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

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Select a patient that you examined during the last three weeks. With this patient in mind, address the following in a SOAP Note:

  • 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, as well as a rationale for this treatment and management plan.
  • Reflection notes: What would you do differently in a similar patient evaluation?

What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management including alternative therapies?

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Select a patient that you examined during the last 3 weeks. With this patient in mind, address the following in a SOAP Note: Subjective: What details did the patient provide regarding his or 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? Reflection notes: What would you do differently in a similar patient evaluation?

The importance of clear and evidenced writing is key to all assignments. The clarity with which you explain things, the conciseness of your writing and the correct use of references to support your work underpin the marking criteria for all assignments.

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The importance of clear and evidenced writing is key to all assignments. The clarity with which you explain things, the conciseness of your writing and the correct use of references to support your work underpin the marking criteria for all assignments.

Tom and Al are members of Barchester University athletics team. They are fierce rivals and one of them has been the winner of each race they have entered for the last two years. They are now competing in the preliminary race of the National University Games. The winner will go on to race in the highly prestigious International University Games.

While practicing two days before the race, Al injures his ankle, and although he is still fit enough to compete in the race, he realizes he now has no chance of defeating Tom. So he decides to find a way to slow Tom down. Al finds a jar containing a strong medical substance at his home, which he has been using as a muscle-relaxer. He reads the label on the jar and discovers that if the medical substance is taken without a doctor’s advice and in a very high dose, it can be dangerous as it increases the heart rate and even causes death in certain circumstances. Al decides that this is just the thing he needs to slow Tom down. Just before the race, Al puts all the contents of the jar containing the medical substance into Tom’s water bottle, and watches as Tom drinks all the contents of the water bottle. Half way through the race, Tom collapses in pain. He is rushed to Barchester University College Hospital (BUCH). The doctors there are able to regulate Tom’s heart beat again and connect him to an oxygen tank to enable him to breathe properly. The following day, however, the small tube which has been carrying oxygen from the tank into Tom’s body becomes disconnected and the doctors fail to realize this. Tom suffers a heart attack, and although the doctors try to resuscitate him, Tom dies.

It is later revealed that Tom is the fourth person in 2 months to die at BUCH following incidents involving the oxygen tank, and that the General Manager of BUCH had been informed of these incidents but had yet to take any steps to address the issue.

Advise Al, the doctors and BUCH of their potential criminal liability. It might be helpful to think about the following:

  1. Al’s criminal liability for murder (actus reus and mens rea) ONLY.
  2. Causation inparticular interventions between conduct and result (novusactus interveniens). Does the doctors’ conduct amount to a novus actus interveniens? Consider Jordan (1956) 40 Cr App R 152; Smith [1959] 2 QB 35; Cheshire [1991] 3 All ER 670.
  3. Mens rea, in particular oblique intention: consider Woollin [1999] 1 AC 82.
  4. The doctors’ criminal liability for killing by gross negligence. Consider

Adomako [1995] 1 A.C. 171.

  1. BUCH’s liability for corporate manslaughter. Consider section 1(1) and (3) of

the Corporate Manslaughter and Corporate Homicide Act 2007.

Method of Approach

You need to ascertain from the facts whether the elements of a crime defined by the substantive law (here murder, gross negliegnce manslaughter and corporate manslaughter) are present i.e. the mens rea/fault and the actus reus. To do this you must research the relevant substantive law and then apply it to the facts. Just stating the substantive law will not be enough to pass the assignment. To obtain a B grade or above there must be evidence of considered thought when applying the law to the facts.

Diagnosing Skin, Eye, Ear, and Throat Disorders

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Diagnosing Skin, Eye, Ear, and Throat Disorders

When entering examination rooms, advanced practice nurses often immediately begin assessing patients by looking for external abnormalities such as skin irritations or cloudy eyes. By making these simple observations, they can determine how to proceed with their patient evaluations. During the patient evaluation, advanced practice nurses will use initial observations to guide them in acquiring the necessary medical history, performing additional assessments, and ordering the appropriate diagnostics. The information obtained during this evaluation process will help in the development of a differential diagnosis. Once a diagnosis is made, the advanced practice nurse can consider potential treatment options and work with the patient to develop a plan of care. For this Discussion, consider the following four case studies of patients presenting with skin, eye, ear, and throat disorders.

Case Study 1:
A 46-year-old male presents to the office complaining of a pruritic skin rash that has been present for a few weeks. He initially noted the rash on his chest, but it then spread to his back and arms. He notes that it does not seem to be on his legs. He recently came home from a trip to Florida, but denies fever, chills, new soaps or detergents, other travel, or known insect bites. He takes occasional ibuprofen for knee pain, but denies taking other medications or having other health problems. He has no known drug allergies. The physical examination reveals a male with a deep tan and notable scattered 1–1.5-centimeter, flat, circular, light-colored patches on his chest, back, and upper extremities.

Case Study 2:
An 86-year-old widowed female is brought to the office by her daughter-in-law. The patient complains of constant tearing and an itchy, burning sensation in both eyes. The patient states this is not a new problem, but it has worsened in the past week and is affecting her vision. The patient complains that her eyes are dry. She thinks the problem must be caused by one of her medications. Her patient medical history is positive for hypertension, atrial fibrillation, and heart failure. She has an allergy to erythromycin that causes rash and elevated liver enzymes. Medications currently prescribed include Furosemide 40 milligrams po twice a day, diltiazem 240 milligrams po daily, lisinopril 20 milligrams po daily, and warfarin 3 milligrams po daily. The physical examination reveals a frail older female with some facial dryness and slight scaling. Her visual acuity is 20/60 OU, 20/40 OD, 20/60 OS. The eyelids are erythematous and edematous with yellow crusting around the lashes. Sclera are injected, conjunctiva are pale, and pupils are equal and reactive to light and accommodation.

Case Study 3:
A middle-aged male presents to the office complaining of a two-day history of a left earache. The onset was gradual, but has steadily been increasing. It has been constantly aching since last night, and his hearing seems diminished to him. Today he thinks the left side of his face may even be swollen. He denies upper respiratory infection, known fever, or chills. His patient medical history is positive for Type 2 diabetes mellitus, hypertension, and hyperlipidemia. The patient has a known allergy to Amoxicillin that results in pruritus. Medications currently prescribed include Metformin 1,000 milligrams po twice a day, lisinopril 20 milligrams po daily, Aspirin 81 milligrams po daily, and simvastatin 40 milligrams po daily. The physical exam reveals a middle aged male at a weight of 160 pounds, height of 5’8”, temperature of 98.8 degrees Fahrenheit, heart rate of 88, respiratory rate of 18, and blood pressure of 138/76. Further examination reveals the following:
Face: Faint asymmetry with left periauricular area slightly edematous
Eyes: sclera clear, conj wnl
L ear: + tenderness L pinna, + edema, erythema, exudates left external auditory canal, TM not visible
R ear: no tenderness, R external auditory canal clear without edema, erythema, exudates
+ tenderness L preauricular node, otherwise no lymphadenopathy
Cardiac: S1 S2 regular. No S3 S4 or murmur.
Lungs: CTA w/o rales, wheezes, or rhonchi.

Case Study 4:
A middle-aged female presents to the office complaining of strep throat. She states she suddenly developed a sore throat yesterday afternoon, and it has gotten worse since then. During the night she felt like she was chilled and feverish. She denies known recent contact with anyone else who had strep throat, but states she has had strep before and it feels like she has strep now. She takes no medications, but is allergic to penicillin. The physical examination reveals a slender female lying on the examination table. She has a temperature of 101 degrees Fahrenheit, heart rate of 112, respiratory rate of 22, and blood pressure of 96/64. The head, eyes, ears, nose, and throat evaluation is positive for bilateral tonsillar swelling without exudates. Her neck is supple with bilateral, tender, enlarged anterior cervical nodes.