NU 664B Week 1 Discussion 1: Telehealth/Transgender

Regis University NU 664B Week 1 Discussion 1: Telehealth/Transgender-Step-By-Step Guide

This guide will demonstrate how to complete the Regis University NU 664B Week 1 Discussion 1: Telehealth/Transgender  assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NU 664B Week 1 Discussion 1: Telehealth/Transgender                                                                      

Whether one passes or fails an academic assignment such as the Regis University NU 664B Week 1 Discussion 1: Telehealth/Transgender     depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NU 664B Week 1 Discussion 1: Telehealth/Transgender                                                                    

The introduction for the Regis University NU 664B Week 1 Discussion 1: Telehealth/Transgender  is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NU 664B Week 1 Discussion 1: Telehealth/Transgender                                                                    

After the introduction, move into the main part of the NU 664B Week 1 Discussion 1: Telehealth/Transgender  assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NU 664B Week 1 Discussion 1: Telehealth/Transgender                                                                    

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NU 664B Week 1 Discussion 1: Telehealth/Transgender                                                                      

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NU 664B Week 1 Discussion 1: Telehealth/Transgender

HPI: An otherwise healthy 35-year-old transgender woman on hormone suppressant therapy presents with a chief complaint of sinus congestion and runny nose that began 2 days ago. She tells you that her sinus infections always start off this way, and she has a wedding to go to this coming weekend and does not want to be sick for this event. She is requesting antibiotics and is quite insistent that she requires this treatment.

In the above presented case, the nurse practitioner would want to gather additional subjective information from the patient to elicit important details in developing a differential diagnosis and treatment plan. According to Dunphy et al. (2019), rhinitis can have several different etiologies including atrophic, medication related, hormonal, infectious, or irritant related causes. Therefore, the nurse practitioner would want to ask

Have you tried any over the counter or prescription medications or supplements to help relieve symptoms? Use of afrin nasal spray for more than 3-4 days can lead to rebound nasal congestion (Dunphy et al.,2019)

How long have you been on hormone suppressant therapy? Have you had any recent lab tests? Fluctuations in estrogen levels may cause nonallergic rhinitis (Dunphy et al.,2019).

Have you had a fever? Could you describe the nasal discharge? What is the color and quality including thickness? Do you have facial pain? According to Frerichs and Brateanu (2020), bacterial rhinosinusitis is suspected with fever high than 102 degrees Fahrenheit, purulent nasal discharge, and facial pain lasting 3 or more days.

Do you use any recreational drugs? According to Dains et al. (2016), acute or chronic cocaine use can cause rebound nasal congestion.

Have you been diving or swimming? This can help elicit possible causes such as an allergic response to chlorine exposure, infection from contaminated water, or barotrauma from diving (Dains et al.,2016).

In biological women it would always be important to inquire about possibility of pregnancy as pregnancy can cause nasal congestion due to hormonal changes (Dains et al.,2016). Pregnancy status would also need to be known prior to prescribing any medications.

Do your symptoms change with position changes? If the symptoms worsen with bending or leaning forward this suggests maxillary sinusitis (Dains et al.,2016).

Are your symptoms cyclic and seasonal? Do you have sneezing, or itching, or burning eyes? If patient responds positively to these questions it would be suggestive of allergic rhinitis (Dains et al.,2016)

Are the symptoms on one or both sides? Bilateral symptoms would indicate allergic or infectious etiology while unilateral symptoms may be caused by nasal polyps, unilateral choanal atresia, foreign body, or septal deviation (Dains et al.,2016).

Do you have any impairment in your ability to smell? Atrophic rhinitis may cause anosmia or a foul odor (Dunphy et al.,2019).

Have you taken an at home covid-19 test? Have you been exposed to anyone with covid-19? Covid-19 can present with rhinorrhea and nasal congestion (Reiss et al., 2020).

References

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical      diagnosis in primary care. St. louis, MO: Elsevier mosby.

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary Care (5th ed.). F. A. Davis Company.

Frerichs, N., & Brateanu, A. (2020). Rhinosinusitis and the role of imaging. Cleveland Clinic Journal of Medicine, 87(8), 485–492. https://doi.org/10.3949/ccjm.87a.19092

Reiss, A. B., De Leon, J., Dapkins, I. P., Shahin, G., Peltier, M. R., & Goldberg, E. R. (2020). A Telemedicine approach to covid-19 assessment and triage. Medicina (Kaunas, Lithuania), 56(9), 461. https://doi.org/10.3390/medicina56090461

Sample Answer 2 for NU 664B Week 1 Discussion 1: Telehealth/Transgender

The differential diagnosis for this patient would include acute viral rhinosinusitis, acute bacterial rhinosinusitis, allergic rhinitis, hormonal related rhinitis, nasal polyps, foreign body, septal deviation, or covid-19.  Acute viral rhinosinusitis, acute bacterial rhinosinusitis, covid-19, rhinitis medicamentosa, and allergic rhinitis all need to be considered because these are the common causes of inflammation of the nasal and sinus mucosa which lead to the presentation of the symptoms the patient is experiencing including rhinitis and sinus pressure (Goldsobel et al., 2019). The other consideration with this particular patient would be rhinitis due to the fact that the patient is on hormonal therapy because fluctuations in estrogen levels may cause rhinitis (Dunphy et al.,2019). Nasal polyps, foreign bodies, or septal deviation can lead to a feeling of pressure or blockage (Dunphy,2019).  Acute viral rhinosinusitis would be at the top of the list of differentials because 95 percent of acute rhinosinusitis cases are caused by viruses that are responsible for uncomplicated upper respiratory infections (Dunphy et al.,2019). According to Dunphy (2019), ruling in the diagnosis of rhinosinusitis is based off a history of upper respiratory symptoms for at least 7 days with the presence of two or more of the following: headache, sinus or facial pain, lack of response to decongestants, and nasal secretions that are colored. The differentiation between viral sinusitis and the possibility that the condition is complicated by bacterial rhinosinusitis is made based on presentation of symptom severity in addition to length of duration of symptoms. When the duration of symptoms has been over a week to ten days the chances of bacterial sinusitis are more likely (Dunphy, 2019). The only definitive way of identifying the causative organism would be a sinus aspiration however, this is not commonly done in practice due to the invasive nature of the procedure (Dunphy,2019). At this time covid-19 testing is readily availably so I would use a covid-19 rapid antigen test to help rule in or out that diagnosis.  A physical examination would help to rule out nasal polyps, septal deviation, or foreign body contributing to symptoms (Dunphy,2019). Physical exam would also be useful in ruling in or out allergic rhinitis. Typically, in allergic rhinitis the nasal mucosa is pale and edematous or may have a bluish hue and the conjunctiva of the eyes may also be inflamed. In the history the patient may report itching, frequent sneezing, or a cyclic pattern to symptoms.  The patient history and hormone screening labs would help rule in or out the possibility of rhinitis caused by hormonal fluctuations (Dunphy,2019). Rhinitis medicamentosa would be ruled out by taking a careful history that involves inquiring about the use of any over the counter or prescription topical vasoconstrictive medications (Dunphy,2019). The patient in this case has not used any over the counter or prescription medications which rules out the diagnosis of rhinitis medicamentosa.

After assessing this patient based on the history provided including the duration and severity of symptoms, I would treat this patient for viral rhinosunisitis. I would recommend that the patient use saline nasal spray twice a day to improve sinus drainage (Dunphy, 2019). The patient should also increase fluid intake and rest. Using heated mist from a hot shower or bath for steam inhalations can help liquefy secretions which will improve nasal and sinus pain. I would also recommend the use of a neti pot for nasal irrigation.  For the nasal congestion I would recommend that the patient use afrin one to two sprays in each nostril three time a day as needed to be used for 3-4 days only (Dunphy,2019). Due to this patient’s history of elevated blood pressure readings, I would prefer to try a nasal spray prior to Sudafed due to the fact that Sudafed can elevate blood pressure. I would advise the patient to use guaifenesin 400 mg every 4 hours as needed because this help will to facilitate drainage of sinus secretions by liquefying them (Dunphy, 2019). For this patient I would educate that the majority of cases of rhinosinusitis are caused by viral infection and that only about 0.5% of all upper respiratory infections are complicated by bacterial infection therefore, there is no medical benefit to antibiotics in this case and there are risks involved with taking unnecessary antibiotics. I would instruct the patient to notify the office if symptoms failed to improve by 7-10 days or if symptoms worsen. I would instruct the patient to also contact the office with worsening facial pain, fever, or if purulent nasal discharge occurred (Dunphy, 2019). I would discuss with the patient that viruses are contagious so I would recommend avoiding contact with others to reduce the spread of the illness (Dunphy,2019). I would recommend that the patient should follow up with the specialist that is providing hormone therapy as levels should be checked. I would not recommend labs or imaging at this time however, if symptoms continued for more than 10 days and were worsened, I would consider antibiotic therapy. Referral to an ENT specialist would be indicated if symptoms still failed to resolve with antibiotic therapy (Dunphy,2019).

In addressing health maintenance, the patient reported using recreational marijuana and I would encourage the patient to refrain from smoking as the inhaled smoke can be an irritant and exacerbate the symptoms that are being reported and lead to developing nasal and sinus symptoms more frequently (Dunphy, 2019). I would also take this opportunity to review the patient’s immunizations and if covid-19 vaccinations and/ or influenza vaccinations were not up to date I would recommend receiving them when symptoms resolve to prevent development of illness in the future.

In addressing the social determinants of health, I would consider the fact that transgender women may be more prone to experience homelessness, unemployment, and poverty (Garcia & Crosby, 2020). Environmental factors can predispose patients to frequent sinus and nasal problems due to contact with allergens and irritants (Dunphy,2019). I would ask about any problems with the home environment and refer the patient to appropriate resources to assist with housing problems if necessary.

References

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary Care (5th

ed.). F. A. Davis Company.

Garcia, J., & Crosby, R. A. (2020). Social Determinants of discrimination and access to health

care among transgender women in Oregon. Transgender Health, 5(4), 225–233.

https://doi.org/10.1089/trgh.2019.0090

Goldsobel, A. B., Prabhakar, N., & Gurfein, B. T. (2019). Prospective trial examining safety and

efficacy of microcurrent stimulation for the treatment of sinus pain and congestion. Bioelectronic Medicine, 5(1). https://doi.org/10.1186/s42234-019-0035-x