Health Care Policy And DERMATOLOGY CASE STUDY: According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long? 

1) Minimum 3 full pages  

Part 1: minimum 1 page

Part 2: minimum 1 page (you must answer this part two times)

Submit 1 document per part

2)¨******APA norms, please use headers

 

All paragraphs must be narrative and cited in the text- each paragraphs

Bulleted responses are not accepted

Dont write in the first person

Dont copy and pase the questions.

Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph

3) It will be verified by Turnitin and SafeAssign 

4) Minimum 9 references not older than 5 years

Part 1: minimum 3 references / Reference  in APA format: http://www.countyhealthrankings.org/ 

 Part 2: minimum 3 references per document

5) ***************Identify your answer with the numbers, according to the question.

Example:

Q 1. Nursing is XXXXX

Q 2. Health is XXXX

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Part 1: Health Care Policy

Go to the following website by clicking on the provided link, http://www.countyhealthrankings.org/ 

Florida and Family and domestic violence.

Review the website and the health outcomes in the County Health Rankings for the area.

1) Briefly list the general statistics pertaining to a specific health concern that is on the rise in selected the city/county (Florida and Family and domestic violence). 

2) How can the creation of a community health center program help to address this public health problem?

3) What can you as a nurse practitioner and/or nurse leader do to influence policy innovation to resolve the problem?

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 Part 2:  DERMATOLOGY CASE STUDY (see attach)

you must answer this part two times

You must submit 2 documents (each one 1 page)

Copy and paste will not be admitted. 

You should address the questions with different wording, different references, but always, objectively answering the questions.

Questions:

Please see below:

 

Primary Diagnosis: Proximal subungual onychomycosis

Differential Diagnosis:  Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis

Special Lab:

Fungal culture confirms fungal infection.

As an NP student, you need to determine the medications for onychomycosis.

1. According to the AAFP/CDC Guidelines, what antifungal medication(s) should this patient be prescribed, and for how long?

2. Write her complete prescriptions using the prescription writing format

3.  What labs for baseline and follow up of therapy would you order for this patient? Give rationale.

 

 

Chief complaint:  “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.

HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief.  She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin  AF cream and it did not help relief her symptoms. She has not tried other remedies.

Denies associated symptoms of fever and chills.

PMH: Diabetes Mellitus, type 2.

Surgeries: None

Allergies: Augmentin

Medication: Metformin 500mg PO BID.

Vaccination History:  Immunization is up to date and she received her flu shot this year.

Social history: College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.

Family history:Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.

ROS:

Constitutional: Negative for fever. Negative for chills.

Respiratory: No Shortness of breath. No Orthopnea

Cardiovascular: Regular rhythm.

Skin: Right great toe swollen, itchy, painful and discolored.

Psychiatric: No anxiety. No depression.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.

NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.

LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.

HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.

MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.

SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.

PSYCH: Normal affect. Cooperative.

Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

Assessment:

Primary Diagnosis: Proximal subungual onychomycosis

Differential Diagnosis:  Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis

Special Lab:

Fungal culture confirms fungal infection.