg/dl; Ind 0.69 mg/dl; Dir 1.21 mg/dl.

Diagnostic test:
Endoscopic Ultrasound of the Pancreas. Solid mass in the head of pancreas 4 cms, infiltrating Wirsung duct. The solid mass impress to infiltrate the superior mesenteric vein. Perilesional node is detected, 1.5 cms, metastatic aspect. Fine needle aspiration (FNA) biopsy: Ductal adenocarcinoma.

Case study questions:

1. Please name the potential most common sites for metastasis on J.C and why?
2. What are tumor cell markers and why tumor cell markers are ordered for a patient with pancreatic cancer?
3. Based on the case study described, proceed to classify the tumor based on the TNM Stage classification. Why this classification important?
4. Discussed characteristic of malignant tumors regarding it cells, growth and ability to spread.
5. Describe the carcinogenesis phase when a tumor metastasizes.
6. Choose the tissue level that is affected on the patient discussed above: Epithelial, Connective, Muscle or Neural. Support your answer.

Submission Instructions:

• Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 
• All replies must be constructive and use literature where possible.

Please use this rubric

 

Discussion Rubric

Discussion Rubric

CriteriaRatingsPts

This criterion is linked to a Learning OutcomeIdentification of Main Issues, Problems, and Concepts

5 to >4.0 ptsDistinguished
Identifies and demonstrates a sophisticated understanding of the issues, problems, and concepts.

4 to >3.0 ptsExcellent
Identifies and demonstrates an accomplished understanding of most issues, problems, and concepts.

3 to >0.0 ptsFair
Identifies and demonstrates an acceptable understanding of most issues, problems, and concepts.

0 ptsPoor
Identifies and demonstrates an unacceptable understanding of most issues, problems, and concepts. Or nothing was posted.

5 pts

This criterion is linked to a Learning OutcomeUse of Citations, Writing Mechanics and APA Formatting Guidelines

3 ptsDistinguished
Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.

2 ptsExcellent
Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors.

1 ptsFair
Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail.

0 ptsPoor
Ineffectively uses the literature and other resources to inform their work. Unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention. Or nothing was posted.

3 pts

This criterion is linked to a Learning OutcomeResponse to Posts of Peers

2 ptsDistinguished
Student constructively responded to two other posts and either extended, expanded or provided a rebuttal to each.

1 ptsFair
Student constructively responded to one other post and either extended, expanded or provided a rebuttal.

0 ptsPoor
Student provided no response to a peer’s post.

2 pts

Total Points: 10

Select a bill that has been proposed (not one that has been enacted) using the congressional websites provided in the Learning Resources.

The Assignment: (1- to 2-p Legislation Grid; 1-page Legislation Testimony/Advocacy Statement)

Be sure to add a title p, an introduction, purpose statement, and a conclusion. This is an APA.

Part 1: Legislation Grid

Based on the health-related bill (proposed, not enacted) you selected, complete the Legislation Grid Template. Be sure to address the following:

• Determine the legislative intent of the bill you have reviewed.
• Identify the proponents/opponents of the bill.
• Identify the target populations addressed by the bill.
• Where in the process is the bill currently? Is it in hearings or committees?

Part 2: Legislation Testimony/Advocacy Statement

Based on the health-related bill you selected, develop a 1-p Legislation Testimony/Advocacy Statement that addresses the following:

• Advocate a position for the bill you selected and write testimony in support of your position.
• Explain how the social determinants of income, age, education, or gender affect this legislation.
• Describe how you would address the opponent to your position. Be specific and provide examples.
• At least 2 outside resources and 2-3 course specific resources are used.

Resources

• Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning.
  • Chapter 5, “Policy Enactment: Legislation and Politics” (pp. 97–117)
  • Chapter 10, “Financing Health Care” (pp. 239–249)
• Congress.govLinks to an external site.. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/
• Taylor, D., Olshansky, E., Fugate-Woods, N., Johnson-Mallard, V., Safriet, B. J., & Hagan, T. (2017). Corrigendum to position statement: Political interference in sexual and reproductive health research and health professional education. Nursing Outlook, 65(2), 346–350Links to an external site..
• United States House of RepresentativesLinks to an external site.. (n.d.). Retrieved September 20, 2018, from https://www.house.gov/
• United States SenateLinks to an external site.. (n.d.). Retrieved September 20, 2018, from https://www.senate.gov/
• United States Senate. (n.d.). Senate organization chart for the 117th CongressLinks to an external site..  https://www.senate.gov/reference/org_chart.htm

 

 

• Review this week’s Learning Resources. Consider the insights they provide about assessing and diagnosing anxiety, obsessive compulsive, and trauma-related disorders.
• Review the Focused SOAP Note template, which you will use to complete this Assignment. There is also a Focused SOAP Note Exemplar provided as a guide for Assignment expectations.
• Review the video, Case Study: Dev Cordoba. You will use this case as the basis of this Assignment. In this video, a Walden faculty member is assessing a mock patient. The patient will be represented onscreen as an avatar.
• Consider what history would be necessary to collect from this patient.
• Consider what interview questions you would need to ask this patient.

The Assignment

Develop a Focused SOAP Note, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis. Incorporate the following into your responses in the template:

• Subjective: What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?
• Objective: What observations did you make during the psychiatric assessment?  
• Assessment: Discuss the patient’s mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis. Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
• Plan: What is your plan for psychotherapy? What is your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan. Also incorporate one health promotion activity and one patient education strategy.
• Reflection notes: What would you do differently with this patient if you could conduct the session again? Discuss what your next intervention would be if you could follow up with this patient. Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion, and disease prevention, taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
• Provide at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines that relate to this case to support your diagnostics and differential diagnoses. Be sure they are current (no more than 5 years old).