How would you treat the various problems?

A Difficult Pregnancy” A Nurse Practitioner’s dilemma

“Aaaargh!” Susan P., Family Nurse Practitioner, felt extremely frustrated as she left Room 12. She had just spent the last 30 minutes with Lydia L., a developmentally disabled, 30-weeks-pregnant, 19-year-old Latina. “What’s wrong, Susan?” asked Bernie C.M., the group’s social worker.

“I’ve just spent the last half-hour with Lydia L., you know, the pregnant girl. I’m just so upset! She’s missed several appointments, even though I had the nurses call her. She was late today, as usual. She’s missed several important tests that need to be done during the second trimester. She’s here today with another urinary tract infection because she didn’t finish all the antibiotics from the last infection—they made her sick and she didn’t call us to let us know she had stopped them, even though I gave her specific verbal and written instructions. Now she’s got large quantities of ketones in her urine. On top of that, her blood type is Rh negative. I’ve worked hard to try to prevent anything from happening. I just don’t know what to do!”

“I understand your frustration. What was her excuse for missing the appointments?” asked Bernie. “That’s just it!” exclaimed Susan. “She has no excuse. She just sits there and smiles. She doesn’t seem to hear me. The more I try to talk to her, the quieter she becomes.” “Any luck setting up help for her? I know she’ll need it with her mom out of the picture and her boyfriend working,” said Bernie.

“Another frustration. The red tape. The forms they want filled out. I just know she won’t have any help when that baby comes.” Susan sat down and held her face in her hands. “This is just what I tried to avoid by keeping her here with us in our family practice rather than transferring her to the high-risk clinic at Children’s Hospital. I didn’t want her to ‘get lost,’ but that seems to be exactly what has happened. What should I do?”

A Nurse Practitioner’s Dilemma: Questions, Answers and Option Statement


The frustration of the nurse practitioner’s justified.
True _____ False _____

The nurse practitioner’s understands the clinical care required in Lydia’s case. True ____ False _____

The patient’s psychosocial issues have been adequately addressed.
True _____ False ____

Father’s Rights allow Lydia’s boyfriend to make decisions about the medical care of the unborn child. True _____ False _____

This the right time in Lydia’s coordinated care for the NP to recommend Lydia for a consultation with Social Work? True _____ False _____

Then briefly discuss how you would address at least 3 of the issues on Lydia’s Case.

In your discussion consider:

How would you treat the various problems?

What are the psychosocial issues?

What are the ethical issues?

How would you feel caring for this patient?

What are the treatments for reducing high cholesterol?

a Physician’s Assistant and you are set to meet with a patient to talk about his cholesterol panel. The patient, Mr. Brown, is a 56 year old male who leads a largely sedentary lifestyle. He has admitted, in a previous visit, that his favorite activity is sitting on the couch and eating snacks while watching sports. He has also expressed concerns that you would try to drastically change his lifestyle (which he does not want to do) if his tests came back high. The panel that came back on Mr. Brown contains the following results: Test Result Triglycerides 145 mg/dL Cholesterol 210 mg/dL HDL 33 mg/dL LDL 160 mg/dL • Report the results to Mr. Brown – be sure to tell him his exact numbers. • Interpret the results for Mr. Brown – are the results normal? Abnormal? What are the normal/abnormal ranges for each test? • What are triglycerides? • What is cholesterol? • What are LDL and HDL? • Where is cholesterol produced? • What are the causes of high cholesterol? • What are the treatments for reducing high cholesterol? • What are the side effects of medication for treating high cholesterol? • Do the benefits of lowering cholesterol outweigh the risks of taking medication? • What options exist for a person to try and reduce his/her cholesterol without taking medication? • How would you alleviate any fears Mr. Brown may have regarding his condition? • What recommendations would you make to Mr. Brown knowing his concerns? • What approach would you take to encourage him to make any necessary lifestyle changes?



1500 Words



Write a research proposal that follows on from MY LAST ASSIGNMENT Literature Review (IMPACT OF NATURAL DISASTER ON MENTAL HEALTH). This last assignment is attached below. You will need to include the following:

Title and 100 word summary of the proposed study
Rationale for the research (refer here back to the literature review)
Aims and Objectives, or research question/s
Research Design including
    Sampling Procedure
    Data Collection Procedure
    Draft Research Instrument(s)
    Proposed Data Analysis
Ethical Considerations
Limitations and Strengths of the project
Proposed Timetable

Please remember this is a proposal only.
No data collection is to be undertaken at all.

A minimum of 10 ACADEMIC sources should be used in the proposal in APA 6th format.

The Research Proposal must be typed on a word processor.

Assessment Criteria

The assignment will be assessed according to the following criteria:(each criteria will be given equal weighting)

Demonstrated case for the research including rationale
Quality of proposed research design
Critical awareness of both limits and possible external factors affecting the proposal.
Strength of considerations of limitations and ethical issues within the research
Adherence to academic conventions of writing (e.g. referencing; writing style)
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Gynecologic Health

Select a patient that you examined as a nurse practitioner student during the last three weeks of clinical on OB/GYN Issue. With this patient in mind, address the following in a SOAP Note 1 OR 2 PAGES :

Subjective: What details did the patient provide regarding her personal and medical history?

Objective: What observations did you make during the physical assessment?

Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?

Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters for this patient , as well as a rationale for this treatment and management plan.

Very Important: Reflection notes: What would you do differently in a similar patient evaluation?


Gagan, M. J. (2009). The SOAP format enhances communication. Kai Tiaki Nursing New Zealand, 15(5), 15.

Tharpe, N. L., Farley, C., & Jordan, R. G. (2013). Clinical practice guidelines for midwifery & Women’s health (4th ed.). Burlington, MA: Jones & Bartlett Publishers.

Chapter 6, “Care of the Well Woman Across the Life Span” ,“Care of the Woman Interested in Barrier Methods of Birth Control” (pp. 275–278)

Chapter 7, “Care of the Woman with Reproductive Health Problems”

“Care of the Woman with Dysmenorrhea” (pp. 366–368)

“Care of the Woman with Premenstrual Symptoms, Syndrome (PMS), or Dysphoric Disorder (PMDD)” (pp. 414–418)