APA stile, no plagiarism. This is an example of SOAP notes:

Patient Information 

Name: Mr. R.G.

Age: 58-year-old

Sex: Male

Source: Patient

Allergies: No known allergies. No seasonal allergies detected

Current Medications: No current medication mentioned by the patient. 

PMH: The patient has been abusing alcohol but quit two years back. He is suffering from obesity disorder and hypothyroidism. 

Immunizations: Immunization is up to date. 

History of the Family: Mother- deceased at 70 years, no information related to the cause of his death but was having obesity disorder. 

Father still alive: History of Type II diabetes, Hypertension

Soap Notes 

Subjective

Chief Complain (CC): the patient came to the facility complaining of heat intolerance, and sweating.  

HPI: Mr. R.G he is having an increased nervousness, sweating, and hotness of the body. 

ROS

General: Patient appears to be weak and fatigue. He has a loss in the body weight, poor sleep, thirst, nausea, and increased frequency of defection. He also states of losing appetite and shaking.  

Constitutional:  The patient denies of having chest pain, palpitations, shortness of breath, and disorientation. 

Respiratory: No shortness of breath with no asthma or seasonal allergies

Cardiovascular: no history of Dyslipidemia, no history of high blood pressure. He has no dyspnea on exertion, there is absent of cough, edema, or heart murmurs. 

Gastrointestinal: the patient has nausea but no vomiting. The patient has lost appetite. 

GU: He denies vaginal discharge, no irritation in his urinary tract. 

Objective

Mr. R.G appears to be little disturbed, maintains his eye contact, clearly gives a proper description of how he feels and his age, and the dressing as per the present weather.

Vital Signs: B/P: 105/95 mmHg, Regular pulse of 90 beats per min, Temprature: 96.5; Height: 70 inches; weight: 113 lb: BMI: 16.2. 

Clear and normal breathing sounds with no adventitious breathing sounds. Goiter noted on palpation.

Cardiovascular: no apparent distress, fidgeting in the seat, no presence of murmurs and gallops. 

Gastrointestinal: soft and non-tendered abdomen when touched. 

GU: suprapubic regions are tender to touch 

Assessment

Hyperthyroidism, a disease related to Graves’ illness

Plan

To acquire the baseline thyroid stimulating hormone assay; prescription of the antithyroid medications such as Carbimazole and propylthiouracil; performing thyroid hormone level using thyroid stimulating hormone blood test.; monitoring the thyroid-stimulating hormone assay at first and the third months, performing radioactive iodine treatment when necessary. In case the thyroid hormone level is not improved, thyroid lobectomy will be performed 

 

"Looking for a Similar Assignment? Order now and Get 10% Discount! Use Code "GET10" in your order"

Informatics have changed dramatically in the last ten years. The changes in health care alone have forced organizations to do things far differently than they imagined. The massive amounts of data available grow every day. The purpose of this assignment is to use data and trends to forecast the future of the fields of informatics. 

Research resent trends to forecast what the coming years may bring for the field of informatics.

Use data to support your predictions 

Include a minimum of three peer- reviewed sources

Format your answer according to APA guidelines

650-800 word paper 

 

"Looking for a Similar Assignment? Order now and Get 10% Discount! Use Code "GET10" in your order"

can you help me to write this observation and you can use the information i have mentioned in draft and follow the rubrics APA format ( PACU 

Observation Site Grading Rubric

Category

% allocated

Achieved

Comments

“Time Out” Protocol

Aspects (10%), importance of   (5%), procedure for (5%)

20 %

5 safety guidelines/practices   (4% each)

· Must be specific to the   observation site

· Were these followed? (5%)

25 %

Priority nursing diagnosis for   1 patient in which you observed care (5%)

· Must include: related to   (5%), as evidenced by (5%), intervention (5%), goals (2.5%), and evaluation   (2.5%)

· No risk for diagnosis   will be accepted

25 %

Ethical/legal dilemma (include   a possible one if one was not witnessed)

10 %

Personal Reflection

5 %

2 Peer reviewed Nursing Journal   Articles (5% each) integrated into paper for support

10 %

APA Format

1-2 errors -1

2-4 errors -3

>5 errors Loss of 5

5 %

 

"Looking for a Similar Assignment? Order now and Get 10% Discount! Use Code "GET10" in your order"

Transactional Vs Transformational Leadership.

Using the Internet,read at least 2 articles each on Transactional Vs Transformational Leadership. Summarize the articles in 300 words or more. Provide appropriate reference. 

· Combine each summarize in one paper but do not change the wording of the original summary. Include the team member’s name, name of the article and references.

· As a term, write a comprehensive summary of the articles. Present a discussion of what your team learned from this exercise. 

 

"Looking for a Similar Assignment? Order now and Get 10% Discount! Use Code "GET10" in your order"

In 500 words or more, discuss the risk and costs of compromised data integrity breaches. Focus on integrity not confidentiality. Look at military, education, science, medicine, finance, utilities, municipalities, etc.

Include at least one quote from 3 articles, place them in quotation marks and cite in-line (as all work copied from another should be handled).

Cite your sources in a reference list at the end. Do not copy without providing proper attribution (quotation marks and in-line citations). Write in essay format not in bulleted, numbered or other list format. 

Reply to two classmates’ posting in a paragraph of at least five sentences by asking questions, reflecting on your own experience, challenging assumptions, pointing out something new you learned, offering suggestions. These peer responses are not ‘attaboys’.   You should make your initial post by Thursday evening so your classmates have an opportunity to respond before Sunday.at midnight when all three posts are due. 

It is important that you use your own words, that you cite your sources, that you comply with the instructions regarding length of your post and that you reply to two classmates in a substantive way (not ‘nice post’ or the like).  Your goal is to help your colleagues write better. Do not use spinbot or other word replacement software. It usually results in nonsense and is not a good way to learn anything. . I will not spend a lot of my time trying to decipher nonsense. Proof read your work or have it edited. Find something interesting and/or relevant to your work to write about.  Please do not submit attachments unless requested.

 

"Looking for a Similar Assignment? Order now and Get 10% Discount! Use Code "GET10" in your order"