DO NOT POST A SOAP NOTE. Post your differential diagnosis.
Include the additional questions you would ask the patient. Be sure to
include an explanation of the tests you might recommend, ruling out any
other issues or concerns and include your rationale. Be specific and
provide examples. Use your Learning Resources and/or evidence from the
literature to support your explanations.
Elaine
Goodwin is a 38-year-old G1 P1 LC 1 presenting to your clinic today to
discuss contraceptive options. She states that she is not interested in
having more children but her new partner has never fathered a child. Her
medical history is remarkable for exercise-induced asthma, seizure
disorder (her last seizure was five years ago), and IBS. Her surgical
history remarkable only for tonsils as a child. Her social history is
negative for alcohol, tobacco, and recreational drugs. She has no known
drug allergies
and takes Lamictal (lamotrigine) and Trileptal (oxcarbazepine). Hospitalizations
were only for childbirth. Family history reveals that her maternal
grandmother alive with dementia, while her maternal grandfather is
alive COPD. Her paternal grandparents are both deceased due to an
automobile accident. Her mother is alive
with osteopenia and fibromyalgia, and her dad is alive with a history of
skin cancer (basal cell). Elaine has one older sister with no medical
problems and one younger brother with no reported medical problems.
Height 5’ 7” Weight 148 (BMI 23.1), BP 118/72 P 68
HEENT: wnl
Neck: supple without adenopathy
Lungs/CV: wnl
Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge
Abd: soft, +BS, no tenderness
VVBSU: wnl, except 1st degree cystocele
Cervix: firm, smooth, parous, without CMT
Uterus: RV, mobile, non-tender, approximately 8 cm,
Adnexa: without masses or tenderness
Excellent
Point range: 90–100
Good
Point range: 80–89
Fair
Point range: 70–79
Poor
Point range: 0–69
Main Posting:
Response to the case study discussion questions
includes appropriate diagnoses with explanations of appropriate
diagnostic tests and treatment options as directed, is based on
evidence-based research where appropriate, and is incorporates syntheses
representative of knowledge gained from the course readings for the
module and current credible sources.
Points Range:
40 (40%) – 44 (44%)
Thoroughly responds to the discussion question(s).
Post includes approprite diagnoses including explanations of appropriate diagnostic tests and treatment options.
Incorporates syntheses representative of knowledge gained from the
course readings for the module and current credible sources, with no
less than 75% of post the post having exceptional depth and breadth.
Supported by at least 3 current credible sources.
Points Range:
35 (35%) – 39 (39%)
Responds to most of the discussion question(s)
Post includes approprite diagnoses with explanations of appropriate diagnostic tests and treatment options.
Somewhat incorporates syntheses representative of knowledge gained from
the course readings for the module and current credible sources with no
less than
50% of the post having exceptional depth and breadth.
Supported by at least 3 credible references.
Points Range:
31 (31%) – 34 (34%)
Responds to some of the discussion question(s).
Post contains incomplete or vague diagnoses or explanations of appropriate diagnostic tests and treatment options.
Is somewhat lacking in synthesis of knowledge gained from the course readings for the module and current credible sources.
Post is cited with fewer than 2 credible references.
Points Range:
0 (0%) – 30 (30%)
Does not respond to the discussion question(s).
Post contains incomplete diagnoses or explanations of appropriate
diagnostic tests and treatment options, or diagnoses and/or explanations
are missing.
Lacks synthesis gained from the course readings for the module and current credible sources.
Contains only 1 or no credible references.
Main Posting:
Writing
Points Range:
6 (6%) – 6 (6%)
Written clearly and concisely.
Contains no grammatical or spelling errors.
Further adheres to current APA manual writing rules and style.
Points Range:
5 (5%) – 5 (5%)
Written concisely.
May contain one to two grammatical or spelling errors.
Adheres to current APA manual writing rules and style.
Points Range:
4 (4%) – 4 (4%)
Written somewhat concisely.
May contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
Points Range:
0 (0%) – 3 (3%)
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Posting:
Timely and full participation
Points Range:
9 (9%) – 10 (10%)
Meets requirements for timely, full, and active participation.
Posts main discussion by due date.
Points Range:
8 (8%) – 8 (8%)
Posts main discussion by due date.
Meets requirements for full participation.
Points Range:
7 (7%) – 7 (7%)
Posts main discussion by due date.
Points Range:
0 (0%) – 6 (6%)
Does not meet requirements for full participation.
Last Completed Projects
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