discuss the following:A 6-year-old has a yellow vaginal discharge. The examination is otherwise normal.What are the key points in the history and physical examination?As a primary care provider, How would your approach differ if the patient were a sexually active 16-year-old?What are the similarities and differences in the approach?Submission Instructions:Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

Discussion 7: Case 6Mrs. P. is an 80-year-old woman recently discharged from a 24-hour observation stay at the hospital after being diagnosed with acute bronchitis. She has a history of heart failure, hypertension, osteoarthritis, GERD, and hyperlipidemia. She has no history of smoking. While in the hospital she was prescribed doxycycline, prednisone 15 mg to taper, and a tiotropium inhaler. Her current list of daily medications prior to hospitalization includes metoprolol succinate 12.5 mg, pantoprazole 40 mg, atorvastatin 10 mg, lisinopril 10 mg, furosemide 40 mg, potassium chloride 20 meq bid, acetaminophen 650 mg bid for pain and tramadol 25 mg as needed. She lives alone but will reside temporarily with her daughter while she recovers. Her discharge report indicated resolving bronchitis, no exacerbation of heart failure, and stable arthritic pain. Today she reports 1 week after discharge with her daughter for a primary care appointment, and they both were concerned about the number of medications she was prescribed and wanted her medications reviewed. In further review, she was found to have lost weight over the past 6 months of 5 lbs and her current BMI is 25. She states that the weight loss may be due to a change to a healthier diet and reducing sodium as instructed. She also reports no symptoms of GERD for the past 6 months and minimal arthritic pain because of regular use of acetaminophen and daily walking in the halls of her independent living facility. Upon examination her lungs are clear to auscultation and no evidence of lower extremity edema.Discuss the following:1) In reviewing her medication list and current symptoms and clinical signs, whichmedication could the nurse practitioner consider de-prescribing.2) Once the patient has completed the prednisone taper, which medication could the nurse practitioner begin to reduce given the patient’s reported symptoms.3) Given the absence of an exacerbation of heart failure and compliance with a reduced sodium diet, what other medication(s) adjustments could the nurse practitioner consider atthis time.Submission Instructions:Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

Select one public and one private managed health care system and prepare a PowerPoint briefing with a comparison of the two. Prepare the presentation as if you were explaining the advantages and disadvantages of each to an audience of senior leaders, whether the systems compete or might follow one another in some type of sequence.While distinguishing between the two, be sure to include the following:Summarize how systems are publicly or privately funded.Evaluate how costs are managed in each type of system and determine the impact on care quality.Interpret how each type of system delivers care to patients.Validate the key challenges each system encounters.Associate a key past or present healthcare reform that may require positive adjustments in how the system currently operates.Incorporate appropriate animations, transitions, and graphics as well as speaker notes for each slide. The speaker notes may be comprised of brief paragraphs or bulleted lists.Support your presentation with at least five scholarly resources. In addition to these specified resources, other appropriate scholarly resources may be included.Length: 12-15 slides (with a separate reference slide)Notes Length: 200-350 words for each slideBe sure to include citations for quotations and paraphrases with references in APA format and style where appropriate.