Health Systems: Daniel, a DNP prepared ED NP identified that patients seen in the ED for various reasons had undiagnosed HTN. He observed that the patient’s chief compliant was well addressed but the HTN was not. He has approached the hospital system about the problem and suggested an outpatient clinic adjacent to the ED to address the HTN and other coincidentally found problems. What AP roles, core competencies and support are needed to make this happen?

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number. Case 1Case 2Case 3Chief Complaint (CC) “I am here today due to frequent and watery bowel movements”“I have pain in my belly”“neck swelling”History of Present Illness (HPI)A 37-year-old European American female presents to your practice with “loose stools” for about three days. One event about every three hoursA 25-year-old female presents to the emergency room (ER) with complaints of severe abdominal pain for 2 weeks . The pain is sharp and crampy It hurts if I run, sit down hard, or if I have sexA 42-year-old African American female who refers that she has been noticing slow and progressive swelling on her neck for about a year. Also she stated she has lost weight without any food restrictionPMHNo contributory Patient deniesPatient denies PSHAppendectomy at the age of 14 Surgical removal of benign left breast nodule 2 years agoDrug Hx No medsBirth controlNo medication at the timeAllergiesPenicillinNKANKASubjectiveFever and chills, Lost appetite Flatulence No mucus or blood on stoolsNausea and vomiting, Last menstrual period 5 days ago, New sexual partner about 2 months ago, No condoms, he hates them No pain, blood or difficulty with urinationMild difficult to shallow, Neck feels tight, Pt states she feels PalpitationsObjective Data PEB/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8B/P 138/90; temperature 99°F;  (RR) 20; (HR) 110, regular; oxygen saturation (PO2) 96%; pain 5/10 B/P 158/90; Pulse 102; RR 20; Temp 99.2; Ht 5,4; wt 114; BMI 19.6 Generalwell-developed female in no acute distress, appears slightly fatiguedacute distress and severe pain42-year-old female appears thin. She is anxious – pacing in the room and fidgeting, but in no acute distress. HEENTAtraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous. Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip. Bulging eyes NeckSuppleDiffuse enlargement of the thyroid glandLungsCTA AP&L CTA AP&L CTA AP&LCardS1S2 without rub or gallopS1S2 without rub or gallopS1S2 without rub, TachycardiaAbdpositive bowel sounds (BS) in all four quadrants; no masses; no organomegaly noted; diffuse, mild, bilateral lower quadrant pain noted Mild diffuse tenderness. INSPECTION: no masses or thrills noted; no discoloration and skin is warm to; no tattoos or piercings; abdomen is nondistended and round • AUSCULTATION: bowel sounds (BS) are normal in all four quadrants, no bruits noted • PALPATION: on palpation, abdomen is tender to touch in four quadrants; tenderness noted on light palpation, deep palpation reveals no masses, spleen and liver unremarkable • PERCUSSION: tympany heard in all quadrants, no dullness noted in abdominal area benign, normoactive bowel sounds x 4GU Non contributory• EXTERNAL: mature hair distribution; no external lesions on labia • INTROITUS: slight green-gray discharge, no lesions • VAGINAL: normal rugae; moderate amount of green discharge on vaginal walls • CERVIX: nulliparous os with small amount of purulent discharge from os with positive cervical motion tenderness (CMT) • UTERUS: ante-flexed, normal size, shape, and position • ADNEXA: bilateral tenderness with fullness; both ovaries without masses • RECTAL: deferred • VAGINAL DISCHARGE: green in color Non contributoryExtno cyanosis, clubbing or edemano cyanosis, clubbing or edemano cyanosis, clubbing or edemaIntegumentgood skin turgor noted, moist mucous membranesintact without lesions masses or rashesThin skin, Increase moistureNeuroNo obvious deformities, CN grossly intact II-XIINo obvious deficits and CN grossly intact II-XIINo obvious deficits and CN grossly intact II-XII Once you received your case number, answer the following questions: What other subjective data would you obtain? What other objective findings would you look for? What diagnostic exams do you want to order? Name 3 differential diagnoses based on this patient presenting symptoms? Give rationales for your each differential diagnosis.

Discussion: Differential Diagnosis for Skin ConditionsProperly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.In this Discussion, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.Note: Your Discussion post should be in the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week's Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.To prepare:Review the Skin Conditions document provided in this week’s Learning Resources, and select two conditions to closely examine for this Discussion.Consider the abnormal physical characteristics you observe in the graphics you selected. How would you describe the characteristics using clinical terminologies?Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.Consider which of the conditions is most likely to be the correct diagnosis, and why.By Day 3Post a description of the two graphics you selected (identify each graphic by number). Use clinical terminologies to explain the physical characteristics featured in each graphic. Formulate a differential diagnosis of three to five possible conditions for each. Determine which is most likely to be the correct diagnosis, and explain your reasoning.Read a selection of your colleagues’ responses.·Consider which of the conditions is most likely to be the correct diagnosis, and why.Post a 1 page paper APA formatYour Discussion post should be in the SOAP (Subjective, Objective, Assessment, and Plan) note format,1.a description of the two graphics you selected (identify each graphic by number). (see sample skin conditions attached)2.Use clinical terminologies to explain the physical characteristics featured in each graphic.3.Formulate a differential diagnosis of three to five possible conditions for each.4.Determine which is most likely to be the correct diagnosis, and explain your reasoning.READINGSBall, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel's guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.oChapter 8, “Skin, Hair, and Nails” (pp. 114-165)This chapter reviews the basic anatomy and physiology of skin, hair, and nails. The chapter also describes guidelines for proper skin, hair, and nails assessments.