WEEK 7: Task: Assessing, Diagnosing, and Treating Abdominal, Urological, and Gynecological Issues
Correct historical past taking of belly, urological, and gynecological complaints is crucial for finishing an Assessment of the older grownup. For this Task, as you look at this week’s affected person case research, take into account the way you would possibly consider and deal with older grownup sufferers who current with well being considerations associated to the belly, urological, or gynecological To organize:
Overview the case research offered by your Teacher.
Replicate on the affected person’s signs and elements of issues that could be current.
Take into account the way you would possibly assess, carry out diagnostic exams, and suggest medicines to deal with sufferers presenting with the signs within the case.
RESOURCES:
REQUIRED RESOURCES
Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2019). Urological and gynecological issues. In Superior follow nursing within the care of older adults (2nd ed., pp. 280–304). F. A. Davis.
Demarest, L. (2019). Gotta go proper now: What’s overactive bladder? Nursing Made Extremely Simple!, 17(Four), 11–14. https://doi.org/10.1097/01.NME.0000559586.35631.37
Jackson, P., & Vigiola, C. M. (2018). Intestinal obstruction: Analysis and administration. American Household Doctor, 98(6), 362–367.
Shian, B., & Larson, S. T. (2018). Abdominal wall ache: Scientific analysis, differential prognosis, and therapy. American Household Doctor, 98(7), 429–436.
OTHER RESOURCES:
Interact-IL (Producer). (2017e). Neighborhood providers for the older grownup: Entry and fee techniques [Video]. https://engageil.com/modules/community-services-for-the-older-adult-access-and-payment-systems/
Be aware: View the Neighborhood Companies for the Older Grownup: Entry and Fee Programs video module accessible on this free course.
Interact-IL (Producer). (2017x). Offering culturally applicable take care of LGBTQ older adults [Video]. https://engageil.com/modules/primary-care-best-practices-for-lgbtq-older-adults/
Be aware: View the Offering Culturally Acceptable Look after LGBTQ Older Adults video module accessible on this free course.
Interact-IL (Producer). (2017y). Sexuality and the older grownup [Video]. https://engageil.com/modules/sexuality-and-the-older-adult/
Be aware: View the Sexuality and the Older Grownup video module accessible on this free course.
INSTRUCTIONS::::!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Entry the Targeted SOAP Be aware Template on this week’s Assets. Make sure observe adjustments are OFF: see the directions in doc sharing. YOU CAN ALSO USE THE SOAP WORD DOC AS YOUR TEMPLATE FOR YOUR NOTE – REMOVE ALL THE EXTRA WORDING AND INSTRUCTIONS PLEASE.
The Task: Full the Targeted SOAP Be aware Template offered for the affected person within the case research. Remember to tackle the next:
Subjective: What was the affected person’s subjective criticism? What particulars did the affected person present relating to their historical past of current sickness and private and medical historical past? Embrace a listing of prescription and over-the-counter medicine the affected person is at the moment taking. Evaluate this record to the American Geriatrics Society Beers Standards® and take into account different medicine if applicable. Present a assessment of techniques.
Goal: What observations did you word from the bodily Assessment? What had been the lab, imaging, or useful assessments outcomes?
Assessment: Present a minimal of three differential diagnoses. Checklist them from high precedence to least precedence. Evaluate the diagnostic standards for every and clarify what guidelines every differential in or out. Clarify you crucial considering course of that led you to the first prognosis you chose. Embrace pertinent positives and pertinent negatives for the particular affected person case.
Plan: Present an in depth therapy plan for the affected person that addresses every prognosis, as relevant. Embrace documentation of diagnostic research that might be obtained, referrals to different health-care suppliers, therapeutic interventions, schooling, disposition of the affected person, caregiver Help, and any deliberate follow-up visits. Present a dialogue of well being promotion and illness prevention for the affected person, taking into account affected person components, previous medical historical past (PMH), and different threat components. Lastly, embody a mirrored image assertion on the case that describes insights or classes discovered.
Present a minimum of three evidence-based peer-reviewed journal articles or evidenced-based pointers, which relate to this case to Help your diagnostics and differentials diagnoses. Make sure they’re present (not more than 5 years previous) and Help the therapy plan in following present requirements of care. Observe APA seventh version formatting.
NOTE: SOAP notes are digital. Please fill in any lacking data. Don’t write in your cleaning soap word “data lacking”. You fill this data in out of your previous experiences with sufferers. Factors are deducted for lacking data. *bear in mind all cleaning soap notes should comprise affected person well being promotion and schooling. ALSO: when you prescribe medicines, the identify, route, dose, length, and cease date is required. That is particularly necessary in acute care.
MORE DETAIL ON INSTRUCTIONS
o put together:
• Overview the case research offered by your Teacher.
• Replicate on the affected person’s signs and elements of issues that could be current.
• Take into account the way you would possibly assess, carry out diagnostic exams, and suggest medicines to deal with sufferers presenting with the signs within the case.
• Entry the Targeted SOAP Be aware Template on this week’s Assets.
The Task:
Full the Targeted SOAP Be aware Template offered for the affected person within the case research. Remember to tackle the next:
• Subjective: What was the affected person’s subjective criticism? What particulars did the affected person present relating to their historical past of current sickness and private and medical historical past? Embrace a listing of prescription and over-the-counter medicine the affected person is at the moment taking. Evaluate this record to the American Geriatrics Society Beers Standards®, and take into account different medicine if applicable. Present a assessment of techniques.
• Goal: What observations did you word from the bodily Assessment? What had been the lab, imaging, or useful assessments outcomes?
• Assessment: Present a minimal of three differential diagnoses. Checklist them from high precedence to least precedence. Evaluate the diagnostic standards for every, and clarify what guidelines every differential in or out. Clarify you crucial considering course of that led you to the first prognosis you chose. Embrace pertinent positives and pertinent negatives for the particular affected person case.
• Plan: Present an in depth therapy plan for the affected person that addresses every prognosis, as relevant. Embrace documentation of diagnostic research that might be obtained, referrals to different health-care suppliers, therapeutic interventions, schooling, disposition of the affected person, caregiver Help, and any deliberate follow-up visits. Present a dialogue of well being promotion and illness prevention for the affected person, taking into account affected person components, previous medical historical past (PMH), and different threat components. Lastly, embody a mirrored image assertion on the case that describes insights or classes discovered.
• Present a minimum of three evidence-based peer-reviewed journal articles or evidenced-based pointers, which relate to this case to Help your diagnostics and differentials diagnoses. Make sure they’re present (not more than 5 years previous) and Help the therapy plan in following present requirements of care. Observe APA seventh version formatting.
THE CASE SOAP NOTE:
Week 7: Abdominal, Urinary, and Gynecological
Case 1: UTI
R.B. 95-year-old, white male, at the moment residing in a talented nursing facility (SNF)
Chief criticism: “My urine is de facto crimson.”
HPI: On Wednesday (2 days in the past) the affected person was delivered to your clinic by his son and complained that his urine gave the impression to be brilliant crimson in coloration. You ordered labs, urinalysis, tradition, and sensitivity, and the outcomes are beneath.
Allergy symptoms: Penicillin: Hives
Drugs: Tamsulosin Zero.Four mcg, 2 capsules day by day, Aspirin 325 mg day by day, Atorvastatin 10 mg 1 pill day by day, Donepezil 10 mg 1 pill PO QHS, Metoprolol 25 mg Zero.5 mg pill each 12 hours, Acetaminophen 500 mg 1 pill BID
Code standing: DNR Common weight loss program, pureed texture, honey-thickened liquids
Vitals: BP 122/70, HR 66, Temp 98.Zero F, Resp 18, Pulse ox 98% Weight:____ BMI:____
PMH: Cognitive communication deficit, pneumonitis as a consequence of inhalation of meals and vomit, dysphagia, R-side hemiplegia and hemiparesis previous ischemic CVA, average vascular dementia, malignant neoplasm of prostate, new-onset atrial fibrillation (12/2019), DVT on left decrease extremity, gross hematuria
Labs:
RBC three.53 (L)
Hemoglobin 10.2 (L)
Microscopic Assessment, Urine, straight Cath
Element:
WBC UA 42 (H) (Zero-5/ HPF)
RBC, UA >900 (H) (Zero-5/HPF)
Epithelial cells, urine 2 (Zero-Four /HPF)
Hyaline casts, UA Zero (Zero-2 /LPF)
Urinalysis
Shade Pink
Look (Urine) Clear
Ketones, UA Hint
Particular gravity 1.020 (1.005-1.Zero25)
Blood, UA Massive
PH, Urine 7.Zero (5.Zero-Eight.Zero)
Leukocytes Small
Nitrites Optimistic
C&S outcomes weren’t accessible but.
TEMPLATE IN SEPARATE FILE:
Rubric Element
Choose Grid View or Checklist View to vary the rubric’s structure.
Identify: NRNP_6540_Week7_Assignment_Rubric
• Grid View
• Checklist View
Glorious Good Honest Poor
Create documentation within the Targeted SOAP Be aware Template concerning the affected person within the case research to which you had been assigned.
Within the Subjective part, present:
• Chief criticism
• Historical past of current sickness (HPI)
• Present medicines, checked towards Beers Standards
• Allergy symptoms
• Affected person medical historical past (PMHx)
• Overview of techniques 9 (9%) – 10 (10%)
The response throughly and precisely describes the affected person’s subjective criticism, historical past of current sickness, present medicines, allergy symptoms, medical historical past, and assessment of all techniques that may inform a differential prognosis. A radical cross-check of medicines towards the Beers Standards has been accomplished and applicable different medicine really useful if relevant. Eight (Eight%) – Eight (Eight%)
The response precisely describes the affected person’s subjective criticism, historical past of current sickness, present medicines, allergy symptoms, medical historical past, and assessment of all techniques that may inform a differential prognosis. A cross-check of medicines towards the Beers Standards has been accomplished and applicable different medicine really useful if relevant. 7 (7%) – 7 (7%)
The response describes the affected person’s subjective criticism, historical past of current sickness, present medicines, allergy symptoms, medical historical past, and assessment of all techniques that may inform a differential prognosis, however is considerably obscure or accommodates minor innacuracies. A cross-check of medicines towards the Beers Standards has been accomplished however options could also be lacking. Zero (Zero%) – 6 (6%)
The response offers an incomplete or inaccurate description of the affected person’s subjective criticism, historical past of current sickness, present medicines, allergy symptoms, medical historical past, and assessment of all techniques that may inform a differential prognosis. A cross-check of medicines towards the Beers Standards has not been accomplished. Or, subjective documentation is lacking.
Within the Goal part, present:
• Bodily examination documentation of techniques pertinent to the chief criticism, HPI, and historical past
• Diagnostic outcomes, together with any labs, imaging, or different assessments wanted to develop the differential diagnoses 9 (9%) – 10 (10%)
The response completely and precisely paperwork the affected person’s bodily examination for pertinent techniques. Diagnostic exams and their outcomes are completely and precisely documented. Eight (Eight%) – Eight (Eight%)
The response precisely paperwork the affected person’s bodily examination for pertinent techniques. Diagnostic exams and their outcomes are precisely documented. 7 (7%) – 7 (7%)
Documentation of the affected person’s bodily examination is considerably obscure or accommodates minor innacuracies. Diagnostic exams and their outcomes are documented however comprise minor innacuracies. Zero (Zero%) – 6 (6%)
The response offers incomplete or inaccurate documentation of the affected person’s bodily examination. Programs could have been unnecessarily reviewed, or, goal documentation is lacking.
Within the Assessment part, present:
• At the least three (three) differentials with supporting proof. Clarify what guidelines every differential in or out, and justify your main prognosis choice. Embrace pertinent positives and pertinent negatives for the particular affected person case. 23 (23%) – 25 (25%)
The response lists so as of precedence a minimum of three distinctly completely different and detailed doable circumstances for a differential prognosis of the affected person within the assigned case research, and offers a radical, correct, and detailed justification for every of the circumstances chosen. 20 (20%) – 22 (22%)
The response lists so as of precedence a minimum of three completely different doable circumstances for a differential prognosis of the affected person within the assigned case research and offers an correct justification for every of the circumstances chosen. 18 (18%) – 19 (19%)
The response lists three doable circumstances for a differential prognosis of the affected person within the assigned case research, with some vagueness and/or inaccuracy within the circumstances and/or justification for every. Zero (Zero%) – 17 (17%)
The response lists two or fewer, or is lacking, doable circumstances for a differential prognosis of the affected person within the assigned case research, with inaccurate or lacking justification for every situation chosen.
Within the Plan part, present:
• An in depth therapy plan for the affected person that addresses every prognosis, as relevant. Consists of documentation of diagnostic research that might be obtained, referrals to different health-care suppliers, therapeutic interventions, schooling, disposition of the affected person, and any deliberate observe up visits.
• A dialogue associated to well being promotion and illness prevention taking into account affected person components, PMH, and different threat components.
• Reflections on the case describing insights or classes discovered. 27 (27%) – 30 (30%)
The response completely and precisely outlines a therapy plan for the affected person that addresses every prognosis and contains diagnostic research neeed, referrals, therapeutic interventions, affected person schooling and disposition, and deliberate follow-up visits. A radical and correct dialogue of well being promotion and illness prevention associated to the case is offered. Reflections on the case show sturdy crucial considering and synthesis of concepts. 24 (24%) – 26 (26%)
The response precisely outlines a therapy plan for the affected person that addresses every prognosis and contains diagnostic research neeed, referrals, therapeutic interventions, affected person schooling and disposition, and deliberate follow-up visits. An correct dialogue of well being promotion and illness prevention associated to the case is offered. Reflections on the case show crucial considering. 21 (21%) – 23 (23%)
Identify: NRNP_6540_Week7_Assignment_Rubric
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Targeted SOAP Be aware Template
Affected person Data:
Initials, Age, Intercourse, Race
S (subjective)
CC (chief criticism): a BRIEF assertion figuring out why the affected person is right here, acknowledged within the affected person’s personal phrases (as an illustration “headache,” NOT “dangerous headache for three days”).
HPI (historical past of current sickness): That is the symptom Assessment part of your word. Thorough documentation on this part is crucial for affected person care, coding, and billing Assessment. Paint an image of what’s incorrect with the affected person. Use LOCATES Mnemonic to finish your HPI. It is advisable begin EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You need to embody the seven attributes of every principal symptom in paragraph kind not a listing. If the CC was “headache”, the LOCATES for the HPI would possibly seem like the next instance:
• Location: Head
• Onset: three days in the past
• Character: Pounding, stress across the eyes and temples
• Related indicators and signs: Nausea, vomiting, photophobia, phonophobia
• Timing: After being on the pc all day at work
• Exacerbating/relieving components: Gentle bothers eyes; Aleve makes it tolerable however not fully higher
• Severity: 7/10 ache scale
Present Drugs: Embrace dosage, frequency, size of time used, and motive to be used; additionally embody over-the-counter (OTC) or homeopathic merchandise.
Allergy symptoms: Embrace medicine, meals, and environmental allergy symptoms individually, together with an outline of what the allergy is (i.e., angioedema, anaphylaxis, and so on.). It will Help decide a real response versus intolerance.
PMHx: Embrace immunization standing (word date of final tetanus for all adults), previous main sicknesses, and surgical procedures. Relying on the CC, extra information is usually wanted.
Soc and Substance Hx: Embrace occupation and main hobbies, household standing, tobacco and alcohol use (earlier and present use), and every other pertinent knowledge. All the time add some well being promo Question Assignment right here, resembling whether or not they use seat belts on a regular basis or whether or not they have working smoke detectors in the home, residing atmosphere, textual content/cellular phone use whereas driving, and Help system.
Fam Hx: Sicknesses with doable genetic predisposition, contagious, or power sicknesses. Cause for dying of any deceased first-degree family must be included. Embrace mother and father, grandparents, siblings, and kids. Embrace grandchildren if pertinent.
Surgical Hx: Prior surgical procedures.
Psychological Hx: Prognosis and therapy. Present considerations (anxiousness and/or despair). Historical past of self-harm practices and/or suicidal or homicidal ideation.
Violence Hx: Concern or points about security (private, dwelling, group, sexual (present and historic).
Reproductive Hx: Menstrual historical past (date of LMP), Pregnant (sure or no), Nursing/lactating (sure or no), contraceptive use (methodology used), kinds of intercourse (oral, anal, vaginal, different, any sexual considerations).
ROS (assessment of signs): Cowl all physique techniques that will enable you to embody or rule out a differential prognosis You must record every system as follows:
• Basic:
• Head:
• EENT (eyes, ears, nostril, and throat):
• And so forth.:
Be aware: You must record these in bullet format, and doc the techniques so as from head to toe.
Instance of Full ROS:
GENERAL: No weight reduction, fever, chills, weak spot, or fatigue.
HEENT:
• Eyes: No visible loss, blurred imaginative and prescient, double imaginative and prescient or yellow sclerae.
• Ears, Nostril, Throat: No listening to loss, sneezing, congestion, runny nostril, or sore throat.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest ache, chest stress or chest discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting or diarrhea. No belly ache or blood.
GENITOURINARY: Burning on urination. Final menstrual interval (LMP), MM/DD/YYYY.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling within the extremities. No change in bowel or bladder management.
MUSCULOSKELETAL: No muscle, again ache, joint ache or stiffness.
HEMATOLOGIC: No anemia, bleeding or bruising.
LYMPHATICS: No enlarged nodes. No historical past of splenectomy.
PSYCHIATRIC: No historical past of despair or anxiousness.
ENDOCRINOLOGIC: No experiences of sweating, chilly or warmth intolerance. No polyuria or polydipsia.
REPRODUCTIVE: Not pregnant and no current being pregnant. No experiences of vaginal or penile discharge. Not sexually energetic.
ALLERGIES: No historical past of bronchial asthma, hives, eczema or rhinitis.
O (goal)
Bodily examination: From head-to-toe, embody what you see, hear, and really feel when doing all your bodily examination. You solely want to look at the techniques which can be pertinent to the CC, HPI, and Historical past. Don’t use “WNL” or “regular.” You need to describe what you see. All the time doc in head to toe format (i.e., Basic: Head: EENT: and so on.).
Diagnostic outcomes: Embrace any labs, x-rays, or different diagnostics which can be wanted to develop the differential diagnoses (Help with evidenced and pointers).
A (Assessment)
Differential diagnoses: Checklist a minimal of three differential diagnoses. Your main or presumptive prognosis must be on the high of the record. For every prognosis, present supportive documentation with evidence-based pointers.
P (plan)
Consists of documentation of diagnostic research that might be obtained, referrals to different health-care suppliers, therapeutic interventions, schooling, disposition of the affected person, and any deliberate observe up visits. Every prognosis or situation documented within the Assessment must be addressed within the plan. The small print of the plan ought to observe an orderly method.
Additionally included on this part is the reflection. Replicate on this case, and focus on what you discovered, together with any “aha” moments or connections you made.
Additionally embody in your reflection, a dialogue associated to well being promotion and illness prevention taking into account affected person components (resembling, age, ethnic group, and so on.), PMH, and different threat components (e.g., socio-economic, cultural background, and so on.).
References
You might be required to incorporate a minimum of three evidence-based peer-reviewed journal articles or evidenced-based pointers, which relate to this case to Help your diagnostics and differentials diagnoses. Remember to use right APA seventh version formatting.
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DIFFERENTIAL DIAGNOSIS AND TREATMENT OF UROLOGICAL AND GYNECOLOGICAL DISEASES
For an older grownup, an in depth historical past of belly, urological, and gynecological issues is required. Take into account how you would consider and deal with older grownup sufferers who current with belly, urological, or gynecological points. Prep:
Overview your teacher’s case research.
Take into account the affected person’s signs and any underlying sicknesses.
Take into account how chances are you’ll assess, diagnose, and deal with folks with the signs on this scenario.
RESOURCES REQUIRED
L. Kennedy-Malone, L. Martin-Plank, & E. Duffy (2019). Urogynecological illnesses Superior follow nursing in ageing (2nd ed., pp. 280–304). DAVIS, F.
L Demarest (2019). What’s an overactive bladder? Nursing Made Easy, 17(Four), 11–14. https://doi.org/10.1097/01.NME.0000559586.35631.37
P. Jackson & C. M. Vigiola (2018). GI obstruction: prognosis and therapy AFM, 98(6), 362–367.
Shian, B., S. T. Larson (2018). Ache within the belly wall: examination, prognosis, and remedy AFM 98(7), 429–436.
OTHER SUPPORT:
(Producer) (2017e). Entry and fee for senior group providers [Video]. https://engageil.com/modules/community-services-for-the-older-adult-access-and-payment-systems/
Be aware: View the free Neighborhood Companies for the Aged: Entry and Fee Programs video module.
Interact-IL (Producer). (2017x). Culturally competent take care of LGBTQ seniors [Video]. https://engageil.com/modules/primary-care-best-practices-for-lgbtq-older-adults /
View the free video module Offering Culturally Acceptable Look after LGBTQ Older Adults.
Interact-IL (Producer). (2017y). Sexuality and Growing old [Video]. https://engageil.com/modules/sexuality-and-the-older-adult/
View the free course’s video module on Sexuality with Older Adults.
INSTRUCTIONS::::!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
For additional data, see this week’s Assets. Be certain that observe adjustments is off: see doc sharing. Please take away all further wording and directions from the SOAP WORD DOCUMENT.
The Process: The case research affected person’s Targeted SOAP Be aware Template is offered. Deal with the next:
Subjective: How did the affected person really feel? What data did the affected person disclose about their present illness, private and medical historical past? Embrace a listing of present prescription and OTC medicines. Evaluate this record to the AGS Beers Standards® and examine options. Overview techniques.
What did you discover through the bodily examination? Was the lab, imaging, or useful testing resulted?
Present three differential prognosis. Prioritize them from highest to lowest. Evaluate the diagnostic standards for every differential and clarify why. Describe your crucial considering course of that led to your main prognosis. Embrace the affected person’s particular positives and negatives.
Plan: Give the affected person a transparent therapy plan that addresses every prognosis. Remember to seize the outcomes of any diagnostic exams, referrals to different well being care professionals and any deliberate follow-up appointments. Focus on with the affected person well being promotion and sickness prevention, taking into consideration affected person variables, previous medical historical past, and different threat components. Lastly, embody a case reflection assertion describing key takeaways.
Cite a minimum of three peer-reviewed journal papers or evidence-based pointers that Help your prognosis and differential diagnoses on this occasion. Guarantee they’re up-to-date (lower than 5 years previous) and complement the therapy technique. Format in APA seventh version.
VIRTUALIZED SOAP NOTES Please full any gaps. Nullify the knowledge in your cleaning soap word. You fill within the blanks with earlier affected person encounters. Lacking data reduces factors. *Do not forget that all cleaning soap notes should promote affected person well being. The identify, methodology, dose, length, and cease date of medicine are additionally needed. That is essential in acute care.
REVIEW THE CASE STUDY PROVIDED BY YOUR INSTRUCTOR.
• Take into account the affected person’s signs and any underlying illnesses.
• Take into account how chances are you’ll assess, diagnose, and deal with sufferers with the signs on this scenario.
Acquire this week’s Targeted SOAP Be aware Template.
The Process:
The case research affected person’s Targeted SOAP Be aware Template is offered. Deal with the next:
In what approach did the affected person really feel? What data did the affected person disclose about their present illness, private and medical historical past? Embrace a listing of present prescription and OTC medicines. Evaluate this record to the AGS Beers Standards® and examine options. Overview techniques.
• Goal: What did the bodily Assessment reveal? Was the lab, imaging, or useful testing resulted?
• Analysis: Present three differential diagnoses. Prioritize them from highest to lowest. Evaluate the diagnostic standards for every differential and clarify why. Describe your crucial considering course of that led to your main prognosis. Embrace the affected person’s particular positives and negatives.
• Plan: Create a therapy plan for the affected person that addresses all diagnoses. Remember to seize the outcomes of any diagnostic exams, referrals to different well being care professionals and any deliberate follow-up appointments. Focus on with the affected person well being promotion and sickness prevention, taking into consideration affected person variables, previous medical historical past, and different threat components. Lastly, embody a case reflection assertion describing key takeaways.
•
Cite a minimum of three peer-reviewed journal papers or evidence-based pointers that Help your prognosis and differential diagnoses on this occasion. Guarantee they’re up-to-date (lower than 5 years previous) and complement the therapy technique. Format in APA seventh version.
