Part 1.As a Family Nurse Practitioner this client is seeking medical care and complain of chest pain.A SOAP note is a form of written documentation many healthcare professions use to record a patient or client interaction. ... However, all SOAP notes must include Subjective, Objective, Assessment, and Plan sections, hence the acronym SOAP. Submit a SOAP note.APA format Attached are samples.Please use as reference ONLYPlagiarism is never acceptable – give credit when credit is due - cite your sourcesThe Topic to address: Chest Pain What questions will you ask for a client complaining of chest pain? Give the rationale for each (articles, books, abstracts, etc.). What are 2 normal findings and 2 abnormal findings that can be identified from one of your questions?Use in-text citations citations and References.Part2.Respond to classmates Soap notes. below Use APA format.Respond to each student’s postings separately with substantive comments. Substantive comments add to the discussion and provide your fellow students with information that will enhance the learning environment.The postings should be at least one paragraph (approximately 100 words) and include references References and citations should conform to the APA 6th edition.Remember: Please respect the opinions of others, even if their views differ. In other words, disagree professionally and respectfully.Student1Brooke U2D1-Chest painPt presenting with chest pain should have the following questions asked:When did the pain start? What were you doing when the pain first occurred? Rationale: Ischemic pain tends to come on gradually and get worse over time; it generally lasts from two to five minutes after resting if it is related to exertion (Aroesty & Kannam, 2016). Describe the pain and where exactly it is located? Rationale: Pain in the area of the chest can occur for several reasons and be related to GI concerns, musculoskeletal issues, or cardiac concerns. For this reason, all complaints of chest pain should be taken seriously and further investigated. If the patient is able to point with a finger to one area of pain, it is unlikely to be caused by cardiac ischemia (Aroesty & Kannam, 2016).Two normal findings in this category would be localized skin pain from a bruise after mild trauma and reproducible muscle pain from muscle strain after heavy lifting. Although, chest pain of any kind should not be viewed as “normal.”Two abnormal findings in this category would be the abrupt tearing pain in the anterior chest wall as well as decreased femoral pulses indicating an aortic dissection, and crushing midsternal chest pain that radiates into the jaw and left arm indicating acute coronary syndrome.How long does the pain last? Is it constant or intermittent?Rationale: Pain that presents with physical activity or exertion but is relieved within minutes of resting is typically angina (Aroesty &Kannam, 2016). Is there anything that makes the pain better or worse? Rationale: Pain that is aggravated by chest wall movement is often due to inflammation of chest wall cartilage or costochondritis (Dains, Baumann, & Scheibel, 2016).Do you have any other symptoms related to the pain? Rationale: Associated symptoms such as shortness of breath, lightheadedness, dizziness, palpitations, or diaphoresis can be an indication of a serious cardiac concern. SOAP NOTE:S:Pt is a 50yr old male who presents today with a complaint of “I have chest pain and it’s been going on for a weeks now.” He describes the pain as a dull, intermittent pain located in the upper left portion of his chest. Pt states the pain comes and goes and is worse with activity. Rates pain 4/10. Denies radiation of pain. Denies SOB, N/V, lightheadedness. Pt states that he tries sitting down and resting when it starts and that seems to provide some relief. PMH: Significant for MI in 2010 with stents placed x2. Pt also has hyperlipidemia and htn. Medications: ASA, Lipitor, and MetoprololAllergies: NKAFamily Hx: Mother currently alive and healthy. Father died of a heart attack 2 yrs ago. Social Hx: Pt is going through a divorce after 17 yrs of marriage. States he has a lot of stress in his life right now. Pt works as a taxi driver and says he doesn’t get much exercise because he spend most of the day in his car. Denies alcohol or tobacco use. O:Middle aged, uncomfortable appearing male sitting up in bed. A&Ox4, appears well cared for and is a reliable historian. VS: T-97.8 P-104 R-20 BP 152/98 Pox 98% room airHt 69in, Wt 186 lbsResp: Lungs clear to auscultation bilaterally on anterior and posterior chest. Respirations even and unlabored. CV: S1, S2 WNL. Heart rate- slight tachycardia at a rate of 104 with regular rhythm noted. No murmurs or gallops heard. Extremities: Skin warm, dry, and intact. Palpable pulses noted to all 4 extremities. No edema noted.A: Chest pain-R/O MI vs angina vs stress/anxiety HTNP: EKGLabs including CMP, CBC, Lipid profile, and cardiac enzymes. CXRIncrease metoprololEducate on stress relieving techniquesReferencesAroesty, J., & Kannam, J. (2016). Chest pain: Beyond the basics. Retrieved from https://www.uptodate.com/contents/chest-pain-beyon...Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier.Student2Chest pain can arise from several different organ systems, including the cardiovascular system, pulmonary system, musculoskeletal system, and gastrointestinal system (Fass & Achem, 2011). Chest pain can also be involved in anxiety or panic disorders (Bickley, 2016). According to Fass and Achem, “noncardiac chest pain is defined as recurrent chest pain that is indistinguishable from ischemic heart pain after a reasonable workup has excluded a cardiac cause” (p. 110). Since cardiac chest pain is often a serious condition, it is important that these conditions be ruled out first, before investigating the other possible causes (Fass & Achem, 2011). A series of appropriate questions can help the provider key in on the source of the patient’s chest pain. Questions to ask regarding chest pain include: location of pain, description of pain, severity, factors that aggravate, factors that relieve, timing, and other noticeable symptoms (Bickley, 2016). From the question regarding relieving factors, there can be some “normal” findings and some “abnormal” findings. While any type of chest pain is not “normal,” chest pain that is relieved by rest may be considered normal, whereas chest pain not relieved by rest can be a sign of a myocardial infarction (Bickley, 2016). Also, chest pain that is triggered by exertion is often more normal than chest pain that arises suddenly in the absence of exertion (Bickley, 2016).SOAP note:S- Mr. T is a 40 year old man visiting the clinic today with the chief complaint of chest pain. He states that he has been experiencing chest pain on and off for the last week.. He describes the pain as burning and squeezing, that can become severe at times. The pain can also be felt in his back. He has been under a lot of stress lately and is worries about his heart. He states he has been working until late in the evening and then coming home to eat dinner and go to bed. He has noticed the chest pain to be worse at the end of the day when his body “is supposed to be relaxing.” He states he has to sit up in bed and take deep breathes in order to make the pain subside. He also notices he coughs more when his chest hurts. The patient maintains a healthy body weight and exercises 2-3 times per week. He does not notice any chest pain with exertion. He has no family history of heart disease. He takes no medications and is on a daily multivitamin.O- Temperature 98.4 F; HR 80 bpm; 18 breaths per minute; BP 122/88. Patient alert and oriented. CV: Regular rate and rhythm; no murmurs noted; pulses 2+; no peripheral edema. Lungs: clear auscultation and percussion bilaterally. Abdomen: active bowel sounds, no tenderness to the touch. Skin: warm to touch, no redness or diaphoresis. EKG normal. Blood tests normal.A-Non-cardiac chest pain; GERDP-Refer to a gastroenterologist for diagnosis and treatment of GERD. Educate patient on how to keep a food diary to identify aggravating foods. Encourage patient to eat at least 2-3 hours before going to sleep.ReferencesBickley, L. S. (2016). Bates' Guide to Physical Examination and History Taking, 12th Edition [VitalSource Bookshelf version]. Retrieved from https://bookshelf.vitalsource.com/books/9781496354...Fass, R., & Achem, S. R. (2011). Noncardiac chest pain: Epidemiology, natural course and pathogenesis. Journal of Neurogastroenterology and Motility, 17(2), 110–123. http://doi.org/10.5056/jnm.2011.17.2.110

Due 06/12/2019Respond to at least two colleagues by addressing an example in each colleague’s post in at least one of the following ways: Suggest a strategy for addressing a situation that your colleague described in one of his or her examples.Offer additional thoughts regarding the impact of the interaction described in the example. Response to Kahle How a Social Work Administrator's Personal Leadership Philosophy and Style may Influence a Human Services Organization's Culture Northouse (2018) suggested that supervisors are the most significant factors of shaping and incorporating an organizations mission and culture. Leaders are seen as a growth catalyst, and stakeholders follow the footsteps of leaders. The individual's perspective/assumptions often impact the philosophy and style of administrators. The behaviors a leader utilizes, e.g., controlling or hands-off; significantly affects the organization's culture and effectiveness. According to Tsai (2011), leadership styles are associated with job satisfaction, productivity, and healthy work environments. As well as echoing and promoting the organizational culture and goals. How an Organization's Culture Might Influence a Social Work Administrator's Personal Leadership Style Northouse (2018) discussed that individuals have biases and presumptions that impact their leadership styles, and beliefs regarding individuals work ethics. Settings are also influenced by the populations and mission of an organization which can empower employees and promote the organizational culture, and develop change when needed. How Interactions with Stakeholders may Ultimately Impact the Organization's Treatment of Clients Northouse (2018) recommended the significant influences associated with leadership styles and the treatment of consumers. Supervisors are associated with the implementation and maintenance of organizational culture directly influencing client care. Interactions and the expectations of stakeholders contribute to the ethical and respected organization and can significantly disrupt client treatment, staff retention, and networking abilities. References Northouse, P. G. (2018). Introduction to leadership: Concepts and practice (4th ed.). Washington, DC: Sage. Tsai, T., (2011). Relationship between Organizational Culture, Leadership Behavior and Job Satisfaction. BMC Health Services Research, 11(1), 98–106. Response to Hilda How a Social Work Administrator’s Personal Leadership Philosophy and Style May Influence a Human Services Organization’s Culture. There are two basic leadership philosophies: Theory X and Theory Y. Theory X includes people who do not like work. They need guidance, and they want trust and responsibility. Theory Y people enjoy work. They are self-starters, and they typically are responsible (Northouse, 2018). Both theories can influence an organization’s culture. If the organization's leader’s philosophy is X they always have control of employees. They dictate the workload, rules, and regulations. The employees have little if any say in work performance. The leader feels this type of leadership is needed to produce the best possible outcome for the organization. The culture is very militaristic and is one of structure and discipline. It does not make for a fun work environment. If the organization's leader’s philosophy is Y they believe people enjoy work and can work well on their own. Workers love to be responsible for their own actions. The culture has little structure because the worker is trusted to complete work to the best of their ability. Organization’s Culture Might influence a Social Work Administrator’s Personal Leadership Style. Every leader needs to aware of their personal leadership style. A leader’s ability to self-identify their leadership style will create a skilled leader (Northouse, 2018). If the organization’s culture is different form the social worker’s leadership style, the social worker may need to change and adjust to better suit the style. The leader of an organization needs to be flexible. The leader's personal style may need to change to produce the best possible outcome for the organization. If the social worker's leadership style clashes with employees, a third leadership philosophy called Theory X can be used. Theory X considers the culture and allows the employees input on decisions (Northouse, 2018). The leader being flexible will provide the best possible outcome for the organization. Interactions With Stakeholders May Ultimately Impact the Organization’s Treatment of Clients. The stakeholders have a vested interest in the organization’s success. The objectives of the stakeholders can conflict with the best interest of clients. An example would be the management of organizational cost. The organization’s high social workers to client caseload ratio is one possible conflict. The leader may submit a proposal to increase the social worker’s headcount. The stakeholder's refusal to approve funding for additional headcount impacts the quality of treatment given to clients. Reference: Northouse, P. G. (2018). Introduction to leadership: Concepts and practice (4th ed.). Washington, DC: Sage.

Write a reflection paper for the leadership simulation below, The Anatomy of Care.In this paper:Describe key leadership principles presented in the videoDemonstrate how the principles can be applied in real world scenariosIncorporate the principles of governance, leadership and management in order to create a vision that will empower fellow employees, foster collaboration amongst staff and create a successful healthcare environment geared towards patient care.Explain how these positive changes will alter the course of actions and guide decision making for the participants. The paper should be 1–2 pages, excluding title and references pages. Use current APA formatting to style your paper and to cite your sources. Integrate your sources into the paragraphs. Use internal citations pointing to evidence in the literature and supporting your ideas. You will need to include a reference page listing those sources.https://learn.westcoastuniversity.edu/courses/1/OC_PH545_202007SUIIOL_OL-A/content/_4765860_1/lessons/sco_player_veils/index.html