For this assignment you will be given a case study about a young lady named Sarah Smith. Review the information provided and answer the questions following. Be sure to cite your references. Look at Sarah as if she is a patient in your office seeking care. What are your immediate concerns? What needs to be done for her? Be thorough and succinct in your responses.Case Study:Sarah Smith is a 28 y/o African American female who presents to the office with c/o wound to her left foot for the past few days. States she had tripped and fell while barefoot scraping the top of her foot on the pavement. She denies any other injury from the incident. Over the past 24 hours the wound has had “smelly” drainage. Has been experiencing generalized achiness, but denies fever and chills. Did not seek medical attention at the time of injury. Has been using hydrogen peroxide to clean her wound. Is unclear of her last tetanus vaccination. Patient PMHx significant for DM II. States that she takes her medications when she remembers, and does not always check her blood sugar.PMHx:Asthma: no hospitalizations for exacerbation.DM IIPSHx:DeniesSHx:Former tobacco user: ceased smoking 2 years ago. Had smoked 1ppd x 5 yearsETOH: sociallyIllicit drugs: deniesFHx:Significant for paternal DM, otherwise unremarkableMedications:Metformin: 500mg BID po - did not take the last few daysAlbuterol MDI: 2 puffs every 6 hours prn - last use just PTASingulair: 10mg po dailyTrinessa: 1 tab po daily - last taken this amAllergies:PCN: hivesLNMP: 2 weeks ago.G0p0ROS:General: denies any weight changes, fatigue or fever; + body achesSkin: denies any rashes; + wound to left footHEENT: denies headache, head injury, dizziness, lightheadedness; Denies any vision changes Denies any hearing changes, tinnitus, vertigo, earache Denies any nasal congestion, discharge, nose bleeds or sinus tenderness Denies any sore throat, difficulty swallowingNeck: denies any swollen glands, painBreasts: denies any pain, dischargeRespiratory: denies any dyspnea; positive cough and wheezingCV: denies any chest pain, edemaGI: denies any nausea/vomiting/diarrhea/constipation; denies bloody stoolsPV: denies claudication, swelling to LEGU: denies frequency, urgency, burning; Denies vaginal discharge, itching, sores Denies penile discharge, itching or soresMS: positive pain to left footPsych: denies nervousness, depressionNeuro: denies Headache, dizziness, vertigo, syncope, weakness; + numbness to right LEHeme: denies any easy bruisingPhysical Exam:Vital signs: 100.5 (tympanic), 162/88, 118, 22, O2 sat 95% on RA Height: 5’5” Weight: 250 lbs. Blood glucose: 230 (Fasting; states has not eaten yet today)patient awake, alert, oriented x 4 in NADSkin: warm, dry, color WNL. 4 cm lesion noted to anterior left foot with crusting and purulent drng; + surrounding erythema extending up 7 cm proximallyHEENT: head nontraumatic, normocephalicPupils PERRLA, EOMs intact; disc margins sharp, without hemorrhages, exudates; no AV nicking notedEars: bilateral TM with good cone of light and intactNose: mucosa pink, septum midline; no sinus tenderness appreciatedMouth: mucosa pink, moist; tongue midline; tonsils 1+ without exudateNeck: supple; trachea midline; no LADResp: regular and unlabored; lungs with end expiratory wheezing throughoutCV: RRR, S1 and S2 noted; no s3, s4 or murmur appreciatedAbdomen: soft, non-distended; Bs + x 4; no tenderness with palpation; no CVA tenderness with percussionGenitalia: deferredRectal: deferredExtremities: warm and without edema; calves supple, non-tenderPV: no LE edemaMS: + swelling to left foot; + tenderness of 2-4th left metatarsals; + left pedal pulse; CMS intact; Cap refill < 2 sec.Neuro: alert, cooperative; thought coherent; oriented x 4; cranial nerves II-XII intactQuestions:1. List your differentials for her current problems. Remember you should have at least three different differentials for each problem. Include rationale for each differential.2. At this time what medical diagnoses are you most concerned about? Do they impact other diagnoses? If so, how?3. What diagnostic images would you order? Provide your rationale. What are you trying to rule in or out?4. What laboratory work would you order? What would you anticipate to be abnormal? Provide your rationale for each.5. What is your comprehensive plan of care? Include your rationales.To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Resources.Assignment RequirementsBefore finalizing your work, you should:be sure to read the Assignment description carefully (as displayed above)consult the Grading Rubric to make sure you have included everything necessary; andutilize spelling and grammar check to minimize errors.Your writing Assignment should:follow the conventions of Standard English (correct grammar, punctuation, etc.);be well ordered, logical, and unified, as well as original and insightful;display superior content, organization, style, and mechanics; and

For this Discussion, your instructor will assign you a case number. Case # Assigned 2 Case 1Case 2Case 3 Cases G.K. is a family nurse practitioner in the health department of a large city. She is responsible for following up with infants and children who have been referred to the health department. Most of her referrals come from the hospital upon discharge of an infant going home to a potentially high-risk environment. G.K. follows up with each child to ensure he or she is in a safe environment and is growing and developing adequately. She provides education and support to the parents so they can anticipate and respond appropriately to the challenges of raising children. M.T. is a nurse practitioner in a busy OBGYN clinic. Her clients include women from various socioeconomic and cultural backgrounds. M.T. spends her time educating women about interventions for a healthy pregnancy. She promotes the physical, mental, and spiritual health of her clients throughout the childbearing years. Although she primarily works with the pregnant woman, her ultimate goal is to assist each family to have a healthy pregnancy and birth outcome and lay the foundation for satisfactory parenting and family life. A.V. is a nurse practitioner working with the public health department. Community assessments reveal that one rural community has a high rate of teenage pregnancy. A.V. conducts parenting classes at the local high school and aims to reach first-time expectant parents. Her goal is to provide parents with information about what to expect of a new baby and basic care for the infant. She realizes that continuity with education may be an issue. Many of her previous classes began with high attendance at the beginning of her 12-week sessions. Over time, interest began to fade, and participation declined. She tries a different approach with the current series of lectures. She reduces the session to 6 weeks and changes the format to one hour of lecture combined with questions and answers, with the second hour consisting of interactive demonstration. Questions for the case Define and describe the following influences that can affect individual’s potential for growth: • genetic factors • prenatal and postnatal exposures • nutritional factors • environmental factors • life style • health care practices. M.T. participates in community health fairs educating childbearing-age women about healthy lifestyles that can improve chances for a healthy pregnancy. Women should be made aware that certain preconception interventions may improve not only the outcomes of pregnancy but their overall health as well. Design a plan that fits the needs for the health fair that M.T. is participating. List the recommendations and the rationales. What recommendations would you give to a group of expectant teenagers that are attending to your Health Promotion and Disease Prevention educational sessions regarding breastfeeding. Include recommendation in how to increase the duration to this activity. Once you received your case number; answer the specific question on the table above. Then, continue to discuss the 2 topics listed below for your case: Describe the relationship between culture and growth and development. Assess whether all growth and development milestones should be applied to all children regardless of cultural background. Design a teaching plan for parents regarding injury prevention during infancy. In your teaching plan you must include the home of an infant injury proof.