Question are in the attached file. Please review the rubricYour assignment will be graded based on this rubric.RubricU/W4 Clinical Challenge James Lewis and Jessica Johnson Rubric24 possible pointsExcellent4 pointsGood3 pointsSatisfactory2 pointsDeficient1 pointNot present0 pointsExplanation of issues–/4 pointsIssue/problem to be considered critically is stated clearly and described comprehensively, delivering all relevant information necessary for full understanding.Issue/problem to be considered critically is stated, described, and clarified so that understanding is not seriously impeded by omissions.Issue/problem to be considered critically is stated but description leaves some terms undefined, ambiguities unexplored, boundaries undetermined, and/or backgrounds unknown.Issue/problem to be considered critically is stated without clarification or description.Absent presentation of the Issue/problemEvidence–/4 pointsSelecting and using information to investigate a point of view or conclusionInformation is taken from source(s) with enough interpretation/evaluation to develop a comprehensive analysis or synthesis. Viewpoints of experts are questioned thoroughly.Information is taken from source(s) with enough interpretation/evaluation to develop a coherent analysis or synthesis.Viewpoints of experts are subject to questioning.Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis.Viewpoints of experts are taken as mostly fact, with little questioning.Information is taken from source(s) without any interpretation/evaluation.Viewpoints of experts are taken as fact, without question.No information nor source(s) is presentedInfluence of context and assumptions–/4 pointsThoroughly (systematically and methodically) analyzes own and others’ assumptions and carefully evaluates the relevance of contexts when presenting a position.Identifies own and others’ assumptions and several relevant contexts when presenting a position.Questions some assumptions. Identifies several relevant contexts when presenting a position. May be more aware of others’ assumptions than one’s own (or vice versa).Shows an emerging awareness of present assumptions (sometimes labels assertions as assumptions). Begins to identify some contexts when presenting a position.No awareness nor assumptions presentedStudent’s position (perspective, thesis/hypothesis)–/4 pointsSpecific position (perspective, thesis/hypothesis) is imaginative, taking into account the complexities of an issue.Limits of position (perspective, thesis/hypothesis) are acknowledged.Others’ points of view are synthesized within position (perspective, thesis/hypothesis).Specific position (perspective, thesis/hypothesis) takes into account the complexities of an issue.Others’ points of view are acknowledged within position (perspective, thesis/hypothesis).Specific position (perspective, thesis/hypothesis) acknowledges different sides of an issue.Specific position (perspective, thesis/hypothesis) is stated, but is simplistic and obvious.No positions statedConclusions and related outcomes (implications and consequences)–/4 pointsConclusions and related outcomes (consequences and implications) are logical and reflect student’s informed evaluation and ability to place evidence and perspectives discussed in priority order.Conclusion is logically tied to a range of information, including opposing viewpoints; related outcomes (consequences and implications) are identified clearly.Conclusion is logically tied to information (because information is chosen to fit the desired conclusion); some related outcomes (consequences and implications) are identified clearly.Conclusion is inconsistently tied to some of the information discussed; related outcomes (consequences and implications) are oversimplified.Lack conclusion References–/4 pointsThe student cites authors of recent references (5 years or less of published) related to the topic of the discussion forum, written according to the latest edition of APA.Sometimes the student cites authors of recent references (5 years or less of published) related to the topic of the discussion forum, written according to the latest edition of APA.On rare occasions the student cites authors of recent references (5 years or less of published) related to the topic of the discussion forum, written according to the latest edition of APA.The student never cites authors of recent references (5 years or less of published) related to the topic of the discussion forum, written according to the latest edition of APA.No references includedDEPARTAMENTO DE CIENCIAS NATURALES
PROGRAMA DE ENFERMERÍA
S/W4: ABDOMEN URINARY MALE AND FEMALE REPRODUCTIVE SYSTEM
CLINICAL CHALLENGE: APPLICATION TO CLINICAL PRACTICE
Hopknsmedicine.org
James Lewis is a 24-year-old male who is seen in the clinic for “pain in the groin.” During the interview
the patient states, “I have a soreness in my groin area on both sides.” Mr. Lewis denies any trauma to
the area, states he has not done any heavy lifting, nor has he been involved in athletic activities or
“working out.” He reports that he is in good health. He does not take any medications except vitamins
and, occasionally, some non-aspirin product for a headache. He denies nausea, vomiting, diarrhea, or
fever. He has no pain in his legs or back. He tells the nurse his appetite is okay but he is tired. He thinks
his fatigue is because he’s been “a little worried about this problem and really having a hard time
deciding to come in for help.”
When asked about the onset of the problem, Mr. Lewis explains that he “started feeling some achiness
about a week ago.” When asked if he has ever experienced these feelings before, he replies, “No.” He is
then asked to describe or discuss any other symptoms. He looks away, shifts in his chair, and then says,
“Well, I have had some burning when I pass urine and it’s kind of cloudy.”
When asked if he has ever had a problem like this before, he replies, “Yes, about 2 months ago.” With
further questioning, the nurse learns that Mr. Lewis was diagnosed with gonorrhea and treated with an
injection and pills he was supposed to take for a week. He says he was not supposed to have sex until he
finished the pills. When asked if he followed the prescribed treatment, he reluctantly responds that he
finished all but a couple of pills and he did have sex with one of his girlfriends about 4 or 5 days after he
got the injection. Mr. Lewis tells the nurse he did not inform his girlfriends of his problem and he
generally avoids condoms because “I’ve known these girls for a long time.”
The physical assessment yields the following information: B/P 128/86, P 96, RR 20, T 98.6. His color is
pale, and the skin is moist and warm. External genitalia are intact, without lesions or erythema. There is
lymphadenopathy in bilateral groin areas. Compression of the glans yields milky discharge. A smear of
urethral discharge is obtained.
The nurse knows that Mr. Lewis’s original gonococcal infection was treated with an injection, most likely
ceftriaxone. The nurse also knows that chlamydia is present in almost half of the patients with
gonorrhea and is treated with a 7-day regimen of oral antibiotics. Between 40% and 60% of patients
with gonorrhea have lymphadenopathy.
Based on the data, the nurse suspects that Mr. Lewis has a reinfection with gonorrhea and may have a
concomitant chlamydial infection.
The nurse recommends single-injection treatment for gonorrhea and a new oral regimen for chlamydia.
A urine specimen will be obtained and submitted with the urethral discharge smear. The patient will be
scheduled for a follow-up phone conference about the laboratory results in 48 hours and a return visit in
7 days. The nurse conducts an information, education, and advice session prior to discharge from the
clinic
Jessica Johnson, a 24-year-old Caucasian female, arrives in the clinic with lower abdominal pain and
nausea. She states, “I’ve had this throbbing pain for 3 days and it kept getting worse.” She further states,
“I haven’t been able to eat. I feel awful. You have to do something for the pain.”
The nurse explains that more information is needed so that the proper treatment can be initiated. In
further interview the following information is obtained. Ms. Johnson’s last menstrual period was 1 week
ago and she had more crampiness than usual. She has had brownish, thick vaginal discharge on and off
since then. She has had some itchiness in the vaginal area and burning when she voids. She states she
has to go to the bathroom all the time: “All I did was pee little bits, until this pain got to me. I have
hardly gone since last night.”
When asked about the pain, Ms. Johnson says it is mostly 8 on a scale of 1 to 10 and getting pretty
constant. “Nothing I do helps, except it helps a little if I curl up and hold still.”
Physical assessment reveals a thin, pale female. VS: B/P 108/64, P 92, RR 20, T 101.4°F. Skin is hot, dry,
poor turgor. Mucous membranes dry. Posture—abdominal guarding. Abdomen BS positive in all 4
quadrants , tenderness in RLQ drainage, pain upon cervical and uterine movement. Cultures from
vaginal secretions obtained To lab, Blood drawn for CBC, To lab Urine specimen obtained—clear, yellow
To lab
The patient’s clinic record reveals that she has been sexually active since age 16. She has had multiple
partners and one abortion. She has been treated for an STD three times, most recently 2 months prior
to this visit. The patient is on birth control pills. She has no allergies to medications, and no family
history of cardiovascular, abdominal, neurologic, urologic, endocrine, or reproductive disease.
Interpretation of the data suggests a diagnosis of PID. The options are outpatient treatment with
antibiotics and education about limitations in activity and sexual practices, or inpatient treatment with
intravenous fluids, antibiotics, analgesia, and bed rest.
Because Ms. Johnson is acutely ill, with pain and dehydration, she is admitted to the acute care facility
with a diagnosis of PID.
Clinical Challenge question:
What healthy people 2020 objectives are related to each scenario: James Lewis and Jessica
Johnson?
Your answer must not exceed a total of 100 words. Students must write their and upoload them a total
of three pages is required for this work
Work format: follow the 6th edition APA manual (for this course will accept single space)
Total pages: 3 pages student must summarize data and concepts demonstrating the integration of
knowledge, according to the following distribution:
Page 1: Title
Page 2: Answer questions
Page 3: Bibliography
Revise and answer according to the rubric included in the work
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