Tag: Pathophysiology & Pharmacology

  • [Solved] Dr R Judy Mark

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    310 This week we are introduced to both _genetics_ and _genomics_ in healthcare. As you complete the readings for this week, consider both the risks and benefits of using both _genetics_ and _genomics_ in caring for patients. What are three risks and three benefits? What safeguards would you suggest…

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    310

    This week we are introduced to both _genetics_ and _genomics_ in healthcare. As you complete the readings for this week, consider both the risks and benefits of using both _genetics_ and _genomics_ in caring for patients. What are three risks and three benefits? What safeguards would you suggest to ensure that the benefits of using genetics and genomics in healthcare outweigh the risks?

    315

    Antibiotic resistance has exponentially increased in the last two decades and this is widely contributed to the liberal prescriptions of antibiotics for various conditions, even when medically unnecessary. Even though antibiotics are some of the most effective medications for treatment of infectious diseases, the over prescription of them leads to an accelerated rate of resistance. It is also interesting that conditions such as C Diff, with overt symptoms such as diarrhea, are treated with high dose and various antibiotics that have the potential to compound the already present issue. Please review the following article and share your experience with the use of antibiotics as treatment and potential consequences for future patient care.

    Anwar, M., Raziq, A., Shoaib, M., Baloch, N. S., Raza, S., Sajjad, B., Sadaf, N., Iqbal, Z., Ishaq, R., Haider, S., Iqbal, Q., Ahmad, N., Haque, N., & Saleem, F. (2021). Exploring Nurses' Perception of Antibiotic Use and Resistance: A Qualitative Inquiry. _Journal of multidisciplinary healthcare_, _14_, 1599–1608. [https://doi.org/10.2147/JMDH.S309020](https://doi.org/10.2147/JMDH.S309020)

    [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254422/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254422/)

    400

    For this week's discussion, please select or describe a current ethical issue in the healthcare of veterans.  This may be one you found on the VA Scandals webpage, or another topic of interest to you.

    Describe the issue, which ethical principle it violates, and then share at least 2 recommendations that could

    improve the ethical treatment of veterans.

    – 2 years ago

  • [Solved] Collaboration for Improving Outcomes– Evidence-Based Practice and Case Management

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    – [\ \ Screenshot2.png](https://www.sweetstudy.com/files/screenshot2-png-10149297 "Screenshot2.png") – 2 years ago

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    – [\
    \
    Screenshot2.png](https://www.sweetstudy.com/files/screenshot2-png-10149297 "Screenshot2.png")

    – 2 years ago

  • [Solved] clinical sbar

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    – 2 years ago **files (3)** – ## PRAC6665FocusedSOAPNoteTemplaterev12.20221.doc – ## week7sbar.docx – ## NRNP_PRAC_6665_6675_FocusedSOAP_Note_Exemplar_rev.4.20221.docx **## PRAC6665FocusedSOAPNoteTemplaterev12.20221.doc** [removed] **## week7sbar.docx** 2 The patient is a 16-year-old male w…

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    Assignment Prompt & Instructions

    – 2 years ago

    **files (3)**

    – ## PRAC6665FocusedSOAPNoteTemplaterev12.20221.doc

    – ## week7sbar.docx

    – ## NRNP_PRAC_6665_6675_FocusedSOAP_Note_Exemplar_rev.4.20221.docx

    **## PRAC6665FocusedSOAPNoteTemplaterev12.20221.doc**

    [removed]

    **## week7sbar.docx**

    2

    The patient is a 16-year-old male with a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD), primarily inattentive presentation, who presents for follow-up regarding symptom management. He reports ongoing difficulty with focus and task completion in school, particularly during independent study periods. Parents and teachers have noted some improvement in his ability to stay on task since starting medication but report continued challenges with organization and time management. The patient denies significant side effects from his current medication but notes occasional appetite suppression. Sleep and mood are stable.     Continue methylphenidate extended-release 20 mg once daily, with instructions to take the medication in the morning with food to minimize appetite effects. Educate the patient and parents on strategies to support organization, such as using a planner and setting reminders. Emphasize adherence to medication and maintaining a consistent daily routine. Plan for a follow-up in one month to evaluate symptom progression, medication efficacy, and any potential side effects.

    · Review the
    **Kaltura button** from the
    **Classroom Support Center** (accessed via the
    **Help** button) for help creating your self-recorded Kaltura video.

    · Select an
    adult patient that you examined during the last 4 weeks who presented with a disorder
    other than the disorder present in your Week 3 Case Presentation.

    · Create a Focused SOAP Note on this patient using the template provided in the Learning Resources. There is also a completed Focused SOAP Note Exemplar provided to serve as a guide to assignment expectations.
    **Please** **Note:**

    · All SOAP notes must be signed, by your Preceptor.
    **Note:** Electronic signatures are not accepted.

    · When you submit your note, you should include the complete focused SOAP note as a Word document and PDF/images of the completed assignment signed by your Preceptor.

    · You must submit your SOAP note using Turnitin.
    **Note:** If both files are not received by the due date, faculty will deduct points per the Walden Grading Policy.

    · Then, based on your SOAP note of this patient, develop a video case study presentation. Take time to practice your presentation before you record.

    · Include at least five scholarly resources to support your assessment, diagnosis, and treatment planning.

    · Ensure that you have the appropriate lighting and equipment to record the presentation.

    **The Assignment**

    **Record** yourself presenting the complex case for your clinical patient.

    **Do not sit and read your written evaluation!** The video portion of the assignment is a simulation to demonstrate your ability to succinctly and effectively present a complex case to a colleague for a case consultation. The written portion of this assignment is a simulation for you to demonstrate to the faculty your ability to document the complex case as you would in an electronic medical record. The written portion of the assignment will be used as a guide for faculty to review your video to determine if you are omitting pertinent information or including non-essential information during your case staffing consultation video.

    In your presentation:

    · Dress professionally and present yourself in a professional manner.

    · Display your photo ID at the start of the video when you introduce yourself.

    · Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).

    · Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management.

    · Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.

    · Be succinct in your presentation, and do not exceed 8 minutes. Specifically address the following for the patient, using your SOAP note as a guide:

    ·
    **Subjective:** What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

    ·
    **Objective:** What observations did you make during the psychiatric assessment?

    ·
    **Assessment:** Discuss patient mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis, and why? Describe how your primary diagnosis aligns with
    _DSM-5_ diagnostic criteria and supported by the patient’s symptoms.

    ·
    **Plan:** In your video, describe your treatment plan using clinical practice guidelines supported by evidence-based practice. Include a discussion on your chosen FDA-approved psychopharmacologic agents and include alternative treatments available and supported by valid research. All treatment choices must have a discussion of your rationale for the choice supported by valid research. What were your follow-up plan and parameters? What referrals would you make or recommend as a result of this treatment session?

    · In your written plan include all the above as well as include one social determinant of health according to the HealthyPeople 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health. As a future advanced provider, what are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking.

    ·
    **Reflection notes:** What would you do differently with this patient if you could conduct the session over? If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow up, discuss what your next intervention would be.

    **## NRNP_PRAC_6665_6675_FocusedSOAP_Note_Exemplar_rev.4.20221.docx**

    **NRNP/PRAC 6665 & 6675 Focused SOAP Psychiatric Evaluation Exemplar**

    INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY

    If you are struggling with the format or remembering what to include, follow the
    Focused SOAP Note Evaluation Template
    **_AND_** the Rubric
    as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. After reviewing full details of the rubric, you can use it as a guide.

    In the
    Subjective section, provide:

    · Chief complaint

    · History of present illness (HPI)

    · Past psychiatric history

    · Medication trials and current medications

    · Psychotherapy or previous psychiatric diagnosis

    · Pertinent substance use, family psychiatric/substance use, social, and medical history

    · Allergies

    · ROS

    Read rating descriptions to see the grading standards!

    In the
    Objective section, provide:

    · Physical exam documentation of systems pertinent to the chief complaint, HPI, and history

    · Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.

    Read rating descriptions to see the grading standards!

    In the
    Assessment section, provide:

    · Results of the mental status examination,
    _presented in paragraph form._

    · At least three differentials with supporting evidence. List them from top priority to least priority. Compare the
    _DSM-5_-TR diagnostic criteria for each differential diagnosis and explain what
    _DSM-5-TR_ criteria rules out the differential diagnosis to find an accurate diagnosis.
    _Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case_.

    ·
    Read rating descriptions to see the grading standards!

    Reflect on this case. Include: Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (
    **_demonstrate critical thinking beyond confidentiality and consent for treatment_**!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

    (The FOCUSED SOAP psychiatric evaluation is typically the
    _follow-up visit_ patient note. You will practice writing this type of note in this course. You will be focusing more on the symptoms from your differential diagnosis from the comprehensive psychiatric evaluation narrowing to your diagnostic impression. You will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

    EXEMPLAR BEGINS HERE

    **Subjective:**

    **CC** (chief complaint): A
    brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

    **HPI**: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:

    N.M. is a 34-year-old Asian male presents for medication management follow up for anxiety. He was initiated sertraline last appt which he finds was effective for two weeks then symptoms began to return.

    Or

    P.H., a 16-year-old Hispanic female, presents for follow up to discuss previous psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications as we deferred until further testing and screening was conducted.

    Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

    Paint a picture of what is wrong with the patient. First what is bringing the patient to your follow up evaluation? Document symptom onset, duration, frequency, severity, and impact. What has worsened or improved since last appointment? What stressors are they facing? Your description here will guide your differential diagnoses into your diagnostic impression. You are seeking symptoms that may align with many
    _DSM-5_ diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

    **Substance Use History:** This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

    **Current Medications**: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

    **Allergies**:
    Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

    **Reproductive Hx**:
    Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns

    **ROS**: Cover all body systems that may help you include or rule out a differential diagnosis. Please note: THIS IS DIFFERENT from a physical examination!

    You should list each system as follows:
    General:Head:
    EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

    Example of Complete ROS:

    GENERAL: No weight loss, fever, chills, weakness, or fatigue.

    HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

    SKIN: No rash or itching.

    CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

    RESPIRATORY: No shortness of breath, cough, or sputum.

    GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

    GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

    NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

    MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

    HEMATOLOGIC: No anemia, bleeding, or bruising.

    LYMPHATICS: No enlarged nodes. No history of splenectomy.

    ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

    **Objective:**

    **Diagnostic results**: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).

    **Assessment:**

    **Mental Status Examination:** For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

    He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.

    **Diagnostic Impression**:
    You must begin to narrow your differential diagnosis to your diagnostic impression. You must explain how and why (your rationale) you ruled out any of your differential diagnoses. You must explain how and why (your rationale) you concluded to your diagnostic impression. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

    **Also included in this section is the reflection.** Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

    Also include in your reflection a discussion related to legal/ethical considerations (
    **demonstrating critical thinking beyond confidentiality and consent for treatment!**), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

    **Case Formulation and Treatment Plan**

    Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions including psychotherapy and/or psychopharmacology, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner.
    ***See an example below. You will modify to your practice so there may be information excluded/included. If you are completing this for a practicum, what does your preceptor document?**

    Risks and benefits of medications are discussed including non- treatment. Potential side effects of medications discussed (be detailed in what side effects discussed). Informed client not to stop medication abruptly without discussing with providers. Instructed to call and report any adverse reactions. Discussed risk of medication with pregnancy/fetus, encouraged birth control, discussed if does become pregnant to inform provider as soon as possible. Discussed how some medications might decreased birth control pill, would need back up method (exclude for males).

    Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs. Instructed to avoid this practice. Encouraged abstinence. Discussed how drugs/alcohol affect mental health, physical health, sleep architecture.

    Initiation of (list out any medication and why prescribed, any therapy services or referrals to specialist):

    Client was encouraged to continue with case management and/or therapy services (if not provided by you)

    Client has emergency numbers: Emergency Services 911, the Client's Crisis Line
    **1-800-_______**. Client instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal. (only if you or preceptor provided them)

    Reviewed hospital records/therapist records for collaborative information; Reviewed PMP report (only if actually completed)

    Time allowed for questions and answers provided. Provided supportive listening. Client appeared to understand discussion. Client is amenable with this plan and agrees to follow treatment regimen as discussed. (this relates to informed consent; you will need to assess their understanding and agreement)

    Follow up with PCP as needed and/or for:

    Labs ordered and/or reviewed (write out what diagnostic test ordered, rationale for ordering, and if discussed fasting/non fasting or other patient education)

    Return to clinic:

    Continued treatment is medically necessary to address chronic symptoms, improve functioning, and prevent the need for a higher level of care.

    **References (move to begin on next page)**

    You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

    © 2022 Walden University Page 1 of 3

    **## NRNP_PRAC_6665_6675_FocusedSOAP_Note_Exemplar_rev.4.20221.docx**

    **NRNP/PRAC 6665 & 6675 Focused SOAP Psychiatric Evaluation Exemplar**

    INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY

    If you are struggling with the format or remembering what to include, follow the
    Focused SOAP Note Evaluation Template
    **_AND_** the Rubric
    as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. After reviewing full details of the rubric, you can use it as a guide.

    In the
    Subjective section, provide:

    · Chief complaint

    · History of present illness (HPI)

    · Past psychiatric history

    · Medication trials and current medications

    · Psychotherapy or previous psychiatric diagnosis

    · Pertinent substance use, family psychiatric/substance use, social, and medical history

    · Allergies

    · ROS

    Read rating descriptions to see the grading standards!

    In the
    Objective section, provide:

    · Physical exam documentation of systems pertinent to the chief complaint, HPI, and history

    · Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.

    Read rating descriptions to see the grading standards!

    In the
    Assessment section, provide:

    · Results of the mental status examination,
    _presented in paragraph form._

    · At least three differentials with supporting evidence. List them from top priority to least priority. Compare the
    _DSM-5_-TR diagnostic criteria for each differential diagnosis and explain what
    _DSM-5-TR_ criteria rules out the differential diagnosis to find an accurate diagnosis.
    _Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case_.

    ·
    Read rating descriptions to see the grading standards!

    Reflect on this case. Include: Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (
    **_demonstrate critical thinking beyond confidentiality and consent for treatment_**!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

    (The FOCUSED SOAP psychiatric evaluation is typically the
    _follow-up visit_ patient note. You will practice writing this type of note in this course. You will be focusing more on the symptoms from your differential diagnosis from the comprehensive psychiatric evaluation narrowing to your diagnostic impression. You will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

    EXEMPLAR BEGINS HERE

    **Subjective:**

    **CC** (chief complaint): A
    brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

    **HPI**: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:

    N.M. is a 34-year-old Asian male presents for medication management follow up for anxiety. He was initiated sertraline last appt which he finds was effective for two weeks then symptoms began to return.

    Or

    P.H., a 16-year-old Hispanic female, presents for follow up to discuss previous psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications as we deferred until further testing and screening was conducted.

    Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

    Paint a picture of what is wrong with the patient. First what is bringing the patient to your follow up evaluation? Document symptom onset, duration, frequency, severity, and impact. What has worsened or improved since last appointment? What stressors are they facing? Your description here will guide your differential diagnoses into your diagnostic impression. You are seeking symptoms that may align with many
    _DSM-5_ diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

    **Substance Use History:** This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

    **Current Medications**: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

    **Allergies**:
    Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

    **Reproductive Hx**:
    Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns

    **ROS**: Cover all body systems that may help you include or rule out a differential diagnosis. Please note: THIS IS DIFFERENT from a physical examination!

    You should list each system as follows:
    General:Head:
    EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

    Example of Complete ROS:

    GENERAL: No weight loss, fever, chills, weakness, or fatigue.

    HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

    SKIN: No rash or itching.

    CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

    RESPIRATORY: No shortness of breath, cough, or sputum.

    GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

    GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

    NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

    MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

    HEMATOLOGIC: No anemia, bleeding, or bruising.

    LYMPHATICS: No enlarged nodes. No history of splenectomy.

    ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

    **Objective:**

    **Diagnostic results**: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).

    **Assessment:**

    **Mental Status Examination:** For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

    He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.

    **Diagnostic Impression**:
    You must begin to narrow your differential diagnosis to your diagnostic impression. You must explain how and why (your rationale) you ruled out any of your differential diagnoses. You must explain how and why (your rationale) you concluded to your diagnostic impression. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

    **Also included in this section is the reflection.** Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

    Also include in your reflection a discussion related to legal/ethical considerations (
    **demonstrating critical thinking beyond confidentiality and consent for treatment!**), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

    **Case Formulation and Treatment Plan**

    Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions including psychotherapy and/or psychopharmacology, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner.
    ***See an example below. You will modify to your practice so there may be information excluded/included. If you are completing this for a practicum, what does your preceptor document?**

    Risks and benefits of medications are discussed including non- treatment. Potential side effects of medications discussed (be detailed in what side effects discussed). Informed client not to stop medication abruptly without discussing with providers. Instructed to call and report any adverse reactions. Discussed risk of medication with pregnancy/fetus, encouraged birth control, discussed if does become pregnant to inform provider as soon as possible. Discussed how some medications might decreased birth control pill, would need back up method (exclude for males).

    Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs. Instructed to avoid this practice. Encouraged abstinence. Discussed how drugs/alcohol affect mental health, physical health, sleep architecture.

    Initiation of (list out any medication and why prescribed, any therapy services or referrals to specialist):

    Client was encouraged to continue with case management and/or therapy services (if not provided by you)

    Client has emergency numbers: Emergency Services 911, the Client's Crisis Line
    **1-800-_______**. Client instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal. (only if you or preceptor provided them)

    Reviewed hospital records/therapist records for collaborative information; Reviewed PMP report (only if actually completed)

    Time allowed for questions and answers provided. Provided supportive listening. Client appeared to understand discussion. Client is amenable with this plan and agrees to follow treatment regimen as discussed. (this relates to informed consent; you will need to assess their understanding and agreement)

    Follow up with PCP as needed and/or for:

    Labs ordered and/or reviewed (write out what diagnostic test ordered, rationale for ordering, and if discussed fasting/non fasting or other patient education)

    Return to clinic:

    Continued treatment is medically necessary to address chronic symptoms, improve functioning, and prevent the need for a higher level of care.

    **References (move to begin on next page)**

    You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

    © 2022 Walden University Page 1 of 3

    **## PRAC6665FocusedSOAPNoteTemplaterev12.20221.doc**

    [removed]

    **## week7sbar.docx**

    2

    The patient is a 16-year-old male with a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD), primarily inattentive presentation, who presents for follow-up regarding symptom management. He reports ongoing difficulty with focus and task completion in school, particularly during independent study periods. Parents and teachers have noted some improvement in his ability to stay on task since starting medication but report continued challenges with organization and time management. The patient denies significant side effects from his current medication but notes occasional appetite suppression. Sleep and mood are stable.     Continue methylphenidate extended-release 20 mg once daily, with instructions to take the medication in the morning with food to minimize appetite effects. Educate the patient and parents on strategies to support organization, such as using a planner and setting reminders. Emphasize adherence to medication and maintaining a consistent daily routine. Plan for a follow-up in one month to evaluate symptom progression, medication efficacy, and any potential side effects.

    · Review the
    **Kaltura button** from the
    **Classroom Support Center** (accessed via the
    **Help** button) for help creating your self-recorded Kaltura video.

    · Select an
    adult patient that you examined during the last 4 weeks who presented with a disorder
    other than the disorder present in your Week 3 Case Presentation.

    · Create a Focused SOAP Note on this patient using the template provided in the Learning Resources. There is also a completed Focused SOAP Note Exemplar provided to serve as a guide to assignment expectations.
    **Please** **Note:**

    · All SOAP notes must be signed, by your Preceptor.
    **Note:** Electronic signatures are not accepted.

    · When you submit your note, you should include the complete focused SOAP note as a Word document and PDF/images of the completed assignment signed by your Preceptor.

    · You must submit your SOAP note using Turnitin.
    **Note:** If both files are not received by the due date, faculty will deduct points per the Walden Grading Policy.

    · Then, based on your SOAP note of this patient, develop a video case study presentation. Take time to practice your presentation before you record.

    · Include at least five scholarly resources to support your assessment, diagnosis, and treatment planning.

    · Ensure that you have the appropriate lighting and equipment to record the presentation.

    **The Assignment**

    **Record** yourself presenting the complex case for your clinical patient.

    **Do not sit and read your written evaluation!** The video portion of the assignment is a simulation to demonstrate your ability to succinctly and effectively present a complex case to a colleague for a case consultation. The written portion of this assignment is a simulation for you to demonstrate to the faculty your ability to document the complex case as you would in an electronic medical record. The written portion of the assignment will be used as a guide for faculty to review your video to determine if you are omitting pertinent information or including non-essential information during your case staffing consultation video.

    In your presentation:

    · Dress professionally and present yourself in a professional manner.

    · Display your photo ID at the start of the video when you introduce yourself.

    · Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).

    · Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management.

    · Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.

    · Be succinct in your presentation, and do not exceed 8 minutes. Specifically address the following for the patient, using your SOAP note as a guide:

    ·
    **Subjective:** What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

    ·
    **Objective:** What observations did you make during the psychiatric assessment?

    ·
    **Assessment:** Discuss patient mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis, and why? Describe how your primary diagnosis aligns with
    _DSM-5_ diagnostic criteria and supported by the patient’s symptoms.

    ·
    **Plan:** In your video, describe your treatment plan using clinical practice guidelines supported by evidence-based practice. Include a discussion on your chosen FDA-approved psychopharmacologic agents and include alternative treatments available and supported by valid research. All treatment choices must have a discussion of your rationale for the choice supported by valid research. What were your follow-up plan and parameters? What referrals would you make or recommend as a result of this treatment session?

    · In your written plan include all the above as well as include one social determinant of health according to the HealthyPeople 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health. As a future advanced provider, what are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking.

    ·
    **Reflection notes:** What would you do differently with this patient if you could conduct the session over? If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow up, discuss what your next intervention would be.

    **## NRNP_PRAC_6665_6675_FocusedSOAP_Note_Exemplar_rev.4.20221.docx**

    **NRNP/PRAC 6665 & 6675 Focused SOAP Psychiatric Evaluation Exemplar**

    INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY

    If you are struggling with the format or remembering what to include, follow the
    Focused SOAP Note Evaluation Template
    **_AND_** the Rubric
    as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. After reviewing full details of the rubric, you can use it as a guide.

    In the
    Subjective section, provide:

    · Chief complaint

    · History of present illness (HPI)

    · Past psychiatric history

    · Medication trials and current medications

    · Psychotherapy or previous psychiatric diagnosis

    · Pertinent substance use, family psychiatric/substance use, social, and medical history

    · Allergies

    · ROS

    Read rating descriptions to see the grading standards!

    In the
    Objective section, provide:

    · Physical exam documentation of systems pertinent to the chief complaint, HPI, and history

    · Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.

    Read rating descriptions to see the grading standards!

    In the
    Assessment section, provide:

    · Results of the mental status examination,
    _presented in paragraph form._

    · At least three differentials with supporting evidence. List them from top priority to least priority. Compare the
    _DSM-5_-TR diagnostic criteria for each differential diagnosis and explain what
    _DSM-5-TR_ criteria rules out the differential diagnosis to find an accurate diagnosis.
    _Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case_.

    ·
    Read rating descriptions to see the grading standards!

    Reflect on this case. Include: Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (
    **_demonstrate critical thinking beyond confidentiality and consent for treatment_**!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

    (The FOCUSED SOAP psychiatric evaluation is typically the
    _follow-up visit_ patient note. You will practice writing this type of note in this course. You will be focusing more on the symptoms from your differential diagnosis from the comprehensive psychiatric evaluation narrowing to your diagnostic impression. You will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

    EXEMPLAR BEGINS HERE

    **Subjective:**

    **CC** (chief complaint): A
    brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

    **HPI**: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:

    N.M. is a 34-year-old Asian male presents for medication management follow up for anxiety. He was initiated sertraline last appt which he finds was effective for two weeks then symptoms began to return.

    Or

    P.H., a 16-year-old Hispanic female, presents for follow up to discuss previous psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications as we deferred until further testing and screening was conducted.

    Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

    Paint a picture of what is wrong with the patient. First what is bringing the patient to your follow up evaluation? Document symptom onset, duration, frequency, severity, and impact. What has worsened or improved since last appointment? What stressors are they facing? Your description here will guide your differential diagnoses into your diagnostic impression. You are seeking symptoms that may align with many
    _DSM-5_ diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

    **Substance Use History:** This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

    **Current Medications**: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

    **Allergies**:
    Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

    **Reproductive Hx**:
    Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns

    **ROS**: Cover all body systems that may help you include or rule out a differential diagnosis. Please note: THIS IS DIFFERENT from a physical examination!

    You should list each system as follows:
    General:Head:
    EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

    Example of Complete ROS:

    GENERAL: No weight loss, fever, chills, weakness, or fatigue.

    HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

    SKIN: No rash or itching.

    CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

    RESPIRATORY: No shortness of breath, cough, or sputum.

    GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

    GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

    NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

    MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

    HEMATOLOGIC: No anemia, bleeding, or bruising.

    LYMPHATICS: No enlarged nodes. No history of splenectomy.

    ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

    **Objective:**

    **Diagnostic results**: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).

    **Assessment:**

    **Mental Status Examination:** For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

    He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.

    **Diagnostic Impression**:
    You must begin to narrow your differential diagnosis to your diagnostic impression. You must explain how and why (your rationale) you ruled out any of your differential diagnoses. You must explain how and why (your rationale) you concluded to your diagnostic impression. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

    **Also included in this section is the reflection.** Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

    Also include in your reflection a discussion related to legal/ethical considerations (
    **demonstrating critical thinking beyond confidentiality and consent for treatment!**), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

    **Case Formulation and Treatment Plan**

    Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions including psychotherapy and/or psychopharmacology, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner.
    ***See an example below. You will modify to your practice so there may be information excluded/included. If you are completing this for a practicum, what does your preceptor document?**

    Risks and benefits of medications are discussed including non- treatment. Potential side effects of medications discussed (be detailed in what side effects discussed). Informed client not to stop medication abruptly without discussing with providers. Instructed to call and report any adverse reactions. Discussed risk of medication with pregnancy/fetus, encouraged birth control, discussed if does become pregnant to inform provider as soon as possible. Discussed how some medications might decreased birth control pill, would need back up method (exclude for males).

    Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs. Instructed to avoid this practice. Encouraged abstinence. Discussed how drugs/alcohol affect mental health, physical health, sleep architecture.

    Initiation of (list out any medication and why prescribed, any therapy services or referrals to specialist):

    Client was encouraged to continue with case management and/or therapy services (if not provided by you)

    Client has emergency numbers: Emergency Services 911, the Client's Crisis Line
    **1-800-_______**. Client instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal. (only if you or preceptor provided them)

    Reviewed hospital records/therapist records for collaborative information; Reviewed PMP report (only if actually completed)

    Time allowed for questions and answers provided. Provided supportive listening. Client appeared to understand discussion. Client is amenable with this plan and agrees to follow treatment regimen as discussed. (this relates to informed consent; you will need to assess their understanding and agreement)

    Follow up with PCP as needed and/or for:

    Labs ordered and/or reviewed (write out what diagnostic test ordered, rationale for ordering, and if discussed fasting/non fasting or other patient education)

    Return to clinic:

    Continued treatment is medically necessary to address chronic symptoms, improve functioning, and prevent the need for a higher level of care.

    **References (move to begin on next page)**

    You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

    © 2022 Walden University Page 1 of 3

    **## PRAC6665FocusedSOAPNoteTemplaterev12.20221.doc**

    [removed]

    **## week7sbar.docx**

    2

    The patient is a 16-year-old male with a diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD), primarily inattentive presentation, who presents for follow-up regarding symptom management. He reports ongoing difficulty with focus and task completion in school, particularly during independent study periods. Parents and teachers have noted some improvement in his ability to stay on task since starting medication but report continued challenges with organization and time management. The patient denies significant side effects from his current medication but notes occasional appetite suppression. Sleep and mood are stable.     Continue methylphenidate extended-release 20 mg once daily, with instructions to take the medication in the morning with food to minimize appetite effects. Educate the patient and parents on strategies to support organization, such as using a planner and setting reminders. Emphasize adherence to medication and maintaining a consistent daily routine. Plan for a follow-up in one month to evaluate symptom progression, medication efficacy, and any potential side effects.

    · Review the
    **Kaltura button** from the
    **Classroom Support Center** (accessed via the
    **Help** button) for help creating your self-recorded Kaltura video.

    · Select an
    adult patient that you examined during the last 4 weeks who presented with a disorder
    other than the disorder present in your Week 3 Case Presentation.

    · Create a Focused SOAP Note on this patient using the template provided in the Learning Resources. There is also a completed Focused SOAP Note Exemplar provided to serve as a guide to assignment expectations.
    **Please** **Note:**

    · All SOAP notes must be signed, by your Preceptor.
    **Note:** Electronic signatures are not accepted.

    · When you submit your note, you should include the complete focused SOAP note as a Word document and PDF/images of the completed assignment signed by your Preceptor.

    · You must submit your SOAP note using Turnitin.
    **Note:** If both files are not received by the due date, faculty will deduct points per the Walden Grading Policy.

    · Then, based on your SOAP note of this patient, develop a video case study presentation. Take time to practice your presentation before you record.

    · Include at least five scholarly resources to support your assessment, diagnosis, and treatment planning.

    · Ensure that you have the appropriate lighting and equipment to record the presentation.

    **The Assignment**

    **Record** yourself presenting the complex case for your clinical patient.

    **Do not sit and read your written evaluation!** The video portion of the assignment is a simulation to demonstrate your ability to succinctly and effectively present a complex case to a colleague for a case consultation. The written portion of this assignment is a simulation for you to demonstrate to the faculty your ability to document the complex case as you would in an electronic medical record. The written portion of the assignment will be used as a guide for faculty to review your video to determine if you are omitting pertinent information or including non-essential information during your case staffing consultation video.

    In your presentation:

    · Dress professionally and present yourself in a professional manner.

    · Display your photo ID at the start of the video when you introduce yourself.

    · Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).

    · Present the full complex case study. Include chief complaint; history of present illness; any pertinent past psychiatric, substance use, medical, social, family history; most recent mental status exam; current psychiatric diagnosis including differentials that were ruled out; and plan for treatment and management.

    · Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.

    · Be succinct in your presentation, and do not exceed 8 minutes. Specifically address the following for the patient, using your SOAP note as a guide:

    ·
    **Subjective:** What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis? What is the duration and severity of their symptoms? How are their symptoms impacting their functioning in life?

    ·
    **Objective:** What observations did you make during the psychiatric assessment?

    ·
    **Assessment:** Discuss patient mental status examination results. What were your differential diagnoses? Provide a minimum of three possible diagnoses and why you chose them. List them from highest priority to lowest priority. What was your primary diagnosis, and why? Describe how your primary diagnosis aligns with
    _DSM-5_ diagnostic criteria and supported by the patient’s symptoms.

    ·
    **Plan:** In your video, describe your treatment plan using clinical practice guidelines supported by evidence-based practice. Include a discussion on your chosen FDA-approved psychopharmacologic agents and include alternative treatments available and supported by valid research. All treatment choices must have a discussion of your rationale for the choice supported by valid research. What were your follow-up plan and parameters? What referrals would you make or recommend as a result of this treatment session?

    · In your written plan include all the above as well as include one social determinant of health according to the HealthyPeople 2030 (you will need to research) as applied to this case in the realm of psychiatry and mental health. As a future advanced provider, what are one health promotion activity and one patient education consideration for this patient for improving health disparities and inequities in the realm of psychiatry and mental health? Demonstrate your critical thinking.

    ·
    **Reflection notes:** What would you do differently with this patient if you could conduct the session over? If you are able to follow up with your patient, explain whether these interventions were successful and why or why not. If you were not able to conduct a follow up, discuss what your next intervention would be.

    **## NRNP_PRAC_6665_6675_FocusedSOAP_Note_Exemplar_rev.4.20221.docx**

    **NRNP/PRAC 6665 & 6675 Focused SOAP Psychiatric Evaluation Exemplar**

    INSTRUCTIONS ON HOW TO USE EXEMPLAR AND TEMPLATE—READ CAREFULLY

    If you are struggling with the format or remembering what to include, follow the
    Focused SOAP Note Evaluation Template
    **_AND_** the Rubric
    as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. After reviewing full details of the rubric, you can use it as a guide.

    In the
    Subjective section, provide:

    · Chief complaint

    · History of present illness (HPI)

    · Past psychiatric history

    · Medication trials and current medications

    · Psychotherapy or previous psychiatric diagnosis

    · Pertinent substance use, family psychiatric/substance use, social, and medical history

    · Allergies

    · ROS

    Read rating descriptions to see the grading standards!

    In the
    Objective section, provide:

    · Physical exam documentation of systems pertinent to the chief complaint, HPI, and history

    · Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.

    Read rating descriptions to see the grading standards!

    In the
    Assessment section, provide:

    · Results of the mental status examination,
    _presented in paragraph form._

    · At least three differentials with supporting evidence. List them from top priority to least priority. Compare the
    _DSM-5_-TR diagnostic criteria for each differential diagnosis and explain what
    _DSM-5-TR_ criteria rules out the differential diagnosis to find an accurate diagnosis.
    _Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case_.

    ·
    Read rating descriptions to see the grading standards!

    Reflect on this case. Include: Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (
    **_demonstrate critical thinking beyond confidentiality and consent for treatment_**!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

    (The FOCUSED SOAP psychiatric evaluation is typically the
    _follow-up visit_ patient note. You will practice writing this type of note in this course. You will be focusing more on the symptoms from your differential diagnosis from the comprehensive psychiatric evaluation narrowing to your diagnostic impression. You will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)

    EXEMPLAR BEGINS HERE

    **Subjective:**

    **CC** (chief complaint): A
    brief statement identifying why the patient is here. This statement is verbatim of the patient’s own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

    **HPI**: Begin this section with patient’s initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:

    N.M. is a 34-year-old Asian male presents for medication management follow up for anxiety. He was initiated sertraline last appt which he finds was effective for two weeks then symptoms began to return.

    Or

    P.H., a 16-year-old Hispanic female, presents for follow up to discuss previous psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications as we deferred until further testing and screening was conducted.

    Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.

    Paint a picture of what is wrong with the patient. First what is bringing the patient to your follow up evaluation? Document symptom onset, duration, frequency, severity, and impact. What has worsened or improved since last appointment? What stressors are they facing? Your description here will guide your differential diagnoses into your diagnostic impression. You are seeking symptoms that may align with many
    _DSM-5_ diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

    **Substance Use History:** This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

    **Current Medications**: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

    **Allergies**:
    Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

    **Reproductive Hx**:
    Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns

    **ROS**: Cover all body systems that may help you include or rule out a differential diagnosis. Please note: THIS IS DIFFERENT from a physical examination!

    You should list each system as follows:
    General:Head:
    EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

    Example of Complete ROS:

    GENERAL: No weight loss, fever, chills, weakness, or fatigue.

    HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.

    SKIN: No rash or itching.

    CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.

    RESPIRATORY: No shortness of breath, cough, or sputum.

    GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.

    GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color

    NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.

    MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

    HEMATOLOGIC: No anemia, bleeding, or bruising.

    LYMPHATICS: No enlarged nodes. No history of splenectomy.

    ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

    **Objective:**

    **Diagnostic results**: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).

    **Assessment:**

    **Mental Status Examination:** For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—DO NOT just copy the example. You may use a preceptor’s way of organizing the information if the MSE is in paragraph form.

    He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking.   He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.

    **Diagnostic Impression**:
    You must begin to narrow your differential diagnosis to your diagnostic impression. You must explain how and why (your rationale) you ruled out any of your differential diagnoses. You must explain how and why (your rationale) you concluded to your diagnostic impression. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

    **Also included in this section is the reflection.** Reflect on this case and discuss whether or not you agree with your preceptor’s assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

    Also include in your reflection a discussion related to legal/ethical considerations (
    **demonstrating critical thinking beyond confidentiality and consent for treatment!**), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

    **Case Formulation and Treatment Plan**

    Includes documentation of diagnostic studies that will be obtained, referrals to other health care providers, therapeutic interventions including psychotherapy and/or psychopharmacology, education, disposition of the patient, and any planned follow-up visits. Each diagnosis or condition documented in the assessment should be addressed in the plan. The details of the plan should follow an orderly manner.
    ***See an example below. You will modify to your practice so there may be information excluded/included. If you are completing this for a practicum, what does your preceptor document?**

    Risks and benefits of medications are discussed including non- treatment. Potential side effects of medications discussed (be detailed in what side effects discussed). Informed client not to stop medication abruptly without discussing with providers. Instructed to call and report any adverse reactions. Discussed risk of medication with pregnancy/fetus, encouraged birth control, discussed if does become pregnant to inform provider as soon as possible. Discussed how some medications might decreased birth control pill, would need back up method (exclude for males).

    Discussed risks of mixing medications with OTC drugs, herbal, alcohol/illegal drugs. Instructed to avoid this practice. Encouraged abstinence. Discussed how drugs/alcohol affect mental health, physical health, sleep architecture.

    Initiation of (list out any medication and why prescribed, any therapy services or referrals to specialist):

    Client was encouraged to continue with case management and/or therapy services (if not provided by you)

    Client has emergency numbers: Emergency Services 911, the Client's Crisis Line
    **1-800-_______**. Client instructed to go to nearest ER or call 911 if they become actively suicidal and/or homicidal. (only if you or preceptor provided them)

    Reviewed hospital records/therapist records for collaborative information; Reviewed PMP report (only if actually completed)

    Time allowed for questions and answers provided. Provided supportive listening. Client appeared to understand discussion. Client is amenable with this plan and agrees to follow treatment regimen as discussed. (this relates to informed consent; you will need to assess their understanding and agreement)

    Follow up with PCP as needed and/or for:

    Labs ordered and/or reviewed (write out what diagnostic test ordered, rationale for ordering, and if discussed fasting/non fasting or other patient education)

    Return to clinic:

    Continued treatment is medically necessary to address chronic symptoms, improve functioning, and prevent the need for a higher level of care.

    **References (move to begin on next page)**

    You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

    © 2022 Walden University Page 1 of 3

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    Overview: Lifestyle modifications play a crucial role in preventing and managing chronic diseases such as cardiovascular disease. For this discussion, you will explore how lifestyle changes-such as nutrition, physical activity, stress management, and avoiding harmful behaviors–can prevent or modify…

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    Overview: Lifestyle modifications play a crucial role in preventing and managing chronic diseases such as cardiovascular disease. For this discussion, you will explore how lifestyle changes-such as nutrition, physical activity, stress management, and avoiding harmful behaviors–can prevent or modify disease processes and promote restoration of health. (CSLO#4).

    1. Choose a Disease Process: Select a specific disease process (e.g., hypertension, Type 2 diabetes, coronary artery disease, chronic obstructive pulmonary disease).

    2. Discuss Lifestyle Changes: Describe at least two lifestyle changes that can prevent, modify, or restore health in relation to your selected disease. Use evidence-based practice (EBP) to support your discussion.

    o Include specific examples of dietary changes, physical activity, smoking cessation, or stress management techniques.

    3. Explain the Impact: Discuss how these lifestyle changes influence the disease process. Explain the physiological or behavioral changes that occur as a result.

    4. Relate to Nursing Practice: Identify the nurse's role in educating and promoting these lifestyle modifications. How can nurses empower patients to adopt and sustain these changes?

    5. Support with Evidence: Integrate at least two peer-reviewed scholarly sources published within the last five years. Use APA format for in-text citations and your reference list.

    Please this discussion most has between 400-500 words.

    – 2 years ago

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    Overview: Lifestyle modifications play a crucial role in preventing and managing chronic diseases such as cardiovascular. For this discussion, you will explore how lifestyle changes—such as nutrition, physical activity, stress management, and avoiding harmful behaviors—can prevent or modify disease …

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    Overview: Lifestyle modifications play a crucial role in preventing and managing chronic diseases such as cardiovascular. For this discussion, you will explore how lifestyle changes—such as nutrition, physical activity, stress management, and avoiding harmful behaviors—can prevent or modify disease processes and promote restoration of health. (CSLO #4)

    1. Choose a Disease Process: Select a specific disease process (e.g., hypertension, Type 2 diabetes, coronary artery disease, chronic obstructive pulmonary disease).

    2. Discuss Lifestyle Changes: Describe at least two lifestyle changes that can prevent, modify, or restore health in relation to your selected disease. Use evidence-based practice (EBP) to support your discussion.

    o Include specific examples of dietary changes, physical activity, smoking cessation, or stress management techniques.

    3. Explain the Impact: Discuss how these lifestyle changes influence the disease process. Explain the physiological or behavioral changes that occur as a result.

    4. Relate to Nursing Practice: Identify the nurse's role in educating and promoting these lifestyle modifications. How can nurses empower patients to adopt and sustain these changes?

    5. Support with Evidence: Integrate at least two peer-reviewed scholarly sources published within the last five years. Use APA format for in-text citations and your reference list.

    – 2 years ago

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    Overview: Lifestyle modifications play a crucial role in preventing and managing chronic diseases such as cardiovascular. For this discussion, you will explore how lifestyle changes—such as nutrition, physical activity, stress management, and avoiding harmful behaviors—can prevent or modify disease …

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    Overview: Lifestyle modifications play a crucial role in preventing and managing chronic diseases such as cardiovascular. For this discussion, you will explore how lifestyle changes—such as nutrition, physical activity, stress management, and avoiding harmful behaviors—can prevent or modify disease processes and promote restoration of health. (CSLO #4).

    1. Choose a Disease Process: Select a specific disease process (e.g., hypertension, Type 2 diabetes, coronary artery disease, chronic obstructive pulmonary disease).

    2. Discuss Lifestyle Changes: Describe at least two lifestyle changes that can prevent, modify, or restore health in relation to your selected disease. Use evidence-based practice (EBP) to support your discussion.

    o Include specific examples of dietary changes, physical activity, smoking cessation, or stress management techniques.

    3. Explain the Impact: Discuss how these lifestyle changes influence the disease process. Explain the physiological or behavioral changes that occur as a result.

    4. Relate to Nursing Practice: Identify the nurse's role in educating and promoting these lifestyle modifications. How can nurses empower patients to adopt and sustain these changes?

    5. Support with Evidence: Integrate at least two peer-reviewed scholarly sources published within the last five years. Use APA format for in-text citations and your reference list.

    Search forums

    Please use  around 400 to 500 words.

    – 2 years ago

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    **Instructions: Select two of the following neurotransmitters:** – Serotonin – Norepinephrine – Dopamine – Acetylcholine – Glutamate – Melatonin – Histamine – GABA For each neurotransmitter, please discuss the following: pharmacologic action, the drug class it is most closely linked to, expected out…

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    **Instructions: Select two of the following neurotransmitters:**

    – Serotonin
    – Norepinephrine
    – Dopamine
    – Acetylcholine
    – Glutamate
    – Melatonin
    – Histamine
    – GABA

    For each neurotransmitter, please discuss the following: pharmacologic action, the drug class it is most closely linked to, expected outcomes, and potential side effects. Based on this information, which condition would these neurotransmitters be considered for the treatment plan?

    – 2 years ago

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    See attached for word documents for instructions and samples. – 2 years ago **files (2)** – ## Instructions.docx – ## SampleInternetNavigationProject-1.docx **## Instructions.docx** **Internet Navigation Project** This project corresponds to health effects of exercise and physical activity and requi…

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    See attached for word documents for instructions and samples.

    – 2 years ago

    **files (2)**

    – ## Instructions.docx

    – ## SampleInternetNavigationProject-1.docx

    **## Instructions.docx**

    **Internet Navigation Project**

    This project corresponds to health effects of exercise and physical activity and requires you to research a Centers for Disease Control national dataset to collect and interpret relevant physical activity (exposure) and outcome information (disease prevalence, economic cost of disease, morbidity and mortality statistics).

    Goal: Understanding the data by using online resources like CDC Behavioral Risk Factor surveillance website to underscore the magnitude of the obesity problem and why physical activity is so important to health.
    **You will be reporting prevalence rates for two topics: Physical Activity and Obesity.**

    TOPIC ONE: PHYSICAL ACTIVITY

    1. Search the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Survey (BRFSS) link (
    [http://www.cdc.gov/brfss/brfssprevalence/index.html](http://www.cdc.gov/brfss/brfssprevalence/index.html)) and look to the "Explore BRFSS data by topic section. In the "Class" area choose: Physical Activity

    2. For the topic select: Physical Activity

    3. Choose one year at a time. Select the years of your choice. You will report on two different years (the larger the gap between the years the better). In the "question" link  choose: Adults with 30+ minutes of moderate activity five or more days per week (Do not select 20+ minutes question).

    4.  For each year report the following below:Then select "no" for the response

    1. For each of the two years choose two qualifiers to report on: Gender, Age group, Race/Ethnicity, Education, Household income. These are selected by clicking on the "view by" tab.

    5. Then report the crude prevalence for each category (there will be four displayed) shown. Tell the reader the percentages for each category and what states specifically correspond to each category.

    TOPIC TWO: BMI CATEGORIES

    1. Search the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Survey (BRFSS) link (
    [http://www.cdc.gov/brfss/brfssprevalence/index.html](http://www.cdc.gov/brfss/brfssprevalence/index.html)) and look to the "Explore BRFSS data by topic section. In the "Class" area choose: Overweight and obesity

    2. For the topic select: BMI categories

    3. In the "question" link  choose the only question to select – Weight classification of BMI

    4. Select the same two years you reported on for physical activity. (Remember, the larger the gap between the years the better). For each year report the following below:Then for the response select "Obese (BMI 30.0 – 99.8)"

    1. For each of the two years choose two qualifiers to report on: Gender, Age group, Race/Ethnicity, Education, Household income.

    5. Then report the crude prevalence for each category (there will be four displayed) shown. Tell the reader the percentages for each category and what states specifically correspond to each category.

    Lastly, tell the reader how how the physical activity data correlate with the obesity/BMI data you found? What do the trend data suggest? How do you interpret these data? What does this mean for public health practitioners? Where should our programs focus in the future?

    **## SampleInternetNavigationProject-1.docx**

    Running Head: INTERNET NAVIGATION 1

    INTERNET NAVIGATION PROJECT 7

    Internet Navigation Project

    Student Name

    National University

    **Title of Paper Here**

    **Physical Activity (Qualifiers: Gender Female)**

    **1996**

    70.8 – 77.1%: Washington, Oregon, Nevada, Idaho, Utah, Montana, Wyoming, Colorado, New Mexico, Minnesota, Vermont, New Hampshire, Hawaii, Massachusetts

    77.2 – 79.8%: California, Alaska, Arizona, Texas, Wisconsin, Illinois, Michigan, Florida, Virginia, New Jersey, Connecticut, Rhode Island, Maine

    79.9 – 83.9%: North Dakota, South Dakota, Nebraska, Kansas, Oklahoma, Iowa, Missouri, Arkansas, Louisiana, Alabama, New York, Pennsylvania, District of Columbia

    84 – 89.9%: Indiana, Kentucky, Tennessee, Mississippi, Ohio, West Virginia, North Carolina, South Carolina, Georgia, Maryland, Delaware, Puerto Rico

    **2000**

    72.7 – 75.8%: Washington, Oregon, Alaska, Idaho, Montana, Utah, Wyoming, Colorado, Michigan, Virginia, Vermont, District of Columbia

    75.9 – 78.5%: California, Nevada, New Mexico, North Dakota, South Dakota, Wisconsin, Florida, Maine, New Hampshire, Massachusetts, Connecticut, Rhode Island, Pennsylvania

    78.6 – 82.3%: Arizona, Texas, Nebraska, Minnesota, Iowa, Missouri, Arkansas, Illinois, Alabama, Georgia, South Carolina, Maryland, New Jersey, New York,

    82.4 – 86.7%: Delaware, West Virginia, North Carolina, Ohio, Indiana, Kentucky, Tennessee, Mississippi, Louisiana, Kansas, Oklahoma, Puerto Rico

    **Physical Activity (Qualifiers: Age Group 18 – 24)**

    **1996**

    65.4 – 70.4%: Washington, Oregon, Montana, Wyoming, Utah, Colorado, South Dakota, Minnesota, New Jersey, Vermont, Puerto Rico

    70.5 – 75.7%: Idaho, Texas, Louisiana, Mississippi, Florida, Wisconsin, Michigan, Pennsylvania, Maine, Rhode Island, Connecticut

    75.8 – 80.2%: California, North Dakota, Kansas, Oklahoma, Iowa, Missouri, Illinois, Indiana, Alabama, North Carolina, New York, Delaware

    80.3 – 85.9%: Arizona, Nebraska, Arkansas, Ohio, Kentucky, Tennessee, Georgia, South Carolina, West Virginia, Virginia, Maryland

    **2000**

    62.6 – 69.2%: Washington, Oregon, Alaska, Wyoming, North Dakota, Illinois, Pennsylvania, Virginia, Rhode Island, Connecticut, District of Columbia

    69.3 – 73.1%: California, Nevada, Utah, Montana, Colorado, Michigan, Indiana, Arkansas, Alabama, New York, Vermont, , Massachusetts, New Jersey, Delaware

    73.2 – 76.9%: Idaho, Arizona, New Mexico, South Dakota, Texas, Oklahoma, Missouri, Mississippi, Georgia, Florida, South Carolina, West Virginia, Maryland, New Hampshire

    77 – 82.9%: Puerto Rico, Nebraska, Kansas, Louisiana, Iowa, Wisconsin, Minnesota, Tennessee, Kentucky, Ohio, North Carolina, Maine

    **BMI (Qualifiers: Gender Female)**

    **1996**

    10.7 – 14.1%: Nevada, Arizona, Utah, Montana, Wyoming, Colorado, South Dakota, Minnesota, Georgia, New Jersey, New Hampshire, Connecticut, Rhode Island, Massachusetts, Hawaii

    14.2 – 17.6%: Washington, Oregon, California, Idaho, New Mexico, North Dakota, Nebraska, Kansas, Oklahoma, Florida, Virginia, New York, Maine, Vermont

    17.7 – 19.1%: Alaska, Puerto Rico, Texas, Iowa, Arkansas, Wisconsin, Illinois, Kentucky, Michigan, Tennessee, North Carolina, Pennsylvania, Delaware, Maryland

    19.2 -21.4%: Missouri, Louisiana, Mississippi, Alabama, Indiana, Ohio, West Virginia, South Carolina, District of Columbia

    **2000**

    14.2 – 17.1%: Nevada, Montana, Wyoming, Colorado, Minnesota, Virginia, New Hampshire, Massachusetts, Rhode Island, Denver

    17.2 – 19.8%: Washington, California, Idaho, Utah, Arizona, New Mexico, North Dakota, South Dakota, Nebraska, Wisconsin, Florida, New York, New Jersey, Vermont

    19.9 – 22.1%: Oregon, Alaska, Kansas, Oklahoma, Iowa, Missouri, Illinois, Indiana, Michigan, Kentucky, Ohio, Maine, Pennsylvania, Maryland

    22.2 – 26.3%: Texas, Arkansas, Louisiana, Mississippi, Alabama, Georgia, Tennessee, Puerto Rico, South Carolina, North Carolina, West Virginia, District of Columbia

    **BMI (Qualifiers: Age Group 18 – 24)**

    **1996**

    3.7 – 6.8%: Idaho, Arizona, Colorado, Nebraska, Kansas, Minnesota Mississippi, Indiana, Georgia, New Hampshire, District of Columbia, Puerto Rico

    6.9 – 8.1%: Washington, Oregon, Wyoming, New Mexico, South Dakota, North Dakota, Wisconsin, Arkansas, Tennessee, Virginia, North Carolina, New Jersey, Connecticut

    8.2 – 10.4%: California, Nevada, Utah, Montana, Texas, Illinois, Florida, New York, Vermont, Massachusetts, Rhode Island, Delaware

    10.5 – 17.4%: Alaska, Oklahoma, Louisiana, Iowa, Missouri, Alabama, South Carolina, Michigan, Kentucky, Ohio, West Virginia, Pennsylvania, Maryland, Maine

    **2000**

    3.4 – 9.1%: Montana, Utah, Colorado, Minnesota, South Carolina, Virginia, New York, Maryland, Delaware, New Jersey, Rhode Island, District of Columbia

    9.2 – 11.2%: Washington, California, Alaska, Nevada, Idaho, Wyoming, South Dakota, Texas, Missouri, Florida, Puerto Rico, Massachusetts, Connecticut

    11.3 -12.8%: Hawaii, Arizona, New Mexico, North Dakota, Nebraska, Kansas, Wisconsin, Michigan, Indiana, Ohio, West Virginia, Pennsylvania, Georgia, Vermont

    12.9 – 19.2%: Oregon, Oklahoma, Arkansas, Louisiana, Iowa, Illinois, Mississippi, Alabama, Tennessee, Kentucky, North Carolina, New Hampshire, Maine

    Internet Navigation Project

    The Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Survey (BRFSS) was used to explore the years 1996 and 2000 on how physical activity correlates with body mass index (BMI). In both topics physical activity and BMI, the two qualifiers focused on the female gender and the age group 18 to 24 years old. The physical activity topic focused on adults whose response was no to engaging in thirty minutes or more of moderate activity five or more days per week. The BMI topic focused on weight classification by BMI.

    According to the BRFSS in 1996, thirty minutes of any physical activity five or more days per week said the female gender had a higher crude prevalence of 84 to 89.9 percent in the southern states compared to the states in the west coast region that had a lower crude prevalence between 77.8 to 77.1 percent. However, in 2000 there was an increase of states in the central and southern region that had a higher crude prevalence of 78.6 to 82.3 percent. The northwest states remained having a low crude prevalence similar to the year 1996. In 2000 the states that continued in the high crude prevalence similar to the year 1996 were Oklahoma, Louisiana, Iowa, Alabama, Kentucky, and Maine. Concentrating on the age group 18 to 24 year olds on physical activity in 1996, states in the east coast had a higher crude prevalence of 80.3 to 85.9 percent. The states that remained in this higher category in 2000 were Nebraska, Tennessee, Kentucky, and Ohio.

    Reviewing the BMI topic with a response of an obese BMI of 30.0 to 99.8 in the female gender in the year 1996 the state in the west coast had either a crude prevalence of 10.7 to 14.1 percent or 12.2 to 17.6 percent. The southern states and some states in the east coast had a high crude prevalence of 17.7 to 19.1 percent or 19.2 to 21.4 percent. However, in 2000 there was a drastic increase of states mainly in the southern area that hit the higher crude prevalence percentage of 22.2 to 26.3. These states included, Texas, Arkansas, Louisiana, Mississippi, Alabama, Georgia, Tennessee, South Carolina, North Carolina, and West Virginia. In 2000, the west coast remained in the lower crude prevalence percentage of 14.2 to 17.1 percent or 17.2 to 19.8 percent.

    Comparing the physical activity data and BMI data there is a comparison that show how states that do not stay physically active have a higher BMI. Physical activity in 1996 based on age group did not improve in the central states but increased in 2000. Along the same lines there is significant correlation comparing the physical activity data to the BMI data that focused on age. The BMI data displayed no improvement from 1996 to 2000 but an increase in the central states as well. The south and east coast displayed a higher crude prevalence percentage in physical activity in the age group of 18 to 24 years old and the female gender. This relates to the BMI data that also illustrates the same pattern in the age group of 18 to 24 years old and the female gender. The BMI in 1996 has increased in 2000 mainly in the south and east coast, similarly to the physical activity data where those states have indicated low physical activity.

    Due to the increase in obesity in the United States there has been many programs implemented to help this growing epidemic. However, public health practitioners should focus on promoting and educating exercise and physical activity. There are programs already implemented that will help our future generations such as the
    _Let’s Move!_ campaign, a national initiative launch by First Lady Michelle Obama on February 9, 2010 (Gibi, 2013). The campaign plays an important role to putting children on the path to a healthy future by educating people on the importance of supporting and practicing a healthy lifestyle. The campaign aims to change an environment of a community to ensure families have access to healthy and affordable foods. A campaign that works toward stopping obesity is very important because in the article
    _Vital Signs: Obesity Among Low-Income, Preschool-Ages Children – United States, 2008-2011_ mentioned, “overweight or obese preschoolers are five times as likely to become overweight or obese adults, compared with their normal eight peers. In older children and adolescents, obesity is associated with high cholesterol, high blood sugar, asthma and mental health problems” (May et al., 2013, p. 633). The lack of physical activity and poor diet is connected to the increase in BMI and obesity. It is important for health practitioners to encourage a healthy lifestyle by promoting healthy eating and physical activity; the combination reduces an individual’s risk of developing chronic diseases. The BRFSS data displays that the lack of exercise does play a factor with the increase in BMI.

    References

    Centers for Disease Control and Prevention. (2016).
    _BRFSS Prevalence & Trends Data_. Retrieved from http://www.cdc.gov/brfss/brfssprevalence/index.html

    Gibi, K. (2013). Let’s Move! Cities, Towns and Counties.
    _Parks & Recreation,_ 48 (10), 37-39.

    May, A. L., Liping, P., Sherry, B., Blanck, H. M., Galuska, D., Dalenius, K., & Grummer-Strawn, L. M. (2013). Vital Signs: Obesity Among Low-Income, Preschool-Aged Children — United States, 2008-2011.
    _MMWR: Morbidity & Mortality Weekly Report_,
    _62_(31), 629-634.

    **## SampleInternetNavigationProject-1.docx**

    Running Head: INTERNET NAVIGATION 1

    INTERNET NAVIGATION PROJECT 7

    Internet Navigation Project

    Student Name

    National University

    **Title of Paper Here**

    **Physical Activity (Qualifiers: Gender Female)**

    **1996**

    70.8 – 77.1%: Washington, Oregon, Nevada, Idaho, Utah, Montana, Wyoming, Colorado, New Mexico, Minnesota, Vermont, New Hampshire, Hawaii, Massachusetts

    77.2 – 79.8%: California, Alaska, Arizona, Texas, Wisconsin, Illinois, Michigan, Florida, Virginia, New Jersey, Connecticut, Rhode Island, Maine

    79.9 – 83.9%: North Dakota, South Dakota, Nebraska, Kansas, Oklahoma, Iowa, Missouri, Arkansas, Louisiana, Alabama, New York, Pennsylvania, District of Columbia

    84 – 89.9%: Indiana, Kentucky, Tennessee, Mississippi, Ohio, West Virginia, North Carolina, South Carolina, Georgia, Maryland, Delaware, Puerto Rico

    **2000**

    72.7 – 75.8%: Washington, Oregon, Alaska, Idaho, Montana, Utah, Wyoming, Colorado, Michigan, Virginia, Vermont, District of Columbia

    75.9 – 78.5%: California, Nevada, New Mexico, North Dakota, South Dakota, Wisconsin, Florida, Maine, New Hampshire, Massachusetts, Connecticut, Rhode Island, Pennsylvania

    78.6 – 82.3%: Arizona, Texas, Nebraska, Minnesota, Iowa, Missouri, Arkansas, Illinois, Alabama, Georgia, South Carolina, Maryland, New Jersey, New York,

    82.4 – 86.7%: Delaware, West Virginia, North Carolina, Ohio, Indiana, Kentucky, Tennessee, Mississippi, Louisiana, Kansas, Oklahoma, Puerto Rico

    **Physical Activity (Qualifiers: Age Group 18 – 24)**

    **1996**

    65.4 – 70.4%: Washington, Oregon, Montana, Wyoming, Utah, Colorado, South Dakota, Minnesota, New Jersey, Vermont, Puerto Rico

    70.5 – 75.7%: Idaho, Texas, Louisiana, Mississippi, Florida, Wisconsin, Michigan, Pennsylvania, Maine, Rhode Island, Connecticut

    75.8 – 80.2%: California, North Dakota, Kansas, Oklahoma, Iowa, Missouri, Illinois, Indiana, Alabama, North Carolina, New York, Delaware

    80.3 – 85.9%: Arizona, Nebraska, Arkansas, Ohio, Kentucky, Tennessee, Georgia, South Carolina, West Virginia, Virginia, Maryland

    **2000**

    62.6 – 69.2%: Washington, Oregon, Alaska, Wyoming, North Dakota, Illinois, Pennsylvania, Virginia, Rhode Island, Connecticut, District of Columbia

    69.3 – 73.1%: California, Nevada, Utah, Montana, Colorado, Michigan, Indiana, Arkansas, Alabama, New York, Vermont, , Massachusetts, New Jersey, Delaware

    73.2 – 76.9%: Idaho, Arizona, New Mexico, South Dakota, Texas, Oklahoma, Missouri, Mississippi, Georgia, Florida, South Carolina, West Virginia, Maryland, New Hampshire

    77 – 82.9%: Puerto Rico, Nebraska, Kansas, Louisiana, Iowa, Wisconsin, Minnesota, Tennessee, Kentucky, Ohio, North Carolina, Maine

    **BMI (Qualifiers: Gender Female)**

    **1996**

    10.7 – 14.1%: Nevada, Arizona, Utah, Montana, Wyoming, Colorado, South Dakota, Minnesota, Georgia, New Jersey, New Hampshire, Connecticut, Rhode Island, Massachusetts, Hawaii

    14.2 – 17.6%: Washington, Oregon, California, Idaho, New Mexico, North Dakota, Nebraska, Kansas, Oklahoma, Florida, Virginia, New York, Maine, Vermont

    17.7 – 19.1%: Alaska, Puerto Rico, Texas, Iowa, Arkansas, Wisconsin, Illinois, Kentucky, Michigan, Tennessee, North Carolina, Pennsylvania, Delaware, Maryland

    19.2 -21.4%: Missouri, Louisiana, Mississippi, Alabama, Indiana, Ohio, West Virginia, South Carolina, District of Columbia

    **2000**

    14.2 – 17.1%: Nevada, Montana, Wyoming, Colorado, Minnesota, Virginia, New Hampshire, Massachusetts, Rhode Island, Denver

    17.2 – 19.8%: Washington, California, Idaho, Utah, Arizona, New Mexico, North Dakota, South Dakota, Nebraska, Wisconsin, Florida, New York, New Jersey, Vermont

    19.9 – 22.1%: Oregon, Alaska, Kansas, Oklahoma, Iowa, Missouri, Illinois, Indiana, Michigan, Kentucky, Ohio, Maine, Pennsylvania, Maryland

    22.2 – 26.3%: Texas, Arkansas, Louisiana, Mississippi, Alabama, Georgia, Tennessee, Puerto Rico, South Carolina, North Carolina, West Virginia, District of Columbia

    **BMI (Qualifiers: Age Group 18 – 24)**

    **1996**

    3.7 – 6.8%: Idaho, Arizona, Colorado, Nebraska, Kansas, Minnesota Mississippi, Indiana, Georgia, New Hampshire, District of Columbia, Puerto Rico

    6.9 – 8.1%: Washington, Oregon, Wyoming, New Mexico, South Dakota, North Dakota, Wisconsin, Arkansas, Tennessee, Virginia, North Carolina, New Jersey, Connecticut

    8.2 – 10.4%: California, Nevada, Utah, Montana, Texas, Illinois, Florida, New York, Vermont, Massachusetts, Rhode Island, Delaware

    10.5 – 17.4%: Alaska, Oklahoma, Louisiana, Iowa, Missouri, Alabama, South Carolina, Michigan, Kentucky, Ohio, West Virginia, Pennsylvania, Maryland, Maine

    **2000**

    3.4 – 9.1%: Montana, Utah, Colorado, Minnesota, South Carolina, Virginia, New York, Maryland, Delaware, New Jersey, Rhode Island, District of Columbia

    9.2 – 11.2%: Washington, California, Alaska, Nevada, Idaho, Wyoming, South Dakota, Texas, Missouri, Florida, Puerto Rico, Massachusetts, Connecticut

    11.3 -12.8%: Hawaii, Arizona, New Mexico, North Dakota, Nebraska, Kansas, Wisconsin, Michigan, Indiana, Ohio, West Virginia, Pennsylvania, Georgia, Vermont

    12.9 – 19.2%: Oregon, Oklahoma, Arkansas, Louisiana, Iowa, Illinois, Mississippi, Alabama, Tennessee, Kentucky, North Carolina, New Hampshire, Maine

    Internet Navigation Project

    The Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Survey (BRFSS) was used to explore the years 1996 and 2000 on how physical activity correlates with body mass index (BMI). In both topics physical activity and BMI, the two qualifiers focused on the female gender and the age group 18 to 24 years old. The physical activity topic focused on adults whose response was no to engaging in thirty minutes or more of moderate activity five or more days per week. The BMI topic focused on weight classification by BMI.

    According to the BRFSS in 1996, thirty minutes of any physical activity five or more days per week said the female gender had a higher crude prevalence of 84 to 89.9 percent in the southern states compared to the states in the west coast region that had a lower crude prevalence between 77.8 to 77.1 percent. However, in 2000 there was an increase of states in the central and southern region that had a higher crude prevalence of 78.6 to 82.3 percent. The northwest states remained having a low crude prevalence similar to the year 1996. In 2000 the states that continued in the high crude prevalence similar to the year 1996 were Oklahoma, Louisiana, Iowa, Alabama, Kentucky, and Maine. Concentrating on the age group 18 to 24 year olds on physical activity in 1996, states in the east coast had a higher crude prevalence of 80.3 to 85.9 percent. The states that remained in this higher category in 2000 were Nebraska, Tennessee, Kentucky, and Ohio.

    Reviewing the BMI topic with a response of an obese BMI of 30.0 to 99.8 in the female gender in the year 1996 the state in the west coast had either a crude prevalence of 10.7 to 14.1 percent or 12.2 to 17.6 percent. The southern states and some states in the east coast had a high crude prevalence of 17.7 to 19.1 percent or 19.2 to 21.4 percent. However, in 2000 there was a drastic increase of states mainly in the southern area that hit the higher crude prevalence percentage of 22.2 to 26.3. These states included, Texas, Arkansas, Louisiana, Mississippi, Alabama, Georgia, Tennessee, South Carolina, North Carolina, and West Virginia. In 2000, the west coast remained in the lower crude prevalence percentage of 14.2 to 17.1 percent or 17.2 to 19.8 percent.

    Comparing the physical activity data and BMI data there is a comparison that show how states that do not stay physically active have a higher BMI. Physical activity in 1996 based on age group did not improve in the central states but increased in 2000. Along the same lines there is significant correlation comparing the physical activity data to the BMI data that focused on age. The BMI data displayed no improvement from 1996 to 2000 but an increase in the central states as well. The south and east coast displayed a higher crude prevalence percentage in physical activity in the age group of 18 to 24 years old and the female gender. This relates to the BMI data that also illustrates the same pattern in the age group of 18 to 24 years old and the female gender. The BMI in 1996 has increased in 2000 mainly in the south and east coast, similarly to the physical activity data where those states have indicated low physical activity.

    Due to the increase in obesity in the United States there has been many programs implemented to help this growing epidemic. However, public health practitioners should focus on promoting and educating exercise and physical activity. There are programs already implemented that will help our future generations such as the
    _Let’s Move!_ campaign, a national initiative launch by First Lady Michelle Obama on February 9, 2010 (Gibi, 2013). The campaign plays an important role to putting children on the path to a healthy future by educating people on the importance of supporting and practicing a healthy lifestyle. The campaign aims to change an environment of a community to ensure families have access to healthy and affordable foods. A campaign that works toward stopping obesity is very important because in the article
    _Vital Signs: Obesity Among Low-Income, Preschool-Ages Children – United States, 2008-2011_ mentioned, “overweight or obese preschoolers are five times as likely to become overweight or obese adults, compared with their normal eight peers. In older children and adolescents, obesity is associated with high cholesterol, high blood sugar, asthma and mental health problems” (May et al., 2013, p. 633). The lack of physical activity and poor diet is connected to the increase in BMI and obesity. It is important for health practitioners to encourage a healthy lifestyle by promoting healthy eating and physical activity; the combination reduces an individual’s risk of developing chronic diseases. The BRFSS data displays that the lack of exercise does play a factor with the increase in BMI.

    References

    Centers for Disease Control and Prevention. (2016).
    _BRFSS Prevalence & Trends Data_. Retrieved from http://www.cdc.gov/brfss/brfssprevalence/index.html

    Gibi, K. (2013). Let’s Move! Cities, Towns and Counties.
    _Parks & Recreation,_ 48 (10), 37-39.

    May, A. L., Liping, P., Sherry, B., Blanck, H. M., Galuska, D., Dalenius, K., & Grummer-Strawn, L. M. (2013). Vital Signs: Obesity Among Low-Income, Preschool-Aged Children — United States, 2008-2011.
    _MMWR: Morbidity & Mortality Weekly Report_,
    _62_(31), 629-634.

    **## Instructions.docx**

    **Internet Navigation Project**

    This project corresponds to health effects of exercise and physical activity and requires you to research a Centers for Disease Control national dataset to collect and interpret relevant physical activity (exposure) and outcome information (disease prevalence, economic cost of disease, morbidity and mortality statistics).

    Goal: Understanding the data by using online resources like CDC Behavioral Risk Factor surveillance website to underscore the magnitude of the obesity problem and why physical activity is so important to health.
    **You will be reporting prevalence rates for two topics: Physical Activity and Obesity.**

    TOPIC ONE: PHYSICAL ACTIVITY

    1. Search the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Survey (BRFSS) link (
    [http://www.cdc.gov/brfss/brfssprevalence/index.html](http://www.cdc.gov/brfss/brfssprevalence/index.html)) and look to the "Explore BRFSS data by topic section. In the "Class" area choose: Physical Activity

    2. For the topic select: Physical Activity

    3. Choose one year at a time. Select the years of your choice. You will report on two different years (the larger the gap between the years the better). In the "question" link  choose: Adults with 30+ minutes of moderate activity five or more days per week (Do not select 20+ minutes question).

    4.  For each year report the following below:Then select "no" for the response

    1. For each of the two years choose two qualifiers to report on: Gender, Age group, Race/Ethnicity, Education, Household income. These are selected by clicking on the "view by" tab.

    5. Then report the crude prevalence for each category (there will be four displayed) shown. Tell the reader the percentages for each category and what states specifically correspond to each category.

    TOPIC TWO: BMI CATEGORIES

    1. Search the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Survey (BRFSS) link (
    [http://www.cdc.gov/brfss/brfssprevalence/index.html](http://www.cdc.gov/brfss/brfssprevalence/index.html)) and look to the "Explore BRFSS data by topic section. In the "Class" area choose: Overweight and obesity

    2. For the topic select: BMI categories

    3. In the "question" link  choose the only question to select – Weight classification of BMI

    4. Select the same two years you reported on for physical activity. (Remember, the larger the gap between the years the better). For each year report the following below:Then for the response select "Obese (BMI 30.0 – 99.8)"

    1. For each of the two years choose two qualifiers to report on: Gender, Age group, Race/Ethnicity, Education, Household income.

    5. Then report the crude prevalence for each category (there will be four displayed) shown. Tell the reader the percentages for each category and what states specifically correspond to each category.

    Lastly, tell the reader how how the physical activity data correlate with the obesity/BMI data you found? What do the trend data suggest? How do you interpret these data? What does this mean for public health practitioners? Where should our programs focus in the future?

    **## SampleInternetNavigationProject-1.docx**

    Running Head: INTERNET NAVIGATION 1

    INTERNET NAVIGATION PROJECT 7

    Internet Navigation Project

    Student Name

    National University

    **Title of Paper Here**

    **Physical Activity (Qualifiers: Gender Female)**

    **1996**

    70.8 – 77.1%: Washington, Oregon, Nevada, Idaho, Utah, Montana, Wyoming, Colorado, New Mexico, Minnesota, Vermont, New Hampshire, Hawaii, Massachusetts

    77.2 – 79.8%: California, Alaska, Arizona, Texas, Wisconsin, Illinois, Michigan, Florida, Virginia, New Jersey, Connecticut, Rhode Island, Maine

    79.9 – 83.9%: North Dakota, South Dakota, Nebraska, Kansas, Oklahoma, Iowa, Missouri, Arkansas, Louisiana, Alabama, New York, Pennsylvania, District of Columbia

    84 – 89.9%: Indiana, Kentucky, Tennessee, Mississippi, Ohio, West Virginia, North Carolina, South Carolina, Georgia, Maryland, Delaware, Puerto Rico

    **2000**

    72.7 – 75.8%: Washington, Oregon, Alaska, Idaho, Montana, Utah, Wyoming, Colorado, Michigan, Virginia, Vermont, District of Columbia

    75.9 – 78.5%: California, Nevada, New Mexico, North Dakota, South Dakota, Wisconsin, Florida, Maine, New Hampshire, Massachusetts, Connecticut, Rhode Island, Pennsylvania

    78.6 – 82.3%: Arizona, Texas, Nebraska, Minnesota, Iowa, Missouri, Arkansas, Illinois, Alabama, Georgia, South Carolina, Maryland, New Jersey, New York,

    82.4 – 86.7%: Delaware, West Virginia, North Carolina, Ohio, Indiana, Kentucky, Tennessee, Mississippi, Louisiana, Kansas, Oklahoma, Puerto Rico

    **Physical Activity (Qualifiers: Age Group 18 – 24)**

    **1996**

    65.4 – 70.4%: Washington, Oregon, Montana, Wyoming, Utah, Colorado, South Dakota, Minnesota, New Jersey, Vermont, Puerto Rico

    70.5 – 75.7%: Idaho, Texas, Louisiana, Mississippi, Florida, Wisconsin, Michigan, Pennsylvania, Maine, Rhode Island, Connecticut

    75.8 – 80.2%: California, North Dakota, Kansas, Oklahoma, Iowa, Missouri, Illinois, Indiana, Alabama, North Carolina, New York, Delaware

    80.3 – 85.9%: Arizona, Nebraska, Arkansas, Ohio, Kentucky, Tennessee, Georgia, South Carolina, West Virginia, Virginia, Maryland

    **2000**

    62.6 – 69.2%: Washington, Oregon, Alaska, Wyoming, North Dakota, Illinois, Pennsylvania, Virginia, Rhode Island, Connecticut, District of Columbia

    69.3 – 73.1%: California, Nevada, Utah, Montana, Colorado, Michigan, Indiana, Arkansas, Alabama, New York, Vermont, , Massachusetts, New Jersey, Delaware

    73.2 – 76.9%: Idaho, Arizona, New Mexico, South Dakota, Texas, Oklahoma, Missouri, Mississippi, Georgia, Florida, South Carolina, West Virginia, Maryland, New Hampshire

    77 – 82.9%: Puerto Rico, Nebraska, Kansas, Louisiana, Iowa, Wisconsin, Minnesota, Tennessee, Kentucky, Ohio, North Carolina, Maine

    **BMI (Qualifiers: Gender Female)**

    **1996**

    10.7 – 14.1%: Nevada, Arizona, Utah, Montana, Wyoming, Colorado, South Dakota, Minnesota, Georgia, New Jersey, New Hampshire, Connecticut, Rhode Island, Massachusetts, Hawaii

    14.2 – 17.6%: Washington, Oregon, California, Idaho, New Mexico, North Dakota, Nebraska, Kansas, Oklahoma, Florida, Virginia, New York, Maine, Vermont

    17.7 – 19.1%: Alaska, Puerto Rico, Texas, Iowa, Arkansas, Wisconsin, Illinois, Kentucky, Michigan, Tennessee, North Carolina, Pennsylvania, Delaware, Maryland

    19.2 -21.4%: Missouri, Louisiana, Mississippi, Alabama, Indiana, Ohio, West Virginia, South Carolina, District of Columbia

    **2000**

    14.2 – 17.1%: Nevada, Montana, Wyoming, Colorado, Minnesota, Virginia, New Hampshire, Massachusetts, Rhode Island, Denver

    17.2 – 19.8%: Washington, California, Idaho, Utah, Arizona, New Mexico, North Dakota, South Dakota, Nebraska, Wisconsin, Florida, New York, New Jersey, Vermont

    19.9 – 22.1%: Oregon, Alaska, Kansas, Oklahoma, Iowa, Missouri, Illinois, Indiana, Michigan, Kentucky, Ohio, Maine, Pennsylvania, Maryland

    22.2 – 26.3%: Texas, Arkansas, Louisiana, Mississippi, Alabama, Georgia, Tennessee, Puerto Rico, South Carolina, North Carolina, West Virginia, District of Columbia

    **BMI (Qualifiers: Age Group 18 – 24)**

    **1996**

    3.7 – 6.8%: Idaho, Arizona, Colorado, Nebraska, Kansas, Minnesota Mississippi, Indiana, Georgia, New Hampshire, District of Columbia, Puerto Rico

    6.9 – 8.1%: Washington, Oregon, Wyoming, New Mexico, South Dakota, North Dakota, Wisconsin, Arkansas, Tennessee, Virginia, North Carolina, New Jersey, Connecticut

    8.2 – 10.4%: California, Nevada, Utah, Montana, Texas, Illinois, Florida, New York, Vermont, Massachusetts, Rhode Island, Delaware

    10.5 – 17.4%: Alaska, Oklahoma, Louisiana, Iowa, Missouri, Alabama, South Carolina, Michigan, Kentucky, Ohio, West Virginia, Pennsylvania, Maryland, Maine

    **2000**

    3.4 – 9.1%: Montana, Utah, Colorado, Minnesota, South Carolina, Virginia, New York, Maryland, Delaware, New Jersey, Rhode Island, District of Columbia

    9.2 – 11.2%: Washington, California, Alaska, Nevada, Idaho, Wyoming, South Dakota, Texas, Missouri, Florida, Puerto Rico, Massachusetts, Connecticut

    11.3 -12.8%: Hawaii, Arizona, New Mexico, North Dakota, Nebraska, Kansas, Wisconsin, Michigan, Indiana, Ohio, West Virginia, Pennsylvania, Georgia, Vermont

    12.9 – 19.2%: Oregon, Oklahoma, Arkansas, Louisiana, Iowa, Illinois, Mississippi, Alabama, Tennessee, Kentucky, North Carolina, New Hampshire, Maine

    Internet Navigation Project

    The Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Survey (BRFSS) was used to explore the years 1996 and 2000 on how physical activity correlates with body mass index (BMI). In both topics physical activity and BMI, the two qualifiers focused on the female gender and the age group 18 to 24 years old. The physical activity topic focused on adults whose response was no to engaging in thirty minutes or more of moderate activity five or more days per week. The BMI topic focused on weight classification by BMI.

    According to the BRFSS in 1996, thirty minutes of any physical activity five or more days per week said the female gender had a higher crude prevalence of 84 to 89.9 percent in the southern states compared to the states in the west coast region that had a lower crude prevalence between 77.8 to 77.1 percent. However, in 2000 there was an increase of states in the central and southern region that had a higher crude prevalence of 78.6 to 82.3 percent. The northwest states remained having a low crude prevalence similar to the year 1996. In 2000 the states that continued in the high crude prevalence similar to the year 1996 were Oklahoma, Louisiana, Iowa, Alabama, Kentucky, and Maine. Concentrating on the age group 18 to 24 year olds on physical activity in 1996, states in the east coast had a higher crude prevalence of 80.3 to 85.9 percent. The states that remained in this higher category in 2000 were Nebraska, Tennessee, Kentucky, and Ohio.

    Reviewing the BMI topic with a response of an obese BMI of 30.0 to 99.8 in the female gender in the year 1996 the state in the west coast had either a crude prevalence of 10.7 to 14.1 percent or 12.2 to 17.6 percent. The southern states and some states in the east coast had a high crude prevalence of 17.7 to 19.1 percent or 19.2 to 21.4 percent. However, in 2000 there was a drastic increase of states mainly in the southern area that hit the higher crude prevalence percentage of 22.2 to 26.3. These states included, Texas, Arkansas, Louisiana, Mississippi, Alabama, Georgia, Tennessee, South Carolina, North Carolina, and West Virginia. In 2000, the west coast remained in the lower crude prevalence percentage of 14.2 to 17.1 percent or 17.2 to 19.8 percent.

    Comparing the physical activity data and BMI data there is a comparison that show how states that do not stay physically active have a higher BMI. Physical activity in 1996 based on age group did not improve in the central states but increased in 2000. Along the same lines there is significant correlation comparing the physical activity data to the BMI data that focused on age. The BMI data displayed no improvement from 1996 to 2000 but an increase in the central states as well. The south and east coast displayed a higher crude prevalence percentage in physical activity in the age group of 18 to 24 years old and the female gender. This relates to the BMI data that also illustrates the same pattern in the age group of 18 to 24 years old and the female gender. The BMI in 1996 has increased in 2000 mainly in the south and east coast, similarly to the physical activity data where those states have indicated low physical activity.

    Due to the increase in obesity in the United States there has been many programs implemented to help this growing epidemic. However, public health practitioners should focus on promoting and educating exercise and physical activity. There are programs already implemented that will help our future generations such as the
    _Let’s Move!_ campaign, a national initiative launch by First Lady Michelle Obama on February 9, 2010 (Gibi, 2013). The campaign plays an important role to putting children on the path to a healthy future by educating people on the importance of supporting and practicing a healthy lifestyle. The campaign aims to change an environment of a community to ensure families have access to healthy and affordable foods. A campaign that works toward stopping obesity is very important because in the article
    _Vital Signs: Obesity Among Low-Income, Preschool-Ages Children – United States, 2008-2011_ mentioned, “overweight or obese preschoolers are five times as likely to become overweight or obese adults, compared with their normal eight peers. In older children and adolescents, obesity is associated with high cholesterol, high blood sugar, asthma and mental health problems” (May et al., 2013, p. 633). The lack of physical activity and poor diet is connected to the increase in BMI and obesity. It is important for health practitioners to encourage a healthy lifestyle by promoting healthy eating and physical activity; the combination reduces an individual’s risk of developing chronic diseases. The BRFSS data displays that the lack of exercise does play a factor with the increase in BMI.

    References

    Centers for Disease Control and Prevention. (2016).
    _BRFSS Prevalence & Trends Data_. Retrieved from http://www.cdc.gov/brfss/brfssprevalence/index.html

    Gibi, K. (2013). Let’s Move! Cities, Towns and Counties.
    _Parks & Recreation,_ 48 (10), 37-39.

    May, A. L., Liping, P., Sherry, B., Blanck, H. M., Galuska, D., Dalenius, K., & Grummer-Strawn, L. M. (2013). Vital Signs: Obesity Among Low-Income, Preschool-Aged Children — United States, 2008-2011.
    _MMWR: Morbidity & Mortality Weekly Report_,
    _62_(31), 629-634.

    **## Instructions.docx**

    **Internet Navigation Project**

    This project corresponds to health effects of exercise and physical activity and requires you to research a Centers for Disease Control national dataset to collect and interpret relevant physical activity (exposure) and outcome information (disease prevalence, economic cost of disease, morbidity and mortality statistics).

    Goal: Understanding the data by using online resources like CDC Behavioral Risk Factor surveillance website to underscore the magnitude of the obesity problem and why physical activity is so important to health.
    **You will be reporting prevalence rates for two topics: Physical Activity and Obesity.**

    TOPIC ONE: PHYSICAL ACTIVITY

    1. Search the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Survey (BRFSS) link (
    [http://www.cdc.gov/brfss/brfssprevalence/index.html](http://www.cdc.gov/brfss/brfssprevalence/index.html)) and look to the "Explore BRFSS data by topic section. In the "Class" area choose: Physical Activity

    2. For the topic select: Physical Activity

    3. Choose one year at a time. Select the years of your choice. You will report on two different years (the larger the gap between the years the better). In the "question" link  choose: Adults with 30+ minutes of moderate activity five or more days per week (Do not select 20+ minutes question).

    4.  For each year report the following below:Then select "no" for the response

    1. For each of the two years choose two qualifiers to report on: Gender, Age group, Race/Ethnicity, Education, Household income. These are selected by clicking on the "view by" tab.

    5. Then report the crude prevalence for each category (there will be four displayed) shown. Tell the reader the percentages for each category and what states specifically correspond to each category.

    TOPIC TWO: BMI CATEGORIES

    1. Search the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Survey (BRFSS) link (
    [http://www.cdc.gov/brfss/brfssprevalence/index.html](http://www.cdc.gov/brfss/brfssprevalence/index.html)) and look to the "Explore BRFSS data by topic section. In the "Class" area choose: Overweight and obesity

    2. For the topic select: BMI categories

    3. In the "question" link  choose the only question to select – Weight classification of BMI

    4. Select the same two years you reported on for physical activity. (Remember, the larger the gap between the years the better). For each year report the following below:Then for the response select "Obese (BMI 30.0 – 99.8)"

    1. For each of the two years choose two qualifiers to report on: Gender, Age group, Race/Ethnicity, Education, Household income.

    5. Then report the crude prevalence for each category (there will be four displayed) shown. Tell the reader the percentages for each category and what states specifically correspond to each category.

    Lastly, tell the reader how how the physical activity data correlate with the obesity/BMI data you found? What do the trend data suggest? How do you interpret these data? What does this mean for public health practitioners? Where should our programs focus in the future?

    **## SampleInternetNavigationProject-1.docx**

    Running Head: INTERNET NAVIGATION 1

    INTERNET NAVIGATION PROJECT 7

    Internet Navigation Project

    Student Name

    National University

    **Title of Paper Here**

    **Physical Activity (Qualifiers: Gender Female)**

    **1996**

    70.8 – 77.1%: Washington, Oregon, Nevada, Idaho, Utah, Montana, Wyoming, Colorado, New Mexico, Minnesota, Vermont, New Hampshire, Hawaii, Massachusetts

    77.2 – 79.8%: California, Alaska, Arizona, Texas, Wisconsin, Illinois, Michigan, Florida, Virginia, New Jersey, Connecticut, Rhode Island, Maine

    79.9 – 83.9%: North Dakota, South Dakota, Nebraska, Kansas, Oklahoma, Iowa, Missouri, Arkansas, Louisiana, Alabama, New York, Pennsylvania, District of Columbia

    84 – 89.9%: Indiana, Kentucky, Tennessee, Mississippi, Ohio, West Virginia, North Carolina, South Carolina, Georgia, Maryland, Delaware, Puerto Rico

    **2000**

    72.7 – 75.8%: Washington, Oregon, Alaska, Idaho, Montana, Utah, Wyoming, Colorado, Michigan, Virginia, Vermont, District of Columbia

    75.9 – 78.5%: California, Nevada, New Mexico, North Dakota, South Dakota, Wisconsin, Florida, Maine, New Hampshire, Massachusetts, Connecticut, Rhode Island, Pennsylvania

    78.6 – 82.3%: Arizona, Texas, Nebraska, Minnesota, Iowa, Missouri, Arkansas, Illinois, Alabama, Georgia, South Carolina, Maryland, New Jersey, New York,

    82.4 – 86.7%: Delaware, West Virginia, North Carolina, Ohio, Indiana, Kentucky, Tennessee, Mississippi, Louisiana, Kansas, Oklahoma, Puerto Rico

    **Physical Activity (Qualifiers: Age Group 18 – 24)**

    **1996**

    65.4 – 70.4%: Washington, Oregon, Montana, Wyoming, Utah, Colorado, South Dakota, Minnesota, New Jersey, Vermont, Puerto Rico

    70.5 – 75.7%: Idaho, Texas, Louisiana, Mississippi, Florida, Wisconsin, Michigan, Pennsylvania, Maine, Rhode Island, Connecticut

    75.8 – 80.2%: California, North Dakota, Kansas, Oklahoma, Iowa, Missouri, Illinois, Indiana, Alabama, North Carolina, New York, Delaware

    80.3 – 85.9%: Arizona, Nebraska, Arkansas, Ohio, Kentucky, Tennessee, Georgia, South Carolina, West Virginia, Virginia, Maryland

    **2000**

    62.6 – 69.2%: Washington, Oregon, Alaska, Wyoming, North Dakota, Illinois, Pennsylvania, Virginia, Rhode Island, Connecticut, District of Columbia

    69.3 – 73.1%: California, Nevada, Utah, Montana, Colorado, Michigan, Indiana, Arkansas, Alabama, New York, Vermont, , Massachusetts, New Jersey, Delaware

    73.2 – 76.9%: Idaho, Arizona, New Mexico, South Dakota, Texas, Oklahoma, Missouri, Mississippi, Georgia, Florida, South Carolina, West Virginia, Maryland, New Hampshire

    77 – 82.9%: Puerto Rico, Nebraska, Kansas, Louisiana, Iowa, Wisconsin, Minnesota, Tennessee, Kentucky, Ohio, North Carolina, Maine

    **BMI (Qualifiers: Gender Female)**

    **1996**

    10.7 – 14.1%: Nevada, Arizona, Utah, Montana, Wyoming, Colorado, South Dakota, Minnesota, Georgia, New Jersey, New Hampshire, Connecticut, Rhode Island, Massachusetts, Hawaii

    14.2 – 17.6%: Washington, Oregon, California, Idaho, New Mexico, North Dakota, Nebraska, Kansas, Oklahoma, Florida, Virginia, New York, Maine, Vermont

    17.7 – 19.1%: Alaska, Puerto Rico, Texas, Iowa, Arkansas, Wisconsin, Illinois, Kentucky, Michigan, Tennessee, North Carolina, Pennsylvania, Delaware, Maryland

    19.2 -21.4%: Missouri, Louisiana, Mississippi, Alabama, Indiana, Ohio, West Virginia, South Carolina, District of Columbia

    **2000**

    14.2 – 17.1%: Nevada, Montana, Wyoming, Colorado, Minnesota, Virginia, New Hampshire, Massachusetts, Rhode Island, Denver

    17.2 – 19.8%: Washington, California, Idaho, Utah, Arizona, New Mexico, North Dakota, South Dakota, Nebraska, Wisconsin, Florida, New York, New Jersey, Vermont

    19.9 – 22.1%: Oregon, Alaska, Kansas, Oklahoma, Iowa, Missouri, Illinois, Indiana, Michigan, Kentucky, Ohio, Maine, Pennsylvania, Maryland

    22.2 – 26.3%: Texas, Arkansas, Louisiana, Mississippi, Alabama, Georgia, Tennessee, Puerto Rico, South Carolina, North Carolina, West Virginia, District of Columbia

    **BMI (Qualifiers: Age Group 18 – 24)**

    **1996**

    3.7 – 6.8%: Idaho, Arizona, Colorado, Nebraska, Kansas, Minnesota Mississippi, Indiana, Georgia, New Hampshire, District of Columbia, Puerto Rico

    6.9 – 8.1%: Washington, Oregon, Wyoming, New Mexico, South Dakota, North Dakota, Wisconsin, Arkansas, Tennessee, Virginia, North Carolina, New Jersey, Connecticut

    8.2 – 10.4%: California, Nevada, Utah, Montana, Texas, Illinois, Florida, New York, Vermont, Massachusetts, Rhode Island, Delaware

    10.5 – 17.4%: Alaska, Oklahoma, Louisiana, Iowa, Missouri, Alabama, South Carolina, Michigan, Kentucky, Ohio, West Virginia, Pennsylvania, Maryland, Maine

    **2000**

    3.4 – 9.1%: Montana, Utah, Colorado, Minnesota, South Carolina, Virginia, New York, Maryland, Delaware, New Jersey, Rhode Island, District of Columbia

    9.2 – 11.2%: Washington, California, Alaska, Nevada, Idaho, Wyoming, South Dakota, Texas, Missouri, Florida, Puerto Rico, Massachusetts, Connecticut

    11.3 -12.8%: Hawaii, Arizona, New Mexico, North Dakota, Nebraska, Kansas, Wisconsin, Michigan, Indiana, Ohio, West Virginia, Pennsylvania, Georgia, Vermont

    12.9 – 19.2%: Oregon, Oklahoma, Arkansas, Louisiana, Iowa, Illinois, Mississippi, Alabama, Tennessee, Kentucky, North Carolina, New Hampshire, Maine

    Internet Navigation Project

    The Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance Survey (BRFSS) was used to explore the years 1996 and 2000 on how physical activity correlates with body mass index (BMI). In both topics physical activity and BMI, the two qualifiers focused on the female gender and the age group 18 to 24 years old. The physical activity topic focused on adults whose response was no to engaging in thirty minutes or more of moderate activity five or more days per week. The BMI topic focused on weight classification by BMI.

    According to the BRFSS in 1996, thirty minutes of any physical activity five or more days per week said the female gender had a higher crude prevalence of 84 to 89.9 percent in the southern states compared to the states in the west coast region that had a lower crude prevalence between 77.8 to 77.1 percent. However, in 2000 there was an increase of states in the central and southern region that had a higher crude prevalence of 78.6 to 82.3 percent. The northwest states remained having a low crude prevalence similar to the year 1996. In 2000 the states that continued in the high crude prevalence similar to the year 1996 were Oklahoma, Louisiana, Iowa, Alabama, Kentucky, and Maine. Concentrating on the age group 18 to 24 year olds on physical activity in 1996, states in the east coast had a higher crude prevalence of 80.3 to 85.9 percent. The states that remained in this higher category in 2000 were Nebraska, Tennessee, Kentucky, and Ohio.

    Reviewing the BMI topic with a response of an obese BMI of 30.0 to 99.8 in the female gender in the year 1996 the state in the west coast had either a crude prevalence of 10.7 to 14.1 percent or 12.2 to 17.6 percent. The southern states and some states in the east coast had a high crude prevalence of 17.7 to 19.1 percent or 19.2 to 21.4 percent. However, in 2000 there was a drastic increase of states mainly in the southern area that hit the higher crude prevalence percentage of 22.2 to 26.3. These states included, Texas, Arkansas, Louisiana, Mississippi, Alabama, Georgia, Tennessee, South Carolina, North Carolina, and West Virginia. In 2000, the west coast remained in the lower crude prevalence percentage of 14.2 to 17.1 percent or 17.2 to 19.8 percent.

    Comparing the physical activity data and BMI data there is a comparison that show how states that do not stay physically active have a higher BMI. Physical activity in 1996 based on age group did not improve in the central states but increased in 2000. Along the same lines there is significant correlation comparing the physical activity data to the BMI data that focused on age. The BMI data displayed no improvement from 1996 to 2000 but an increase in the central states as well. The south and east coast displayed a higher crude prevalence percentage in physical activity in the age group of 18 to 24 years old and the female gender. This relates to the BMI data that also illustrates the same pattern in the age group of 18 to 24 years old and the female gender. The BMI in 1996 has increased in 2000 mainly in the south and east coast, similarly to the physical activity data where those states have indicated low physical activity.

    Due to the increase in obesity in the United States there has been many programs implemented to help this growing epidemic. However, public health practitioners should focus on promoting and educating exercise and physical activity. There are programs already implemented that will help our future generations such as the
    _Let’s Move!_ campaign, a national initiative launch by First Lady Michelle Obama on February 9, 2010 (Gibi, 2013). The campaign plays an important role to putting children on the path to a healthy future by educating people on the importance of supporting and practicing a healthy lifestyle. The campaign aims to change an environment of a community to ensure families have access to healthy and affordable foods. A campaign that works toward stopping obesity is very important because in the article
    _Vital Signs: Obesity Among Low-Income, Preschool-Ages Children – United States, 2008-2011_ mentioned, “overweight or obese preschoolers are five times as likely to become overweight or obese adults, compared with their normal eight peers. In older children and adolescents, obesity is associated with high cholesterol, high blood sugar, asthma and mental health problems” (May et al., 2013, p. 633). The lack of physical activity and poor diet is connected to the increase in BMI and obesity. It is important for health practitioners to encourage a healthy lifestyle by promoting healthy eating and physical activity; the combination reduces an individual’s risk of developing chronic diseases. The BRFSS data displays that the lack of exercise does play a factor with the increase in BMI.

    References

    Centers for Disease Control and Prevention. (2016).
    _BRFSS Prevalence & Trends Data_. Retrieved from http://www.cdc.gov/brfss/brfssprevalence/index.html

    Gibi, K. (2013). Let’s Move! Cities, Towns and Counties.
    _Parks & Recreation,_ 48 (10), 37-39.

    May, A. L., Liping, P., Sherry, B., Blanck, H. M., Galuska, D., Dalenius, K., & Grummer-Strawn, L. M. (2013). Vital Signs: Obesity Among Low-Income, Preschool-Aged Children — United States, 2008-2011.
    _MMWR: Morbidity & Mortality Weekly Report_,
    _62_(31), 629-634.

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